text:
Availability: Holiday Inn Express Glasgow Airport
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Standard Double or Twin
- FREE Breakfast
Breakfast is included in your stay.
- FREE Wifi
Wifi is included in your stay.
Two Single Beds, Two Persons, Nonsmoking
- FREE Breakfast
Breakfast is included in your stay.
- FREE Wifi
Wifi is included in your stay.
One Double and One Sofa Bed
- FREE Breakfast
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- FREE Wifi
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One Double Bed, Non-Smoking, Wheelchair Accessible
- FREE Breakfast
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- FREE Wifi
Wifi is included in your stay.
Hotel with a restaurant, in Paisley (Renfrewshire)
This hotel is located in Paisley (Renfrewshire), near the airport, St. Mirren Park, Paisley Abbey, and Coats Observatory. Local attractions also include Paisley Museum and Art Gallery and Rothesay Dock.
Hotel Features
In addition to a restaurant, Holiday Inn Express Glasgow Airport features a bar/lounge. Other amenities include complimentary wireless Internet access and dry cleaning/laundry services.
Room Amenities
LED televisions come with digital channels. Guestrooms also feature complimentary wireless Internet access, air conditioning, and coffee/tea makers.
Information missing or incorrect? Tell us!Holiday Inn Express Glasgow Airport Amenities
- General
The hotel offers a restaurant. A bar/lounge is on site where guests can unwind with a drink. A complimentary breakfast is offered each morning. An Internet point is located on site and high-speed wireless Internet access is complimentary.
This 3-star property offers access to a business center and a meeting/conference room. This Paisley hotel also offers coffee/tea in the lobby, dry cleaning/laundry services, and express check-out. Limited onsite parking is available on a first-come, first-served basis (surcharge).
Holiday Inn Express Glasgow Airport is a smoke-free property.
- 24-hour front desk
- Air-conditioned public areas
- Total number of rooms - 143
- Number of floors - 4
- Self parking (surcharge)
- Bar/lounge
- Business services
- Coffee/tea in lobby
- Free breakfast
- Currency exchange
- Elevator/lift
- Express check-out
- Internet point
- Free Wi-Fi
- Luggage storage
- One meeting/conference room
- Parking limited (surcharge)
- Dry cleaning/laundry service
- Business center
- Microwave in lobby
- Valet parking (surcharge)
- Parking (surcharge)
- Restaurant
- Safe-deposit box at front desk
- Year Built 2000
- Smoke-free property
- Smoke-free property (fines apply)
- Number of buildings/towers - 1
- Television in lobby
- Internet
Available in all rooms: Free Wi-Fi
Available in some public areas: Free Wi-Fi
- Parking
Parking (surcharge), Self parking (surcharge), Valet parking (surcharge), Parking limited (surcharge)
- Room Amenities
- Cribs/infant beds (complimentary)
- Shower only
- Coffee/tea maker
- Daily housekeeping
- Private bathroom
- Complimentary toiletries
- Iron/ironing board (on request)
- Electronic/magnetic keys
- Air conditioning
- Direct-dial phone
- Digital TV service
- Free Wi-Fi
- Complimentary newspaper
- Hair dryer
- Pillow menu
- Desk
- Dining
A complimentary hot/cold buffet breakfast is served each morning between 6 AM and 10 AM.
Great Room - This family restaurant serves breakfast and dinner. Guests can enjoy drinks at the bar.
- Recreation
The recreational activities listed below are available either on site or nearby; fees may apply.
- Golfing nearby
- Accessibility
To make requests for specific accessibility needs, complete the "Special or Accessibility Requests" section of "Trip Preferences" when you book your hotel.
- Accessible path of travel
- Accessible bathroom
- Roll-in shower
- Accessible parking
- In-room accessibility
- Accessibility equipment for the deaf
- Braille or raised signage
Holiday Inn Express Glasgow Airport Policies & Fees
- Check-in
Minimum check-in age is 18
Check-in time starts at 2 PM
- Check-out
Check-out time is 11 AM
- Payment types
Accepted at this hotel: American Express, Carte Blanche, Diners Club, MasterCard, Visa, JCB International
- Pets
Pets allowed, Pet policy - dogs only, Maximum number of pets per room 1, Pet maximum weight in kg is 20
- General
Extra-person charges may apply and vary depending on hotel policy.
Government-issued photo identification and a credit card or cash deposit are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
- Fees
- The following fees and deposits are charged by the property at time of service, check-in, or check-out.
- Self parking fee: GBP 5 per night
- Pet deposit: GBP 10 per day
The above list may not be comprehensive. Fees and deposits may not include tax and are subject to change.


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After attending a very special Mass at Holy Rosary Cathedral, Toledo, June 13, during which we celebrated the closing of an abortion clinic in Toledo, this special poem written by the "Nuns of the Precious Blood" which was recited. This poem says it all!
My Life Depends on You
Mamma, please don't hurt me,
I'm helpless and so small
if you don't choose to keep me safe,
then I've no one at all.
I'm not a thing to be destroyed -
in private, secretly;
I'm growing here beneath your heart,
I'm real, I'm yours, I'm me!
Perhaps your heart is troubled,
filled with fears or filled with shame.
But Mamma, try to understand
I'm not the one to blame!
I've never, ever hurt you.
so you've nothing to forgive,
Why should I have to die
before I've had my right to live?
If you can't keep me, Mamma,
it's all right, I'll understand,
But please let someone else reach out
to take my tiny hand.
So many childless couples would be
happy as can be,
if they could but adopt and love
a little one like me.
Remember that when you were just
as small and frail as I,
Your mother didn't make the choice
to have her baby die.
You had your chance to live,
so, please, let me have my chance, too.
I can't escape, I can't cry out...
My life depends on you!
For any woman who can bear children, you have been so blessed, for there are many women who can't. Give these children a chance to live and have a wonderful life with someone who will love them unconditionally forever. There are thousands of couples that would cherish these babies.
Wouldn't it be so much better to let your baby live than let someone take its precious life? You can live without shame or regret the rest of your life, if your heart is open to this choice. Please pray about this!
Linda Hayman,

subset: commoncrawl


text:
The Order of the Forks
Images from Camp Jorn: 2011-2012
By Mike Mikkelson m2Creative
About the Author
Publish Date December 10, 2012
Dimensions Standard Landscape 20 pgs Standard Paper
Category Travel
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text: Bowfin - (Amia Calva), better known by its Cajun name "Choupique" is not related to, but is even more ancient than the sturgeons. This bony fish yields a black roe with an earthy and distinctive flavor that makes a good, less expensive substitute for sturgeon caviar. Unlike sturgeon, bowfin roe will turn red if heated.


text:
NOZZLES, spray
Clog-resistant Maximum Free Passage Nozzles
June 6, 2013 4:53 pm | Product Releases | CommentsSpraying Systems Co. has expanded the MFP (Maximum Free Passage) FullJet full cone nozzle line to include 1-1/2", 2", 2-1/2" and 3" sizes for applications with flow rates up to 705 gpm and 80 psi.
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May 15, 2013 7:55 am | Product Releases | CommentsFisnar Inc. brings together an enhanced SV2000N series of close tolerance, minimum overspray valves with a precision SVC100 controller that manages the functions necessary to provide repeatable and precise spray performance.
LISTED UNDER: NOZZLES, sprayAdvertisement


text:
Greyhound Racing Games - Kennel-Woof Park
This virtual greyhound racing game from Blue Square Games offers the excitement of an evening at the track without the need to leave the comfort of your home. Their arcade racing game offers you a meeting of 8 races with the opportunity to bet on a combination of race outcomes. The form gives you an accurate representation of how well a greyhound is likely to do in a race, with the odds calculated accordingly.
How To Play
You can play for fun in Demo mode, or for that added excitement play with real cash. To play for real you'll need to register an account with Blue Square but there is no need to register if selecting demo play. Click on the arrow that corresponds to your required mode of play.
The race card is split between eight races. You can bet on an individual dog within a race, back multiple greyhounds in a race using forecast and tricast bets, or back a series of greyhounds across the racecard in accumulator bets.
Greyhound Info
Also see a short write-up about the dogs chance of winning. |
Race BetsSelect "Race Bets" from the top menu to place single, forecast and tricast bets on one or more dogs within the race. |
Multiple BetsSelect "Multiple Bets" from the top menu to place double, treble and accumulator bets across different races on the race card. |
Once you've entered your required bets. Click the submit button.
Watch The Race
Press the start race button, then sit back and watch your greyhound race.
They're Off - The dogs come out of the traps.
Greyhound positions are shown throughout the race via the in-screen race map. |
Click on a greyhound's number to focus the viewer on that dog. Press the "Skip" button if you just wish to see the result without watching the race. |
Photo finish shows the winner of the race.
Finishing positions are shown. Dogs that you have bet on are indicated with a . |
Winning and losing bets are shown, indicating your profit or loss on the race. |
To play the virtual greyhound racing game, see Kennel-woof Park at Blue Square Games.


text:
Postinduction Treatment for Specific ALL Subgroups
T-Cell ALL
Treatment options
Treatment options under clinical evaluation for T-cell ALL
Current Clinical Trials
Infants With ALL
Treatment options for infants with MLL translocations
Treatment options for infants without MLL translocations
Treatment options under clinical evaluation for infants with ALL
Adolescents and Young Adults With ALL
Treatment options
Treatment options under clinical evaluation for adolescent and young adult patients with ALL
Philadelphia Chromosome–positive ALL
Treatment options
Treatment options under clinical evaluation for Philadelphia chromosome–positive ALL
Current Clinical Trials
T-Cell ALL
Historically, patients with T-cell acute lymphoblastic leukemia (ALL) have had a worse prognosis than children with precursor B-cell ALL. With current treatment regimens, outcomes for children with T-cell ALL are now approaching those achieved for children with precursor B-cell ALL. For example, the 10-year overall survival (OS) for children with T-cell ALL treated on the Dana-Farber Cancer Institute (DFCI) DFCI-95001 (NCT00004034) trial was 90.1% compared with 88.7% for patients with B-cell disease.[1] However, in a review of a large number of patients treated on COG trials over a 15-year period, T-cell immunophenotype still proved to be a negative prognostic factor on multivariate analysis.[2]
Treatment options- Protocols of the former Pediatric Oncology Group (POG) treated children with T-cell ALL differently from children with B-lineage ALL. The POG-9404 protocol for patients with T-cell ALL was designed to evaluate the role of high-dose methotrexate. The multiagent chemotherapy regimen for this protocol was based on the DFCI-87001 regimen.[3]
- Results of the POG-9404 study indicated that the addition of high-dose methotrexate to the DFCI-based chemotherapy regimen resulted in significantly improved event-free survival (EFS) in patients with T-cell ALL (10-year EFS, 78% for those randomly assigned to high-dose methotrexate versus 68% for those randomly assigned to therapy without high-dose methotrexate, P = .05).
- High-dose methotrexate was associated with a lower incidence of relapses involving the central nervous system (CNS).[4] This POG study was the first clinical trial to provide evidence that high-dose methotrexate can improve outcome for children with T-cell ALL. High-dose asparaginase, doxorubicin, and prophylactic cranial irradiation were also important components of this regimen.[1,4]
- Protocols of the former Children's Cancer Group (CCG) treated children with T-cell ALL on the same treatment regimens as children with precursor B-cell ALL, basing protocol and treatment assignment on the patients' clinical characteristics (e.g., age and white blood cell [WBC] count) and the disease response to initial therapy. Most children with T-cell ALL meet National Cancer Institute (NCI) high-risk criteria.
- Results from CCG-1961 for high-risk ALL including T-cell ALL showed that an augmented Berlin-Frankfurt-Münster (BFM) regimen with a single delayed intensification course produced the best results for patients with morphologic rapid response to initial induction therapy (estimated 5-year EFS, 83%).[5,6] Almost 60% of events in this group, however, were isolated CNS relapses.
- Overall results from POG-9404 and CCG-1961 were similar, although POG-9404 used cranial radiation for every patient, while CCG-1961 used cranial radiation only for patients with slow morphologic response.[6,4]
- Among children with NCI standard-risk T-cell ALL, the EFS for those treated on CCG-1952 and COG-1991 studies was inferior to the EFS for those treated on the POG-9404 study.[7]
- In the Children's Oncology Group (COG), children with T-cell ALL are not treated on the same protocols as children with precursor B-cell ALL. Pilot studies from the COG have demonstrated the feasibility of incorporating nelarabine (a nucleoside analog with demonstrated activity in patients with relapsed and refractory T-cell lymphoblastic disease) [8,9] in the context of a BFM regimen for patients with newly diagnosed T-cell ALL. The pilot study showed a 5-year EFS rate of 73% for all patients receiving nelarabine and 69% for those patients with a slow early response.[10]
- The role of prophylactic cranial radiation in the treatment of T-cell ALL is controversial. Some groups, such as St. Jude Children's Research Hospital (SJCRH) and the Dutch Childhood Oncology Group (DCOG), do not use cranial radiation in first-line treatment of ALL, while other groups, such as DFCI, COG, and BFM, use radiation for the majority of patients with T-cell ALL.
Treatment options under clinical evaluation for T-cell ALL include the following:
- COG-AALL0434 (NCT00408005) (Combination Chemotherapy in Treating Young Patients With Newly Diagnosed T-Cell ALL or T-cell Lymphoblastic Lymphoma):
COG-AALL0434 is a phase III trial utilizing a modified augmented BFM regimen for patients aged 1 to 30 years with T-cell ALL. Patients are classified into one of three risk groups (low, intermediate, or high) based on NCI age/leukocyte criteria, CNS status at diagnosis, morphologic marrow response on days 15 and 29, and minimal residual disease (MRD) level at day 29. The objectives of the trial include the following:
- To determine the safety and efficacy of adding nelarabine to the modified augmented BFM regimen in high- and intermediate-risk patients.
- To determine the relative safety and efficacy of high-dose (5 g/m2) versus Capizzi escalating lower-dose methotrexate without rescue plus PEG-asparaginase during interim maintenance.
- To test the efficacy of treating NCI standard-risk T-cell ALL patients, without CNS disease, who are rapid responders (about 15% of patients) without cranial radiation.
- DFCI-11-001 (NCT01574274) (SC-PEG Asparaginase versus Oncaspar in Pediatric ALL and Lymphoblastic Lymphoma):
Patients with T-cell ALL are eligible to enroll on a DFCI ALL Consortium protocol that is comparing the pharmacokinetics and toxicity of two forms of intravenous PEG-L-asparaginase (pegaspargase [Oncaspar] and calaspargase pegol [SC-PEG]). Patients will be randomly assigned to receive a single dose of one of these preparations during multiagent induction, and then either pegaspargase every 2 weeks (15 doses total) or calaspargase pegol every 3 weeks (10 doses total) during the 30-week consolidation phase.
This protocol is also testing whether antibiotic prophylaxis (with fluoroquinolones) reduces rates of bacteremia and other serious bacterial infections during the remission induction phase. All T-cell patients are treated on the high-risk arm of this trial, regardless of other presenting characteristics.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with T-cell childhood acute lymphoblastic leukemia. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Infants With ALLInfant ALL is uncommon, representing approximately 2% to 4% of cases of childhood ALL.[11] Because of their distinctive biological characteristics and their high risk of leukemia recurrence, infants with ALL are treated on protocols specifically designed for this patient population. Common therapeutic themes of the intensive chemotherapy regimens used to treat infants with ALL are the inclusion of postinduction intensification courses with high doses of cytarabine and methotrexate.[12-14] Despite intensification of therapy, long-term EFS rates remain below 50%. Infants with congenital leukemia (diagnosed within 1 month of birth) have a particularly poor outcome (17% OS).[15][Level of evidence: 2A].
For infants with MLL gene rearrangement, the EFS rates continue to be in the 17% to 40% range.[12,13,15-17][Level of evidence: 2A] Factors predicting poor outcome for infants with MLL translocations include the following:[13]; [18][Level of evidence: 3iDii]
- A very young age (<6 months).
- Extremely high presenting leukocyte count (≥200,000–300,000/μL).
- High levels of MRD at the end of induction and consolidation phases of treatment.
Infants with MLL gene translocations are generally treated on intensified chemotherapy regimens using agents not typically incorporated into frontline therapy for older children with ALL. However, despite these intensified approaches, EFS rates remain poor for these patients.
Evidence (intensified chemotherapy regimens for infants with MLL translocations):
- The international Interfant clinical trials consortium utilized a cytarabine-intensive chemotherapy regimen, with increased exposure to both low- and high-dose cytarabine during the first few months of therapy, resulting in a 5-year EFS of 37% for infants with MLL translocations.[13]
- The COG tested intensification of therapy with a regimen including multiple doses of high-dose methotrexate, cyclophosphamide, and etoposide, resulting in a 5-year EFS of 34%.[12]
The role of allogeneic hematopoietic stem cell transplant (HSCT) during first remission in infants with MLL gene translocations remains controversial.
Evidence (allogeneic HSCT in first remission for infants with MLL translocations):
- On a Japanese clinical trial conducted between 1998 and 2002, all infants with MLL-rearrangement were intended to proceed to allogeneic HSCT from the best available donor (related, unrelated, or umbilical cord) 3 to 5 months after diagnosis.[19]
- The 3-year EFS for all enrolled infants was 44%. This result was due, in part, to the high frequency of early relapses, even with intensive chemotherapy; of the 41 infants with MLL-rearrangement on that study who achieved complete remission (CR), 11 infants (27%) relapsed before proceeding to transplant.
- In a COG report that included 189 infants treated on CCG or POG infant ALL protocols between 1996 and 2000, there was no difference in EFS between patients who underwent HSCT in first CR and those who received chemotherapy alone.[20]
- The Interfant clinical trials group, after adjusting for waiting time to transplantation, also did not observe any difference in disease-free survival (DFS) in high-risk infants (defined by prednisone response) with MLL translocations treated on the Interfant-99 trial with either allogeneic HSCT in first CR or chemotherapy alone.[13]
- In a subset analysis from the same trial, allogeneic HSCT in first remission was associated with a significantly better DFS for infants with MLL translocations who were younger than 6 months at diagnosis and had either a poor response to steroids at day 8 or leukocyte counts of at least 300,000/µL.[21] In this subset, HSCT in first remission was associated with a 64% reduction in the risk of failure resulting from relapse or death compared with chemotherapy alone.
The optimal treatment for infants without MLL translocations also remains unclear.
- On the Interfant-99 trial, patients without MLL translocations achieved a relatively favorable outcome with the cytarabine-intensive treatment regimen (4-year EFS was 74%).[13]
- A favorable outcome for this subset of patients was obtained in a Japanese study using therapy comparable to that used to treat older children with ALL;[16] however, that study was limited by small numbers (n = 22) and a highly unusual gender distribution (91% males).
Treatment options under clinical evaluation include the following:
- Interfant-06 Study Group trial (DCOG-INTERFANT-06) (Different Therapies in Treating Infants With Newly Diagnosed Acute Leukemia): The Interfant-06 Study Group is conducting an international collaborative randomized trial (including sites in the United States) to test whether an ALL/acute myeloid leukemia hybrid regimen might improve outcomes for infants with MLL-rearranged ALL. The role of allogeneic transplantation in first remission is also being assessed in high-risk patients (defined as infants with MLL-rearranged ALL, younger than 6 months, and WBC >300,000 /µL) or poor peripheral blood response to steroid prophase. Infants with MLL-rearranged ALL with high MRD at end of consolidation phase are also eligible for allogeneic HSCT in first remission regardless of other presenting features.
- COG-AALL0631 (Combination Chemotherapy With or Without Lestaurtinib in Treating Infants With Newly Diagnosed ALL): In this COG study of infant ALL, an FLT3 inhibitor, lestaurtinib, is being studied in infants with MLL rearrangement. Infants with MLL rearrangement are known to have a high level of FLT3 mRNA expression and lestaurtinib has been shown to selectively kill MLL-rearranged ALL cells in vitro and in vivo.[22] This study combines lestaurtinib with intensive chemotherapy previously utilized in POG-P9407. An initial safety/activity phase has been completed and the efficacy phase in which children will be randomly assigned to chemotherapy with or without lestaurtinib is now underway. Infants with germline MLL are nonrandomly assigned to less-intensive chemotherapy without lestaurtinib.
Adolescents and young adults with ALL have been recognized as high risk for decades. Outcomes in almost all studies of treatment are inferior in this age group compared with children younger than 10 years.[23-25] The reasons for this difference include more frequent presentation of adverse prognostic factors at diagnosis, including the following:
- T-cell immunophenotype.
- Philadelphia chromosome–positivity (Ph+).
- Lower incidence of favorable cytogenetic abnormalities.
In addition to more frequent adverse prognostic factors, patients in this age group have higher rates of treatment-related mortality [24-27] and non-adherence to therapy.[26,28]
Treatment optionsStudies from the United States and France were among the first to identify the difference in outcome based on treatment regimens.[29] Other studies have confirmed that older adolescent and young adult patients fare better on pediatric rather than adult regimens.[29-33]; [34][Level of evidence: 2A] These study results are summarized in Table 3.
Given the relatively favorable outcome that can be obtained in these patients with chemotherapy regimens used for high-risk pediatric ALL, there is no role for the routine use of allogeneic HSCT for adolescents and young adults with ALL in first remission.[25]
Evidence (pediatric treatment regimen):
- Investigators reported on 197 patients aged 16 to 21 years treated on the CCG study (a pediatric ALL regimen) who showed a 7-year EFS of 63% compared with 124 adolescents and young adults treated on the Cancer and Leukemia Group B (CALGB) study (an adult ALL regimen) with a 7-year EFS of 34%.[29]
- A study from France of patients aged 15 to 20 years and diagnosed between 1993 and 1999 demonstrated superior outcome for patients treated on a pediatric trial (67%; 5-year EFS) compared with patients treated on an adult trial (41%; 5-year EFS).[35]
- In the COG high-risk study (CCG-1961), the 5-year EFS rate for 262 patients aged 16 to 21 years was 71.5%.[25][Level of evidence: 1iiDi] For rapid responders randomly assigned to early intensive postinduction therapy on the augmented intensity arms of this study, the 5-year EFS rate was 82% (n = 88).
- The DFCI ALL Consortium reported that a study of 51 adolescents aged 15 to 18 years in a pediatric trial had a 5-year EFS of 78%.[31]
- In an SJCRH study, 44 adolescents aged 15 to 18 years had an EFS of approximately 85% ± 5%.[24]
- In a Spanish study, 35 adolescents (aged 15–18 years) and 46 young adults (aged 19–30 years) with standard-risk ALL were treated with a pediatric-based regimen.[34][Level of evidence: 2A]
- EFS rate was 61%.
- The OS rate was 69%.
- There were no differences in outcome between adolescents and young adults.
Other studies have confirmed that older adolescent patients and young adults fare better on pediatric rather than adult regimens (see Table 3).[30,32]; [34][Level of evidence: 2A]
The reason that adolescents and young adults achieve superior outcomes with pediatric regimens is not known, although possible explanations include the following: [30]
- Treatment setting (i.e., site experience in treating ALL).
- Adherence to protocol therapy.
- The components of protocol therapy.
Site and Study Group | Adolescent and Young Adult Patients (No.) | Median age (y) | Survival (%) |
United States [29] | |||
CCG (Pediatric) | 197 | 16 | 67, OS 7 y |
CALGB (Adult) | 124 | 19 | 46 |
France [35] | |||
FRALLE 93 (Pediatric) | 77 | 16 | 67 EFS |
Italy [36] | |||
AEIOP (Pediatric) | 150 | 15 | 80, OS 2 y |
GIMEMA (Adult) | 95 | 16 | 71 |
Netherlands [37] | |||
DCOG (Pediatric) | 47 | 12 | 71 EFS |
Sweden [38] | |||
NOPHO 92 (Pediatric) | 36 | 16 | 74, OS 5 y |
Adult ALL | 99 | 18 | 39 |
United Kingdom [32] | |||
MRC ALL (Pediatric) | 61 | 15–17 | 71, OS 5 y |
UKALL XII (Adult) | 67 | 15–17 | 56 |
ALL = acute lymphoblastic leukemia; EFS = event-free survival; OS = overall survival. | |||
AEIOP = Associazione Italiana Ematologia Oncologia Pediatrica; CALGB = Cancer and Leukemia Group B; CCG = Children's Cancer Group; DCOG = Dutch Childhood Oncology Group; FRALLE = French Acute Lymphoblastic Leukaemia; GIMEMA = Gruppo Italiano Malattie e Matologiche dell'Adulto; HOVON = Dutch-Belgian Hemato-Oncology Cooperative Group; LALA = France-Belgium Group for Lymphoblastic Acute Leukemia in Adults; MRC = Medical Research Council (United Kingdom); NOPHO = Nordic Society for Pediatric Hematology and Oncology; UKALL = United Kingdom Acute Lymphoblastic Leukaemia. |
Adolescents with ALL appear to be at higher risk than younger children for developing therapy-related complications, including osteonecrosis, deep venous thromboses, and pancreatitis.[31,39] Before the use of postinduction intensification for treatment of ALL, osteonecrosis was infrequent. The improvement in outcome for children and adolescents aged 10 years and older was accompanied by an increased incidence of osteonecrosis.
The weight-bearing joints are affected in 95% of patients who develop osteonecrosis and operative interventions are needed for management of symptoms and impaired mobility in more than 40% of cases. The majority of the cases are diagnosed within the first 2 years of therapy and often the symptoms are recognized during maintenance.
Evidence (osteonecrosis):
- In the CCG-1961 high-risk ALL study, alternate-week dosing of dexamethasone was compared with standard continuous dexamethasone during delayed intensification to see if the osteonecrosis risk could be reduced.[39]
- The median age at symptom onset was 16 years.
- The cumulative incidence was higher in adolescents and young adults aged 16 to 21 years (20% at 5 years) than in those aged 10 to 15 years (9.9%) or in patients aged 1 to 9 years (1%).
- Operative interventions are needed for management of symptoms and impaired mobility in more than 40% of cases.
- The use of alternate-week dosing of dexamethasone as compared with standard continuous dexamethasone during delayed intensification in CCG-1961 reduced the risk of osteonecrosis. The greatest impact was seen in females aged 16 to 21 years, who showed the highest incidence of osteonecrosis with standard therapy containing continuous dexamethasone; osteonecrosis was reduced with alternate-week dexamethasone postinduction (57.6% to 5.6%).
Treatment options under clinical evaluation include the following:
- COG-AALL0434 (NCT00408005) (Combination Chemotherapy in Treating Young Patients With Newly Diagnosed T-Cell ALL or T-cell Lymphoblastic Lymphoma): This is a phase III trial for patients aged 1 to 30 years with T-cell ALL utilizing a modified augmented BFM regimen. Patients are classified into one of three risk groups (low, intermediate, or high) based on NCI age/leukocyte criteria, CNS status at diagnosis, morphologic marrow response on days 15 and 29, and MRD level at day 29. The following are objectives of the trial: (1) to determine the safety and efficacy of adding nelarabine to the modified augmented BFM regimen in high- and intermediate-risk patients, (2) to determine the relative safety and efficacy of high-dose versus Capizzi methotrexate during interim maintenance, and (3) to test the efficacy of treating low-risk T-cell ALL patients without cranial radiation.
- COG-AALL1131 (Combination Chemotherapy in Treating Young Patients With Newly Diagnosed High-Risk ALL): The COG-AALL1131 protocol for patients with high-risk B-precursor ALL includes a randomized comparison of triple intrathecal chemotherapy (methotrexate, cytarabine, and hydrocortisone) with intrathecal methotrexate, with the objective of determining whether triple intrathecal chemotherapy reduces CNS-relapse rates and improves overall EFS. Patients with very high-risk disease include those who, at diagnosis:
- Are aged 13 years or older.
- Have 0.01% or more detectable MRD at end induction.
- Have CNS3 disease.
- Have iAMP21.
- Have severe hypodiploidy, and/or
- Have an M3 marrow on day 29 (induction failure).
These patients are eligible for a three-arm study designed to assess the efficacy of either clofarabine/etoposide/cyclophosphamide versus cyclophosphamide/etoposide versus the standard cyclophosphamide/thioguanine/cytarabine combination during the consolidation and late intensification phases.
Philadelphia chromosome–positive (Ph+) ALL is seen in about 3% of pediatric ALL cases, increases in adolescence, and is seen in 15% to 25% of adults. In the past, this subtype of ALL has been recognized as extremely difficult to treat with poor outcome. In 2000, an international pediatric leukemia group reported a 7-year EFS of 25%, with an OS of 36%.[40] In 2010, the same group reported a 7-year EFS of 31% and an overall survival of 44% in Ph+ ALL patients treated without tyrosine kinase inhibitors.[41] Treatment of this subgroup has evolved from emphasis on aggressive chemotherapy, to bone marrow transplantation, and currently to combination therapy using chemotherapy plus tyrosine kinase inhibitor.
Treatment optionsPre-tyrosine kinase inhibitor era
Before the use of imatinib mesylate, HSCT from a matched sibling donor was the treatment of choice for patients with Ph+ ALL.[42-44] Data to support this include a retrospective multigroup analysis of children and young adults with Ph+ ALL, in which HSCT from a matched sibling donor was associated with a better outcome than standard (pre-imatinib mesylate) chemotherapy.[40] In this retrospective analysis, Ph+ ALL patients undergoing HSCT from an unrelated donor had a very poor outcome. However, in a follow-up study by the same group evaluating outcomes in the subsequent decade (pre-imatinib mesylate era), transplantation with matched-related or matched-unrelated donors were equivalent. DFS at the 5-year time point showed an advantage for transplantation in first remission compared with chemotherapy that was borderline significant (P = .049), and OS was also higher for transplantation compared with chemotherapy, although the advantage at 5 years was not significant.[41]
Factors significantly associated with favorable prognosis in the pre-tyrosine kinase inhibitor era included the following:
- Younger age at diagnosis.[41]
- Lower leukocyte count at diagnosis.[41]
- Early response measures.[41,45,46]
- Ph+ ALL with a rapid morphologic response or rapid peripheral blood response to induction therapy.[41,45]
Following MRD by reverse transcription polymerase chain reaction for the BCR-ABL fusion transcript may also be useful to help predict outcome for Ph+ patients.[47-49]
Tyrosine kinase inhibitor eraImatinib mesylate is a selective inhibitor of the BCR-ABL protein kinase. Phase I and II studies of single-agent imatinib in children and adults with relapsed or refractory Ph+ ALL have demonstrated relatively high response rates, although these responses tended to be of short duration.[50,51]
Clinical trials in adults and children with Ph+ ALL have demonstrated the feasibility of administering imatinib mesylate in combination with multiagent chemotherapy.[52-54] Preliminary outcome of results for Ph+ ALL demonstrated a better outcome after HSCT if imatinib was given before or after transplant.[55-58]
Evidence (imatinib mesylate):
- The COG-AALL0031 study evaluated whether imatinib mesylate could be incorporated into an intensive chemotherapy regimen for children with Ph+ ALL. Patients received imatinib mesylate in conjunction with chemotherapy during postinduction therapy. Some children proceeded to allogeneic HSCT after two cycles of consolidation chemotherapy with imatinib mesylate, while other patients received imatinib mesylate in combination with chemotherapy throughout all treatment phases.[54]
- The 3-year EFS for the 25 patients who received intensive chemotherapy with continuous dosing of imatinib mesylate is 87.7% ± 10.9%. These patients fared better than historic controls treated with chemotherapy alone (without imatinib mesylate), and at least as well as the other patients on the trial who underwent allogeneic transplantation. Longer follow-up is necessary to determine whether this novel treatment improves cure rate or merely prolongs DFS.
- A nonrandomized study reported the outcome in 16 pediatric patients with Ph+ ALL who were treated with chemotherapy, imatinib, and allogeneic HSCT.[58]
- With a median follow-up of 65 months, the 5-year EFS was 81% for patients who received imatinib compared with 30% (P = .01) for a historic control group treated similarly, but without imatinib.[59] Of note, only one of the 16 patients received prophylactic imatinib posttransplant.
- The EsPhALL trial tested whether imatinib (administered discontinuously) given in the context of intensive chemotherapy improves outcome for pediatric Ph+ ALL patients, most of whom (80%) received an allogeneic HSCT in first CR. Patients were classified as either good risk or poor risk based on early response measures and remission status at the end of induction. Good- risk patients (N = 90) were randomly assigned to receive imatinib or not; poor-risk patients (N = 70) were directly assigned to imatinib. Interpretation of this study is limited due to the high noncompliance rate with randomized assignment in good-risk patients and early closure before reaching goal accrual due to publication of the results of the COG AALL1131 trial on which imatinib had been given continuously with chemotherapy. The overall DFS of patients treated on this trial appeared to be better than historic controls, and when analyzed as-treated (and not by intent-to-treat), good-risk patients who received imatinib had a superior DFS. The EsPhALL trial has since been amended to test continuous dosing of imatinib; results are pending.[60]
Dasatinib, a second-generation inhibitor of tyrosine kinases, is currently being studied in the initial treatment of Ph+ ALL. Dasatinib has shown significant activity in the CNS, both in a mouse model and a series of patients with CNS-positive leukemia.[61] The results of a phase I trial of dasatinib in pediatric patients indicated that once-daily dosing was associated with an acceptable toxicity profile, with few nonhematologic grade 3 or 4 adverse events.[62]
Treatment options under clinical evaluation for Philadelphia chromosome–positive ALLTreatment options under clinical evaluation include the following:
- COG-AALL1122 (NCT01460160) (Pediatric Ph+ ALL): In this international collaborative study, patients receive dasatinib, which has increased affinity for BCR/ABL1, in conjunction with a chemotherapy backbone based on the European EsPhALL regimen. Allogeneic HSCT in first remission is reserved for those patients with suboptimal early response to therapy, as measured by morphology and MRD techniques. The goals of this study include the following:
- To determine the safety and feasibility of administering dasatinib with this chemotherapy regimen.
- To determine the 3-year EFS of patients treated in this manner.
- To compare outcomes with patients treated on prior trials using similar chemotherapy with imatinib mesylate.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with Philadelphia chromosome positive childhood precursor acute lymphoblastic leukemia. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
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- Hilden JM, Dinndorf PA, Meerbaum SO, et al.: Analysis of prognostic factors of acute lymphoblastic leukemia in infants: report on CCG 1953 from the Children's Oncology Group. Blood 108 (2): 441-51, 2006. [PUBMED Abstract]
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- Silverman LB, McLean TW, Gelber RD, et al.: Intensified therapy for infants with acute lymphoblastic leukemia: results from the Dana-Farber Cancer Institute Consortium. Cancer 80 (12): 2285-95, 1997. [PUBMED Abstract]
- van der Linden MH, Valsecchi MG, De Lorenzo P, et al.: Outcome of congenital acute lymphoblastic leukemia treated on the Interfant-99 protocol. Blood 114 (18): 3764-8, 2009. [PUBMED Abstract]
- Tomizawa D, Koh K, Sato T, et al.: Outcome of risk-based therapy for infant acute lymphoblastic leukemia with or without an MLL gene rearrangement, with emphasis on late effects: a final report of two consecutive studies, MLL96 and MLL98, of the Japan Infant Leukemia Study Group. Leukemia 21 (11): 2258-63, 2007. [PUBMED Abstract]
- Biondi A, Rizzari C, Valsecchi MG, et al.: Role of treatment intensification in infants with acute lymphoblastic leukemia: results of two consecutive AIEOP studies. Haematologica 91 (4): 534-7, 2006. [PUBMED Abstract]
- Van der Velden VH, Corral L, Valsecchi MG, et al.: Prognostic significance of minimal residual disease in infants with acute lymphoblastic leukemia treated within the Interfant-99 protocol. Leukemia 23 (6): 1073-9, 2009. [PUBMED Abstract]
- Kosaka Y, Koh K, Kinukawa N, et al.: Infant acute lymphoblastic leukemia with MLL gene rearrangements: outcome following intensive chemotherapy and hematopoietic stem cell transplantation. Blood 104 (12): 3527-34, 2004. [PUBMED Abstract]
- Dreyer ZE, Dinndorf PA, Camitta B, et al.: Analysis of the role of hematopoietic stem-cell transplantation in infants with acute lymphoblastic leukemia in first remission and MLL gene rearrangements: a report from the Children's Oncology Group. J Clin Oncol 29 (2): 214-22, 2011. [PUBMED Abstract]
- Mann G, Attarbaschi A, Schrappe M, et al.: Improved outcome with hematopoietic stem cell transplantation in a poor prognostic subgroup of infants with mixed-lineage-leukemia (MLL)-rearranged acute lymphoblastic leukemia: results from the Interfant-99 Study. Blood 116 (15): 2644-50, 2010. [PUBMED Abstract]
- Brown P, Levis M, McIntyre E, et al.: Combinations of the FLT3 inhibitor CEP-701 and chemotherapy synergistically kill infant and childhood MLL-rearranged ALL cells in a sequence-dependent manner. Leukemia 20 (8): 1368-76, 2006. [PUBMED Abstract]
- Nachman J: Clinical characteristics, biologic features and outcome for young adult patients with acute lymphoblastic leukaemia. Br J Haematol 130 (2): 166-73, 2005. [PUBMED Abstract]
- Pui CH, Pei D, Campana D, et al.: Improved prognosis for older adolescents with acute lymphoblastic leukemia. J Clin Oncol 29 (4): 386-91, 2011. [PUBMED Abstract]
- Nachman JB, La MK, Hunger SP, et al.: Young adults with acute lymphoblastic leukemia have an excellent outcome with chemotherapy alone and benefit from intensive postinduction treatment: a report from the children's oncology group. J Clin Oncol 27 (31): 5189-94, 2009. [PUBMED Abstract]
- Pichler H, Reismüller B, Steiner M, et al.: The inferior prognosis of adolescents with acute lymphoblastic leukaemia (ALL) is caused by a higher rate of treatment-related mortality and not an increased relapse rate--a population-based analysis of 25 years of the Austrian ALL-BFM (Berlin-Frankfurt-Münster) Study Group. Br J Haematol 161 (4): 556-65, 2013. [PUBMED Abstract]
- Burke MJ, Gossai N, Wagner JE, et al.: Survival differences between adolescents/young adults and children with B precursor acute lymphoblastic leukemia after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 19 (1): 138-42, 2013. [PUBMED Abstract]
- Bhatia S, Landier W, Shangguan M, et al.: Nonadherence to oral mercaptopurine and risk of relapse in Hispanic and non-Hispanic white children with acute lymphoblastic leukemia: a report from the children's oncology group. J Clin Oncol 30 (17): 2094-101, 2012. [PUBMED Abstract]
- Stock W, La M, Sanford B, et al.: What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols? A comparison of Children's Cancer Group and Cancer and Leukemia Group B studies. Blood 112 (5): 1646-54, 2008. [PUBMED Abstract]
- Ramanujachar R, Richards S, Hann I, et al.: Adolescents with acute lymphoblastic leukaemia: emerging from the shadow of paediatric and adult treatment protocols. Pediatr Blood Cancer 47 (6): 748-56, 2006. [PUBMED Abstract]
- Barry E, DeAngelo DJ, Neuberg D, et al.: Favorable outcome for adolescents with acute lymphoblastic leukemia treated on Dana-Farber Cancer Institute Acute Lymphoblastic Leukemia Consortium Protocols. J Clin Oncol 25 (7): 813-9, 2007. [PUBMED Abstract]
- Ramanujachar R, Richards S, Hann I, et al.: Adolescents with acute lymphoblastic leukaemia: outcome on UK national paediatric (ALL97) and adult (UKALLXII/E2993) trials. Pediatr Blood Cancer 48 (3): 254-61, 2007. [PUBMED Abstract]
- Ram R, Wolach O, Vidal L, et al.: Adolescents and young adults with acute lymphoblastic leukemia have a better outcome when treated with pediatric-inspired regimens: systematic review and meta-analysis. Am J Hematol 87 (5): 472-8, 2012. [PUBMED Abstract]
- Ribera JM, Oriol A, Sanz MA, et al.: Comparison of the results of the treatment of adolescents and young adults with standard-risk acute lymphoblastic leukemia with the Programa Español de Tratamiento en Hematología pediatric-based protocol ALL-96. J Clin Oncol 26 (11): 1843-9, 2008. [PUBMED Abstract]
- Boissel N, Auclerc MF, Lhéritier V, et al.: Should adolescents with acute lymphoblastic leukemia be treated as old children or young adults? Comparison of the French FRALLE-93 and LALA-94 trials. J Clin Oncol 21 (5): 774-80, 2003. [PUBMED Abstract]
- Testi AM, Valsecchi MG, Conter V, et al.: Difference in outcome of adolescents with acute lymphoblastic leukemia (ALL) enrolled in pediatric (AIEOP) and adult (GIMEMA) protocols. [Abstract] Blood 104: A-1954, 2004.
- de Bont JM, van der Holt B, Dekker AW, et al.: [Adolescents with acute lymphatic leukaemia achieve significantly better results when treated following Dutch paediatric oncology protocols than with adult protocols]. Ned Tijdschr Geneeskd 149 (8): 400-6, 2005. [PUBMED Abstract]
- Hallböök H, Gustafsson G, Smedmyr B, et al.: Treatment outcome in young adults and children >10 years of age with acute lymphoblastic leukemia in Sweden: a comparison between a pediatric protocol and an adult protocol. Cancer 107 (7): 1551-61, 2006. [PUBMED Abstract]
- Mattano LA Jr, Devidas M, Nachman JB, et al.: Effect of alternate-week versus continuous dexamethasone scheduling on the risk of osteonecrosis in paediatric patients with acute lymphoblastic leukaemia: results from the CCG-1961 randomised cohort trial. Lancet Oncol 13 (9): 906-15, 2012. [PUBMED Abstract]
- Aricò M, Valsecchi MG, Camitta B, et al.: Outcome of treatment in children with Philadelphia chromosome-positive acute lymphoblastic leukemia. N Engl J Med 342 (14): 998-1006, 2000. [PUBMED Abstract]
- Aricò M, Schrappe M, Hunger SP, et al.: Clinical outcome of children with newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia treated between 1995 and 2005. J Clin Oncol 28 (31): 4755-61, 2010. [PUBMED Abstract]
- Mori T, Manabe A, Tsuchida M, et al.: Allogeneic bone marrow transplantation in first remission rescues children with Philadelphia chromosome-positive acute lymphoblastic leukemia: Tokyo Children's Cancer Study Group (TCCSG) studies L89-12 and L92-13. Med Pediatr Oncol 37 (5): 426-31, 2001. [PUBMED Abstract]
- Dombret H, Gabert J, Boiron JM, et al.: Outcome of treatment in adults with Philadelphia chromosome-positive acute lymphoblastic leukemia--results of the prospective multicenter LALA-94 trial. Blood 100 (7): 2357-66, 2002. [PUBMED Abstract]
- Hahn T, Wall D, Camitta B, et al.: The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of acute lymphoblastic leukemia in children: an evidence-based review. Biol Blood Marrow Transplant 11 (11): 823-61, 2005. [PUBMED Abstract]
- Roy A, Bradburn M, Moorman AV, et al.: Early response to induction is predictive of survival in childhood Philadelphia chromosome positive acute lymphoblastic leukaemia: results of the Medical Research Council ALL 97 trial. Br J Haematol 129 (1): 35-44, 2005. [PUBMED Abstract]
- Schrappe M, Aricò M, Harbott J, et al.: Philadelphia chromosome-positive (Ph+) childhood acute lymphoblastic leukemia: good initial steroid response allows early prediction of a favorable treatment outcome. Blood 92 (8): 2730-41, 1998. [PUBMED Abstract]
- Cazzaniga G, Lanciotti M, Rossi V, et al.: Prospective molecular monitoring of BCR/ABL transcript in children with Ph+ acute lymphoblastic leukaemia unravels differences in treatment response. Br J Haematol 119 (2): 445-53, 2002. [PUBMED Abstract]
- Jones LK, Saha V: Philadelphia positive acute lymphoblastic leukaemia of childhood. Br J Haematol 130 (4): 489-500, 2005. [PUBMED Abstract]
- Lee S, Kim YJ, Chung NG, et al.: The extent of minimal residual disease reduction after the first 4-week imatinib therapy determines outcome of allogeneic stem cell transplantation in adults with Philadelphia chromosome-positive acute lymphoblastic leukemia. Cancer 115 (3): 561-70, 2009. [PUBMED Abstract]
- Champagne MA, Capdeville R, Krailo M, et al.: Imatinib mesylate (STI571) for treatment of children with Philadelphia chromosome-positive leukemia: results from a Children's Oncology Group phase 1 study. Blood 104 (9): 2655-60, 2004. [PUBMED Abstract]
- Ottmann OG, Druker BJ, Sawyers CL, et al.: A phase 2 study of imatinib in patients with relapsed or refractory Philadelphia chromosome-positive acute lymphoid leukemias. Blood 100 (6): 1965-71, 2002. [PUBMED Abstract]
- Thomas DA, Faderl S, Cortes J, et al.: Treatment of Philadelphia chromosome-positive acute lymphocytic leukemia with hyper-CVAD and imatinib mesylate. Blood 103 (12): 4396-407, 2004. [PUBMED Abstract]
- Yanada M, Takeuchi J, Sugiura I, et al.: High complete remission rate and promising outcome by combination of imatinib and chemotherapy for newly diagnosed BCR-ABL-positive acute lymphoblastic leukemia: a phase II study by the Japan Adult Leukemia Study Group. J Clin Oncol 24 (3): 460-6, 2006. [PUBMED Abstract]
- Schultz KR, Bowman WP, Aledo A, et al.: Improved early event-free survival with imatinib in Philadelphia chromosome-positive acute lymphoblastic leukemia: a children's oncology group study. J Clin Oncol 27 (31): 5175-81, 2009. [PUBMED Abstract]
- Burke MJ, Trotz B, Luo X, et al.: Allo-hematopoietic cell transplantation for Ph chromosome-positive ALL: impact of imatinib on relapse and survival. Bone Marrow Transplant 43 (2): 107-13, 2009. [PUBMED Abstract]
- Lee S, Kim YJ, Min CK, et al.: The effect of first-line imatinib interim therapy on the outcome of allogeneic stem cell transplantation in adults with newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia. Blood 105 (9): 3449-57, 2005. [PUBMED Abstract]
- de Labarthe A, Rousselot P, Huguet-Rigal F, et al.: Imatinib combined with induction or consolidation chemotherapy in patients with de novo Philadelphia chromosome-positive acute lymphoblastic leukemia: results of the GRAAPH-2003 study. Blood 109 (4): 1408-13, 2007. [PUBMED Abstract]
- Rives S, Estella J, Gómez P, et al.: Intermediate dose of imatinib in combination with chemotherapy followed by allogeneic stem cell transplantation improves early outcome in paediatric Philadelphia chromosome-positive acute lymphoblastic leukaemia (ALL): results of the Spanish Cooperative Group SHOP studies ALL-94, ALL-99 and ALL-2005. Br J Haematol 154 (5): 600-11, 2011. [PUBMED Abstract]
- Rives S, Camós M, Estella J, et al.: Longer follow-up confirms major improvement in outcome in children and adolescents with Philadelphia chromosome acute lymphoblastic leukaemia treated with continuous imatinib and haematopoietic stem cell transplantation. Results from the Spanish Cooperative Study SHOP/ALL-2005. Br J Haematol 162 (3): 419-21, 2013. [PUBMED Abstract]
- Biondi A, Schrappe M, De Lorenzo P, et al.: Imatinib after induction for treatment of children and adolescents with Philadelphia-chromosome-positive acute lymphoblastic leukaemia (EsPhALL): a randomised, open-label, intergroup study. Lancet Oncol 13 (9): 936-45, 2012. [PUBMED Abstract]
- Porkka K, Koskenvesa P, Lundán T, et al.: Dasatinib crosses the blood-brain barrier and is an efficient therapy for central nervous system Philadelphia chromosome-positive leukemia. Blood 112 (4): 1005-12, 2008. [PUBMED Abstract]
- Zwaan CM, Rizzari C, Mechinaud F, et al.: Dasatinib in children and adolescents with relapsed or refractory leukemia: results of the CA180-018 phase I dose-escalation study of the Innovative Therapies for Children with Cancer Consortium. J Clin Oncol 31 (19): 2460-8, 2013. [PUBMED Abstract]


text:
Southern California breaking news and trends
Car thief in Artesia discovers 3-year-old child in backseat
A family tragedy was averted in Artesia this morning after a car thief took off in a stolen vehicle -- with the family's 3-year-old child still inside.
The child was returned a few minutes later, after the thief realized what was in the backseat of the 1983 silver Honda Accord he had just boosted.
L.A. County sheriffs told the Long Beach Press-Telegram that the incident occurred at about 6:15 a.m. today on the 18000 block of Elaine Avenue in Artesia.
When deputies arrived on the scene, they were told that a crying child was seen standing on a curbside nearby. She turned out to be the stolen child, dropped off not far away at South and 186th streets near Cerritos College, CBS reports.
Deputies reunited the child with her family soon after. The silver Honda remains missing.


text:
© 3rd Planet 2010-2013 All Rights Reserved
Wonders of the World (WOW) is a global event that will be launched on the largest venue ever built - The Internet. It will debut in 1st Quarter 2014 and will allow the global tourism industry to showcase the best of each country's travel destinations to the global audience in a highly engaging interactive environment (Interactive 3D). This mega event will also involve the participation of the entire travel industry including media, travel portals and industry partners to join the most talk-about consumer event and share in the extensive publicity that will be created. The event will also herald the launch of many new innovative services which will be available on the hottest-selling consumer devices like the Apple iPads and Android Tablets. Read on to find out more about this exciting event and learn how to maximise your country's publicity in this massive launch.
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The LIP is an inverted airfoil located above the rear edge of the windshield. As air flows between the windshield and the LIP, it follows the underside airfoil of the LIP and is redirected more vertically. This air eddy then diffuses the oncoming air, in effect, to raise the blast of this oncoming airflow. The LIP is made of an impact modified clear acrylic to make it more impact resistant as well as scratch resistant, this material is DOT approved.
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Search for native plants by scientific name, common name or family. If you are not sure what you are looking for, try the Combination Search or our Recommended Species lists.
A low, mat-forming perennial, 1-10 in. tall, with shiny leaves, divided into threes which, if grown in direct sun, turn deep-red in fall. Small, white, five-petaled flowers are numerous in crowded clusters.
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More quality games for Sky Sports customers
Ten races exclusively live on Sky Sports F1 in 2014
Marouane Fellaini finally showed what he could do in a Manchester United shirt, writes Adam Bate.
Watch the full-length version of Sky Sports News' exclusive chat with McLaren boss Ron Dennis.
Adam Bate addresses the main issues to emerge from England's game against Denmark at Wembley.
Listen to the latest news and views from the NFL with our very own Neil Reynolds and Jeff Reinebold.
Norwich could find themselves drifting towards relegation under Chris Hughton, writes Adam Bate.
team 1 | time | team 2 |
No scheduled matches |
Player details | |
Name | Ravichandran Ashwin |
Club | Kolkata Knight Riders |
Batting Style | Right-hand |
Bowling Style | Off break |
India moved into a slim first-innings lead by stumps on day two of the fourth Test against Australia in Delhi despite the best efforts of Nathan Lyon.
Ravi Ashwin moved his match figures to 12-193 as India closed in on a big victory over Australia on day four of the first Test in Chennai.
Ravichandran Ashwin offered some ominous observations on the Mumbai pitch for England after the opening day of the second Test against India.
India spinner Ravichandran Ashwin claimed match figures of 12-85 as New Zealand collapsed to an innings defeat in the first Test.
Ravi Ashwin admitted India were "extremely disappointed but not embarrassed" by their woeful performances in Australia.
Ravi Ashwin says India have nothing to lose as they are again on the back foot in the fourth Test in Adelaide.


text:
Definition of nisei in English:
Line breaks: niseiPronunciation: /ˈniːseɪ
, niːˈseɪ
( plural same or niseis)
North American - An American or Canadian whose parents were immigrants from Japan. Compare with issei and sansei.More example sentences
- Besides the chief instructor, most of the senior students were nisei or sansei and several of them had moved to California from Hawaii where they had earlier begun their aikido training.
- Her mom's father was a U.S. Navy officer on a destroyer en route to invade Kyushu; her father's dad was a nisei returned to Japan to avoid a U.S. internment camp, an engineer working in a factory near Hiroshima at the time of the fatal drop.
- I joined that group shortly thereafter and it was there I met Isao Takahashi Sensei, a middle-aged nisei Hawaiian who spoke English with an accent having lived in Japan as a boy.
1940s: from Japanese, literally 'second generation'.


text:
On June 12, 2011, Sandy Rieder '73 was remembered by several of her classmates with the dedication of a chair in Hood's Beneficial- Hodson Library and Technology Center. Identified with a brass plaque, this chair is a reminder of Sandy's influence on the Hood community. Is there someone who has made a difference in your life who you would like to honor?
Plaques are available for four library items. Pricing is as follows:
Study Room
Study Carrel
To make a lasting tribute, print and fill out the form found in this brochure and mail to:
Office of Institutional Advancement 401 Rosemont Ave. Frederick, Maryland, 21701
For more information, contact Dennis McKinney, director of annual giving, at 301-696-3717 or firstname.lastname@example.com.


text:
Ireland vs. England Rugby: 5 Keys to Irish Victory
By Paul Murphy ,
Before last week's action, both England and Ireland would've seen this rugby game as one of huge importance; now it's probably the biggest game either side will play this year.
France's surprise defeat in Rome means the winner of this game will be odds-on favourite for the Championship and the only side with a realistic shot at a Grand Slam, no disrespect to Italy.
Last season, England's scrum demolished Ireland on their way to a 30-9 victory; the previous year Ireland left England's Grand Slam hopes in tatters with a 24-8 win.
Off the pitch the two nations have a less-than-harmonious history, but on the pitch there is a grudging respect between the two.
If Ireland are to remain on course for victory, these are the keys to beating England.
Ireland under Declan Kidney have developed a reputation as a side that is quick out of the blocks.
In the last year, strong opening stanzas have seen them build leads on France, New Zealand, South Africa and Wales.
If Ireland can start in a similar vein to last weekend it could have a series of knock-on effects for the Irish side.
With a Sunday kickoff the crowd is likely to be less inebriated, possibly working off hangovers and thus less vocal. A quick start would change that, raise the noise level in the stadium and heap the pressure on England.
England are a relatively inexperienced side and have yet to show their mettle in chasing down a lead. It is possible they could buckle under the pressure.
The flip-side of Ireland's tendency to fly out of the blocks is their history of falling off the pace after the restart.
More often than not, once the tide has turned against Ireland they draw the ire of the referee, allowing teams to reel them in off the tee.
Whatever your opinion of Owen Farrell there is no denying one thing: He is a kicking machine. In a recent game for Saracens against Racing Metro, he kicked a perfect 11-of-11, and last weekend he kicked 7-of-8 against Scotland.
England's style of play, while becoming more expansive, relies heavily on Farrell keeping the scoreboard moving. Given a chance in Ireland's half he won't hesitate to take the points.
Rugby is a game of inches, and the great sides live right on the edge of the law. In recent years Ireland have fallen off that edge far too often.
Ireland have to continue living on that edge without infringing unless it's necessary. Having a Pro 12 referee, Jérôme Garcès, could work for or against them.
They will be familiar with his interpretation of the law, but he too will have an idea both who and what to watch for.
At his best he is among the finest scrum-halves in the game; at his worst he is petulant, undisciplined and error-prone.
Blessed with blinding pace, he tends to take a step or two off the base of the breakdown looking for holes in the defensive line.
If he finds one he is lethal, if he doesn't he eats up the space outside him and slows down momentum.
The further England are behind the more likely he is to look for the gap and the more likely he is to be wound up.
Ireland's pillar defence and Conor Murray need to be secure, forcing Youngs to pass and allowing Brian O'Driscoll and Gordan D'Arcy to get a step on the English attackers stopping them building up a head of steam.
Stopping Youngs is the key to taking the pace out of the England attack, and if that happens Ireland have a great chance of winning.
England's attack is a simple but effective one. They come in waves, break the gain-line, secure fast ball and exploit mismatches out wide.
Their ball-carriers tend to run straight and fast, with the strength to break tackles and guile to offload in contact.
Once in behind they are lethal as they have so many strong, powerful runners.
In Owen Farrell, Billy Twelvetrees and Alex Goode they have three distributors who will take turns at first-receiver unleashing forwards.
Ireland's forwards need to make these big tackles and not allow England to suck in the Irish backs. Last weekend's evidence shows that Ireland's pack relish these types of encounters.
The downside of England delaying hitting the deck in contact is that they will leave themselves open to the choke tackle.
Ireland have utilised this tackle to great effect in recent years, and the game could be decided on whether Ireland can get the choke or England can offload in contact.
The back three will also have to keep an eye on Chris Ashton as he tends to float across the back line waiting to bounce on an offload.
Looking through England's results under Stuart Lancaster one thing jumps off the page: They don't concede lots of points.
No matter the opposition, England games tend to be close, at least on paper.
This is built on a rock-solid defensive system implemented by up-and-coming coach Andy Farrell and clearly bought into by the players.
One through 15 they tackle well and rarely make mistakes. They are aggressive at the breakdown without being reckless.
When Ireland get into English territory they need to be patient and wait for the right moment to strike. If the opportunity presents itself to kick for goal, Ireland need to get points on the board.
Isolated ball-carriers will be turned over and England will look to slow down ruck ball. Ireland will need to build through the phases and wait for the holes and mismatches to appear.
England aren't built for chasing a lead, so every point Ireland can get ahead makes it more difficult for England to fight back into the game.


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I was told not to go to like a Walgreens or similar, due to quality specs. The only other quick option is Fedex Kinko's, but none around here do passport photos. I may just have to go to the Post Office and wait in line, the good thing is that I have time. Thanks for the info about the "formalwear", I think I'll do casual dress. Also a big HELLO!! to Doug who is now a member of the Deck 2 Crew.
Awesome excursion on Disney Magic 12 night Northern Capitals cruise; Building the Disney Dream-Shipyard visit. It is not cheap by any sense of the imagination, $2,900 per person, it is limited to 7 people. The excursion includes a chartered flight to Papenburg, Germany where the Meyer Werft shipyard is located. Then spend 3 hours at the port/shipyard, see the Dream under construction, get to meet with the opening crew for the Dream, have a German lunch. It sounds awesome. I love how they are combining the current cruise with the building of the Dream.
Hi Deck 2 Crew!!!!
My name is Leslie, and I am a member of the Mouse Fan Travel team. And although I have been booking clients on this cruise for quite some time --- I have just NOW booked my own!! I will be in cabin #2510!! Hopefully, you all will be seeing a lot of me, as I run around the ship helping with all the magical touches that will be part of Lou's Cruise!!
Can't wait!
Leslie Henson
affiliated w/ MEI & Mouse Fan Travel
Old Magic Kingdom Tour Guides never retire -- we still tell people where to go and what to do!
Glad to have you as a neighbor. Mark and I are in room 2011---got to love that number. Good to know we have a neighbor with power and can guide us as this is our first cruise. Not sure where Vicki's room will be.
Love your tag line......be you still point with two fingers lol.
Welcome to deck 2
Last edited by tinkerbells mom; 03-28-2010 at 08:07 AM. Reason: spelling
Leslie Henson
affiliated w/ MEI & Mouse Fan Travel
Old Magic Kingdom Tour Guides never retire -- we still tell people where to go and what to do!
There are just not enough days to get in all of the restaurants now!! I vote we we all have two dinners each night!!
Leslie Henson
affiliated w/ MEI & Mouse Fan Travel
Old Magic Kingdom Tour Guides never retire -- we still tell people where to go and what to do!
I know that Lou and the crew at MEI & Mouse Fan Travel are working on some pre and post cruise land packages. Is anyone on Deck 2 going to the parks before or after the cruise? If so, are you going before or after? We were thinking we would do it before, but since that is the week of presidents day we were afraid of it being busier then.
Before and after.. nice! Best of both worlds
Haven't asked husband yet. After spending the cruise with my in-laws we may need a vacation----they are good people but easier to make up two minds on what to do next than four. I vote after......
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Escada Ocean Lounge Perfume
By Escada for Women
Escada Ocean Lounge Perfume by Escada, Introduced in 2008 ocena lounge has top notes of plum, strawberry meringe accord, pear nectar and litchi . Middle notes include mimose blossom, jasmine and violet petal sorbet aromas. Base notes are amber, teak wood and sheer vanilla. All products are original, authentic name brands. We do not sell knockoffs or imitations.
- V By Vanderbilt
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- V'e Versace
- Vagabond Prince
- Valentina
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- Valeria
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- Van Cleef
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- Van Gogh
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1.6 oz Eau De Toilette Spray
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Testers are even more discounted than the fancy boxed versions and are great if you don't have a need for the fancy packaging.In Stock & Ready to Ship!
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Customers Who Bought This Item Also Bought
About Escada
History and background of Escada. ESCADA is the international luxury fashion group in women´s designer fashion. It has pursued a course of steady expansion since its founding in 1976 by Margaretha and Wolfgang Ley and today has nearly 440 shops and corners in more than 60 countries. Read more about Escada
More Escada fragrances
for Women: Escada Magnetism , Escada Marine Groove , Escada Taj Sunset , Escada Into The Blue , Escada Moon Sparkle , morefor Men: Escada Moon Sparkle , Escada Sunset Heat , Escada Silver Light , Escada Sentiment , Escada Magnetism , more
See all Escada products
Customer Comments
My Wife was very pleased with her gift and i with the price which i thought would have been much more. Thanks again
S. Dault (Quebec, CA)
by PowerReviewsPros
- Great smell (27)
- Clean & fresh (21)
- Draws compliments (18)
- Great value (18)
- Long-lasting (9)
- Doesn't hold (11)
Best Uses
- Daily use (22)
- Signature fragrance (13)
- Evening (12)
- Special occasions (10)
- Anytime (8)
- Reviewer Profile:
- Natural style (13), Adventurous style (12), Classic style (7)
- Fragrance Type:
- Citrus/fruity (25), Floral (11), Fresh/aquatic (11), Woody/earthy (4), Oriental/spicy (3)
Most Liked Positive Review
Delicious Summer Scent
I absolutely love escada and this is one of the best. It was half the price in fragranceX than in the shops so I got it as soon as I had the money.
Read complete review
I absolutely love escada and this is one of the best. It was half the price in fragranceX than in the shops so I got it as soon as I had the money.
Its very fresh and summery.
You can just imagine beaches and holidays when you smell this.
It could last a bit longer but thats the only bad thing I have to say about it.
Most Liked Negative Review
Happy Juice lol
I love this scent and I wish I could give it 5 stars but it doesn't last at all being it's an Eau de toillette. I was introduced to this scent at the [.....Read complete review
I love this scent and I wish I could give it 5 stars but it doesn't last at all being it's an Eau de toillette. I was introduced to this scent at the [...] counter getting my Can Can refill by Paris Hilton. The lady at the counter spritz this on the tester for me to smell and by the bottle I thought I wasn't going to like it. I immediately fell in love with this fruity scent. I'm normally not into really extremely fruity scents but I promising the woman I would come back later to get the scent ended up coming back to get it the same day. It is that captivating. Someone just please tell Escada to make this an Eau de parfum.
Reviewed by 35 customers
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- Clean & Fresh
- Great Smell
- Great Value
- Sexy
- Doesn't Hold
- Too Weak
Best Uses
- Anytime
- Daily Use
- Evening Use
Comments about Escada Ocean Lounge Perfume:
Super fruity and sexy fragrance! You can smell the strawberry fragrance notes!
- Fragrance Type:
- Citrus/Fruity
- Clean & Fresh
- Draws Compliments
- Great Smell
- Great Value
- Not available locally
Best Uses
- My Daughter's Brand
- Signature Fragrance
Comments about Escada Ocean Lounge By Escada:
My experience with FragranceX was great BUT the postal service in Sri Lanka is a mess.
Had to fill out several forms in triplicate and pay duty to clear the package.
Cannot continue to order for this reason.
- Draws Compliments
- There are NO cons
Best Uses
Comments about Escada Ocean Lounge By Escada:
It's very "tasty"! I seems like a candy thanks to vanilla notes. People always wonder what perfume I use because they like the smell and they make me a lot of compliments!
- Clean & Fresh
- Great Smell
- Not Overpowering
- Sensual
Best Uses
- Anytime
Comments about Escada Ocean Lounge Perfume:
Bought the tester to see what the scent was like. Very cool and refreshing with a sweetness.
- Fragrance Type:
- Citrus/Fruity, Fresh/Aquatic
Best Uses
Comments about Escada Ocean Lounge By Escada:
I bought this for my cousin and she opened it and said, "Oh I don't like that perfume". Fragrance X was flawless in their on the spot reimbursement and no need to beg like so many other companies. FragranceX will remain the most ideal company to buy from even though this gift wasn't a good choice for her, I have zero regrets and was so happy with the A+ service from Fragrance X. Thank you!!!
Displaying reviews 1-5
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Unix as a Second Language
RSS LinkSandra Henry-Stocker has been administering Unix systems for more than 25 years. She describes herself as "USL" (Unix as a second language) but remembers enough English to write books and buy groceries. She currently works for TeleCommunication Systems -- a company that builds innovative technologies to make critical connections happen -- where no one else necessarily shares any of her opinions. This blog offers advice for everyday Unix systems administration and some clever ways to approach more challenging problems. Send comments and suggestions to mailto:firstname.lastname@example.com.
by Sandra Henry-Stocker
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We are excited to release new functionality to enable a 1-click import from Google Code onto the Allura platform on SourceForge. You can import tickets, wikis, source, releases, and more with a few simple steps. Read More
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Travel can teach us about the economy?
16 11 2011"The Buddha whimsically pointed out that seeking happiness in one's material desires is as absurd as "suffering because a banana tree will not bear mangoes." – Rolf Potts in Vagabonding, An Uncommon Guide to the Art of Long-Term World Travel.
You enjoying that coffee? Do you know what that $2 you used to buy it means?
To me, at least?
Probably not.
Well, let me explain. That $2 coffee means a night in Thailand! Yes, Thailand and I did not mistype.
Am I crazy? Maybe, actually. But that's not the point of this column and I'm not crazy for thinking a cup of coffee equals a stay in Thailand.
That cup of coffee I gave-up before my 2009 trip around the world bought me a view of the river Kwai ( you know, the one with the famous bridge over it?) while sitting in a hammock and trapped in a green garden. Yep, all of that and my own room for just $2!
Now calculate your coffees for a week and that's about $10 or a night in Santiago, Chile (or 5 in Thailand) and the most comfortable bed I have ever slept in.
But this column is more than comparing expenditure on coffee and the equivalent bedding you could find in a foreign country.
And in this column, I am not going to argue I am a some kind of personal finance guru. I can't tell you about stocks, bonds, mutual funds and other boring financial instruments.
What I do know is we are in an economic crisis and people are struggling to stay afloat I always hear:
"How do you have any money left?"
I hate money questions, especially when they are about mine, but I can understand where this question comes from.
Why? Well, I had just spent one year traveling around the world where the only income I had was from my somewhat weekly column to this paper.
Even with the year of travel expenditure, however, I had returned home with money in the bank.
Actually enough money to try my hand at my own business and even go out for dinner, which is where I sustained this very question.
Why am I writing about this now? Almost two years since I have returned from that mammoth trip?
Well it has everything to do with what travel can teach you about your economy and I don't mean the mess of Bermuda's (though maybe there could be a few lessons in here too!) And the real lesson I have to teach you is most succinctly phrased by the author of this week's quote, Rolf Potts. His tip: Keep it Simple.
Before I traveled the world for a year, I kept it simple.
New clothes? Nope (or rarely). These were only bought for weddings or if the jeans were finally wearing out.
A house? No, there too. I shared an apartment with three girls and then rented an apartment on my own (which was a splurge,but I didn't have a choice!). I still do not have a house, but that will be the next reason I keep it simple.
I brought lunch to work, gave-up purchasing coffee and rarely went out for dinner.
My biggest splurge was sun glasses and if I live on an Island then I need to protect my eyes!
These economic woes that the US felt first and now Bermuda is experiencing are down to one thing: excess. For some reason there is constantly an urge to have more than you need in material things and compete with those around you.
My attitude: who cares?! Why compete for the large mansion? Why not live within your means or invest in personal growth (schooling?)? Why invest in a big car rather than your own personal improvement?
And travel (i.e. not immersing yourself in a resort in any country, but actually visiting different countries) is all about personal investment. Want a story for the next dinner party that does not hinder around purchasing shoes or a new car? Take that shoe money and run to South America!
Which brings me to the second lesson I learned about keeping it simple: do it for travel too. I never understand tourists who fly around the world to host themselves in a Hilton, Marriott or some other chain hotel.
Why? Because that is exactly what they are: chain, no identity hotels. They are not owned by the people who actually live in the country and they will never possess the ability to immerse you in the culture of Thailand, Chile or Mexico.
Me? I prefer to stay in local joints. In Laos I stayed in a family-run affair and in Niagara-on-the-Lake I stayed in a Bed and Breakfast run by a local. At the B&B, the local, Joe, not only gave me tips on how to visit the area, but was also able to offer us local (not concierge) tips on where to eat.
I have never spent more than $200 on a hotel room and I can't imagine why I ever would. The point of travel is personal growth. How will a resort that mimics your home country do that?
So….to wrap this up, perhaps we all need to take a tip from travel and learn to keep it simple and focus on personal investment, not superficial material investment.
Until next week…I hope you start to focus on improving you (and stop buying the $2 coffee for crying out loud, if you need to save money!!!)


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Home > Grown-Ups > Address Labels For Ladies > Yellow-and-Black-Daisies-Address-Label
Yellow And Black Daisies Address Label
Yellow and black daisies stand in the green grass as a bumble bee buzzes by on this address label. Sold by the sheet. 30 round edged sticky labels on each sheet.
Your satisfaction is guaranteed.
artist: Amy Adele
style: sticky labels
size: 2.5" x 1" (W x H)
paper type: N/A
finish: matte (non-glossy)
recycled: 100% post consumer paper
printing method: digital
printing method: digital
font shown: Jelly Bean
font color shown: black
item code: al585
envelopes: none
(see matching items below for return address printing)


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iOS (formerly known as iPhone OS) is Apple's mobile operating system. Originally developed for the iPhone, it has since been extended to support other Apple, Inc. devices such as the iPod Touch, iPad, and Apple TV.
2k views
What is the fastest way to copy a colour in Photoshop as HEX?
A lot of designers use Photoshop as a design and mockup tool. And in doing so, one of the last steps can be to get a lot of the colour information out so things like gradients and dynamic text can be ...
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How can I spice up my flat iOS icons?
I'm making an icon for a speed reader app for the iPhone. These are more or less the designs I've been toying with:
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wheel - 1:19 am on Dec 6, 2010 (gmt 0)
Bill and I disagree on many things, but we're in lockstep on this one.
With a KVM over IP, there's nothing other than hardware swap that I need to be local for. And hardware swap can be planned for. I can both powercycle over the internet and view the bootup sequence in my browser.
Holy Cow, LiquidWeb's pricing is really high. $150 for unmanaged 1U colo with only 1000MB (500 in / 500 out) transfer and 2 IP's addresses?
Is that high? I pay less than that, but not much less for a 1u unit. but my bandwith is second to none, the facility is world class and the operator is always available. I don't blink at paying a couple hundred bucks a month for something as vital to my business as a webserver.
Particularly after I contrast that with the 10's of thousands I spent on building my own little data center that had poorer quality bandwidth, wasn't redundant, and cost me a lot of time and money to maintain. Really, the cost of a 1u unit like that is almost ridiculous when you look at it.


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The Earlier You See a Psychotherapist, the Better
The importance of seeking treatment at the earliest possible time can never be over emphasized. This is mainly because the longer one stays with a certain illness; the more likely that person is to suffer. The reason for this is that when a bad condition is left untended to, it tends to worsen and what could have been salvaged ends up being also made worse. Since health is very important for any human being, it is imperative that people seek the earliest medical attention as soon as we can so that they can be able to go about their day to day activities properly and without any worries.
However, not all medical conditions warrant seeing a medical professional. There are some diseases which people can treat by themselves through the use of the over the counter medication that can be got from the local prescription stores around the country and at affordable prices. There are even other illnesses that one can even overlook and his or her condition may not worsen as the immune system of the body may take care of the condition. An example of such a disease is the common cold.
According to Dr. Gary Zomalt this is the case mainly when it comes to physical illnesses. This does not apply to psychological illnesses mainly due to the nature of such illnesses. Dr. Gary Zomalt insists that when it comes to psychological illnesses, it is of utmost importance that the patient seeks the earliest possible instance so as to prevent the condition from spiraling out of control, something which psychological conditions are prone to do.
Dr. Gary Zomalt says that one of the major reasons as to why it is important to seek the help of a professional when one has a psychological illness is that unlike the case of physical illnesses such as a cold, psychological illnesses are harder to diagnose. Therefore one cannot claim to be able to treat themselves at home by taking some form of medication. In addition to this is the fact that most people tend to be in denial of their condition and thus usually need the help of a professional in order to come to terms with their condition.
Psychological conditions are not to be overlooked as they tend to worsen and the longer one takes before seeking help, the more difficult it will be for the patient to get cured. Dr. Gary Zomalt insists that it is always best to seek the help of professional at the earliest possible instance.