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Información sobre riesgo, prevención, detección, síntomas, diagnosis, tratamiento y apoyo para el cáncer.
Información sobre el tratamiento del cáncer incluyendo quirúrgica, quimioterapia, radioterapia, estudios clínicos, terapia con protón, medicina complementaria avanzadas.
OncoLink se complace en ofrecer una amplia lista de lista completa de los agentes quimioterapéuticos más comúnmente usados??. Esta guía de referencia incluye información sobre la forma en que cada fármaco se administra, cómo funcionan, y los pacientes los efectos secundarios comunes pueden experimentar.
Maneras que los pacientes de cáncer y las personas que le cuidan puedan enfrentar el cáncer, los efectos secundarios, nutrición, cuestiones en general sobre el apoyo para el cáncer, duelo/decisiones sobre el termino de vida, y experiencias compartidas por sobrevivientes.
National Cancer Institute
Ultima Vez Modificado: 23 de octubre del 2012
Aggressive treatment of malignant disease may produce unavoidable toxicities to normal cells. The mucosal lining of the gastrointestinal tract, including the oral mucosa, is a prime target for treatment-related toxicity by virtue of its rapid rate of cell turnover. The oral cavity is highly susceptible to direct and indirect toxic effects of cancer chemotherapy and ionizing radiation. 1 This risk results from multiple factors, including high rates of cellular turnover for the lining mucosa, a diverse and complex microflora, and trauma to oral tissues during normal oral function. 2 Although changes in soft tissue structures within the oral cavity presumably reflect the changes that occur throughout the gastrointestinal tract, this summary focuses on oral complications of antineoplastic drugs and radiation therapies.
It is essential that a multidisciplinary approach be used for oral management of the cancer patient before, during, and after cancer treatment. A multidisciplinary approach is warranted because the medical complexity of these patients affects dental treatment planning, prioritization, and timing of dental care. In addition, selected cancer patients (e.g., status posttreatment with high-dose head-and-neck radiation) are often at lifelong risk for serious complications such as osteoradionecrosis of the mandible. Thus, a multidisciplinary oncology team that includes oncologists, oncology nurses, and dental generalists and specialists as well as dental hygienists, social workers, dieticians, and related health professionals can often achieve highly effective preventive and therapeutic outcomes relative to oral complications in these patients.
While oral complications may mimic selected systemic disorders, unique oral toxicities emerge in the context of specific oral anatomic structures and their functions.
Frequencies of oral complications vary by cancer therapy; estimates are included in Table 1.
Complication | Reference Citation | Weighted Prevalence |
Bisphosphonate osteonecrosis | 6.1% for all studies (mean) | |
Studies with documented follow-up = 13.3% | ||
Studies with undocumented follow-up = 0.7% | ||
Epidemiological studies = 1.2% | ||
Dysgeusia | CT only = 56.3% (mean) | |
RT only = 66.5% (mean) | ||
Combined CT and RT = 76% (mean) | ||
Oral fungal infection | Of clinical oral fungal infection (all oral candidiasis): | |
Pretreatment = 7.5% | ||
During treatment = 39.1% | ||
Posttreatment = 32.6% | ||
Of oral candidiasis clinical infection by cancer treatment: | ||
During HNC RT = 37.4% | ||
During CT = 38% | ||
Oral viral infection | In patients treated with CT for hematologic malignancies: | |
Patients with oral ulcerations/sampling oral ulcerations = 49.8% | ||
Patients sampling oral ulcerations = 33.8% | ||
Patients sampling independently of the presence of oral ulcerations = 0% | ||
In patients treated with RT: | ||
Patients with RT only/sampling oral ulcerations = 0% | ||
Patients with RT and adjunctive CT/sampling oral ulcerations = 43.2% | ||
Dental disease | For dental caries in patients treated with cancer therapy: | |
All studies = 28.1% | ||
CT only = 37.3% | ||
Post-RT = 24% | ||
Post-CT and -RT = 21.4% | ||
Of severe gingivitis in patients undergoing CT = 20.3% | ||
Of dental infection/abscess in patients undergoing CT = 5.8% | ||
Osteoradionecrosis | In conventional RT = 7.4% | |
In IMRT = 5.2% | ||
In RT and CT = 6.8% | ||
In brachytherapy = 5.3% | ||
Trismus | For conventional RT = 25.4% | |
For IMRT = 5% | ||
For combined RT and CT = 30.7% | ||
Oral paina | VAS pain level (0100) in HNC patients: | |
Pretreatment = 12/100 | ||
Immediately posttreatment = 33/100 | ||
1 mo posttreatment = 20/100 | ||
EORTC QLQ-C30 pain level (0100) in HNC patients: | ||
Pretreatment = 27/100 | ||
3 mo posttreatment = 30/100 | ||
6 mo posttreatment = 23/100 | ||
12 mo posttreatment = 24/100 | ||
Salivary gland hypofunction and xerostomia | Of xerostomia in HNC patients by type of RT: | |
All studies | ||
Pre-RT = 6% | ||
During RT = 93% | ||
13 mo post-RT = 74% | ||
36 mo post-RT = 79% | ||
612 mo post-RT = 83% | ||
12 y post-RT = 78% | ||
>2 y post-RT = 85% | ||
Conventional RT | ||
Pre-RT = 10% | ||
During RT = 81% | ||
13 mo post-RT = 71% | ||
36 mo post-RT = 83% | ||
612 mo post-RT = 72% | ||
12 y post-RT = 84% | ||
>2 y post-RT = 91% | ||
Pre-RT = 12% | ||
During RT = 100% | ||
13 mo post-RT = 89% | ||
36 mo post-RT = 73% | ||
612 mo post-RT = 90% | ||
12 y post-RT = 66% | ||
>2 y post-RT = 68% | ||
CT = chemotherapy; EORTC QLQ-C30 = European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30; HNC = head and neck cancer; IMRT = intensity-modulated radiation therapy; MASCC/ISOO = Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology; RT = radiation therapy; VAS = visual analog scale. | ||
The most common oral complications related to cancer therapies are mucositis, infection, salivary gland dysfunction, taste dysfunction, and pain. These complications can lead to secondary complications such as dehydration, dysgeusia, and malnutrition. In myelosuppressed cancer patients, the oral cavity can also be a source of systemic infection. Radiation of the head and neck can irreversibly injure oral mucosa, vasculature, muscle, and bone, resulting in xerostomia, rampant dental caries, trismus, soft tissue necrosis, and osteonecrosis.
Severe oral toxicities can compromise delivery of optimal cancer therapy protocols. For example, dose reduction or treatment schedule modifications may be necessary to allow for resolution of oral lesions. In cases of severe oral morbidity, the patient may no longer be able to continue cancer therapy; treatment is then usually discontinued. These disruptions in dosing caused by oral complications can directly affect patient survivorship.
Management of oral complications of cancer therapy includes identification of high-risk populations, patient education, initiation of pretreatment interventions, and timely management of lesions. Assessment of oral status and stabilization of oral disease before cancer therapy are critical to overall patient care. Care should be both preventive and therapeutic to minimize risk for oral and associated systemic complications.
Future research targeted at developing technologies is needed to:
Development of new technologies to prevent cancer therapyinduced complications, especially oral mucositis, could substantially reduce the risk of oral pain, oral and systemic infections, and number of days in the hospital; and could improve quality of life and reduce health care costs. New technologies could also provide a setting in which novel classes of chemotherapeutic drugs, used at increased doses, could lead to enhanced cancer cure rates and durability of disease remission.
As has been noted, it is essential that a multidisciplinary approach be used for oral management of the cancer patient before, during, and after cancer treatment. This collaboration is pivotally important for the advancement of basic, clinical, and translational research associated with oral complications of current and emerging cancer therapies. The pathobiologic complexity of oral complications and the ever-expanding science base of clinical management require this comprehensive interdisciplinary approach.
In this summary, unless otherwise stated, evidence and practice issues as they relate to adults are discussed. The evidence and application to practice related to children may differ significantly from information related to adults. When specific information about the care of children is available, it is summarized under its own heading.
Oral complications associated with cancer chemotherapy and radiation result from complex interactions among multiple factors. The most prominent contributors are direct lethal and sublethal damage to oral tissues, attenuation of immune and other protective systems, and interference with normal healing. Principal causes can be attributed to both direct stomatotoxicity and indirect stomatotoxicity. Direct toxicities are initiated via primary injury to oral tissues. Indirect toxicities are caused by nonoral toxicities that secondarily affect the oral cavity, including the following:
Understanding of mechanisms associated with oral complications continues to increase. Unfortunately, there are no universally effective agents or protocols to prevent toxicity. Elimination of preexisting dental/periapical, periodontal, and mucosal infections; institution of comprehensive oral hygiene protocols during therapy; and reduction of other factors that may compromise oral mucosal integrity (e.g., physical trauma to oral tissues) can reduce frequency and severity of oral complications in cancer patients (refer to the Oral and Dental Management Prior to Cancer Therapy and the Management Following Cancer Therapy sections for further information). 1
Complications can be acute (developing during therapy) or chronic (developing months to years after therapy). In general, cancer chemotherapy causes acute toxicities that resolve following discontinuation of therapy and recovery of damaged tissues. In contrast, radiation protocols typically cause not only acute oral toxicities, but induce permanent tissue damage that result in lifelong risk for the patient.
Chemotherapy-induced Complications
Risk factors for oral complications (see Table 2) derive from both direct damage to oral tissues secondary to chemotherapy and indirect damage due to regional or systemic toxicity. For example, therapy-related toxicity to oral mucosa can be exacerbated by colonizing oral microflora when local and systemic immune function is concurrently compromised. Frequency and severity of oral complications are directly related to extent and type of systemic compromise.
Complication | Direct Risk Factor | Indirect Risk Factors |
Oral mucositis | Mucosal cytotoxicity | Decreased local/systemic immunity: local infections, reactivation of HSV |
Physical/chemical trauma | ||
Oral infections: | ||
Viral | Decreased systemic immunity | |
Fungal | Decreased oral mucosal and/or systemic immunity | |
Salivary gland dysfunction | ||
Altered oral flora (decreased bacterial flora) | ||
Bacterial | Inadequate oral hygiene | Decreased oral mucosal and/or systemic immunity |
Mucosal breakdown | Salivary gland dysfunction | |
Acquired pathogens | ||
Taste dysfunction | Taste receptor toxicity | |
Xerostomia | Salivary gland toxicity | Anticholinergic drugs |
Neuropathies | Vinca alkaloid, thalidomide, bortezomib drug use; risk for specific drug toxicity varies | Anemia, dental hypersensitivity, temporomandibular dysfunction/myofascial pain |
Dental and skeletal growth and development (pediatric patients) | Specific drug toxicity | Stage of dental and skeletal maturation |
Gastrointestinal mucositis causing secondary changes in oral status including taste, hygiene, and dietary intake | Mucosal cytotoxicity: radiation, chemotherapy | Nausea and vomiting |
Hemorrhage | Oral mucositis | Thrombocytopenia |
Physical trauma | Decreased clotting factors (e.g., DIC) | |
Infections (e.g., HSV) | ||
DIC = disseminated intravascular coagulation; HSV = herpes simplex virus. |
Ulcerative oral mucositis occurs in approximately 40% of patients receiving chemotherapy. In approximately 50% of these patients, the lesions are severe and require medical intervention including modification of their cytotoxic cancer therapy. Normal oral mucosal epithelium is estimated to undergo complete replacement every 9 to 16 days. Intensive chemotherapy can cause ulcerative mucositis that initially emerges approximately 2 weeks after initiation of high-dose chemotherapy. 2 3 4
Chemotherapy directly impairs replication of basal epithelial cells; other factors, including proinflammatory cytokines and metabolic products of bacteria, may also play a role. The labial mucosa, buccal mucosa, tongue, floor of mouth, and soft palate are more severely affected by chemotherapy than are the attached, heavily keratinized tissues such as the hard palate and gingiva; this may be caused by relative rate of epithelial cell turnover among high-risk versus low-risk oral mucosal tissues. Topical cryotherapy may ameliorate mucositis caused by agents such as 5-fluorouracil (5-FU) by reducing vascular delivery of these toxic agents to replicating oral epithelium. 5
It is difficult to predict whether a patient will develop mucositis strictly on the basis of the classes of drugs that are administered. Several drugs are associated with a propensity to damage oral mucosa:
Anecdotal evidence suggests that patients who experience mucositis with a specific chemotherapy regimen during the first cycle will typically develop comparable mucositis during subsequent courses of that regimen.
Other oral complications typically include infections of the mucosa, dentition/periapices, and periodontium. Prevalence of these infections has been substantiated in multiple studies. 8 9 10 11 Specific criteria for determining risk of infectious flare during myelosuppression have not been developed. Guidelines for assessment primarily address both degree of severity of the chronic lesion and whether acute symptoms have recently (i.e., <90 days) developed. However, chronic asymptomatic periodontitis may also represent a focus for systemic infectious complications since bacteria, bacterial cell wall substances, and inflammatory cytokines may translocate into the circulation via ulcerated pocket epithelium. 10 In addition, poor oral hygiene and periodontitis seem to increase the prevalence of pulmonary infections in high-risk patients. 12
Resolution of oral toxicity, including mucositis and infection, generally coincides with granulocyte recovery. This relationship may be temporally but not causally related. For example, oral mucosal healing in hematopoietic stem cell transplantation patients is only partially dependent on rate of engraftment, especially neutrophils.
Head/Neck Radiationinduced Complications
Head and neck radiation can cause a wide spectrum of oral complications (refer to the list of Oral Complications of Radiation Therapy below). Ulcerative oral mucositis is a virtually universal toxicity resulting from this treatment; there are clinically significant similarities as well as differences compared with oral mucositis caused by chemotherapy. 2 In addition, oral mucosal toxicity can be increased by use of head and neck radiation together with concurrent chemotherapy.
Head and neck radiation can also induce damage that results in permanent dysfunction of vasculature, connective tissue, salivary glands, muscle, and bone. Loss of bone vitality occurs:
These changes can lead to soft tissue necrosis and osteonecrosis that result in bone exposure, secondary infection, and severe pain. 11
Unlike chemotherapy, however, radiation damage is anatomically site-specific; toxicity is localized to irradiated tissue volumes. Degree of damage depends on treatment regimen-related factors, including type of radiation utilized, total dose administered, and field size/fractionation. Radiation-induced damage also differs from chemotherapy-induced changes in that irradiated tissue tends to manifest permanent damage that places the patient at continual risk for oral sequelae. The oral tissues are thus more easily damaged by subsequent toxic drug or radiation exposure, and normal physiologic repair mechanisms are compromised as a result of permanent cellular damage.
Oral and Dental Management Before Cancer Therapy
Back Up
Poor oral health has been associated with increased incidence and severity of oral complications in cancer patients, hence the adoption of an aggressive approach to stabilizing oral care before treatment. 1 2 Primary preventive measures such as appropriate nutritional intake, effective oral hygiene practices, and early detection of oral lesions are important pretreatment interventions.
There is no universally accepted precancer therapy dental protocol because of the lack of clinical trials evaluating the efficacy of a specific protocol. A systematic review of the literature revealed two articles on oral care protocols prior to cancer therapy. 3 One study examined the benefits of a minimal intervention precancer therapy (mostly chemotherapy) dental protocol, and the other examined the impact of an intensive preventive protocol on patients undergoing chemotherapy. Both studies had several flaws, including small sample size or the lack of comparison groups. 3
The involvement of a dental team experienced with oral oncology may reduce the risk of oral complications via either direct examination of the patient or in consultation with the community-based dentist. The evaluation should occur as early as possible before treatment. 4 5 The examination allows the dentist to determine the status of the oral cavity before cancer treatment begins and to initiate necessary interventions that may reduce oral complications during and after that therapy. Ideally, this examination should be performed at least 1 month before the start of cancer treatment to permit adequate healing from any required invasive oral procedures. A program of oral hygiene should be initiated, with emphasis on maximizing patient compliance on a continuing basis.
Oral evaluation and management of patients scheduled to undergo myeloablative chemotherapy should occur as early as possible before initiation of therapy (refer to the list on Oral Disease Stabilization Before Chemotherapy and/or Hematopoietic Stem Cell Transplantation below). To maximize outcomes, the oncology team should clearly advise the dentist as to the patient's medical status and oncology treatment plan. In turn, the dental team should delineate and communicate a plan of care for oral disease management before, during, and after cancer therapy. 5
The overall goal is to complete a comprehensive oral care plan that eliminates or stabilizes oral disease that could otherwise produce complications during or following chemotherapy. Achieving this goal will most likely reduce risk of oral toxicities with resultant reduced risk for systemic sequelae, reduced cost of patient care, and enhanced quality of life. If the patient is unable to receive the medically necessary oral care in the community, the oncology team should assume responsibility for oral management.
It is important to realize that dental treatment plans need to be realistic relative to type and extent of dental disease and how long it could be before resumption of routine dental care. For example, teeth with minor caries may not need restoration before cancer treatment begins, especially if more conservative disease stabilization strategies can be used (e.g., aggressive topical fluoride protocols, temporary restorations, or dental sealants).
Specific interventions are directed to:
Guidelines for dental extractions, endodontic management, and related interventions (see Table 3) can be used as appropriate. 6 7 Antibiotic prophylaxis prior to invasive oral procedures may be warranted in the context of central venous catheters; the current American Heart Association (AHA) protocol for infective endocarditis and oral procedures is frequently used for these patients.
Medical Status | Guideline | Comments |
Patients with chronic indwelling venous access lines (e.g., Hickman). | AHA prophylactic antibiotic recommendations (low risk). | There is no clear scientific proof detailing infectious risk for these lines following dental procedures. This recommendation is empiric. |
Neutrophils | Order CBC with differential. | |
>2,000/mm3 | No prophylactic antibiotics. | |
1,0002,000/mm3 | AHA prophylactic antibiotic recommendations (low risk). | Clinical judgment is critical. If infection is present or unclear, more aggressive antibiotic therapy may be indicated. |
<1,000/mm3 | Amikacin 150 mg/m2 1 h presurgery; ticarcillin 75 mg/kg IV ½ h presurgery. Repeat both 6 h postoperatively. | If organisms are known or suspected, appropriate adjustments should be based on sensitivities. |
Plateletsa | Order platelet count and coagulation tests. | |
>60,000/mm3 | No additional support needed. | |
30,00060,000/mm3 | Platelet transfusions are optional for noninvasive treatment; consider administering preoperatively and 24 h later for surgical treatment (e.g., dental extractions). Additional transfusions are based on clinical course. | Utilize techniques to promote establishing and maintaining control of bleeding (i.e., sutures, pressure packs, minimize trauma). |
<30,000/mm3 | Platelets should be transfused 1 h before procedure; obtain an immediate postinfusion platelet count; transfuse regularly to maintain counts >30,00040,000/mm3 until initial healing has occurred. In some instances, platelet counts >60,000/mm3 may be required. | In addition to above, consider using hemostatic agents (i.e., microfibrillar collagen, topical thrombin). Aminocaproic acid may help stabilize nondurable clots. Monitor sites carefully. |
CBC = complete blood cell count; IV = intravenous. | ||
Assessment of Hematopoietic Stem Cell Transplant Patients
Stages of assessment have been described relative to the hematopoietic stem cell transplant patient (see Table 4). 5 This model provides a useful classification for neutropenic cancer patients in general. Type, timing, and severity of oral complications represent the interaction of local and systemic factors that culminate in clinical expression of disease. Correlating oral status with systemic condition of the patient is thus critically important.
Selected conditioning regimens characterized by reduced intensity for myelosuppression have been used in patients. These regimens have generally been noted to significantly reduce the severity of oral complications early posttransplant, especially for mucositis and infection risk. The guidelines listed in Table 4 can be adjusted to reflect these varying degrees of risk, based on the specific conditioning regimen to be used.
Transplant Phase | Oral Complication |
Phase I: Preconditioning | Oral infections: dental caries, endodontic infections, periodontal disease (gingivitis, periodontitis), mucosal infections (i.e., viral, fungal, bacterial). |
Gingival leukemic infiltrates. | |
Metastatic cancer. | |
Oral bleeding. | |
Oral ulceration: aphthous ulcers, erythema multiforme. | |
Temporomandibular dysfunction. | |
Phase II: Conditioning Neutropenic Phase | Oropharyngeal mucositis. |
Oral infections: mucosal infections (i.e., viral, fungal, bacterial), periodontal infections. | |
Hemorrhage. | |
Xerostomia. | |
Taste dysfunction. | |
Neurotoxicity: dental pain, muscle tremor (e.g., jaws, tongue). | |
Temporomandibular dysfunction: jaw pain, headache, joint pain. | |
Phase III: Engraftment Hematopoietic Recovery | Oral infections: mucosal infections (i.e., viral, fungal, bacterial). |
Acute GVHD. | |
Xerostomia. | |
Hemorrhage. | |
Neurotoxicity: dental pain, muscle tremor (e.g., jaws, tongue). | |
Temporomandibular dysfunction: jaw pain, headache, joint pain. | |
Granulomas/papillomas. | |
Phase IV: Immune Reconstitution Late Posttransplant | Oral infections: mucosal infections (i.e., viral, fungal, bacterial). |
Chronic GVHD. | |
Dental/skeletal growth and development alterations (pediatric patients). | |
Xerostomia. | |
Relapse-related oral lesions. | |
Second malignancies. | |
Phase V: Long-term Survival | Relapse or second malignancies. |
Dental/skeletal growth and development alterations. | |
GVHD = graft-versus-host disease. |
Phase I: Before Chemotherapy
Oral complications are related to current systemic and oral health, oral manifestations of underlying disease, and oral complications of recent cancer or other medical therapy. During this period, oral trauma and clinically significant infections, including dental caries, periodontal disease, and pulpal infection, should be eliminated. Additionally, patients should be educated relative to the range and management of oral complications that may occur during subsequent phases. Baseline oral hygiene instructions should be provided. It is especially important to note whether patients have been treated with bisphosphonates (e.g., patients with multiple myeloma) and to plan their care accordingly.
Phase II: Neutropenic Phase
Oral complications arise primarily from direct and indirect stomatotoxicities associated with high-dose chemotherapy or chemoradiotherapy and their sequelae. Mucositis, xerostomia, and those lesions related to myelosuppression, thrombocytopenia, and anemia predominate. This phase is typically the period of high prevalence and severity of oral complications.
Oral mucositis usually begins 7 to 10 days after initiation of cytotoxic therapy and remains present for approximately 2 weeks after cessation of that therapy. Viral, fungal, and bacterial infections may arise, with incidence dependent on the use of prophylactic regimens, oral status prior to chemotherapy, and duration/severity of neutropenia. Frequency of infection declines upon resolution of mucositis and regeneration of neutrophils. This phenomenon appears to be more a temporal relation than a causative one, based on the predominant evidence. Despite the initial marrow recovery, however, the patient may remain at risk for infection, depending on status of overall immune reconstitution.
Salivary gland hypofunction/xerostomia secondary to anticholinergic drugs and taste dysfunction is initially detected in this phase; the toxicity typically resolves within 2 to 3 months.
In allogeneic transplant patients, while uncommon, hyperacute graft-versus-host disease (GVHD) can occur and can result in significant oral mucosal inflammation and breakdown that can complicate the oral course for patients. Clinical presentation will often not be sufficiently distinct to diagnosis this lesion. The clinical assessment is typically based on the patient experiencing more-severe-than-expected mucositis that will often not heal within the time line for mucosal recovery associated with oral mucositis caused by chemotherapy.
Phase III: Hematopoietic Recovery
Frequency and severity of acute oral complications typically begin to decrease approximately 3 to 4 weeks after cessation of chemotherapy. Healing of ulcerative oral mucositis in the setting of marrow regeneration contributes to this dynamic. Although immune reconstitution is developing, oral mucosal immune defenses may not be optimal. Generally stated, immune reconstitution will take between 6 and 9 months for autologous transplant patients and between 9 and 12 months for allogeneic transplant patients not developing chronic GVHD. Thus, the patient remains at risk for selected infection, including candidal and herpes simplex virus infections.
Mucosal bacterial infections during this phase occur less frequently unless engraftment is delayed or the patient has acute GVHD or is receiving GVHD therapy. Most centers will use systemic infection prophylaxis throughout this period (and, in many instances, longer) to reduce the risk of infections in general, a practice that positively influences the rate and severity of both systemic and local oral infections.
The hematopoietic stem cell transplant patient represents a unique cohort at this point. For example, risk for acute oral GVHD typically emerges during this time in allogeneic graft recipients.
Phase IV: Immune Reconstitution/Recovery from Systemic Toxicity
Oral lesions are principally related to chronic conditioning regimenassociated (chemotherapy with or without radiation therapy) toxi
Dr. Mao talks about complementary and alternative medicine and the importance of being open about their use with cancer caregivers. Read more.
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Calcium Leucovorin, Citrovorum Factor, Folinic Acid
Cladribine (2-CDA, Leustatin®)
Cyclophosphamide (Cytoxan®, Neosar®, Endoxan®)
Cyclosporine (Neoral®, Sandimmune®, Restasis®, Gengraf®)
Cytarabine (Cytosar-U®, Ara-C)
Irinotecan (Camptosar®, CPT-11)
Leucovorin (Calcium Leucovorin, Citrovorum Factor, Folinic Acid)
Calcium Leucovorin, Citrovorum Factor, Folinic Acid
Leucovorin (Calcium Leucovorin, Citrovorum Factor, Folinic Acid)
Leuprolide Acetate (Lupron®, Lupron Depot®, Eligard®, Prostap®, Viadur®) - For Men
Leuprolide Acetate (Lupron®, Lupron Depot®, Eligard®, Prostap®, Viadur®) - For Women
Lupron®, Lupron Depot®, Eligard®, Prostap®, Viadur®
Lupron®, Lupron Depot®, Eligard®, Prostap®, Viadur®
Busulfan (Myleran®, Busulfex®)
Intravesicular Mitomycin (Mutamycin®, Mitomycin-C, given into the bladder)
Mechlorethamine (Mustargen®, Nitrogen Mustard)
mechlorethamine, mustine, Mustargen®
Megestrol (Megace®, Megace-ES®)
Mercaptopurine (Purinethol®, 6-MP)
Methotrexate (Mexate®, Folex®, Rheumatrex®, Amethopterin, MTX)
Mexate®, Folex®, Rheumatrex®, Amethopterin, MTX
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MS Contin®, Avinza®, Kadian®, Oramorph SR®
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Toposar®, VePesid®, Etopophos®,VP-16
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text:
gonzo303 wrote:Obviously I have other art up but Ash's art is sooo damn good.
So I looked high and low to find the other giclees, but couldn't find any info.
oh well it's mine.
Well that may be your problem, you were too high! Also, not really sure what you'd have to take to be low. Maybe some downers?

subset: commoncrawl


text:
Police say customer disarmed suspect in attempted holdup
Police say two men attempting to hold up a convenience store in Springfield early Thursday morning were forced to flee the building after a customer disarmed one of them, took his gun and fired shots at the two men as they fled.
- 1:27 PM, May. 24, 2013


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Modcloth Introduces Its Own Private Label
Modcloth's new "private" label is pretty damn deomocratic.
Each piece in the online retailer's "premiere collection" was sketched by a Modcloth customer, then voted into production by other Modcloth shoppers. Naturally, the fan favorites mirror the site's signature vibe: things that look vintage but aren't (or, perhaps, most of Anthropologie's current stock).
Whether it's a ruffly floral blouse or a Peter Pan-collared sheath, Modcloth's premiere collection would fit right in swaying to the acoustic guitar at a She & Him concert, paired with a red bow barette, mary jane flats and perhaps some messy bangs. The pieces are charming and vaguely hand-me-down-like, but as the product of popular vote, they're also selling quickly. Click through below to shop some of our favorites before they're gone (and shop the full collection here).
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Pink Puppy is introducing Love Me All in One Pink from Puppyzzang.
Pamper your dog with the cutest clothes in the world! Great for any indoor and outdoor event! Make everyone fall in love with your dog with Love Me All in One! Dress your dog in our gorgeous clothes today!
Boys and Girls, it's time to shop! =)
Made with soft cotton. Perfect for Spring, Summer and Fall.
*measure your dog first for the fitment. *x-small: puppies less than 1 year old. =) *small/medium: Yorkshire Terrior/ Maltese *medium/large:Shih Tzu/ Havanese/ Chihuahua/ Toy Poodle + Toy Groups *x-large: Coca Spaniels/Beagles


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Discount Clipart Cat Pictures
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Authors » Bruce Russell
Bruce Russell
Bruce Russell is the author of Jacob's Air, winner of the T A G Hungerford Award in 1995. Since the mid-1970s he has won a number of awards and prizes for his short fiction and is represented in Fiction 88, an anthology of stories chosen by Frank Moorhouse for ABC Books. Bruce grew up in Sydney and in the early seventies lived and taught in North America.
Winner, T A G Hungerford Award, 1995
Books available from Fremantle Press
- Channelling Henry 2003
- Chelsea Manifesto, The 1999
- Jacob's Air 1996
From the Catalogue
Wilderness Society Award
Congratulations to Sally Morgan whose book The Last Dance won the Wilderness Society's 2013 Environment Award for Children's Literature. Meg McKinlay and Kyle Hughes-Odgers were also shortlisted in the same category for Ten Tiny Things


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Free speech: Used or abused?
June 22, 2012 One of the great privileges of being an American is the freedom of speech. Unlike most countries of the world, we can still express our views openly, within reason. more »»
Drilling for true prosperity
June 8, 2012 Recently several landowners in the Mahoning Valley received large checks from gas-drilling companies for mineral rights. more »»
Freedom still worth the fight
May 25, 2012 On Sunday afternoon, the Packard Band will perform its first lawn concert of the season in conjunction with Memorial Day. more »»
Needed:?'Liberated' mothers
May 11, 2012 As we approach Mother's Day in Warren and elsewhere, we need to celebrate the unique blessing of motherhood. more »»
'No fear' mentality a problem
April 27, 2012 It wasn't too many years ago that the logo ''No Fear'' was plastered on clothes items everywher. more »»
Can bad times produce good?
April 13, 2012 Some people see the glass half-empty, while others see it half-full. Perspective is really important. It's possible to emphasize the hole in the doughnut and never enjoy the doughnut itself. more »»
What happened to 'accidents?'
March 30, 2012 Why are some people so quick to place blame on others for events that could not have been prevented? Don't we all have ''accidents,'' or find ourselves in situations beyond our control? Why are we... more »»
Marvel of sowing and reaping
March 16, 2012 It's seed time. Farmers are preparing their fields for the coming harvest. I gladly anticipate the locally grown fruits and veggies that will soon appear. more »»
My compass still points north
March 2, 2012 ''There are no absolutes.'' This is a recurring theme by those who see everything as relevant in the world. more »»
Are we environmentally doomed?
February 17, 2012 According to a recent survey taken by a community action group, Warren should be placed on ''suicide watch. more »»
Have we all abandoned ship?
February 3, 2012 Recently, the Italian cruise ship, Costa Concordia, struck a reef off the coast of the island of Giglio. more »»
Is there no end to Tebowmania?
January 20, 2012 Is the Tebowmania over? I hope so. Denver's recent crushing defeat at the hands of the fired-up New England Patriots should have silenced the "Tebow Craze. more »»
Inventory in unstable world
January 6, 2012 "2011 ends with 4.0 quake." So read the headline of last Sunday's Tribune. The 4.0 magnitude earthquake at 3:04 p.m. (Saturday) shook the Mahoning Valley and jarred area residents. more »»
Reflecting on the Tebow craze
December 23, 2011 In the midst of this Christmas season, there's been somewhat of a football phenomenon called the Tebow effect. more »»
Christmas and America's survival
December 9, 2011 As the song says, ''It's beginning to look a lot like Christmas.'' How delightful it is to witness the display of decorated homes, which offset the evening sk. more »»
Have an attitude of gratitude
November 25, 2011 Happy belated Thanksgiving! I trust the day was special with family and friends, enjoying the traditional turkey feast with all the trimmings. more »»
How behavior affects economy
November 11, 2011 The GOP presidential debates have been replete with issues on health care, national debt and immigratio. more »»
Know the signs of domestic violence
October 28, 2011 DEAR EDITOR: It's an issue no one wants to talk about: domestic violence. more »»
Take another look at 'fright night' traditions
October 28, 2011 ''Yikes,'' I said, as I turned the corner of an aisle in a local supermarket. I ran face to face into a full-length witch's costume. more »»
Turbines in Lordstown are worth the effort
October 28, 2011 DEAR EDITOR: Since the installation of the wind turbines in Lordstown this spring, there has been some to-do about whether they are feasible or no. more »»
Life's fragile, handle with care
October 14, 2011 What are we to say when someone greets you with a "How are you today?" The tendency is to say: "Fine, thank you," even though we haven't really checke. more »» |


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I don't get any girls >_<
I don't get any girls >_<
This will be mine on the 15th
How many time do you have to be told? No one gives a flying fuck about your sex life.
Give Jill a break, Watson.
Oh hey guys what's going on-
Oh yeah.
I feel bad for that Playstation Vita.
If he's really that bad guys, just ignore him. These posts bashing on Watson are unnecessary and unwarranted, and are just as annoying to everyone else as Watson's posts are annoying to you. If you have a beef or annoyance with Watson, just send him a message or PM.
Oh shut the fuck up. And no, I'm not talking to you specifically. But fucking hell guys, how immature are you? You cannot bring up the excuse of "Watson trolled us all, so we can give him a hard time", because you're just consistently berating him, no matter what the subject matter of his posts. If you genuinely can't stand him, and don't want to talk to him at all, just ignore him. Attacking him without provocation isn't proving anything other than your own fickleness.
Ignore him? Okay, that'll work, until he's on his next account of course.
Originally Posted by WatsonOriginally Posted by WatsonOriginally Posted by beardedwalrusOriginally Posted by WatsonOriginally Posted by WatsonOriginally Posted by WatsonAfter reading that, how the hell can you say that telling him that no one gives a flying fuck is "berating him"? He's being an ass.Originally Posted by Watson


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Holiday Fashion Show Benefit
Please join Mary Kay for a Holiday Fashion Show & Boutique at the McCune Mansion featuring fabulous clothing and accessories from The Children's Hour, original designs from SLCC Fashion Institute designers, one-of-a-kind hand-painted silk scarves and hand-woven wool/silk shawls by Sandra Ence, and Hand-crafted jewelry by Brianna Chamberlain.
10% of Boutique purchases will be donated to the American Cancer Society.
Event Underwritten by The McCune Mansion & The McCarthey Family Foundation
CardonFerro Creative
Cheers & Swizzles
Diamond Rental
Inn on the Hill
Talon Printing
The Children's Hour
VPS Valet Parking Services


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E Seus Cometas No Pais Do Baurets (180 gram pressing)
LP (Item 503372) Polydor, 1972 — Condition: New Copy
One of the hardest rocking albums ever cut by Os Mutantes – a record that's got a slightly ironic take on rock and roll styles of the time – still performed with the sense of drama and humor that always made the band so great! Rita Lee and Arnaldo Baptista are still in the group at this point, and they're working amidst a heavy wave of guitars that echo out with a bit of keyboards and some rhythms that are chunky enough to almost be called funky at times, but sweet and dreamy at others – all produced with a flanged-out finish that makes the whole thing sound great! Titles include "Balada Do Louco", "Todo Mundo Pastou II", "Cantor De Mambo", "Dune Buggy", "Rua Augusta", and "Posso Perder Minha Mulher, Minha Mae, Desde Que Eu Tenha, O Rock and Roll". © 1996-2013, Dusty Groove, Inc. |
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Softly: A lost bossa classic from Wanda De Sah – aka Wanda Sa, the wife of Edu Lobo, and a singer who worked with Sergio Mendes in his pre-Brasil 66 days! The album's got a wonderfully laidback feel – ... read more Brazil (LP) 9.99 |
Paulo Moura Quarteto: One of the best albums ever recorded by this Brazilian saxophone giant! This rare 1968 album features Moura working with a quartet that includes Wagner Tiso on piano, Luiz Carlos on bass, and Paschoal ... read more Brazil (LP) 9.99 | ||||
Orlann Divo: Warm bossa grooves – and the second album by Orlandivo, billed here on the cover as Orlann Divo! The album's a great batch of instrumentals – jazzy, with a mix of percussion, bass, and organ ... read more Brazil (LP) 11.99 |
Tempo: The stuff of legend – and one of the greatest albums ever from Brazil's Tamba Trio! The group have a sound here that goes way beyond standard bossa jazz – in that amidst the piano, bass, and ... read more Brazil (LP) 24.99 | ||||
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text: Located at the end of the cul-de-sac on the very private Horstman Lane, #4962 is one of the last remaining building lots located in Horstman Estates. This is your opportunity to call one of Whistler's most exclusive addresses home and your chance to customize the ultimate Whistler retreat. Horstman Estates is located in the Benchlands on Blackcomb mountain and keeps its very own groomed ski in trail which is steps from your would be driveway and front entrance. This neighborhood boasts some of Whistler's most luxurious mountain properties and is within walking distance of the Blackcomb ski lifts. Also within walking distance is the main and upper Whistler villages, the Four Seasons Resort Hotel, The Fairmont Chateau Whistler Golf Club and the ever popular Lost Lake Park where you can cross country ski in the winter and then lie on the beach and bask in the sun come summer time. Your lot, which is quite nearly half and acre in size allows for a build of up to 6,500 square feet and strategically maximizes your sun exposure with the rear of the home facing south/south west. The gentle downward slope of the land creates spectacular mountain views all the while discreetly keeping the attention away from the front of your Whistler home and the would be on-lookers.


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Latest News
•Article submitted by Luke and Ellen Rosenberger, Field Specialists in Nicaragua A few weeks ago, Luke and I drove to Matagalpa, Nicarauga to visit a good friend of ours. While in there, we decided to try and find a church that Luke helped construct on a mission team when he was 11 years old! Amazingly, Luke [...]
Isn't It Interesting How God Moves in His Timing?
Article submitted by Glen Dubois, President of MVI I love God stories. I'd like to tell you one story that started five years ago when we'd gone to Matagalpa, Nicaragua, to purchase the property for a school. The price was to be $60,000. At the closing, the lawyer asked for $30,000 more. We had to [...]
Drought in the Marshall Islands
Article submitted by Steve & Shawn Clark, MVI Field Coordinators in the Marshall Islands We have sent out a prayer request before, but we want to bring it to your attention again. Many of our northern atolls have not had rain in over five months. The water lens that they do have on a few [...]
Luther Meier Shares His Testimony
Luther Meier, MVI Vice-President-at-Large, shares his testimony courtesy of Influence Living
When Choices Really Tear Us Up Inside
Article submitted by Brad and Camie Matlack, Field Coordinators in Kenya A 32-year old lady has been sharing her dream since the day we met her. As we studied God's Word together in a ladies' Bible group, her prayers were consistent. She just wanted to FINISH school! Without even a primary education, this dream appeared [...]


text: A food processor goes beyond the mundane functions of the mixer-grinder and allows you to achieve a whole lot more in lesser time. With an assortment of appliances available, such as Oster food processors, Philips food processors and many other top rated food processors from a variety of brands, you can choose the best one to suit your requirement. Besides acting as a chopper, mincing device and grinder, these food processors also help you knead dough, juice fruits and vegetables, and scrape coconuts.


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Performance Artist,
Writer, Teacher
Welcome to the online home of motivational performer and teacher, Jesse Wilson, where you'll discover his educational presentations for elementary, high school, and college audiences, "Face the City," and "The Night The Moon Ate My Room!" Be sure to check out the coinciding workshops tailored to meet the needs of your students.
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"Jesse Wilson has his finger on the pulse of this generation of students. An extraordinary talent, Jesse speaks to them in a way that touches their hearts and ignites their courage."
Judith Patterson
US Performing Arts


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The summer sun is winding down, subdued by the cooler temperatures of autumn and the holiday season that will follow.
Residents of Pickens County prepare themselves for the change in season with long sleeve shirts, jackets and anticipation.
Meanwhile, wide-eyed kids line the aisles of department stores to stare at the Halloween costumes and the assortment of candy until they are soon replaced by the brighter packaging of Christmas decorations, ornaments and lights.
But must I remind you of the doldrums of winter and the short cold days and the long colder nights that accompany it?
Our daily routines and outdoor activities will all be abandoned, put aside somewhere next to our running shoes and tennis rackets.
And if it should snow, although a rare sight here in the southeast, it will wear out its welcome in just a few hours leaving us imprisoned in our homes as a revolving door of chattering children drip pools of melting snow on the linoleum at the front door.
How I will long for a respite from the winter. Those short stretches of better weather that free us from our overcoats and prompt us once again to go outside.
But by the New Year, I will be entombed by the winter, wrapped in tinsel and packed in a few extra pounds taken on from an endless buffet of colorful holiday meals.
And with all the candy and food threatening a complete renovation to my waistline, a series of New Year's resolutions will surface only to be abandoned by mid-January.
And if that's not enough, my favorite NFL team will no doubt find an abrupt end to their playoff ride, and if only to temper the sting of defeat, I will convince myself that there is always next year.
By late February, I will be desperate for sunshine, humidity and the ability to experience daylight past 6 p.m.
Spring will become a distant mirage, a lighthouse disappearing and reappearing between the crashing waves.
My mind will resurrect images of warmer days and other forms of necessary escape so that I may better cope with the season.
As human beings, we naturally aspire for something better, and for me, something better involves beach sandals and sunglasses.
And it is usually an afternoon in late March or early April that the sun shows up, and brings with it longer days, outdoor enthusiasts and a steady buzz of carpenter bees making routine facial fly-bys.
That, my friends, is the best time of the year, but we are all just beginning to take our first step down the gauntlet of winter where autumn signals the sun to make shorter visits, and the leaves, plants and weaker animals respond by dying.
Now some may enjoy the season, the holidays, and the escape from a South Carolina summer in exchange for its winter, but as for me, I would prefer to assume the role of the groundhog, dig a hole, and sleep through it.


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It was with deep sorrow that members of the advisory board, the honorary board of trustees and the staff members of the Foundation Memorial to the Murdered Jews of Europe learned of the death of Max Bächer.
Uwe Neumärker, director of the Foundation for the Memorial to the Murdered Jews of Europe: »We lost a member who was exceptionally committed, as well as a friend. Max Bächer was one of the first members to be appointed to the advisory board of the Foundation Memorial to the Murdered Jews of Europe. His goal was to 'preserve the quality of Peter Eisenman's design' while at the same time being sure to 'find a place of meaning for the other groups of victims.'«
Max Bächer was born in Stuttgart in 1925. From 1946 onwards, he studied architecture at the Hochschule für Technik in Stuttgart (University of Applied Science) (with history of art and literature as minors). After various stays abroad, he started his own office of architecture in Stuttgart. In 1964, he was offered the chair of designing and interior design at the Technische Universität Darmstadt. From 1981 onwards, he taught as permanent visiting professor at the Tongji University, Shanghai. He was emeritus in 1994. Wolfgang Thierse, President of the Deutsche Bundestag (Germany's national parliament) at the time, appointed Max Bächer to the advisory board of the Foundation Memorial to the Murdered Jews of Europe in May 2000.
Max Bächer died on Monday, December 12, at the age of 86 in Darmstadt. His funeral will be held in Stuttgart.
Foundation Memorial to the Murdered Jews of Europe
Press and Public Relations
Georgenstraße 23, 10117 Berlin
Tel.: +49(0)30 - 26 39 43 26
Fax: +49(0)30 - 26 39 43 26
Email: felizitas.borzym [at] stiftung-denkmal.de


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In the current economic climate, bundled outsourcing can play a key role in helping companies hone their competitive edge and equip themselves to achieve high performance.
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James K. Chen
Academic Appointments
- Associate Professor, Chemical and Systems Biology
- Member, Child Health Research Institute
- Member, Stanford Cancer Institute
- Member, Bio-X
- Associate Professor, Developmental Biology
- Associate Professor (By courtesy), Natural Sciences Cluster - Chemistry Department
Key Documents
Contact Information
- Academic Offices
Personal Information Email Tel (650) 725-3582Alternate Contact Stuart Jeung Administrative Assistant Email Tel Work (650) 736-2999
Professional Overview
Administrative Appointments
- Executive Committee Member, Stanford University Chemical Biology Institute (2012 - present)
- Steering Committee Member, Stanford University School of Medicine Faculty Senate (2012 - present)
- Departmental Representative, Stanford Biosciences Committee on Graduate Admissions and Policy (2012 - present)
- Director, Advisory Committee for the Scholarly Concentrations Program in the Molecular Basis of Medicine (2012 - present)
- Alternate Member, Stanford University Administrative Panel on Laboratory Animal Care (2012 - present)
- Departmental Representative, Stanford University School of Medicine Faculty Senate (2009 - present)
Honors and Awards
- Nature SciCafe Award for Outstanding Research Achievement, Nature Biotechnology and Nature Medicine (2009)
- NIH Director's Pioneer Award, NIH (2008-2013)
- American Cancer Society Research Scholar Award, American Cancer Society (2008-2011)
- Brain Tumor Society Award, Brain Tumor Society/Rachel Molly Markoff Foundation (2006-2008)
- Astellas USA Foundation Award, Astella USA Foundation (2005-2006)
- Terman Fellow, Stanford University (2005-2008)
Professional Education
A.B.: | Harvard College, Chemistry (1991) |
Ph.D.: | Harvard University, Chemistry and Chemical Biology (1999) |
Postdoctoral Fellow: | Johns Hopkins School of Medicine, Molecular Biology and Genetics (2003) |
Postdoctoral Advisees
John Crapster, Lukasz Kowalik, Karen Mruk, Jun Ni, Alison Ondrus, Xiaohu Ouyang, Sayumi Yamazoe
Graduate & Fellowship Program Affiliations
Internet Links
Industry Relationships
Stanford is committed to ethical and transparent interactions with our industrial and other commercial partners. It is our policy to disclose payments (exclusive of travel support) from, and/or equity in, companies or other commercial entities to Stanford faculty of $5,000 or more in total value, as well as any equity in a privately held company, when the faculty member also has institutional responsibilities related to his or her interactions with the company. View Full Information
Scientific Focus
Current Research Interests
The Chen laboratory integrates synthetic chemistry and developmental biology to interrogate the molecular mechanisms that control embryonic patterning, tissue regeneration, and oncogenesis. Our research group is currently focused on three major areas: the identification of small-molecule and genetic regulators of Hedgehog signaling, the development of chemical technologies for perturbing and observing the molecular programs of embryonic patterning and tumorigenesis, and the study of tissue regeneration using zebrafish as a model organism.
Our interest in the Hedgehog pathway arises from its critical role in the patterning of multiple tissues such as the neural tube, craniofacial structures, limbs, and somites. Aberrant Hedgehog pathway activation in children and adults is also linked to several cancers, including those of the skin, brain, and gut. Since the cellular events that transduce the Hedgehog signal from the cell surface to the nucleus are not well understood, we are pursuing genetic and small-molecule screens for new Hedgehog pathway modulators with novel modes of action. These studies will not only provide insights into the basic mechanisms of Hedgehog signal transduction but also provide chemical leads for the development of next-generation chemotherapies and reveal new druggable targets within this tumor-promoting pathway.
Our laboratory is also investigating how Hedgehog signaling and other developmental pathways regulate tissue formation and regeneration in vertebrates. We use the zebrafish as a model organism for these studies, exploiting its rapid ex utero development and amenability to real-time imaging. As part of these efforts, we have developed new strategies for activating and silencing gene expression in zebrafish embryos with unprecedented spatial and temporal precision. These methods utilize chemical probes developed by our research group, including caged reagents that allow light-controlled gene silencing in whole organisms. In conjunction with conventional genetic approaches, these chemical technologies will help us elucidate the genetic programs that control vertebrate development and physiology.
Understanding the molecular mechanisms that underlie tissue regeneration is an emerging interest in our laboratory. The zebrafish is an ideal system for studying these processes, since it has the unique ability to regenerate its heart, retina, spinal cord, fins, and other body parts. Our research group is working with Michael Longaker's laboratory to decipher the molecular and cellular events associated with larval tail regeneration, and we have identified several genes that are upregulated or downregulated in posterior cells after the tail is amputated. We are now using an interdisciplinary approach to determine the roles of these genes in the regenerative process.
- Functional inhibition of UQCRB suppresses angiogenesis in zebrafish. Biochem Biophys Res Commun. 2013; (4): 396-400
- Cyclic caged morpholinos: conformationally gated probes of embryonic gene function. Angew Chem Int Ed Engl. 2012; (28): 6908-11
- Small-molecule inhibitors of the AAA+ ATPase motor cytoplasmic dynein. Nature. 2012; (7392): 125-9
- Spatiotemporal resolution of the Ntla transcriptome in axial mesoderm development. Nat Chem Biol. 2012; (3): 270-6
- The BAH domain of ORC1 links H4K20me2 to DNA replication licensing and Meier-Gorlin syndrome. Nature. 2012; (7392): 115-9
- A crucial requirement for Hedgehog signaling in small cell lung cancer. Nat Med. 2011; (11): 1504-8


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The Florida History Fair: History Really Is Relevant!
May 02
Uncategorized Archaeology Edcuation, Florida History Fair, History Education, National History Day, Reaction, Reform, Revolution, STEM, Tallahassee, University of Maryland at College Park 2 Comments
This was my first year judging the Florida History Fair, and it was a wonderful experience. Each year hundreds of middle and high school students come to Tallahassee to
compete. There are several different categories – performance, documentary, paper, web site and exhibit. This year I judged the first round of middle school web sites and the runoffs for high school web sites. What impressed me most was the great variety of subject matter! The theme this year was "Revolution, Reaction, Reform in History". The topics that the students chose to represent this theme included everything from the Abdication of King Gustav IV is Sweden to the Model T Ford. As a judge I had the opportunity to interview each of the students who's web site I was judging. These kids had already won their county competition in order to make it to the state level. It was great to have a chance to ask them how they decided on their topic. Many of the students had a personal connection to their topic. For example, one student's great grandfather was one of the survivors on the U.S.S. Indianapolis, and she had the opportunity to interview survivors for her project. Another student had taken a trip to Paris with his family and became interested in the French Revolution. The students had to conduct their own research, relate their topic to the theme in some way and come up with their own conclusions through analysis of their topic. It was wonderful to see so many students excited about history!
This competition is part of National History Day, which is a yearlong educational program to get students excited about history and make history come alive. The winners of the Florida History Fair will go on to the national competition this June at the University of Maryland at College Park. At this competition students will have the opportunity to showcase various examples of revolution, reaction and reform from all over the world!
These days history education is sometimes put on the back burner, while most of the emphasis is on STEM education (Science, Technology Engineering and Math). It is
unfortunate to see history education being slighted. It is easy to understand how this occurred when you take into consideration that the results of history education are sometimes less tangible than most other subject areas. In Language Arts a student becomes more literate and learns to use proper grammar…In math a student learns skills that will allow them to keep a balanced check book and count change…in computer class a student learns how to type and navigate the internet…but what are the results of a child learning about history? Simply put, think of the old saying, "Those that do not know history are doomed to repeat it". Today we live in a global economy, with companies conducting business all over the world and the internet connecting people from every background imaginable. Studying history offers the opportunity for students to gain a global perspective and a greater understand of humanity and society. If we relied exclusively on current information and data to understand society we would be at a disadvantage. How would we go about understanding war if our nation is currently at peace? How can we truly have an understanding of today's technology without learning how it evolved from the past? History also gives us a greater appreciation for the rights that we have today. Individuals from the past fought for these rights, and to understand that sacrifice gives us more reason to protect these rights.
History provides us with an understanding of how things change. Anytime there is a drastic change in society today, we look to history for the answer as to why that change may have occurred. History does indeed contributes to the STEM subject areas. One student at the Florida History Fair used anesthesia as an example of revolution in medicine. Another student discussed the discovery of the HeLa Cell, and it's uses in medicine and the implications it had on our society. One student made the bold connection of McCarthyism and how fear is used today in politics and the media. We like to think of traditional subject areas as cut and dry, categorized in their own little boxes, left to stand alone. However, in this day and age, this is no longer the case. Many subject areas cross over into other subjects and no longer can stand completely on their own. It was refreshing to see that students understand this concept and are embracing it. Archaeology is the same way. Archaeologists rely on information provided by historians, forensic scientists, architects and architectural historians, chemists and many other professionals from a wide array of backgrounds. Archaeology also contributes to those subject areas as well. It is for this reason that archaeology education, like history education, is so important. It provides us the only physical evidence of the past, and can give historians actual proof of historic events that helped to shape the world into what it is today. Archaeology can be used to get kids excited about math, science, history and other subject areas because of it's multidisciplinary nature.
In conclusion, I encourage children and adults to learn about history. You don't have to learn everything in a classroom either! Visit a museum or an archaeological site, or read a novel based on historical events or people. One thing that I took away from the history fair is that history is relevant and fun! Take it from me and from the thousands of students that participate in National History Day around the country, history is needed and people still want to learn about our past.


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Personal Messaging temporarily unavailable.
Hi Melodie,Seems that whatever I use I always hit the PCManFM iconon the desktop first. Good old "My Documents".FF
If you use feh only to provide a background, and not pcmafm, there is not desktop icon... unless you configure them with idesk.
PS: Ferdes Fides, idesk is old and not updated but feh is active, see here: http://feh.finalrewind.org/
I think the only trick with iDesk is setting up a iDesk directory in /home/usr, then theicon's file's should be read and work on the desktop, need a little more time to do that.I see what you are driving at.
It does not work like that. Once idesk is installed and you start it (from autostart.sh or from console) a directory .idesktop is created in the home of the user. You will then need to visit it, copy "dot.ideskrc" to your home as ".ideskrc". Then stop idesk (with a killall) and start it without a &, from console : $ idesk
One question. If I don't use feh,where can I change the OpenBox configuration to display an all black screen asopposed to the default grey screen without feh, without PCManFM ? Just can't find it.THX.Patrick
The files idesk reads from (in $HOME/.idesktop) are files ending with ".lnk"


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Browse Bestsellers
491 to 500 of 944 books
Peterson Field Guide to Ferns, Second Edition: Northeastern and Central North America (Peterson Field Guides)
Since 1956, when the late Boughton Cobb wrote his field guide to ferns, this book, unchanged in all the years since, has become the classic on the subject. Now the New England Wild Flower Society ... > read more -
MCTS Self-Paced Training Kit (Exam 70-236): Configuring Microsoft Exchange Server 2007 (Pro - Certification)
Announcing an all-new SELF-PACED TRAINING KIT designed to help maximize your performance on 70-236, the required exam for the new Microsoft Certified Technology Specialist (MCTS): Configuring ... > read more -
The Shorebird Guide
When many birders go out looking at shorebirds, they see a distant mud flat full of grayish brown birds in various shapes and sizes and have no idea where to begin the identification process.When ... > read more -
Human Biology
This market leading human biology text emphasizes the relationships of humans to other living things. Human Biology remains user friendly; relevancy and pedagogy are among its strengths. In this ... > read more -
Sensation and Perception
E. Bruce Goldstein's SENSATION AND PERCEPTION, the best-seller which has helped over 150,000 students understand the ties between how we sense the world and how the body interprets these senses, is ... > read more -
Saltwater Aquariums For Dummies (For Dummies (Lifestyles Paperback))
Demystifies aquarium setup and maintenance Combine and care for a wide variety of marine fish and invertebrates Dive into the colorful world of saltwater fish! This fun, friendly guide ... > read more -
Frauds, Myths, and Mysteries: Science and Pseudoscience in Archaeology
Ancient astronauts? Atlantis? Psychic archaeology? Pharaoh's curses? Committed to the scientific investigation of human antiquity, this indispensable supplementary text uses interesting ... > read more -
Darwin (Norton Critical Editions) (3rd Edition)
"The best Darwin anthology on the market" (Stephen Jay Gould, Harvard) has just become better, in this newly revised version of the now classic Norton Critical Edition, first published in 1970. The ... > read more -
Cultural Anthropology
Build your own awareness of cultures around the world with CULTURAL ANTHROPOLOGY! Emphasizing the issues of gender, stratification, ethnicity, globalization, and the similarities and differences ... > read more -
Rome: An Oxford Archaeological Guide (Oxford Archaeological Guides)
The city of Rome is the largest archeological site in the world. If your idea of a good Roman holiday is uncovering the archeological mysteries of the Roman Empire, then Oxford Archeological Guides: ... > read more
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Marc by Marc Jacobs
Sneaker Wedge in Black/Black/White/Oatmeal
Fashion legend Marc Jacobs introduced his diffusion line, Marc by Marc Jacobs, with a spring 2001 runway show. He has gone on to win seven CFDA awards including Womenswear Designer of the Year, Accessories Designer of the Year and Menswear designer of the year.
- Leather upper with rubber sole
- Hidden wedge measures approx 3" H
- Lace up front
- Velcro strap detail at ankle
- Revolve Style No. MARC-WZ134
- Manufacturer Style No. 635543
- Can't find your size? Place a special order inquiry for this item.
look: -- |
fit: -- |
comfort: -- |
overall: -- |
sizing: -- |


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Waterford hockey teams face off to beat cancer Saturday
Hometown rivals Waterford Kettering and Waterford Mott high school hockey players will face off at the annual "Two Teams, One Cause" game to fight cancer Saturday, Feb. 2, at Lakeland Arena.
The teams will don pink and purple jerseys to show support and raise money for the American Cancer Society. Other funds will be donated for a former teacher fighting cancer, organizers said.
Supporters may also purchase jerseys or T-shirts with funds raised going to battle cancer.
Admission to the game, to be held at 5:30 p.m. at 7330 Highland Road in Waterford. Call 248-673-1261
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Outdoor Research Kids' Alpine Hat
Products on Sale are Discontinued Colors.
DECENT FEATURES of the Outdoor Research Kids' Alpine Hat
- Breathable
- Windproof
- Wicking
- Contoured ear band
- Flat-seam construction
The SPECS
- Weight: (M/L): 1.3 oz / 37 g
- Wind stopper Technical Fleece 100% polyester
- Polar Tec Wind Pro ear panels 90% polyester, 10% elastane
This product can only be shipped within the United States. Please don't hate us.


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A historic work of distinction to rise as the crowning jewel of your home.
You'll understand what Roman author Vitruvius meant when he called Corinthian columns "the imitation of the slenderness of a maiden" as you gaze at the graceful beauty of our nearly seven-foot-tall work of furniture art.
Intricately carved and crowned with acanthus leaf capitols, these Toscano exclusives are cast in quality designer resin and dramatically hand-painted with a weathered, faux stone finish. Set with three six-foot-wide expanses of tempered glass to showcase your collectibles and artifacts, this is a truly amazing statement piece sure to be the centerpiece of your home.
76"W x 19-1/2"D x 79"H. 270 lbs.


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Ria (Re-uh) please be 18+ i'm an artist that adores the body, whether I'm posing for nudes or painting them in my studio. i am also studying sexuality so i can help couples & of course single people with their sexual health and mind :) please do not steal my photos if you ask we can work something out whether it be for your blog or ad campaign. professionals feel free to email me about jobs & shoots - firstname.lastname@example.com if your nice ill be nice | please read FAQ before messaging me <3 spoil me ;) and you can get unpublished pictures. the higher the priority on the item the yummier photos hehehe
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So you've made the decision to buy yourself a portable pet toilet. Congratulations! You're one step closer to a more convenient pet lifestyle. You've jumped online for a bit of research, maybe you've listened to your friends talking about them over coffee, or perhaps you've even seen them advertised on TV. Yet, it's not until you finally get to your local pet retailer that you find yourself staring at two or three similar products. Which one do you choose? There … Continue reading
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Ejection won't cost Rebel time
Posted: February 12, 2013 at 3:33 a.m.
Ole Miss forward Reginald Buckner will be available for Wednesday's game at Texas A&M after being ejected from last Saturday's 98-79 loss at Missouri.
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Sports, Pages 20 on 02/12/2013
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HORSE (TRAINER, JOCKEY) 1. Shanghai Bobby (Todd Pletcher, Rosie Napravnik) You don't have to win them all heading to the Derby. Read »
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Who says you can't wear white after Labor Day!? Add a touch of winter white to your makeup look this fall to make your eyes appear wider and brighter. One easy step is to creating the illusion of having wider, brighter eyes is to use a white e... Read more »