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continuous positive airway pressure
Back to basics in apnea debate: The importance of sleep
Last night on the Truth About Trucking Live online radio program of fuel hauler Allen Smith and his wife, Donna, discussion of the FMCSA's Motor Carrier Safety Advisory Committee and Medical Review Board's joint work ...
The Apnea Hurdle
Lucinda Coulter
February 01, 2012
Coming regulations would force reckoning with a condition common to truckers. And that's not all that could make passing the medical exam even harder.
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text:
| MEDICATION Guide Nicotine Replacement Therapy (NRT) Specifics on Nasal Spray What is the product strength? The nicotine in nasal spray is concentrated at 10 mg/ml.
What is the recommended treatment duration?
What are the adverse reactions and cautionary messages? People with rhinitis, nasal polyps, sinusitis or severe asthma should not use the nasal spray. Check with your doctor if you take prescription medicine for depression, asthma, diabetes or other conditions; your medications may need to be adjusted as you quit. Also, consult your doctor if you are pregnant or breastfeeding. As in using all other forms of nicotine replacement, if you receive too little nicotine you may experience the symptoms of withdrawal. This can occur either from simply not using the inhaler frequently enough, or by not using it properly. It is advised to start using the nicotine spray on your quit day. If you happen to have a brief lapse and smoke a cigarette or briefly use another type of tobacco, do not stop your nicotine therapy program. It is important to quickly get back to your quit plan and try to avoid relapse to your previous smoking or tobacco use. If you resume your previous pattern of tobacco use, stop your nicotine spray and re-examine your quit plan with your doctor or coach. Using tobacco at significant levels and the nasal spray as directed might cause you to ingest an excessive amount of nicotine. While the spray eliminates most of health risks associated with tobacco use, nicotine itself can cause serious medical problems, including death, if abused. Keep out of reach of children and animals. If you are considering using nicotine nasal spray, first read this information from the National Institutes of Health:
Copyright © 1995-2015 HealthWays QuitNet, Inc. Please read the small print. |

subset: commoncrawl


text:
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Introduces object-oriented terms like abstraction and inheritance and shows how to define requirements and use cases and create a conceptual model of your application.
"I was pulling my hair out worrying about how I was going to afford classes. Then I found lynda.com. Thank you, thank you, thank you." —Lynn H.
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text:
Laurenzi Ernst Green
One of the most enjoyable developments in recent jazz and related genres has been the diversification of the trio. Groups including the late Paul Motian's memorable trio with Bill Frisell and Joe Lovano, Ken Vandermark's Sound in Action trio with its dual drummers and, of course, the Bad Plus have opened up the format to all kinds of new musical possibilities and instrumental combinations.
Joining those illustrious ranks, the young collective of tenor saxophonist and "aspiring beatmaker" Dustin Laurenzi, bassist and singer Katie Ernst and drummer Andrew Green offer an entrancing sound that's somewhere between hip-hop and lounge music. Influenced by the spare experimentation of clarinetist Jimmy Giuffre's trios and modern classical music's minimalist school, Laurenzi/Ernst/Green also thrives on healthy doses of front and center tenor.


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Internet Banking Log-on Update
Important Message to Customers
CIBC FirstCaribbean updates customer security.
The safety of our customers' information remains a priority of CIBC FirstCaribbean. To ensure continued security against possible threats we are enhancing the security features of our Internet Banking platform.
Beginning September 2011, the locations where you access Internet Banking will be logged by CIBC FirstCaribbean. Consequently if you log-on to Internet Banking from a new location you will be prompted to answer one of your existing security questions, so we can ensure that you are the person logging into your account.
You are not required to take any action at this time, however, to ensure that you are familiar with your current security questions and memorable word you will see the following screen requesting you to update your information if you wish to.
Should you have any queries about this new system, please contact our Customer Service Centre.


text:
Sign into Storybird to post a comment.
emsi02 hi everyone just wondering what you think of my story
i really do
Rl2013 Hearted.
Rl2013 You must love art & story telling!
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coletrain1 Cute as a bug.
good job
cool love your book bye the way
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fancy_dress Cute as a bug.
fancy_dress Cute and sweet story! Very colorful indeed. A painting will look wonderful with all the colors on it. :)
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that was incredible
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Love you
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pockadots i love your story
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readallalong3988 Hearted.
miz13 Hearted.
Claire doesn't know which colours to use. Will she be able to find some colours and paint a picture?
Published: Jan. 26, 2013
Copyright © All rights reserved


text:
ST. LOUIS (KMOV.com) -- William Lubker was sentenced to 94 months in prison on mail fraud and aggravated identity theft charges associated with a fraud scheme perpetrated on his former employer between 2009 and early this year.
According to court documents, Lubker admitted to defrauding Medstaff Locums, a medical staffing company based in Chicago for which Lubker worked, of more than $400,000 by "placing" phantom employees with the company.
Lubker would tell his employer he had placed a medical professional when in fact no placement had occurred. Lubker would then siphon off portions of payments made by Medstaff Locums to the phantom employee for himself. He would characterize the other portion as a payment back to Medstaff Locums from the medical facility for whom the phantom professional purportedly worked.
Additionally, Lubker admitted to aggravated identity theft by misusing the name and social security account number of "J.P." as one of his phantom professionals. As a result of Lubker's scheme, income was reported to the IRS in the name of J.P.
Lubker, 51, pled guilty in September to one felony count of mail fraud and one felony count of aggravated identity theft, and appeared Tuesday for sentencing.
With his plea, he has agreed to forfeit a number of items purchased with the proceeds of this illegal activity including several items of jewelry, a Rolex watch, a Breitling watch and three firearms.


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Results tagged ' Stan Kasten '
3/29/13-Something Current-LAD-9,LAA-8 by Jon SooHoo/LA Dodgers
Dodgers Indoor Cage Dodgers Weightroom Stephen Downey Ethier and Ramirez Kemp and McGwire Ellis and Mota Carl Craford and Air Jordans Yasiel Puig Outfield flower beds Ryu in interview room Dodgers in their lounge Josh Beckett Ellis and Honeycutt Louis and Kemp Hanley Mattingly and Hillman Hyun-jin Ryu Charlie and Martin Kim Puig Crawford Hidden Helmet Stan Kasten Janet-Marie Smith Above the escalator-full board promo schedule Manny Mota Andre Ethier Valentin and Kemp The Moeller Mark Walter, Mark McGwire
3/10/13-Something Current-LAD-6,COL-1 by Jon SooHoo/LA Dodgers
Aaron Sele works with Dodgers Minor League pitchers New Meiji players watch Dodger Minor Leaguers Matt Magill vs Cincinnati Lasorda and Kasten Lasorda and Dusty Don and friend Marette and Madden Fife Mattingly Kemp Dr. Kipper Dee's fans Rene Lacheman and McGwire Falsone and Schumaker Kershaw Angle and Herrera Puig says "No!"to photo Puig says "Yes!"to photo with Elian Kemp Ellis Lopes and Kemp Kershaw Full House Kemp Gordon Castro, Amezaga, Uribe FalsoneKershaw
3/9/13-Something Current-LAD-3,SEA-2 by Jon SooHoo/LA Dodgers
Doubles-Kershaw/Guerrier vs Wall/Tolleson Ron Cey signs Dee signs Honeycutt throws bp… To Ryu and Kershaw Mattingly signs at Camelback Kemp vs Crawford Gordon Kasten Plosay Seagers Tommy Davis Tommy Davis and Joc Pederson Camelback Ranch-Glendale Shinn and gang Nachos!!!! Big crowd at Camelback Ranch-Glendale Ethier signs Hairston Tommy waves to the crowd Jeremy Moore Ethier doubles Tolleson Jansen Lasorda and Stubbs Gwynn Gwynn Kemp Puig Castellanos home run Success!!! Herrera Gregg GREAT CATCH!!
2/25/13-Something Current-Dodger-7, Cubs-6–Photography by Jon SooHoo/LA Dodgers
Davey Lopes Trey Hillman Spring Drills Matt Kemp Kershaw and Mattingly Dee Gordon A.J. Ellis Don Mattingly Zack Greinke Hyun-jin Ryu putts Sue Falsone and Adrian Gonzalez Koufax,Colletti,Kasten and Lasorda Juan Uribe Jerry Hairston A.J. Ellis Mattingly and Koufax A.J.Ellis and Mattingly Ramon Castro and Chad Billingsley David Kang Casting Tim and Matt Wallach Don Mattingly Chad Billingsley Juan Uribe at first base Nick Punto singles Skip Schumaker Chad Billingsley Tony Gwynn out at second Foul Ball FolliesChris Capuano
Gordon and Gwynn Stan Kasten Gwynn and McPherson Sellers and Puig Matt Guerrier Kevin Gregg Jeremy Moore Matt Wallach Yasiel Puig Osvaldo Martinez Paco Rodriguez Luna and Puig Nick Evans Evans and Wallach Luna Evans Wallach and Wallach Blake Johnson with the saveBlake Johnson and Jesus Flores
2/24/13-Something Current-Dodgers at White Sox-Photography by Jon SooHoo/LA Dodgers
Yeager and Koufax Koufax and Crim Hillman, Patton and Patton Pattons Kasten and Walter (No S) Mattingly and Ventura Cold morning at Camelback Vizcaino Pat Corrales and Pat Listach Gonzalez, Uribe and Cruz The Martin Family McGwire and Mattingly Mark Ellis Greinke Ethier Greinke Foul ball action Federowicz doubles Gonzalez Fed scores from second Greinke Ryu Jeremy Moore Ramirez and McGwire Cruz Gwynn and Castellanos Home run ball action Jarrin, Valenzuela, YniguezThe "Great Wall"


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More by Mecanoo architecten | ||
More student housing projects | ||
More projects in Delft | ||
More from Ursem_Bouwgroep | ||
186 student houses in Delft
Mecanoo architecten | |
location | Delft |
function | student housing |
contributed by | Ursem_Bouwgroep |
In Delft, Ursem Bouwgroep is building 3 blocks containing 186 student houses, with a kitchen and a bathroom. The 3 buildings have 6 floors. The buildings consist of a concrete cernal (for elevator and stairs), surrounded by units. The project will take 7 months and is of a high-end permanent quality that can be compared with traditional building. The design is made by Delft achitecture based office Mecanoo.


text: Hi all, I am AbdulKarim Memon. from VIT, Pune. We are intereseted in conducting a training on GCC/GDB for the students and few faculties at our college. VIT, pune has recently migrated to FOSS. 4 labs have been currently freed from Windows and the lab courses like DSA/OOP/Python/OS/SP etc have been shifted to Linux. The aim of this training session would be to get the students and faculties started with GCC/GDB. Our requirements are: For training of students and faculty members: Total batch strength: approx 20 (since our labs can accomodate max 22) Hands-on required on: GCC/GDB (specially GDB) Duration available: as suitable to you (the speaker) Probable time : ASAP Please let us know the charges with detailed breakup, and other details for requirements stated above. Regards, AbdulKarim Memon Student, Department of Computer Engineering, VishwaKarma Institute of Technology, Pune. -- -AbdulKarim Memon (FOSS user/Promoter)


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Furniture Store Loses $7 Million in Risky Promotion After Seahawks Super Bowl Win [VIDEO]
Aside from Seattle, the happiest people in America can be found in...Houston?
Aside from Seattle, the happiest people in America can be found in...Houston?
A comedy and a drama hit theaters this weekend. A comedy and a drama? That's both kinds of faces on those masks!
One of Pittsburgh's finest may be gone, but he's definitely not forgotten.
You think you're excited for the Super Bowl?
The movement to change the name of the Washington Redskins has grown significantly in recent years.
It looks like Chris Christie and Rob Ford have some company in the 'politicians under fire' camp.
As far as compelling stories go, this one is tough to beat.
This is a different kind of food network star.
Super Bowl XLVIII is less than a week away. Now that both the Denver Broncos and Seattle Seahawks have arrived in the New York metropolitan area, let's take a look at some fast facts about Sunday's game at MetLife Stadium in East Rutherford, N.J. (6:30 p.m. ET on Fox):
A shooting at a suburban shopping mall in Maryland has left at least three dead, according to authorities.


text: Boone and I were constant companions. The relationship prospers under those conditions so that a constant and uninhibited communication conduit exists. To wit, that meant that Boone would respond to hand signals. I wasn't a professional cowboy, but I played cowboy at nearly every opportunity. One afternoon a neighbor asked a few of us to help him move about 60 head of Herefords from one pasture to another. This involved moving the bovines a couple of miles down the county road. For the most part it was an uneventful operation. Boone would remain at heel while I was riding my horse. When we approached a crossroad or open driveway I'd send Boone ahead and whoa her at the junction, and she knew how to keep the cows from breaching her post. My riding buddies were commenting how well behaved a bird dog was at working cows. We were about a quarter mile from our destination when Boone suddenly raced into the herd, giving tongue, as houndsmen often call it. I have no idea what set her off, but the cows began running and veering off the road into the bar pit fenced with rusty barbed wire on rotting lodgepole posts. It was something akin to forcing them through a full choke. The dilapidated fence failed, and the cows scattered. It took us about half an hour to round up the miscreant bovines and get them headed in the right direction again; and another 45 minutes to repair the fence. My companions made me acutely aware of their displeasure. A few years later we moved to northern California where there is plenty of mountain quail. The habitat is filled with dense blackberry brush, and every time we hunted quail Boone would come back looking like she had been in a fight—didn't bother her a bit, but her face would be covered in blood. One day we were driving along when a great big peacock ran across the road in front of us. It was like a cartoon when Boone plastered her face to the windshield, eyes bulging. She thought it was the biggest darn pheasant in the world, and she wanted a piece of it. Whining, barking and whirling, I swear that if she could have figured out how to open the truck door she would have done so and bailed out at 45 mph. At 10 years old she began to show some age—she was a little slower and nearly totally deaf. The deafness was my fault for letting her sleep under the bench as I worked with rifles—stupid me. Still, she enjoyed getting out and chasing a few quail and chukar. I had gotten another Brittany by this time, but Boone was the matron and the little male knew his place. Three years later Boone had become a very senior old girl, and I knew what was coming. I put it off as long as I could—perhaps too long, since she had gone almost blind in addition to being completely deaf. About the 6th of December 1992, we went on our last hunt together. I took her to an easy place where there were plenty of quail. We took it very easy, and though she was blind and deaf, her nose still worked. After about 20 minutes of walking she pointed a single quail. I flushed and killed it, and Boone used her nose to retrieve the bird. I got a picture of us together with our last bird. A week later we were in the vet's office and I was tearfully saying goodbye to my best friend. I took her up to the area where we were a week before. As I carried her over to where she was going to be buried, a small covey of quail flushed. A few minutes later I gathered up the shovel and headed back toward my truck, sobbing. The quail began calling to each other, and the calls had a melancholy tone to them.


text:
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Shows how to master the new Motion Tween model and the Motion Editor to control easing and effects.
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text: The Color of Justice program will be held in Columbia on April 5, 2014 from 9 am to 1:30 pm at the S.C. Bar Conference Center. The committee is seeking volunteers from the SC Bar Young Lawyers Division for both programs. Volunteers would be responsible for assisting with the logistics of the event and joining our students in small groups during lunch to discuss their careers, education paths and answer any inquiring questions our students may have about the legal profession. For the further information on the programs and/or to volunteer, please contact Chisa Putman at email@example.com.


text:
Whiskey Wry Productions
Courtney McCormack, casting dir.
Performing Arts: Musicians & Composers
This listing has expired.
Whiskey Wry Productions
Courtney McCormack, casting dir.
Production Description
Casting "Sack Full of Coal." Project description: "A one-hour sketch show satirizing the holiday season. From the commercialization of the holidays to inappropriate office gift exchanges to taking the Christ out of Christmas to elven slave labor, nothing and no one about the holiday season is safe, especially once everyone's favorite Alpine Christmas demon, the Krampus, makes his appearance."
Producers state: "First drafts of song lyrics are written and we're looking for one composer and one accompanist to help bring our show's musical numbers to life."
Rehearsal and Production Dates & Locations
Rehearses Sunday evenings beginning October 13, with added rehearsals on Wednesday evenings closer to opening; runs Saturdays, November 30, December 7, & December 14 at Gorilla Tango in Chicago, IL.
Compensation & Union Contract Details
Composer stipend available; accompanist paid equal percentage of show profits.


text:
NASHVILLE, Tenn. (AP) — A couple who fled Germany with their five children over fears they would lose custody for not sending them to school has asked a federal appeals court to grant them asylum in the U.S.
The 6th U.S. Circuit Court of Appeals decided this week to hear oral arguments in April.
Attendance in a state-approved school is required in Germany, and parents who violate the law can face fines, jail and possible custody loss. Nonetheless, Uwe and Hannelore Romeike (roh-MEYE-kee) removed their children from school in 2006 because they felt it was turning the children against the family's Christian values.
The U.S. government believes the Romeikes' case does not rise to the level of persecution, and they are not being singled out for their religious beliefs.


text:
When moving to Singapore to live, having you and your family's health in the best possible safety is of utmost importance. Having health insurance not only protects against the life-threatening emergencies but also allows you the comfort to take precautions and get treated while living in Singapore as you would at home.
Healthcare is expensive in Singapore – especially if you want the best private care for you and your family. Global health insurance ensures that you get the treatment you need in Singapore in cases of emergency. This will normally include travel around the region. Global health policies can range hugely, both in terms of price and the benefits that the policies offer.
What to remember when applying for expat insurance
In most cases, the global health insurance provider will not increase the premium if you make a large claim, which separates it from many other classes of insurance. Though, this highlights the importance of outlining any pre-existing health conditions that may affect your health in the future, and affect the structure of your expat insurance plan. Some health conditions may require you to add extensions to your health insurance plan but it is worth doing this, as neglecting to do this can lead to the insurance being a colossal waste of money when you need it most.
Knowing which insurance to pick can be tricky, given the multitude of providers. One thing important to mention is: do not make a decision solely based on price. Some expat insurance providers will offer cheap premiums with multiple exclusions, which is useless to an expat. Peace of mind will be so important to you when living in Singapore.
If you're worried about missing details, it may be worth speaking to an insurance broker, or one of the Global Health Insurance big players. Make sure that you pick a firm that has a reputation of paying claims. Many firms offer cheaper plans but you can often find yourself paying substantial excess fees, filling out endless paperwork, or worst of all – your claim being rejected. Firms like Cigna Insurance may not be the cheapest but they offer plans that will protect you in most eventualities and may be more likely to pay claims in full.


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Football, videogames, music, and sex converge at lastIf you didn't have one yet, prepare to get a full-on chub after watching this video. British electronic outfit Hot Chip has a knack for making some awkward hilarious music videos but their latest for single "Don't Deny Your Heart" may take the cake. The video starts with an innocent match of a PS2-era looking football title that slowly becomes something much more ... interesting. Having the announcers continue their dry, repetitive commentary as the football players ascend to dance heaven and start an orgy (NSFW, maybe?) seals the deal. If FIFA were more like this, I'd be its #1 fan. Going to have this one on repeat, all day. Catchy too! Comments not appearing? Anti-virus apps like Avast or some browser extensions can cause this. Easy fix: Add [*].disqus.com to your software's white list. Tada! Happy comments time again.
Did you know? You can now get daily or weekly email notifications when humans reply to your comments.


text:
Item Details:
For a sportier look while outside, try our SW Mirrored Sport Style #8879. This wraparound style has a lightweight plastic frame with rubberized earpieces. Semi-rimless, shatterproof polycarbonate lenses have a colorful revo mirror on the outside, and a smoke tint with UV protection on the inside.
- Plastic Frame
- UV400 Sun Protection
- Available colors: Black/Grey with Multi Revo Lenses, Red with Yellow Revo Lenses, Blue with Blue Revo Lenses, Grey/Red with Yellow Revo Lenses, Silver with Blue Revo Lenses, Black/Red with Yellow Lenses, Black/Blue with Blue Revo Lenses


text:
Pronunciation: Radiergummi
Added on: 2008-12-22
Listened: 2.2K times
Pronunciation in German [de]
- Pronunciation by Zanzando (Female from Germany)
- Pronunciation by bingomaster (Male from Germany)
- Pronunciation by Bartleby (Male from Germany)
- Pronunciation by Thonatas (Male from Germany)
- Could you do it better? different accent? Pronounce Radiergummi in German
Accents & languages on maps
- Random word: Barschlampe
by Wiktionary Phonetic spelling:
by Yandex Translate English translation:
Radiergummi = Eraser
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text:
Sony teases Microsoft with used-game instructional video
Sony pokes fun at Microsoft's new, more restrictive policy on used games by offering an instructional guide for how to share PlayStation 4 games.
We are finally reveling in an influx of details on the fresh rival gaming systems of Sony's PlayStation 4 and Microsoft's Xbox One. While the two consoles share a physical resemblance, they diverge in a lot of ways. One major difference involves the handling of used games.
Sony has said there will be no restriction on the PS4 used-game market, while Microsoft is placing restrictions on selling and sharing games.
Microsoft's new policies have given Sony an opening to promote the PS4 as a friendlier alternative to the Xbox One. That has resulted in a tongue-in-cheek video released on the official PlayStation YouTube channel, titled "Official PlayStation Used Game Instructional Video."
The instructional video takes all of 22 seconds to watch. It features a couple of Sony guys standing in a studio, demonstrating the proper way to share a PS4 game with a friend: by handing it to him. This simple video has already racked up more than 2 million views.
Gamers have long loved the used-game market, especially in an era when new games can easily cost $60 a pop. It's no surprise that Microsoft's changes have raised a considerable amount of ire and commentary. It may not be the end of the used-game market as we know it, but times are certainly changing. At least we can have a good laugh about it.


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Topic Contents
- Purpose of This PDQ Summary
- General Information
- Cellular Classification
- Classification and Stage Information
- Iris Melanoma
- Ciliary Body Melanoma
- Small Choroidal Melanoma
- Medium and Large Choroidal Melanoma
- Extraocular Extension and Metastatic Intraocular Melanoma
- Recurrent Intraocular Melanoma
- Get More Information From NCI
- Changes to This Summary (12 / 05 / 2007)
- More Information
Intraocular (Eye) Melanoma Treatment (PDQ®): Treatment - Health Professional Information [NCI]
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER |
Intraocular (Eye) Melanoma Treatment
Purpose of This PDQ Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of intraocular (eye) melanoma. This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board.
Information about the following is included in this summary:
- Prognostic factors.
- Cellular classification.
- Staging.
- Treatment options by cancer stage.
This summary is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Some of the reference citations in the summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations. Based on the strength of the available evidence, treatment options are described as either "standard" or "under clinical evaluation." These classifications should not be used as a basis for reimbursement determinations.
This summary is available in a patient version, written in less technical language, and in Spanish.
General Information
Melanoma of the uveal tract (iris, ciliary body, and choroid), though rare, is the most common primary intraocular malignancy in adults. The mean age-adjusted incidence of uveal melanoma in the United States is approximately 4.3 new cases per million population.[1] The age-adjusted incidence of this cancer has remained stable for the past 50 years.
Uveal melanoma is diagnosed mostly at older ages, with a progressively rising age-specific incidence rate that peaks near the age of 70.[1] Host susceptibility factors associated with the development of this cancer include Caucasian race, light eye color, fair skin color, and the ability to tan.[1,2] In view of these susceptibility factors, numerous observational studies have attempted to explore the relationship between sunlight exposure and risk of uveal melanoma. To date, these studies have found only weak associations or yielded contradictory results.[1] Similarly, there is no consistent evidence that occupational exposure to UV light or other agents is a risk factor for uveal melanoma.[1]
Uveal melanomas can arise in the anterior (iris) or the posterior (ciliary body or choroid) uveal tract. Iris melanomas have the best prognosis, whereas melanomas of the ciliary body have the worst. Most uveal tract melanomas originate in the choroid. The ciliary body is less commonly a site of origin, and the iris is the least common. The comparatively low incidence of iris melanomas has been attributed to the characteristic features of these tumors, i.e., they tend to be small, slow growing, and relatively dormant in comparison with their posterior counterparts. Iris melanomas rarely metastasize.[3] Melanomas of the posterior uveal tract are cytologically more malignant, detected later, and metastasize more frequently than iris melanomas. The typical choroidal melanoma is a brown, elevated, dome-shaped subretinal mass. The degree of pigmentation ranges from dark brown to totally amelanotic.
Most uveal melanomas are initially completely asymptomatic. As the tumor enlarges, it may cause distortion of the pupil (iris melanoma), blurred vision (ciliary body melanoma), or markedly decreased visual acuity caused by secondary retinal detachment (choroidal melanoma). Serous detachment of the retina frequently complicates tumor growth. If extensive retinal detachment occurs, secondary angle-closure glaucoma occasionally develops. Clinically, several lesions simulate uveal melanoma, including metastatic carcinoma, posterior scleritis, and benign tumors, such as nevi and hemangiomas.[4]
Careful examination by an experienced clinician remains the most important test to establish the presence of intraocular melanoma. Ancillary diagnostic testing, including fluorescein angiography and ultrasonography, can be extremely valuable in establishing and/or confirming the diagnosis.[5]
A number of factors influence prognosis. The most important are cell type, tumor size, location of the anterior margin of the tumor, the degree of ciliary body involvement, and extraocular extension. Cell type, however, remains the most often used predictor of outcome.[6] The selection of treatment depends on the site of origin (choroid, ciliary body, or iris), the size and location of the lesion, the age of the patient, and whether extraocular invasion, recurrence, or metastasis has occurred. Extraocular extension, recurrence, and metastasis are associated with an extremely poor prognosis, and long-term survival cannot be expected.[7] The 5-year mortality rate caused by metastasis from ciliary body or choroidal melanoma is approximately 30%, compared with a rate of 2% to 3% for iris melanomas.[8] In a group of patients with large tumors of the choroid or choroid and ciliary body, the concurrent presence of abnormalities in chromosomes 3 and 8 was also associated with a poor outcome.[9]
In the past, enucleation (eye removal) was the accepted standard treatment for primary choroidal melanoma, and it remains the most commonly used treatment for large tumors. Because of the effect of enucleation on the appearance of the patient, the diagnostic uncertainty encountered by the ophthalmologist (particularly in the case of smaller tumors), and the potential for tumor spread, alternative treatments, such as radiation therapy (i.e., brachytherapy or external-beam, charged-particle radiation therapy), transpupillary thermotherapy, photocoagulation, and cryotherapy have been developed in an attempt to spare the affected eye and possibly retain useful vision.[10,11] One of the clinical trials of the randomized Collaborative Ocular Melanoma Study compared iodine 125 (125 I) episcleral-plaque brachytherapy to enucleation in treating patients with medium-sized choroidal tumors.[12] Eighty-five percent of the patients treated with 125 I brachytherapy retained their eye for 5 years or more, and 37% had visual acuity better than 20/200 in the irradiated eye 5 years after treatment.[12] No significant differences in mortality were observed between the two study arms after 12 years of follow-up, whether considering death from all causes or death with histopathologically confirmed melanoma metastasis.[13]
Cellular Classification
Primary intraocular melanomas originate from melanocytes in the uveal tract.[1] Four distinct cellular types are recognized in intraocular melanoma (revised Callendar classification):[2]
1. | SPINDLE A CELLS (spindle-shaped cells with slender nuclei and lacking visible nucleoli). |
2. | SPINDLE B CELLS (spindle-shaped cells with larger nuclei and distinct nucleoli). |
3. | EPITHELIOID CELLS (larger polygonal cells with one or more prominent nucleoli). |
4. | INTERMEDIATE CELLS (similar to but smaller than epithelioid cells). |
Most primary intraocular melanomas contain variable numbers of epithelioid, spindle A, and spindle B cells (mixed-cell melanomas). Pure epithelioid-cell primary melanomas are infrequent (approximately 3% of cases).[1] In the Collaborative Ocular Melanoma Study, mixed-cell type melanomas predominated (86% of cases).[3]
Several microscopic features can affect the prognosis of intraocular melanoma, including cell type, mitotic activity, lymphocytic infiltration, and, possibly, fibrovascular loops.[1] Cell type remains the most often used predictor of outcome following enucleation, with spindle A cell melanomas carrying the best prognosis and epithelioid cell melanomas carrying the worst.[1,4]
Classification and Stage Information
Tumor Size
Uveal melanoma most often assumes a nodular or dome-shaped configuration, but occasionally tumors can be flat or diffuse and involve extensive areas of the uvea with little elevation.
Tumor size classifications according to boundary lines are as follows:
1. | SMALL: Range from 1 mm to 3 mm in apical height and have a basal diameter of at least 5 mm.[1] |
2. | MEDIUM: Range from 2 mm to 3 mm up to 10 mm in apical height and have a basal diameter of less than 16 mm.[2] |
3. | LARGE: Greater than 10 mm in apical height or have a basal diameter of at least 16 mm.[3] |
4. | DIFFUSE: Horizontal, flat growth pattern, with the thickness of the tumor measuring approximately 20% or less than the greatest basal dimension; this uncommon variant of uveal melanoma seems to have a poorer prognosis.[4] |
In clinical practice, the tumor base may be estimated in average optic disc diameters (1 dd = 1.5 mm). The average elevation may be estimated in diopters (3 diopters = 1 mm). Other techniques, such as ultrasonography, should be used to provide more accurate measurements.
An important function of ophthalmic ultrasonography is the detection of extrascleral extension.[5,6] Extrascleral extension measuring 2 mm or more in thickness can invariably be demonstrated provided it is located behind the equator where the intraocular tumor, sclera, and adjacent orbital fat are readily imaged.[7] Orbital extraocular extension of choroidal melanoma may be found in eyes with medium and large tumors, but it is very rare in eyes with small melanomas.
Metastatic Disease
Because the uveal tract is a vascular structure without lymphatic channels, tumor spread occurs principally by local extension and by dissemination through the blood stream. If regional preauricular, submandibular, or cervical lymph node involvement is seen, subconjunctival extension of the primary tumor has occurred.[8]
Systemic metastases are generally hematogenous in origin, and the first site identified is usually the liver.[9] Lung, bone, and subcutaneous sites are also common.[9] In the Collaborative Ocular Melanoma Study trials, the liver was the only site of detectable metastasis in 46% of patients with metastases reported during follow-up or at the time of death; 43% had metastases diagnosed in the liver and other sites.[9] In patients with a history of ocular melanoma who present with hepatic metastases of unknown origin, metastatic melanoma should be considered in the differential diagnosis.
It is particularly unusual for choroidal melanomas of any size to invade the optic nerve or its meninges.[10] Metastasis of choroidal melanoma to the contralateral choroid is also rare.[9,11]
Other Classification and Staging
An American Joint Committee on Cancer staging system has been developed for melanoma of the uveal tract,[12] and its widespread utilization has been advocated.[13]
Iris Melanoma
Melanocytic stromal proliferations of the iris are the most common tumors of the iris. Clinical differentiation between an iris nevus and a melanoma might sometimes be difficult and at times impossible. Melanomas of the iris are usually small discrete lesions, though occasionally, they may be diffuse, infiltrative, multiple, and they may result in heterochromia, chronic uveitis, or spontaneous hyphema. Iris melanomas that involve more than 66% of the angle circumference are associated with secondary glaucoma.[1]
Routine evaluation of iris melanomas includes gonioscopy, transillumination of the globe, and indirect ophthalmoscopy with 360° of scleral depression. Photographic documentation is essential to document progression in size or growth of the tumor.[2] Anterior segment fluorescein angiography may be helpful to demonstrate the vascularity of the lesion but is not diagnostic. High-resolution ultrasound biomicroscopy can be used to measure small lesions (basal dimensions and thickness) and to assess tumor involvement of the anterior ciliary body, angle, and overlying sclera.[3] The main disadvantage with this technology is its limited penetration of large lesions. In these cases, conventional ultrasonography is more accurate.
In general, iris melanomas have relatively good outcomes, with a 5-year survival rate of more than 95%. Iris melanomas are predominantly of the spindle cell type and are usually smaller in size than posterior melanomas because of earlier detection. Clinical features, including prominent tumor vascularity, rapid growth, and heterogeneous pigmentation, are associated with an epithelioid cell component.[4] Involvement of the iridocorneal angles is frequently associated with ciliary body invasion.[4]
Conservative management is generally advocated whenever possible, but surgical intervention may be justified with unequivocal tumor growth and with extensive disease at initial examination.
1. | OBSERVATION WITH CAREFUL FOLLOW-UP: In asymptomatic patients with stable lesions; follow-up includes serial photography.[1] |
2. | LOCAL RESECTION: When progressive and pronounced growth is documented. |
3. | ENUCLEATION: If the tumor is not amenable to local resection (diffuse involvement of the iris, involvement of more than 50% of the iris and anterior chamber angle, intractable glaucoma, and extraocular extension).[5] |
4. | PLAQUE RADIOTHERAPY: Offered as an alternative for large, diffuse, surgically nonresectable lesions of the iris.[6] |
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with iris melanoma. 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.
Ciliary Body Melanoma
Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)
Melanoma involving the ciliary body is a rare tumor that carries a poor prognosis. This malignancy is often diagnosed late, and in some cases, diagnosis may be difficult because of similarity to other eye diseases. The differential diagnosis of ciliary body melanoma should be considered in cases of unilateral pigmentary glaucoma and chronic uveitis.[1]
Ultrasound biomicroscopy can be used to evaluate tumor shape, thickness, margins, reflectivity, and local invasion.[2,3] Patients with tumors greater than 7 mm in thickness are at increased risk for metastatic disease and melanoma-related death than patients with thinner tumors.[4]
There are several options for management of ciliary body melanoma. The choice of therapy, however, depends on many factors.
1. | PLAQUE RADIATION THERAPY: A 5-year local control rate of greater than 90% has been reported but is associated with a high incidence of secondary cataract.[4,5][Level of evidence: 3iiiDiv] |
2. | EXTERNAL-BEAM, CHARGED-PARTICLE RADIATION THERAPY: Provides precisely focused radiation with a homogenous dose distribution pattern; requires sophisticated equipment available only at selected centers; involves patient cooperation during treatment (voluntarily fixating the eye on a particular point so the tumor is positioned properly in the radiation beam);[6,7] appears that the tumor control rate is similar to that obtained with plaque radiation therapy, but charged-particle radiation therapy may produce worse anterior-segment complications.[8] |
3. | LOCAL TUMOR RESECTION: Mainly suitable for selected ciliary body or anterior choroidal tumors with smaller basal dimension and greater thickness.[9,10] |
4. | ENUCLEATION: Performed for large melanomas when there is no hope of regaining useful vision; also indicated in the presence of intractable secondary glaucoma and extraocular extension.[5,8] |
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with ciliary body and choroid melanoma, small size. 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.
Small Choroidal Melanoma
The natural history of small choroidal melanoma remains poorly understood. Small, pigmented choroidal lesions cannot always be differentiated reliably on examination. Growth is a presumed indicator of malignant potential.[1]
Although patients diagnosed with small choroidal tumors were not eligible for participation in the Collaborative Ocular Melanoma Study, these patients were offered participation in a prospective follow-up study to evaluate the natural history of small lesions. Two-year and 5-year tumor growth estimates of 21% and 31%, respectively, were reported.[2] Clinical risk factors associated with tumor growth included increased tumor thickness, presence of subretinal fluid, orange pigmentation, absence of drusen, absence of retinal pigment, margin at the optic disc, and epithelial changes surrounding the tumor.[2,3]
The 5-year melanoma-related mortality rate in patients treated for small choroidal melanomas has been reported as high as 12%.[4,5] Several studies indicate that the two most important clinical factors predictive of mortality are larger tumor size (at the time of treatment) and documentation of tumor growth.[6]
Typical features of the tumor on ophthalmoscopy, fluorescein angiography, and ultrasound examination of the eye contribute to the clinical diagnosis. Accuracy of the tumor thickness measurement by echography is an important issue with very small tumors. Wide-field photography is helpful to detect the rate of choroidal tumor growth.[7] Although these techniques have improved the diagnostic differentiation of larger size melanomas, the accuracy of diagnosis for small melanomas is more uncertain. Furthermore, smaller tumors may not produce symptoms, depending on their location with respect to the macula, and may go undetected unless discovered during the course of a routine eye examination.
The management of small choroidal melanomas is controversial. The likelihood of progression from the time of diagnosis to growth warranting treatment has not been well characterized. In the past, many ophthalmologists advocated observation. This was justified on several grounds, including the difficulty in establishing a correct diagnosis, the lack of any documented efficacy for globe-conserving treatments, and concerns for severe treatment-related morbidity. Some investigators have advocated earlier therapeutic intervention, since smaller tumor size at the time of treatment appears to be associated with lower mortality rates.[3,8,9]
The management of choroidal melanomas depends on many factors; most important are tumor size and location.[10] In otherwise healthy patients, a small choroidal melanoma in the posterior fundus is amenable to several treatment options, including radiation therapy, laser photocoagulation, transpupillary thermotherapy, a combination of these methods, or even enucleation.[10,11,12,13]
1. | OBSERVATION: Is important in patients for whom the diagnosis is uncertain or in whom tumor growth is not documented; also is prudent in asymptomatic patients with stable lesions, particularly in elderly or debilitated patients, or in patients with tumor growth in their only useful eye.[5] |
2. | PLAQUE RADIATION THERAPY: Used for small- or medium-sized uveal melanomas, amelanotic tumors, or tumors that touch the optic disc for greater than 3 clock-hours of optic disk circumference.[12,13] |
3. | EXTERNAL-BEAM, CHARGED-PARTICLE RADIATION THERAPY: Provides precisely focused radiation with a homogeneous dose distribution pattern and little lateral spread; requires sophisticated equipment available only at selected centers; involves patient cooperation during treatment (voluntarily fixating the eye on a particular point so the tumor is positioned properly in the radiation beam); in eyes with tumors less than 6 mm in thickness and located more than 3 mm distant from the optic disc or fovea, clinically significant visual loss can usually be avoided.[10,12,13,14] |
4. | GAMMA KNIFE RADIATION SURGERY: Is a newer method of radiation therapy; preliminary experience suggests this treatment may be a feasible option for small-sized to medium-sized melanomas.[15] |
5. | LASER PHOTOCOAGULATION: Can be used in very selected cases of small posterior choroidal melanoma; indirect ophthalmoscope laser therapy may be combined with plaque radiation therapy.[12] |
6. | TRANSPUPILLARY THERMOTHERAPY: Causes substantial tumor necrosis in choroidal melanomas up to 3.5 mm in thickness; currently used in selected cases with deeply pigmented small choroidal melanomas in the posterior pole with minimal or no contact with the optic nerve; can be used as a primary treatment or as an adjunctive method to plaque radiation therapy.[8,9,16,17,18] |
7. | LOCAL TUMOR RESECTION: Used mainly for selected ciliary body or anterior choroidal tumors with smaller basal dimension and greater thickness.[19] |
8. | ENUCLEATION: Is favored when severe intraocular pressure elevation is a factor; may also be considered in small- and medium-sized melanomas that are invading the tissues of the optic nerve; an eye-sparing procedure rather than enucleation should be considered if there is hope for useful vision.[11] |
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with ciliary body and choroid melanoma, small size. 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.
Medium and Large Choroidal Melanoma
Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)
Enucleation remains the standard therapy for most large choroidal melanomas and melanomas that cause severe glaucoma or invade the optic nerve. One of the two clinical trials of the Collaborative Ocular Melanoma Study (COMS) compared preoperative external-beam radiation therapy plus enucleation to enucleation alone in patients with large choroidal tumors to address the concern that enucleation might precipitate tumor metastasis and shorten survival.[1] After 10 years of follow-up, the cumulative all-cause mortality rate for each treatment arm was 61%. In addition, the 10-year rates of death with histopathologically confirmed melanoma metastasis were not significantly different (45% in the pre-enucleation radiation arm and 40% in the enucleation-alone arm, P = .40).[1][Level of evidence: 1iiA]
Episcleral radionuclide plaque brachytherapy and external-beam, charged-particle radiation therapy offer patients eye-sparing and vision-sparing alternatives to enucleation.[2,3] Both treatment approaches result in relatively slow regression of uveal melanoma during a period of 6 months to 2 years. Most tumors regress to approximately 50% of their original thickness; only occasionally does a tumor regress to a completely flat scar.[2] Local control is achieved in a large proportion of treated eyes with either technique. The probability of visual preservation and of eye retention with either method is related to tumor size and location.
Plaque brachytherapy is the most frequently used eye-sparing treatment for choroidal melanoma. Iodine 125 (125 I), gold 198 (198 Au), palladium 103 (103 Pd), and other ophthalmic plaques can be effective in the treatment of medium-sized melanomas.[4,5,6,7]125 I is the most commonly used isotope because of its good tissue penetration, accessibility, adequate shielding of the source, and lesser risk to other ocular structures and medical personnel. Methods to ensure proper plaque placement are critical to successful radiation therapy.[8,9,10,11,12]
Results from the second COMS clinical trial, which compared 125 I plaque brachytherapy to enucleation in patients with medium-sized choroidal tumors, revealed no significant difference in cumulative all-cause mortality between the two study arms at 12 years of follow-up (43% for 125 I plaque brachytherapy vs. 41% for enucleation; risk ratio = 1.04; 95% CI, 0.86–1.24).[13][Level of evidence: 1iiA] In addition, the 12-year rates of death with histopathologically confirmed melanoma metastasis did not differ significantly between the 2 study arms (21% in the 125 I brachytherapy arm and 17% in the enucleation arm, P = .62). Among the patients treated with 125 I brachytherapy, 85% retained their eye for 5 years or more, and 37% had visual acuity better than 20/200 in the irradiated eye 5 years after treatment.[14]
Charged-particle radiation therapy can be performed with a proton beam or helium ions.[15,16] Some investigators report better tumor control with helium ion irradiation than with 125 I episcleral plaque treatment in terms of local tumor control and eye retention; however, more anterior segment complications are found.[15,17]
Another radiation therapy technique occasionally employed but not as extensively studied is Gamma Knife surgery. Preliminary evidence suggests that Gamma Knife surgery may be a feasible treatment option for medium-sized choroidal melanomas.[18]
Tumor growth pattern is a factor in the therapeutic decision. If there is a diffuse melanoma or if there is extraocular extension, enucleation should be considered, but radiation therapy can be employed for less extensive disease.
Medium-sized choroidal melanomas
1. | PLAQUE RADIATION THERAPY: Allows eye preservation in most patients, but vision is generally reduced; probability of vision preservation after treatment is related to tumor size and location.[2,3,4,5,6,7,8,9,10,11,12,14,15,19] |
2. | EXTERNAL-BEAM, CHARGED-PARTICLE RADIATION THERAPY: Provides precisely focused radiation with a homogeneous dose distribution pattern and little lateral spread; requires sophisticated equipment available only at selected centers; involves patient cooperation during treatment (voluntarily fixating the eye on a particular point so the tumor is positioned properly in the radiation beam); allows for good local tumor control and reasonable retention of the treated eye for periods of as long as 10 years after treatment, according to reports.[15,16,17] |
3. | LOCAL EYE-WALL RESECTION: Allows for good ocular retention rates and visual results; survival does not appear to be compromised.[20,21] |
4. | COMBINED THERAPY, WITH ABLATIVE LASER COAGULATION OR TRANSPUPILLARY THERMOTHERAPY TO SUPPLEMENT PLAQUE TREATMENT: Can be used to minimize recurrence; transpupillary thermotherapy can be used in conjunction with plaque radiation therapy for medium-sized and larger melanomas as an adjuvant treatment to enhance the effects of radiation therapy and to minimize damage to normal ocular tissue;[22] the addition of laser photocoagulation to plaque radiation therapy for juxtapapillary choroidal melanoma has been reported to increase tumor control substantially;[23] ocular side effects do occur but are usually not clinically significant. |
5. | ENUCLEATION: Is considered primarily if there is a diffuse melanoma or if there is extraocular extension; radiation complications or tumor recurrence may eventually make enucleation necessary.[22] |
Large choroidal melanomas
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with ciliary body and choroid melanoma, medium/large size. 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.
Extraocular Extension and Metastatic Intraocular Melanoma
Extrascleral extension usually confers a poor prognosis. For patients with gross tumor involvement of the orbit, treatment requires orbital exenteration often combined with preoperative or postoperative radiation therapy; however, there is no evidence that this radical surgery will prolong life. Most patients with localized or encapsulated extraocular extension are not exenterated. This subject is controversial.[1,2,3,4,5]
No effective method of systemic treatment has been identified for patients with metastatic ocular melanoma.[6]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with extraocular extension melanoma and metastatic intraocular melanoma. 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.
Recurrent Intraocular Melanoma
The prognosis for any patient with recurring or relapsing disease is poor, regardless of cell type or stage. The question and selection of further treatment depends on many factors, including the extent of the lesion, age and health of the patient, prior treatment, and site of recurrence, as well as individual patient considerations. Clinical trials are appropriate and should be considered whenever possible.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent intraocular melanoma. 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.
Get More Information From NCI
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. A trained Cancer Information Specialist is available to answer your questions.
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
For more information from the NCI, please write to this address:
NCI Public Inquiries Office |
Suite 3036A |
6116 Executive Boulevard, MSC8322 |
Bethesda, MD 20892-8322 |
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).
Changes to This Summary (12 / 05 / 2007)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Added Purpose of This PDQ Summary as a new section.
More Information
- PDQ® - NCI's Comprehensive Cancer Database.
Full description of the NCI PDQ database.
- PDQ® Cancer Information Summaries: Adult Treatment
Treatment options for adult cancers. - PDQ® Cancer Information Summaries: Pediatric Treatment
Treatment options for childhood cancers. - PDQ® Cancer Information Summaries: Supportive and Palliative Care
Side effects of cancer treatment, management of cancer-related complications and pain, and psychosocial concerns. - PDQ® Cancer Information Summaries: Screening/Detection (Testing for Cancer)
Tests or procedures that detect specific types of cancer. - PDQ® Cancer Information Summaries: Prevention
Risk factors and methods to increase chances of preventing specific types of cancer. - PDQ® Cancer Information Summaries: Genetics
Genetics of specific cancers and inherited cancer syndromes, and ethical, legal, and social concerns. - PDQ® Cancer Information Summaries: Complementary and Alternative Medicine
Information about complementary and alternative forms of treatment for patients with cancer.
This information is intended mainly for use by doctors and other health care professionals. If you have questions about this topic, you can ask your doctor, or call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).
Date Last Modified: 2007-12-05


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Anett Kontaveit
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May 30th, 2012, 04:27 PM
Senior Member
Join Date: Mar 2012
Location: Sibiu
Posts: 3,768
Re: Anett Kontaveit
Than I propose you to create a gap between #200 and #300 and move the players, so that the #300-#400 spots could have two players on each position, so they can all be ranked as they deserve.
You were pointless actually. Than you came up with statistics and you are no more. But statistics aren't so relevant for me. I still think Donna would beat Anett. At least on hard, which is the most common surface.
But to start with the begining, I didn't ever say Donna
better than Anett, I've said
(me, myself) think that she is better. You could've told me your believings are the other way around and it would be fine, but you claim - as you always do - that your opinions are the right ones, meaning I was wrong.
And you defend Anett like I'm hating on her or something. No, you know I don't. I'm just telling my opinions, which may prove true, or may prove wrong and which aren't related at all with my preferences, but with my judgement.
There's a lot of facts that decide the winner of a match and indirect statistics (by indirect I mean not face to face statistics, but judging on matches against different other players) aren't one of them.
If you think Donna is not as good as people think, I wonder why do you always post there and criticise her schedule. On the other hand I believe in Anett.
And most important than everything is that it's not important at all who's better than whom. Both are promising players and when they will face each other, we shall see who's who.
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Children were: Michel Forget .
He was married to Madeleine Martin on 6 Feb 1652/53 in Quebec. Children were: Jean-Baptiste II Forget.
He was married to Marie Racette on 1 Jul 1799 in Ste-des-Plaines, Terrebonne Co.. Children were: Joseph Issac Forget.
He was married to Marie-Josephe Gosselin on 14 Jun 1751.
She was married to Jean-Francois Gosselin on 4 Nov 1749 in St. Jean, Ile'd Orleans, Montmorency, Quebec, Canada. Children were: Francois Gosselin, Pierre Gosselin, Marie-Josephe Gosselin, Marie-Charlotte Gosselin, Marie-Madeleine Gosselin , Marie-Angelique Gosselin.
Children were: Angelique Fortier.
Children were: Marie-Anne Fortier.
She was married to Pierre Gosselin on 29 Jan 1750/51. Children were: Marie-Marguerite Gosselin, Pierre-Noel Gosselin, Josephe-Marie Gosselin.
He was married to Xainte Cloutier on 11 Nov 1681 in L'Islet Chateau Richer PQ. Children were: Genevieve Fortin.
He was married to Genevieve Gamache on 11 Nov 1652 in Québec, QC Marié au Cap Tourmente. Children were: Pierre Fortin.
Children were: Marie-Louise Bernier, Joseph Marie Bernier, Basile Bernier.
He was married to Marie-Gertrude Hudon on 4 Jul 1697 in Rivière-Ouelle, QC. Children were: Marie Josette Fortin, Marie-Anne Fortin, Barbe Fortin, Pierre Fortin, Reine Fortin, Marie-Madeleine Fortin, Marie Fortin, Joseph Fortin, Louis Fortin.
She was married to Dewitt Haynes in 1919.
Children were: Genevieve Gosselin, Angelique Gosselin.
Children were: Joseph Fournier.
Children were: Jean Baillargeon.
He was married to Marie-Madeleine Gosselin on 24 Aug 1715 in Notrre-Dame de Quebec. Children were: Francois Fradet, Marie-Elisabeth Fradet, Jean-Marie Fradet, Marie-Reine Fradet, Marie-Louise Genevieve Fradet, Louise-Genevieve Fradet , Cecile Fradet, Justine Fradet, Pierre Michel Fradet, Michelle Justine Fradet, Louis-Marie Felix Fradet , Jean-Francois Fradet, Marie-Therese Fradet, Marguerite Fradet.
Children were: Marie-Madeleine Francois.
Children were: Charlotte-Francoise Thibault , Marguerite-Jeanne Thibault, Guillaume Thibault, Francois Thibault, Nicolas Thibault, Anne Thibault.


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Nicklaus and Boccieri Golf Reveal a 'Secret'
01.08.13 | GolfGetaways
Boccieri Golf, maker of award-wining equipment such as the Tour-proven Heavy Putter, has tapped Jack Nicklaus to help launch the Secret Grip, a patented technological breakthrough that allows players to easily back-weight their clubs, similar to the way Nicklaus did during his career while winning 73 PGA Tour titles, including a record 18 professional major championships.
The Secret Grip represents the first time in nearly two decades that Nicklaus has given his endorsement to equipment not under the Nicklaus Golf banner. He will appear in promotional materials for the product and use it on his own clubs. Beginning in March, the Secret Grip will be available at Dicks and Golf Galaxy retailers nationwide.
"Throughout my career, all my golf clubs were back-weighted,"Â Nicklaus said. "The main benefit was that it helped slow down my hands and reduce dispersion. There are a lot of people who could benefit from the philosophy that I used and that is why we have been working with Boccieri Golf. If we can make the game easier and thus more enjoyable for people, that's not only a good thing for them, it's good for the game of golf."
The Secret Grip is designed to be installed quickly and affordably on every manufacturer's clubs. Its heavier weight raises the club's balance point, promoting consistent crisp contact for greater control and distance. This is achieved via a tungsten weight in the butt-end, combined with a compound that's 40-percent heavier than what's used in standard grips.
"Extensive research and testing has proven that counterweighting helps everyone from the high-handicapper to all-time greats like Jack,"Â says Stephen Boccieri, President and CEO of Boccieri Golf. "With the Secret Grip, players benefit from our unique weighting system without changing the brand or style they prefer. It is really like getting a new set of clubs."Â
Prototypes of the Secret Grip were unveiled last year and garnered praise from dozens of leading media outlets. This included receiving "Top Products from the 2012 PGA Show"Â honors from Golf Digest and GOLF Magazine. Recent consumer launch-monitor testing of more than 500 players showed 95 percent reported a strong preference for the Secret Grip versus traditional grips.
Further advantages of the Secret Grip ($16.99 each) include:
- Total length one-inch longer than standard, allowing players to grip-down for improved play around the green or on uneven lies
- A built-up lower section "â often preferred by PGA Tour players "â completely removes the need for additional grip tape wrapping
The latest introduction in a line of pioneering equipment from Boccieri Golf that includes the popular Heavy Putter collection, along with the critically acclaimed "Control Series"Â of full swing clubs, the Secret Grip can be purchased at www.boccierigolf.com. It will soon be offered at leading retailers nationwide.
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05.25.13Gifts, Gadgets, and Gizmos for Dads, Grads, Grooms and All Deserving Golfers
Weekend Golfer Magazine


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Friday, July 15 2011
For 'Harry Potter' fans, an era is ending
Friday marks the end of an era. Some, like Warner Bros. executive Dan Fellman, compare its finality to the breakup of the Beatles. When "Harry
Thursday, November 11 2010
Part I of final 'Potter' installment is highlight of 2010 holiday season
LOS ANGELES — Warner Bros. Pictures is about to lose a major rainmaker, so it's going to let him linger a little longer before letting him
Wednesday, November 10 2010
'Potter' a film franchise like no other: Box-office wizardry nears its end
On a sticky June night just outside London, the magic finally came to an end for the cast and crew of the Harry Potter movies. After a decade together, the small army that has been the busiest in British filmmaking wrapped the final shoot of the last Potter production.


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New Black Entertainment Capital of the World. Las Vegas has established itself as the new black entertainment capital. Appearing in one week were: George Kirby, Harry Belafonte, Nancy Wilson, Sammy Davis Jr., Ella Fitzgerald, Billy Eckstine, Joe Williams, Redd Foxx, Billy Daniels, Davis' musical director, George Rhodes, Donald Mills, Jimmy Randolph, Harry Mills, Sonny Charles, Herbert Mills, Hines, Hines & Dad's musical director, Paul Curry Price
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Best SUVs and Crossover SUVs of 2010: Page 2
There are plenty of worthwhile alternatives to our Best SUVs and Crossover SUVs of 2010 -- especially if you're looking for the top choice in a specific category. You'll not be disappointed with any of the following.
The best small SUV of 2010 is the Subaru Forester. This stout little wagon evolved from compact-car tight to compact-crossover roomy with its 2009 redesign. Forester continues for 2010 as a smart-sized five-seater with performance and utility that shames a long list of rivals that look more overtly SUV-like. The turbocharged 2.5XT models are serious fun. Base price range: $20,990-$29,190.
The best midsize SUV of 2010 is the Honda Pilot. It looks like a tough-hombre SUV but Pilot is really a precision-tooled crossover. It's sized for easy suburban maneuvering yet has three rows of seats. Performance surpasses expectations; build quality is hard to fault. Debatable styling and too many dashboard buttons are distractions but not disqualifiers. Base price range: $28,605-$39,355.
The best large SUV of 2010 is the Mercedes-Benz GL-Class. Mercedes engineering and prestige, private-railcar accommodations for seven, and confidence-inspiring road manners – what's not to like? Well, the price. But you do get to choose between two stirring V-8 engines and a BlueTec diesel V-6 that delivers a palatable 17/23 mpg (city/highway). Base price range: $60,825-$84,725.
The best city SUV of 2010 is the Volvo XC60. Modern Euro styling means the new-for-2010 XC60 looks the part at the toniest of haunts. Responsive performance, elevated seating, and tidy dimensions ease the stress of urban driving. And should your attention wander, automatic braking sensors stop it dead to prevent a buzz-killing rear-end collision. Base price range: $38,550-$48,900.
The best family SUV of 2010 is the Toyota Highlander. Spacious and refined, the Highlander easily hauls your brood and all its caboodle. This Camry-based crossover seats seven and has styling that won't embarrass the gotta-look-macho dad. Highlander offers three engine choices: the four-cylinder holds its own and is easy on the wallet; the V-6 is the pick for no-sweat acceleration; and the gas-electric hybrid returns a pleasant 27/25 mpg (city/highway). Base price range: $26,505-$35,320.
The best fuel-efficient SUV of 2010 is the Ford Escape Hybrid. The Methuselah of crossovers gets a hybrid heart and new life as America's highest-mileage SUV. Along with its Mazda Tribute Hybrid and Mercury Marnier Hybrid corporate cousins, the Escape Hybrid is rated at 34/31 mpg (city/highway). The gas-electric powertrain provides adequate performance and sort of compensates for the ancient feel of a basic design that's a decade old. Base price range: $25,995-$34,735.
The best off-road SUV of 2010 is the Jeep Wrangler. You can buy a rear-wheel-drive Wrangler, but what's the point? Any four-wheel-drive version of this classic can conquer the toughest of trails and the off-road-engineered Rubicon models lunch on big boulders and bad bogs. Wrangler offers a two-door body style and the longer four-door Unlimited, both with hard or soft tops. Wrangler is poorly suited as a daily driver, but no 4x4 puts you more in touch with the out-of-doors. Base price range: $21,915-$32,800.
The best luxury SUV of 2010 is the Land Rover Range Rover. In a delightful colonial turnabout, Britain's iconic Land Rover brand is now owned by India's Tata Motor. The former subjects are wise stewards of a tradition that's brought us this debonair SUV. The Range Rover isolates you from most every unpleasantness, wafts you over hill and pothole, and whistles you along on the strength of V-8s ranging from 375 to 510 horsepower. Base price range: $79,275-$95,125.
The best inexpensive SUV of 2010 is the Hyundai Tucson. Hyundai lets its hair down with this flamboyantly restyled version of its compact crossover. All-new for 2010, the Tucson refines the high-content-at-competitive-prices formula that's made this South Korean automaker among the world's most successful. Tucson is agile, roomy, and solid, but ride quality, steering feel, and engine smoothness need work. Base price range: $19,790-$29,940.
The best towing SUV of 2010 is the Toyota Sequoia. As if to overcompensate for years of middling dimensions, Toyota got all gargantuan with the 2009 redesign of its biggest SUV. Based on the Tundra pickup, this body-on-frame wagon takes up lots of space on the road and guzzles lots of gas. But Sequoia easily holds eight passengers and offers class-leading towing capacity. Equipped with the 381-horsepower 5.7-liter V-8, it can pull a 10,000-pound trailer. Even the new-for-2010 base V-8 -- a sensible 4.6-liter with 310 horses – will tow 7,100 pounds. Base price range: $39,480-$59,855.


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Robert Pagliarini
Hi. My name is Robert Pagliarini. I know . . . it's long and hard to pronounce. It's a great name to have for search engines and when making reservations at Italian restaurants, but that's where the benefits end. It's pronounced PAL-YUH-REE-NEE, as in "your pal, Pagliarini."
I am obsessed with making the most of my other 8 hours to create an ideal life. (Do I have an "ideal" life? No. Am I working on it? Absolutely.) I'm also obsessed with sharing what I know, inspiring others to achieve their ideal life, and learning from others who are improving their lives.
For a guy who hated English class, I'm thrilled to have written The Other 8 Hours, the #1 national bestselling personal finance book, The Six-Day Financial Makeover, and the popular ebook, Plan Z: How to Survive the 2009 Financial Crisis (and even live a little better).
I love sharing my ideas. I've appeared as a financial expert on 20/20, Good Morning America, Dr. Phil, ABC Morning News, NPR's Marketplace and in The Wall Street Journal, Newsweek, BusinessWeek, Money Magazine and many others.
I write a weekly column for CBS called Your Other 8 Hours at www.yourother8hours.com.
I am a Certified Financial Planner™ and have a master's degree in financial services. I am the president of Pacifica Wealth Advisors, a boutique wealth management firm recently ranked one of the top in the nation. I am currently completing a master's degree in counseling psychology.
I'm also passionate about a non-profit I co-founded and help operate called the Band of Brothers Foundation that helps impoverished children around the world.
I live with my wife and daughter in Orange County, California. On most Sundays you'll find us at Saddleback Church, and occasionally at Disneyland.


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Chevy Woods - 357 (Prod. By Shawty Redd)
357 Chevy Woods Produced by Shawty Redd
Have you heard Chevy Woods's new track 357 (Prod By Shawty Redd)? It dropped on Tuesday, May 31st, 2011.
Give 357 (Prod By Shawty Redd) a listen - it's a new offering from Chevy Woods. It was dropped on Tuesday, May 31st, 2011. Chevy Woods's musical situation is improving with every new release, and 357 (Prod By Shawty Redd) will most definitely help the cause. It's a fine addition to the growing body of work Chevy Woods has been developing since stepping foot in the game. We're looking forward to what Chevy Woods has in store.
Check out Chevy Woods on Crazy, featuring Wiz Khalifa. If you dig this, visit Chevy Woods's profile for the latest info, news, songs, and mixtapes. Follow Chevy Woods on Facebook and Twitter, if you aren't already.
Let us know what you think, folks.


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Tristan was born in 1995, and La Vea, says Diane, "just took interest and just loved my family. He loves my kids like they're his own."
So when a 12-year-old Tristan took an interest in carting, Uncle Jim said he'd buy him a cart. Since then, he has footed the bill for all of Tristan's racing expenses. That totals more than $150,000 a year.
"I guess our story's a little different than most people's," Diane says. After all, most people don't have a money tree.
Because Juan works full-time and Diane spends just two days a week as a dental hygienist, she became Tristan's manager and master of finances. Petite and tan with dark hair and narrow eyeliner-rimmed eyes, she drives the trailer, chooses the mechanic, and hires the coaches — half a dozen in the past two years, before she found Jay.
For a day of coaching, Diane will pay Jay $350. That's at least $2,800 a month. To race on the cart circuit, they needed at least two chassis, which cost around $4,500 each. Tristan has five. Each of his two engines cost $3,000, plus the higher-horsepower engines he leases from Jay for races cost $750 per day. A mechanic costs around $250 a day. The 46-foot trailer Diane schleps from Boca to Homestead twice weekly cost a cool $60,000. A race weekend — with entry fees, hotel rooms, and airfare — will hit $5,000. Most weekends are race weekends. For a big race, such as the Newcastle championship they're preparing for at the Homestead practice, Diane expects to spend about $10,000.
"In order to win, you have to race a lot, have a lot of seat time," Diane says. "And in order to do that, you need money. So it really comes down to money — and a lot of luck."
As Jay leans against the chainlink fence and watches Tristan, he notes which turns he needs to be quicker on, which kids he could have passed. Sometimes Tristan psychs himself out, Jay explains, when he knows he's behind a ranked driver.
After the practice run ends, Tristan sits in a red fold-out chair, his race jumpsuit unzipped. Jay tells him: "Go get a track map so we can go over everything."
Inside, the trailer is dim and cool. He and Tristan lean over the map, marking X's and lines with black pen. "This is pretty simple," Jay says. "You want to be on the front before the A-wall, if that makes sense." Tristan nods. "The others are overdriving, and then they're like, 'Fuck.'"
Tristan draws a line along a straightaway, curving it along a bend. "I get my right tires around here, then turn in for this." Jay wants Tristan to hit the throttle harder at the apex, but Tristan says he opened it up around the turn.
The door swings open, and Jay and Tristan squint into the sunlight. Diane sticks one foot in and shouts, "You're up!"
Tristan zips up his suit, picks up his helmet with both hands, and heads to the track. In the next heat, he takes first, beating kids who have been nationally ranked.
"Indiana's going to be great," Diane says.
Everyone is disappointed by New Castle, Indiana. The chilly morning sky is the shade of dishwater, and a defective bumper has not improved the afternoon's spirits.
"That's the third fucking time that thing broke," Diane yells in their tent, which serves as a base camp for the race. A table full of Pringles, bananas, apples, and caramel dipping sauce separates seven or eight mismatched fold-out chairs. An identical table nearby serves as a cart workstation and is scattered with bolts and wrenches smeared with motor grease.
A bolt snapped twice in practices leading up to the accident in the qualifying heat. "I've never heard of that happening — a bumper breaking three times in one week," Diane rants.
It takes a certain kind of kid to get in a cart where he has to drape his legs over a fire extinguisher, so it goes without saying that it takes a certain kind of parent to be a "racing mom." Diane once got out of her car at a red light and kicked a dent in another driver's door. She didn't think he'd been driving safely, and no one was going to endanger her kids, who watched from the back-seat window.
Tristan returns with Matt Long, a curly-haired mechanic Diane hired for the week. Tristan wasn't disqualified after all, but he was penalized — heavily, Matt explains. Tristan finished sixth in the first qualifying heat, so he'll start in the back of the pack in Saturday's final race. Essentially, he has already lost.
"Three times in one week," Diane repeats. Of the bolt, she says, "Obviously, they're doing it too tight."
The bumper is missing a chunk where it swung down in the back right corner. The mechanic twists off the remaining bolt to remove the whole thing. They'll replace it with another bumper, off another one of Tristan's cars. Matt works quietly, not acknowledging Diane's comments about the bolt. But privately, he says the incident wasn't surprising. "These bolts are only good for three races. They break every fourth. They're cheap bolts, and Jay and I are always telling her that," the mechanic says. He claims Diane buys "home-remodeling grade" instead of the industrial-grade bolts needed for racing.


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Learning Event Patterns from Text AbstractWe propose a pipeline for learning event templates from a large corpus of textual news articles. An event template is a machine-usable semantic data structure, in our case a graph, describing a certain event type. Such a template encodes the most characteristic information for a certain type of event; for instance, an earthquake template would encode "x people dead" and/or "town y shook at time z". Event templates have potential to be used as an input for information extraction tasks or automated ontology extension. We present preliminary results of applying the proposed pipeline on a subset of news articles.
[Edit] |


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Watch Carly Rae Jepsen's Music Video For 'This Kiss'
Carly Rae Jepsen simply cannot ignore "This Kiss."
Carly Rae Jepsen Says Her Duet With Justin Bieber is 'Charming & Feel Good'
The "Call Me Maybe" singer finds a special someone in her new music video. As she performs in a club and enjoys a photo shoot with close friends, Carly can't help but keep her eyes on an attractive photographer.
Carly Rae Jepsen Releases New Album 'Kiss!'
In the end, Carly ends up taking a risk and approaches the mystery man. Where will they share a very special kiss? You have to watch the video for yourself below!


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For a man who accuses his opponent of lying to the American people, John Kerry sure thinks it's a winning strategy, himself. The Washington Times is reporting:
U.N. ambassadors from several nations are disputing assertions by Democratic presidential candidate Sen. John Kerry that he met for hours with all members of the U.N. Security Council just a week before voting in October 2002 to authorize the use of force in Iraq.
I went to meet with the members of the Security Council in the week before we voted. I went to New York. I talked to all of them to find out how serious they were about really holding Saddam Hussein accountable.
Thanks to some friends in New York, I was invited to come up and meet with the Security Council in the week prior to the vote, and I wanted to do that, because I valued my vote. And I wanted to know what the real readiness and willingness of our partners was to take this seriously. So I sat with the French and British, Germans, with the entire Security Council, and we spent a couple of hours talking about what they saw as the path to a united front in order to be able to deal with Saddam Hussein.
Truth Laid Bear shows why this story is a major threat to the Kerry campaign.


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Golden BullAn edict by the Emperor Charles IV., issued at the Diet of Nuremberg in 1356, for the purpose of fixing how the German emperors were to be elected. (See Bull.) Source: Dictionary of Phrase and Fable, E. Cobham Brewer, 1894 More on Golden Bull from Infoplease:
24 X 7Private Tutor
Explore Algebra 2 , Homework Help


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Published on -8/3/2014, 5:55 PM
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Sharon Katherine (Schmidtberger) Urban, 63, died Friday, August 1st, 2014, at her farm home near Loretto, KS after a lengthy illness.
She was born on May 10th, 1951, at St. Anthony Hospital, Hays, KS to Ike and Albertina (Sander) Schmidtberger.
She grew up in Victoria and had a wonderful childhood with her family, cousins and neighborhood friends. She attended daily mass at St. Fidelis Church.
She graduated from Victoria Grade and High Schools. She was an early female in the field of computing and graduated from college in Wichita, KS. She moved to the Dallas/Fort Worth, TX area in 1970, with two sisters. She worked at JC Penney, Stark Taylor Cotton Company, whose owner later became the mayor of the City of Dallas, Toyo Cotton Company and Ross Perots' Electronic Data Systems.
She married Don J. Urban on November 26th, 1983, at Victoria. After marriage, she worked with computers at Fort Hays State University until the birth of her second child. She was an active farmer and farmer's wife, and later became president of a small construction business and lived on their farm north of Bison by Loretto, KS. Her life long dream was to live on a farm. She and her large family sang in the church choir. She was a member of Singerbund and a member of St. Joseph's Church of Liebenthal and St. Mary's Church of Loretto, KS.
She is survived by her husband, Don, of the home; two sons, Matthew and Seth, Loretto, KS; twelve brothers and sisters: Verlin (JoAnn), Salina, KS; Connie Jimenez, Hurst, TX; Alice (Don) Peterka, Wilson, KS; Clara (Tom) Walters, Catherine, KS; Joanne Detwiler, Olathe, KS; Arlene (Bill) Delka, Guide Rock, NE; Mary Ann Schmidtberger; *; Ike (Betty), Newton, KS; Richard (Deborah), Newton, KS; Larry, Victoria, KS; Dianne (Coy) Blumenthal, Bladen, NE; and Cathy Schmidtberger (Robert Lang-significant other), Bedford, TX; sister-in-law, Patricia Urban, Middlesex, NJ; many nieces and nephews, as well as great nieces & nephews.
She was preceded in death by her parents; her father and mother-in-law, John and Anna Urban; a brother-in-law, Dennis Urban; and a sister-in-law, Diane Urban.
Services are 10:00 a.m. Saturday, August 9, 2014, at The Basilica of St. Fidelis Victoria, Kansas. A private family inurnment will be held at later date.
A vigil service will be at 7:00 p.m. Friday, followed by a family rosary at the Basilica of St. Fidelis.
The family will be receiving relatives and friends from 6:00 to 9:00 p.m. Friday, and from 9:30 to 10:00 a.m. Saturday, at The Basilica of St. Fidelis Victoria, Kansas.
Memorials to the Harold Dorzweiler Memorial Cancer Fund, St. Joseph Church Building Fund Liebenthal, KS or St. Mary's Church Building Fund Loretto, KS.
Cline's Mortuary of Hays, 1919 East 22nd Street, Hays, KS 67601 is in charge of arrangements.
Condolences can be sent via e-mail to firstname.lastname@example.com.


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Tested by the Good Housekeeping Research Institute
Walmart Home Trends Outdoor Tablecloth
Product Review
About GHRI Ratings
XGood Housekeeping Research Institute (GHRI) ratings are based on laboratory tests conducted by our scientists at the U.S.'s foremost consumer products evaluation laboratory, and incorporate consumer feedback. GHRI is situated on the 29th floor of the Hearst Tower in New York City and is staffed by chemists, engineers, nutritionists, textile specialists, culinary experts, and other scientists.
Using state-of-the-art equipment, GHRI experts test consumer products — from microwaves to mascaras — for their performance, safety, and, with the help of volunteer testers, ease of use.
Established in 1900, before there was a Federal Drug Administration or a Federal Trade Commission, GHRI has always been the most trusted source consumers can rely on to choose products that are safe and effective.
If price is your biggest concern, then add Walmarts Home Trends wipe-down tablecloth to your cart. More pliable than the traditional PVC vinyl, the soft-touch cloth doesnt take on stains or absorb spilled liquids. Even after setting for a day, spills came out easily with a simple soap and water wipe-down. And as the most affordable product tested, you dont have to worry about bringing this along to picnics or on hikes, making it a great pick for a wipe-down tablecloth. walmart.com
Colors: Wave, Bamboo, Leaf, Flowers
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GHRI Tested: Tablecloths
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Pacifica: Australasian Theological Studies
Description: Pacifica is owned by the Pacifica Theological Studies
Association, which was formed in 1987 to publish a scholarly journal
covering all aspects of Christian theology and to provide a forum for
theologians of Australasia and the West Pacific Basin. Pacifica serves
the needs of scholars and students in responding to the challenges
facing the Christian Church today and in the future. It also brings
the unique contribution of Australasia and the West Pacific to the
international Church and the international community of scholars.
Language: English
Country: United Kingdom
Publisher: SAGE Publications
Frequency: 3 times a year
Fee information current as of 3 April 2013
Open Access: No
Subscription fee or article fee: Yes
Publication fee for authors: No
Abstracts: Yes
Abstracts language: English
Email: http://paa.sagepub.com/feedback
Start year: 1988
Keywords: Religion, Australia, New Zealand
Subject: Philosophy, Psychology, Religion
Date posted: 3 April 2013


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During a special ribbon-cutting ceremony on April 1, community and hospital leaders officially welcomed PeaceHealth United General Medical Center as part of PeaceHealth's Northwest Network. The Washington hospital began affiliating with PeaceHealth in 2009 to provide specialty services on its campus in Sedro-Woolley. In the fall of 2011, following multiple community forums, Public Hospital District (PHD) #304 commissioners and PeaceHealth boards approved an alliance that would ensure District ownership of facilities, with PeaceHealth management of clinical services."PeaceHealth values and advocacy for patient safety matched our goals." said Chuck Ruhl, PHD #304 commissioner. "The alignment seemed a perfect fit for the continued operation of United General in the new world of health care." Nancy Steiger, CEO and chief mission officer for the Northwest Network, said PeaceHealth was pleased to accept. "Our mission and core values call us to respond when asked to help provide needed health care. This will help ensure that residents of Public Hospital District 304 have local access to specialized, sustainable and innovative health care."Alan Yordy, PeaceHealth CEO, noted the significance of United General joining the PeaceHealth family."We are honored to have been invited to serve the Sedro-Woolley community. Our mission and core values call us to respond, just as PeaceHealth's founding sisters did in 1891 when they arrived to provide health care for loggers and miners in the area."Pictured in top photo: Left to right, Jim Barnhart, PeaceHealth United General Medical Center CAO; Nancy Steiger, CEO & Chief Mission Officer, PeaceHealth Northwest Network; Chuck Ruhl, President, Hospital District 304 Board of Commissioners; Greg Reed, Board of Directors, PeaceHealth United General.
About United General Hospital: United General Hospital has been a vital part of the community since 1965. The 25-bed critical access hospital serves Public Hospital District #304, including Burlington, Sedro-Woolley, Bayview, Samish Island, Concrete, Marblemount, Clear Lake and areas of Mount Vernon – over 2,000 square miles in Skagit (and parts of Whatcom) County. The hospital is governed by a five-member board of commissioners. A critical access hospital that has earned statewide recognition for quality and safety, United offers state-of-the-art technology in its North Puget Cancer Center, Diagnostic Imaging Center, Sleep Disorders Center and other patient care areas.