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Session 7
Attended: Alex, Andrew & Nenad
Venue: My place
Covers events on Stardate 37440 to 37498.
Acting Captain's log, stardate 37440.1
We have finally emerged from the Styx Rift, our survey complete. We made contact with Starfleet and were immediately contacted directly by Admiral Sturek. He has ordered the Rutan to investigate a distress signal that has been received from a civilian passenger liner, the S.S. Gradalis.
Chief Engineer's log, stardate 37440.1
Indecision kills, and Bell is lucky it didn't kill us. We had barely left the Styx rift behind when we were diverted to answer a distress call from a Medusan ship named the Gradalus, a specially design cruise liner.
It turned out that a pirate ship, the Regis Heart, had disabled the Gradalus by literally blowing one of their warp nacelles off. After dithering about what to do, Bell sent me and a boarding party across to the Gradalus where we ascertained that the crew and passengers were alright.
I'll be frank, Medusans make my antennae curl. Scary, scary things. Though it turns out that their passengers are even weirder. Seemed civil though.
Unfortunately after that things went very pear-shaped. The pirates caught us with our pants down with the transporter tactics – beaming in, first, a bomb, and later boarders. I immediately went about using our excess dilithium as inefficiently as possible. Though that worked sort of.
I have to say, Bell's tactics were dubious, but in my magnanimous way, I'm going to blame on first engagement nerves. Which he shouldn't have.
Eventually the Regis Heart fled, after we had their shield down. And our prisioners were freed. Looking at it, I found a damage positron displacement coil, which is the likely reason for the brig shields failing. Shouldn't happen again.
Chief Science Officer's log, stardate 37440.1
Well, we have finally left the Styx rift, it has been a long four months, and I was looking forward to some R & R, but it doesn't look like that will happen anytime soon.
As soon as we have left the rift, we were sent on another mission. We had received a distress signal from the Gradius, and, being the closest federation ship, we needed to respond. The ship was crewed by Medusans, and transported six passengers. I was looking forward to having a chance to examine some of the stranger species in the federation, but ended up spending all my time on the ship.
When we arrived to the site of the distress call, I observed three bodies, and as we got closer, I was able to identify them. One of them was the Gradius, while another was 'The Rigel's Heart', a federation starship which had gone missing about 20 years ago.
As we approached even closer, we realised that the Gradius had been damaged, and one of its warp nacelles had been blown off. We also observed a tractor mine between the two ships. The distress signal was coming from Rigel's Heart, rather than from the Gradius. Neither ship responded to our hails.
Closer scans identified that the Medusans and the bedeels were still on their ship, while there were a lot of Orions on Rigel's heart. We decided to interrogate one of our prisoners when we realised this.
It took some persuasion, but eventually, one of the prisoners admitted that he had heard of the ship, and that it was a smuggler.
After a lot of deliberation, we beamed an away team across to the other ship, while I continued monitoring the scanners. The team reported that the crew and passengers were unharmed. They were fired on by Rigel's heart, and key components of their ship were beamed away. A scan of the Rigel's Heart confirmed that the missing components were there.
As soon as we beamed the away team back, all hell broke lose. I detected another transporter signal coming into our ship from the Rigel's heart, and an explosion shook the Rutan. Simultaneously, the Rigel's Heart raised its shields and began firing on us.
Two of the cargo bays that showed up empty on my scanners revealed that they actually contained shuttles altered for dog fighting. Bloody Orions! We should have blown the ship out of space the moment we saw them.
During the battle, they rammed us, and beamed one of their kind into our brig, where he tried to free the prisoners, but I managed to contain them all in that area.
I am not sure what Shran did to one of the probes, but when it hit the Orions, it completely knocked out their shields and engine.
We thought that we had them, especially after they ejected their warp core, and started negotiating for us to take care of their wounded, but they powered up their shields, and beamed their people back to their ship, before running away, like the cowards that they are. They even somehow managed to deactivate the shields on the brig… I didn't know that they had that kind of technology.
We made our way back to the nearest starbase, towing the gradius, where we finally offloaded all the samples that we have collected from the Styx rift, and we got some new crew to replace our losses. We will not have time to rest for long, since we have to go on a mission to the Beta quadrant. Well, at least somebody has noticed my scientific skills. I have been promoted to Lieutenant.
GM's Summary:
However, all was not well! (Again.) Suspiciously, the signal did not appear to be coming from the Gradalis itself. As the nearest Starfleet vessel, the Rutan would have to take its chances and investigate anyway, as the next nearest vessel was the training ship, USS Saracen NCC-33470(1), still a week away. Having received a temporary promotion to Commander, Bell led his ship towards the distress call. Approaching cautiously, Graan(2) was able to detect that there were three large objects at the source of the signal. One was a Sydney-class ship, like the Gradalis, but the other two were a large asteroid and a second ship of the Deneva class. Neither ship responded to hails.
Moving in to visual range, it was confirmed that they were indeed looking at the S.S. Gradalis NDT-10116, as well as the S.S. Rigel's Heart NFT-8896, a freighter reported missing with all hands years ago, near Klingon space and Starbase 22. A warp nacelle, apparently belonging to the Gradalis, hung in the space between the two ships. The Rigel's Heart appeared to be transmitting the Gradalis's emergency signal. Very cautiously, with shields raised, Bell ordered Rutan to inch closer. Fortunately, Lt Wise at Tactical, noticed that an unexploded gravitic mine was also sitting between the ships. This was fired on from long range and destroyed.
Coming in closer, Graan scanned the two ships. The Gradalis contained its 27 Medusan crewmembers and 6 giant Bedeel passengers(3). The Rigel's Heart was crewed by a number of Orions, Nausicaans and Humans, as well as a few who went unidentified. They appeared to be carrying a cargo of unprocessed iron ore, and had clearly modified their ship since its disappearance. Curious to know who they were dealing with, the crew went down to the brig, to see if their prisoners(4) knew anything. They quickly became impatient when "Richard" let slip that he knew something, but wouldn't give any details. After hitting him around and almost throwing him out the airlock, he finally agreed to tell them that he had heard that it was a smuggler's ship. This seems to have appeased Graan and Shran, who had led the interrogation (Bell left them to return to the bridge), and he was returned to his cell.
Continuing to be cautious, Bell ordered Shran to beam over to the Gradalis with a security and medical team, to establish contact with whoever was there. Once aboard, they spoke to the Medusans via the ship's intercomm, and found out that the Orion ship had attacked them unprovoked, destroying one of their warp nacelles and transporting away key sections of their EPS conduits before they could raise their shields. This left them stranded and unable to call for help.
Rutan's crew worked out an elaborate plan to storm the Rigel's Heart and capture it, but this came to nothing, as the Orions had been awaiting their moment to strike, and as Rutan lowered its shields to transport Lt Shran back, they snuck in a transport of their own, setting small explosives next to each of the ship's computer cores. As these went off, the Orions raised their own shields and charged in to attack the Rutan, revealing their uprated phasers and launching a string of shuttles (previously undetected by Graan's scans) to help in their concentrated attack. Eventually, their overwhelming attack breached Rutan's shields and they transported an Orion aboard, who freed the prisoners and stunned the guard on duty in the brig. Fortunately, somebody raised the brig's internal force fields, trapping them inside.
The Rigel's Heart continued to pound the Rutan, buckling its port nacelle. Bell ordered the ship to flee while they still could, leaving the shuttles behind. However, when the Rigel's Heart turned back and began to fire on the Gradalis, Bell was forced turn back and make a hit-and-run attack on the pirates. Fortunately, Shran had been working on modifying a probe to use as a makeshift torpedo(5), and this was just about ready. As the Rutan flew by, the probe bomb hit the Rigel's Heart solidly on one side, and the ship immediately began to suffer from failing systems, including warp, impulse, main power, weapons, shields, etc.(6). A hail from the Orion captain seemed to confirm this, as he surrendered unconditionally and requested medical assistance for his crew. Bell accepted the surrender, once the Rigel's Heart had jettisoned its warp core, and ordered the first batch of 6 Orions to be beamed aboard. However, the tricky Orions had not ejected their warp core, but merely a decoy. No sooner had Rutan beamed the first batch of Orions across than the Rigel's Heart reactivated all its systems (which had, of course, never really been damaged by the probe bomb) and beamed them back, except for one unfortunate bugger, as well as grabbing the four who were trapped inside the brig.
Having recaptured their men, the Orions went to warp, fleeing towards the Styx Rift. Bell ordered the Rutan to give chase, but changed his mind after a while, deciding that it was more important to deal with the disabled S.S. Gradalis. The Rutan's engineers gave the Gradalis a field repair, before the USS Saracen arrived and the two Starfleet ships jointly towed the hulk to Starbase 282, while the USS Mek'leth NCC-62537 was sent to hunt for the Rigel's Heart. In trying to work out how the prisoners had been beamed out of the shielded brig, the crew found that the Orions had attached a device of some sort to the brig wall, shortly before their transport, but did not get around to examining it closely enough to say for certain what it was(7).
At the starbase, the Rutan and the Gradalis both received repairs, and the Rutan's many samples collected in the Styx Rift were offloaded, while Bell gave his report on the ship's last few months of operations. As the repairs were soon over, and Starfleet Command already had plans for the Rutan, Bell had his temporary promotion extended indefinitely and was ordered to take the Rutan to the Alpha Quadrant, where it was urgently needed for some unspecified task.
What will this new mission be? Tune in next week, more or less, and I may or may not have another log prepared for you to find out(8)!
GM's Commentary:
(1) This Miranda-class ship was also the training ship with which Lt Graan had his cadet cruise, several years earlier. I've also obviously stolen the whole ship directly from Jason Green's USS Saracen game, though by 2371, when that game began, it had been reconverted to an active duty Starfleet explorer once more.
(2) Scot, who plays Dr Amri, was unavailable for this session.
(3) The Bedeels are highly intelligent 40 meter long mammalian centipedes. Made them up myself, and I was quite proud of them. Of course, they were only ever intended to fill a small role in this adventure, so I didn't really get to show them off, but I have this strange feeling that they'll make a second appearance at some point…
(4) "Thomas", "Richard" & "Henry", the two Orions and a Nausicaan who the Rutan's crew apprehended back in episode 3.
(5) The Rutan, being a standard Oberth class ship, has no torpedo launcher.
(6) For a makeshift bomb, a result like this, even against an old freighter, should have been really suspicious, but the crew appear to have swallowed it.
(7) Also, I had to make this up on the fly, as I'd forgotten about those damn internal shields. But I can justify it now, should anyone bother to ask. You see, I'm trying to make this as much like the real Star Trek experience as possible, and poor continuity and a good dose of RetCon is very important.
(8) The point of this mission, from the GM's point of view, was purely to get Thomas, Richard & Henry off the Rutan and back among their Orion buddies. Whether this was for important future plot purposes or simply to cover up a blunder of my own before anyone noticed it, I am unable say at this juncture. Unfortunately, I didn't prepare for this adventure quite as well as I should have, so it didn't run 100% smoothly, but I think it was still fun enough.
From next episode, we'll also be featuring some new player characters.


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Tingling Feet Related To Hiv
Here's a taste of what TheBody.com has to offer on this topic:
Ask the Experts
Burning and Tingling in hands and feetHello Doc Keith, Please answermy question and let me feel reassured. I am on atripla since march 2009 and my v/l is undectable and CD4 count is over 500, but when I sit I feel a burning sensation in my feet and tingling in my hands.. what could...
Response from Keith Henry, M.D.
University of Minnesota, School of Medicine...HIV drug related neuropathy can be seen with Atripla no not common (<< 5%). Almost always drug related neuropathy involves the toes/feet well Read more »
Numbness and tingling in feet sole and just starting atriplaHello Doc Keith,I started taking atripla a few days ago because my CD 4 count was 323 and v/l was... Read more »
Epzicom and IsentressSince I've switched to Epzicom and Isentress.I've had tingling and stinging sensations in my hands... Read more »
An Overview of Reyataz (Atazanavir)...known as Reyataz, is a type of medicine called a protease inhibitor (PI). Atazanavir works by blocking protease, a protein that HIV needs to make more copies of itself. During the normal HIV life cycle, an HIV protein called protease cuts long... Read more »
An Overview of Trizivir (AZT/3TC/Abacavir)...transcriptase inhibitor (NRTI). NRTIs block reverse transcriptase, a protein that HIV needs to make more copies of itself. HIV/AIDS-Related Uses Abacavir sulfate, lamivudine, and zidovudine are approved individually by the FDA for the... Read more »
An Overview of Epzicom (Abacavir/3TC, Kivexa)...of these medicines are nucleoside reverse transcriptase inhibitors (NRTIs). NRTIs block reverse transcriptase, a protein that HIV needs to make more copies of itself. HIV/AIDS-Related Uses Abacavir sulfate and lamivudine are approved... Read more »
An Overview of Epivir (3TC, Lamivudine)...transcriptase inhibitor (NRTI). NRTIs block reverse transcriptase, a protein that HIV needs to make more copies of itself. HIV/AIDS-Related Uses Lamivudine was approved by the FDA on November 17, 1995, for use in combination with other... Read more »
Connect With Others
I am not imagining this but tingling hands/feets!!
Posted by ExWorryWart, 5 Replies...exposure? This is the only symptom that is consistent and not going away.. PLZ HELP I had anxiety disorder earlier but never had tingling (unless during panic attacks)...this one is consistent and burns too...I looked over anxiety forum and that... Read more »
numbness and tingling
Posted by Anonymous, 4 Replies...thought i was the only one with this numbing problem but there seems to be more of this happening,I know you can get it from hiv drugs but as you know ive tested neg at 3 and 4 months.At first i thought it could be from spending so much time on... Read more »
Two Potential Risks at Doctor's Office
Posted by Anonymous, 3 Replies...way to that. I have been to a hand specialist and he really can't pinpoint what's going on in my hands. I was told by an hiv+ person that the tingling associated with hiv starts 4 or 5 years into the illness and primarily starts in the feet... Read more »
Posted by Anonymous, 2 Replies...months now,I woke up this morning and my toes are now going numb and tingling.I was reading that that can be a problem with early hiv infection.As you know i just had my 23 week neg test and was relieved by that.now with this happening with my... Read more »
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Open Phones with Katha Pollitt
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The Bi-College Department of East Asian Languages and Cultures (EALC) links rigorous language training to the study of East Asian, and particularly Chinese and Japanese, culture and society.
In addition to our intensive programs in Chinese and Japanese languages, departmental faculty offer courses in East Asian literature, religion, film, art and visual culture, and social and intellectual history.
Thursday, April 2nd, 2015
4:30PMHank Glassman make-up classHank Glassman make-up class http://www.haverford.edu/calendar/details/264177 Hall 007 2015-04-02T16:30:00 2015-04-02T17:30:00


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Hump through the doorway
We're installing a solid woven bamboo floor in the kitchen/dining room, adjoining hallways, and living room of our 1972 house on a subfloor. We removed engineered wood floors from the kitchen/dining area and hallways. The living room has had carpet for the last 35 years.
The problem is that as we came to the open doorway between the dining room and the living room, we realized there is a hump in the floor as you pass from one room to the other. Checking the hall floor on the same line, there is also a hump there.
Dining room transition to living room (that's a piece of the bamboo):
Hallway along the same line:
The gap you see is 3/8" at most.
This hallway had wood flooring until last week and we never noticed this hump before. Of course, the guy who installed that floor used monster staples and bamboo requires delicate 1-1/4" brad nails.
We're wondering if we scrape away the vinyl, maybe 8" on either side of the hump, and even plane away a bit of the underlying plywood, if we could reduce the the hump sufficiently. Is this even a good idea? Is there a better method?
You could always build up the floor before & after the hump. Using thin pieces of plywood or some kind of under layer.
Maybe just scrape away the vinyl from where the hump is, but leave it in place before/after to give that gradual shimmed transition to the hump.
When we sought to reduce these "humps'...what we did was a combination of reducing the crown by excavating it down and gradually building up the slopes on either side. As the previous poster suggests, we used thin plywood and other materials to do that.
If it was wood before...
You are making the big mistake many make, when checking for 3/16 in 10 feet Teeter totter on the crown, then measure.
You may find you're barely out and the reason you never noticed.
No, you are not going to use 1-1/4 brad nails!!!! Unless you want a very squeaky, creaky and loose floor. If it doesn't fold the brad nail. Strand is hard stuff.
You are either going to glue it down(which may be the only option), or you are going to use 1-1/4 to 1-1/2, 18 gauge cleats, and watch for fastener pimple, because it is so dense.
Thanks all. We've been sidetracked for the moment by the discovery of termites in the baseboard on one wall of the living room. Termites are a fact of life in So. CA, but this was a bit of a surprise as we get inspected every year and missed these. In our defense, we have a fireplace and a toy box on that wall, plus the corner has been hidden behind a treadmill for a while. We took the opportunity to pull out the old hearth seating and brick facing around the fireplace and found termite nirvana in the beam over the fireplace too. Yuck. So the flooring was delayed for a bit while we took care of the termites, but we'll be able to resume this week. I'm looking forward to having a complete floor once again.


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In the Spring of Things Dress in Floral$89.99Price: $89.99
Embody the rejuvenating springtime air by styling yourself in this floral swing dress from Bettie Page! Boasting a bow-tied bust and a bodice cutout - and bedecked in hues of cornflower, vermillion, and teal - this white midi evokes a sense of sunny style.
Le Chic Noir Dress$89.99Price: $89.99
Bring your own dramatic flair to the cabaret in this dazzling LBD! Adorned with a cascading array of sequins and a fringe-trimmed hem, this sassy chiffon frock is the cats meow.
Wing the Blues Dress$89.99Price: $89.99
Hum a soulful tune as you skip along in this charming aqua-blue frock. Featuring a colorful array of butterflies and blossoms, a surplice neckline, and a swingy, pleated skirt, this vintage-inspired A-line brightens any day!
Deco My Golly Dress$99.99Price: $99.99
Exude the uniquely lavish elegance of the 20s in this vintage-inspired, ivory shift dress! Touting a gold-beaded, art-deco-inspired design, a V-neck, and a scalloped hem, this drop-waist frock is a dazzling nod to the pursuit of elegance.
Just Like the Movies Dress in Ruby$79.99Price: $79.99
As the big romantic moment plays, you exhale a swooning sigh and, inspired by the film's glamour, dash off to find this red lace dress. Hugged by its sheath silhouette and surplice neckline, this ruffle-trimmed stunner incites you to explore your own stylish storylines!
Lady Love Song Dress in Diamonds$89.99Price: $89.99
Who wouldn't want to croon a ballad when they see you in this sultry frock? Stunningly satiny, with a crossover sweetheart neckline, a textured pattern, and a silhouette that caresses your figure,this black and white dress is meant to impress.
All I Bead is You Dress$144.99Price: $144.99
The instant you lay eyes on this decadent grey cocktail dress, you know it meets all of your dazzling requirements. Boasting ornate silver beading and a sheer, teardrop-paneled neckline, this sassy sheath is all-around stunning!


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Narrow your search
Technically Incorrect: A prankster troupe invades an Apple store, masquerading as employees. What results is instructive.
Sprint, AT&T and other carriers have lined up with a wide range of pricing options for consumers. Samsung has a lot riding on getting off to a good start.
Exactly how much will Samsung's new smartphones cost? We break it down for you.
With Google's mix-and-match Project Ara handsets, the time is ripe for wacky add-ons to truly customize your phone.
A pair of lawsuits challenge agency's new Internet traffic rules, calling them a violation of federal law.
CNET's Marguerite Reardon takes a look at T-Mobile's new plan to entice wireless customers to jump ship from their existing carriers.
When the two browsers launch along with Windows 10, the future-focused Spartan will have a clear edge over the legacy-minded Internet Explorer 11.
Normally $24.99, this orb-shaped speaker comes in your choice of colors and offers amazing battery life.
Technically Incorrect: A California woman gets a letter from Time Warner Cable, with her first name changed to the C-word.
The world's largest mobile-chips company cut its guidance Wednesday, suggesting that Samsung won't use its latest processor for its next Galaxy S smartphone.


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my early summer garden - photo heavy
here are my garden beds: front yard and back yard. The predominant colours in the front bed is currently blues and pinks. By midsummer many yellows will be coming up.
front view
another view
and another
the backyard
I got more photos but lets start with this.
Oh Janna, I love EVERYTHING. Your gardens look so lush and well-established. I particularly love the very last photo. That is so creative and evokes such feeling. What a wonderful vignette. Thanks for posting these. You did a great job. Please post more!!
Oh, lovely! More details, please?
What are the pink flowers around the purple spires? Is that salvia 'May Night'? Is that gomphrena mixed in? Is that chives in bloom in several clumps along the path?
I can't quite see clearly this early in the morning!
Beautiful. I loved the curved stone walk as well.
thanks ladies. I apologize for not putting in details so here it is.
I practise a form of gardening called meadow gardening. So I put large spikey flowers (evoking grasss and other spikey plants) against daisy or umbrell form planting. And since I dug my bed deep and broke the soil deep, I am able to cram as many plants as possible in such tight spaces. I've hardly any weeds as they are crowded out. However I do have to thin out the plants later in the season.
The spikey blue purple plants are cardona sages. The pink blooms are astrantias - a favorite of mine. I also have pink yarrows there but it's not readily seen in these photos. The tall pink cushion types are knautia macedonia.
The beds are bordered by lavenders - a huge number of them. I've grosso, french and munstead lavenders.
Expected to bloom soon are my russian sages, veronicastrum ,filipendula, phloxes, more yarrows, california poppies, false sunflowers,rudbeckia hirta, rudbeckia goldsturm, coreopsis moonbeam, echinacea, butterfly bushes, and also for the first time ever for me.. verbena bonariensis (can't wait) -- there are more plants but I forget now. I got delphiniums there as well but over the years they've been crowded out and got smaller blooms so I may have to do something about that.
In the backyard -- the house on a log is surrounded by a dwarf joe pye weed, angelica hydrangea and filipendula. Earlier in the year I had primroses and the bugbane blooming there. Later in the season, my rudbeckia goldturm will be blooming in this corner.
Those are knautia macedonia. I have 2 kinds. The light pink/lavender types which are taller and more whispy and the shorter fushia coloured ones.
Cameron - sorry this got left out. Yes those are chives. I've tons of them - all started from one clump. Hated to get rid of them so I started to use them as edging materials.
Very pretty! Thanks so much for posting. I have been curious to see pictures ever since you posted about your black/brown fence. It really does make the foliage pop.
Is the clematis General Sikorski? I love the use of chives. I'm excited for you with the verbena bonariensis! I could only find the dwarf form here. Going to need to winter sow some, I guess.
The black/brown fence actually came out very well. I decided on this early on when I noticed we hadn't had much room in the back and I wanted to hide the ugly fence and to create a perception of depth. So borrowing the idea from inner city gardens here in Toronto, I used it to 'expand' my space. I will post more photos later in the season. My limelight hydrangeas, astilbes, phloxes, lunaria, veronica candelabra are not in bloom yet. The rhododendron and lilac are done though.
I use a trio of clematis sharing the same trellis and the one you are seeing in bloom at this moment I think is a simple Jackmanii. I'm afraid I don't take notice to what kinds I have. The pink clematis is just beginning to bloom. An earlier light pink/white clematis is past bloom.
I started my verbena from seed indoors. that's because I've failed each time I sow them out directly. I think that's because I have a tendency to weed the soil early in the season and may have killed off the seedlings by accident.
Fabulous, Ianna!! I love those purple spikes, and thought they were like my veronica 'Crater Blue Lake' (I think!!) - I'll post a pic later. I love the combos!!
I'd love to see your lavenders when they bloom, and hear how you compare them!! I need some advice as to which would do best for me!! TFS.
Here are more photos of the backyard
hostas at the base of a serviceberry tree
dropsmore honeysuckle
the deck
the pond. It's just a shallow stone pond with a fountain (water spilling out of the pot). This will change dramatically at the end of the season. I'm planning to put in a rectangular modern pond. Keeping my fingers crossed I do it right.
merindah- the garden is now 4 years old. Perennials will mature fast so you would have great results in the following year.


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Hiv Uni-gold Recombigen Test
Here's a taste of what TheBody.com has to offer on this topic:
Ask the Experts
rapid test from Trinity Biotech accurate??I went to get tested at 13 weeks after exposure at a lab and got non reacteve results from a Trinity Biotech product they use all the time. I did some research and found out the folloging:Trinity Biotechs Uni-Gold RecombigenHIV test is approved by...
Response from Robert J. Frascino, M.D.
The Robert James Frascino AIDS Foundation...Hello,You didn't see anything posted about UniGold Recombigen Rapid Tests from Trinity Biotech!? Hmmm . . . I doubt you searched all that hard! But no matter, the information in Read more »
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False Positive? Uni-gold rapid testDr Bob,Thanks for all the work you do; you really are moving the fight forward. I have donated and... Read more »
FDA Approves Trinity Biotech's Uni-Gold Recombigen HIV Test for Use in Doctors' Offices, Clinics... FDA has approved Ireland-based Trinity Biotech 's Uni-Gold Recombigen HIV test for use in almost 200,000 clinics and doctors' offices in the United States, the company on Wednesday announced, Read more »
Gold Mines in Kenyan Community Create Challenges for HIV/AIDS Awareness Efforts, IRIN/ PlusNews Reports... HIV/AIDS awareness messages targeted at the gold mining communities of Nyatike in Kenya's Migori district are having little impact, Tom Rakewa, Migori district's HIV/AIDS officer, Read more »
David Gold Speaks Out on the Need for an HIV Vaccine...vaccine, and hopefully also a cure, and hopefully one that we can afford to distribute around the world." -- Activist David Gold, Editor of the IAVI Report A graduate of Boston University School of Law, David Gold became involved with the... Read more »
AngloGold Signs Pact to Fight AIDS...AngloGold, one of the world's largest mining groups, signed an agreement with five trade unions last week to combat HIV/AIDS in its mines, Read more »
Connect With Others
ConfusedRead more »
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testing questionsRead more »
Resource Centers
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Jeter doubles, now 3 from 3,000, but Yankees lose
Sizemore also made a nice defensive play in the fifth, robbing Nick Swisher of extra bases with a leaping grab at the wall in right-center.
NOTES: Yankees 3B Alex Rodriguez went 2 for 4 and made a diving stop of Santana's sharp grounder with the bases loaded to end the sixth. Rodriguez is hitting .397 (23 of 58) with 10 RBIs since June 18. ... New York had won seven straight series, but lost an outright set in Cleveland for the first time since Aug. 2-4, 2005, when the Indians also took two of three. ... The series drew 102,702, Cleveland's largest three-day weekday total since July 23-25, 2007, vs. Boston. ... The Indians will call up former Yankees minor league RHP Zach McAllister to start Thursday against Toronto. McAllister came over last season in a trade for Austin Kearns, who wound up re-signing with the Indians.
The Associated Press


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Hot For Teacher!
Question, would you miss a day of school if he was your math teacher?
Question, would you miss a day of school if he was your math teacher?
Have we've been lied to this whole time? Was it just an old wives tale?
Some say it's been long overdue, but finally, Justin Bieber gets clowned by some of your favorite rappers and celebrities during the 'Comedy Central Roast' program on Monday night
McDonald's is testing markets to see how an all-day breakfast menu would work. We already say, good idea.
A man who served as an Army combat medic confronted a panhandler for posing as a veteran in military attire after realizing he had never actually served.
Basketball player Lloyd Hickson's goal was to slam dunk over a convertible in a dunk contest—but let's just say he came up a little bit short.
How much trust do you put into your GPS?
Joe Weller is at it again, attacking his girlfriend with brutal WWE moves. This time, WWE Hall Of Famer Jim Ross is on commentary and WWE manager Paul Heyman arrives to address some of the moves Weller is using.
R&B singer Ciara may be a mom now, but that doesn't mean she still isn't deemed sexy. When she revealed the cover art for her new album, Jackie, more than a few folks were intrigued because the stunning beauty happens to be topless on the cover.
At Jay Z's TIDAL press conference this week, Rihanna was caught eyeing Nicki Minaj's breasts. The photo has since turned into a hilarious meme spreading across the internet.
Vin Diesel, he of the bulging biceps, shiny scalp and low vocal register, has been making the press rounds for Furious 7 over the past few weeks. Considering just how crazy his new movie is, he sure has a lot to talk about. But even the unlimited number of potential conversation topics to mined from the insanity of the seventh film in the Fast and Furious saga couldn't stop him from teasing the eighth film in the franchise, which may be set in New York City.
Michael Buble posted a video to his Facebook page of his 19-month-old kid, Noah, dancing to an episode of Mickey Mouse Clubhouse.
Have we've been lied to this whole time? Was it just an old wives tale?
In a new interview, Vanessa Hudgens spoke briefly about the downside of dating Zac Efron.


text:
Humorist's Ohio Home On National Register Of Historic Places
The suburban ranch-style home in Ohio where humor writer Erma Bombeck launched her nationally syndicated column has been added to the National Register of Historic Places.
Listen to the Story
The U.S. Army is considering new rules that would clamp down on tattoos for soldiers, and at least one local tattoo artist fears the new rules could do major damage to the tattoo culture.
The U.S. Army is mulling over the new rules that would restrict such work below the elbows and knees.
"If you're willing to die for me, I'm more than willing to tattoo you, man,†says tattoo artist Joey Knuckles. He's been tattooing for 10 years, but he's been around the business for much longer than that. He grew up watching other artists at work, honing their craft, specializing in classic American folk designs.
Now Knuckles has his own shop, High Street Tattoo in the heart of the popular Short North neighborhood.
He says members of the military were among the first to make tattoos popular in the U.S. and played a major role in developing the culture, especially the Asian-influenced designs.
"You know these guys would travel over there," Knuckles says, "and either get tattooed over there or they would see people with other tattoos or see tattoo imagery or like the beautiful dragons and stuff like that and come back and those with artistic skill would reinterpret those designs and draw them themselves.â€
The new rules would grandfather-in any current soldiers who already have tattoos below the knees and elbows, and service members are reportedly flooding tattoo shops to get one last piece of work done before the rules are finalized.
While that may ramp up business for shops like High Street Tattoo, Knuckles says it's not worth the long-term consequences.
"Me looking at it like 'There's business coming in because guys are getting tattooed more right now because they're not going to be able to get tattooed much' is very short-sided.
"I look at it more as it's almost damaging a culture of proud tattooed soldiers.â€
The new rule is under final review. If approved, the restrictions would go into effect about 60 days later.


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To learn about the living life behind a lens we started series featuring 500px photographers, their photos and stories behind them. This story is about Niko Tavernise's behind the scenes photos of deeply psychological masterwork — the Black Swan film.
Niko Tavernise is a man of many trades. He is entrepreneur, videographer, producer, director and behind-the-scenes photographer. Originally from the mountains of Massachusetts he now resides in NYC, coincidentally the city where the Black Swan was filmed. Niko worked behind the scenes photographing, as well as working on the making-of movie. Please enjoy Niko's photographs, their honesty and elegance.
All photos that Niko Tavernise took during the filming of Black Swan where photographed with his trusty cameras Canon 1D MKII and 5D MKII. For video footage he used a Canon 5D. During all the shoots Niko favoured 28 1.8 lens, in his words "...basically, it was so light and on a full frame 5D it was fantastic. I usually have 3 cameras dangling from my neck so having a light lens is a life saver."Did you know that Natalie Portman danced all of her parts while filming Black Swan? In the movie it is 80% Natalie Portman dancing and 20% her double. There are 139 dance shots in the film. 111 are Natalie Portman untouched and 28 are her dance double Sarah Lane.
To add Niko to friends, comment on his photos and follow his future posts visit his 500px page. If you are captivated by Niko Tavernise's photographs and would like to see more visit his website nikotavernise.com or take a sneak peek at "Metamorphosis" the making-of video by Niko.
Thanks for reading! This could be your feature, email us firstname.lastname@example.com and let us know about one of your photographic stories or future projects.
For artists and creators, copyright is often a challenge because on one hand they want to protect their work and on the other they'd like it to spread.
Now you can do both with Creative Commons licensing attribution. Last week we have added Creative Commons licensing to 500px that gives our photographers more options to let others share and re-use their work. This opt-in program provides the 500px community with greater flexibility on usage, photo attribution and additional sharing opportunities.
Visit 500px Creative Commons licensing page to see the latest photos added to Creative Commons. Search for photos under specific license using 500px Search. Or add a license to your photo and see where it could take you from there.
Would you like to add a license to your 500px photos?
You can change a license of any existing and new photos in the Organizer's photo edit settings or look for the License Type drop down menu when uploading a photo. There are several licenses to chose from, ranging from standard Copyright to Attribution Creative Commons. For a full list and license descriptions read 500px Support article. Licenses can be revised by a photographer at any time.
Creative Commons being part of 500px was just an idea brought up in a conversation during ChaseJarvis LIVE "The Future of Photo Sharing" episode and now it is reality. Let us know in the comments below what other great features you would like to see at 500px.
It's great to watch videos made by photographers as you can witness photographs literally come to life. Last time we shared with you "Scenes From Niceland" by Joe Capra, an Iceland time-lapse shot during 17 day solo trip around the island. Today's featured video is by Guille Ibanez. Two minute view of the hustle and bustle of the Hong Kong's busy city life. Dare to watch the entire video without blinking :)
In our opinion photographers make great videographers. Do you have a video that you'd like to share or you're in a process of planning a shoot? Let us know! Email us email@example.com. We're always open to your ideas and collaborations, and would love to feature you on our blog.
Hi all,
We are excited to announce that 500px has acquired the team behind Pulpfingers — the iOS appmaker company based in Strasbourg, France. Please welcome Jerome Scheer and David Charlec, the founders of Pulpfingers, who have joined 500px today.
With the help of Pulpfingers' technology and expertise we will work to develop and design even more beautiful, useful, and feature-packed apps for 500px. The ISO500 app will remain available in the App Store and users can expect an update that will introduce enhancements as well as support for iPhone 5.
"We're looking forward to continuing our vision and building beautiful, high quality applications for 500px," says Charlec.
"It's a great fit for us because we love photography, we love design, and we love the 500px community," says Scheer. "We're excited about the possibilities now that we're combining forces."
"It's been our intention to increase our presence in Europe and we've been looking for the right opportunity," says Gutsol. "We have huge numbers of photographers in Germany, France and Spain, so a central presence in France makes a lot of sense".
This marks the next step in our company evolution to lead the best online photography apps in the world.
For more details please read Colleen Taylor's latest TechCrunch article.
Today we'd like to introduce you to Markus Studtmann, Berlin based photographer. His urban exploration photos of abandoned interiors immediately catch the eye. Making one wonder if these are really photographs or highly realistic paintings.
Did you know that Markus photographs with Canon 5D Mark II and holds a Ph.D in Psychology? Visit Markus Studtmann's 500px page to see more of his photos, add Markus to friends and follow his future shared photos. Visit Store page to purchase his photographs and browse photos for sale.
Thanks for reading!


text:
PORT OF SPAIN, TRINIDAD - There will be some exciting times ahead for West Indies especially with the establishment of the Caribbean Premier League (CPL) Twenty20 in 2013.
KINGSTON, Jamaica – Jamaica's cricket authorities say they will be looking to use the Trelawny Multi-purpose Stadium for future international matches, as they move to take advantage of the commercial prospects offered by the country's north coast tourism belt.
HOBART, Tasmania – West Indies Twenty20 star Chris Gayle failed again to extend his poor run of form as his Sydney Thunder remained winless in the Australian Big Bash here Saturday.
MELBOURNE, Australia – Despite the presence of several West Indies stars, interest in the Australian Big Bash appears to be waning with television ratings and crowd attendance down from last year, the Melbourne Age has reported.
BRISBANE, AUSTRALIA - Young West Indies and Brisbane Heat firebrand Kemar Roach says he was the "spark" who started Ricky Ponting's long spiral towards retirement.
West Indies Cricket Board Inc.
P.O. Box 616 W, St. John's, Antigua
Tel : 268-481-2450
Fax : 268-481-2498
Email: firstname.lastname@example.com


text:
Quality Hotel Waterfront Alesund
Nedre Strandgate 25-27
Alesund, 6004
Phone: (47) 70 111900
Fax: (47) 70 111910
Entertainment Venues
»Teatret Vårt
Since its inception in 1972, the Teatret Vårt has been treating audiences with exceptional performances. This regional theater is one of the oldest theaters in Norway. For the theater schedule and other details, call ahead.
Julsundvegen 4
Molde, 6412
Earn valuable points toward free nights.


text: Civil Law Jobs 63 were found based on your criteria Post a job. It's free! Newest Jobs First Oldest Jobs First Most Employer Hours Least Employer Hours Most Dollars Paid Least Dollars Paid Highest Feedback Score Lowest Feedback Score 1 2 3 4 5 … › » Need a writer to prepare law-related, encyclopedia-type articles Hourly – More than 6 months – Less than 10 hrs/week – Posted Jan. 18 2015 I'm looking for a writer with experience with, and knowledge of, different legal subjects (e.g., contracts, torts, estate planning, criminal law, constitutional law, etc.) to prepare informative encyclopedia-type articles for me on an on-going basis. article-writing civil-law content-writing corporate-law criminal-law internet-research legal-research legal-writing paralegal Construction Law - French questions Fixed-Price – Est. Budget: $100.00 Posted Sept. 23 2014 I need someone who read and write in French, with a legal background, to write 30 questions with answers related to legal statutes and regulations that it is written in French. Also, 5 legal cases that I will provide you, will have to be summarized (Facts, Issues, Rational and Conclusion). civil-law french legal-writing Searching for Licensed Attorney to assist w/ answering a US District court civil lawsuit Hourly – Less than 1 week – 10-30 hrs/week – Posted Aug. 29 2014 - Seeking timely review of the plaintiff's complaint. - The summons was served to only one of the two parties named in the lawsuit on 08/13/14 and requires an answer to the court filed in 21 days. - Drafting either a motion or answer to the complaint - Identifying ways to request extension. civil-law legal-research legal-writing real-estate-law Legal Research Hourly – Less than 1 month – Less than 10 hrs/week – Posted Aug. 27 2014 Looking for an experienced legal researcher in the field of Statutes of Limitations for mortgage loans in various states in the US. Please reply only if you have specific extensive knowledge in that field. civil-law legal-research LEGAL WRITING Hourly – More than 6 months – 30+ hrs/week – Posted Aug. 15 2014 YOU MUST HAVE some qualifications in Law, and be able to write in fluent English. YOU MUST have Skype and a webcam for a video call. JOB ROLE: You will be researching and reading materials provided. You will be discussing the subject matter. You will be writing legal articles. WARNING! Do not APPLY IF YOU PLAN TO COPY AND PASTE content from other sources it needs to 100% plagiarism FREE content. Please message me with your Skype ID if your ... article-writing civil-law corporate-law criminal-law legal-research legal-writing Marriage Based Immigration Lawyer Needed for affidavit letter for CIS Fixed-Price – Est. Budget: $60.00 Posted Aug. 9 2014 Me and My husband went to the AOS interview yesterday, and we think we didn't clearly answer some of the questions. We need an experienced lawyer to help us draft an affidavit to sent to CIS before they make a decision. The letter should re-enforce our faithfuly marriage and the questions that are raised in the interview. 1. Apartment Lease was signed by wife before decided to getting married. And didn't bring the lease to the interview since ... civil-law Australian Legal Research Hourly – Less than 1 week – Less than 10 hrs/week – Posted Aug. 1 2014 Our company needs a 1 page brief on whether venue owners can be liable for a patron who leaves the premises drunk and then drives a vehicle. The freelancer will be required to: - find relevant Victorian (AUS) legislation that may apply - find any relevant cases anywhere in Australia - find SOME (no more than 3) international cases from Canada, New Zealand or England - summarise the principles in these cases. We will NOT require an in depth analysis of the legislation or ... civil-law internet-research legal-research legal-writing paralegal Draft a contract Fixed-Price – Est. Budget: $100.00 Posted July 21 2014 I need a contract for a web based group-on styled business. We need to make sure we have a non compete agreement, non disclosure agreement and all other legal terms necessary for this styled business. This contract needs to be from our business to our respective vendors. civil-law contract-drafting corporate-law legal-writing Irrevocable Living Trust - United States Hourly – 1 to 3 months – Less than 10 hrs/week – Posted July 21 2014 I am interested in personal asset protection and believe that an Irrevocable Living Trust (IRL) is the right path. I may be wrong about this choice and if you have different advice I appreciate your advice. If you agree that an IRL is the best choice, then please specify how many IRL in the United States you have done. Thanks. civil-law Need assistance with Research and Drafting an amended complaint and dismissal in California Superior Court Fixed-Price – Est. Budget: $100.00 Posted July 11 2014 I filed a complaint in California Superior Court. Two defendants answered and I would like to reject their answer and file an amended complaint. Want someone well versed or able to research California Litigation Law and respond. Please see price before RESPONDING and also please state how long you need to complete once hired and your experience in this area. civil-law corporate-law legal-research legal-writing


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Page 1
RESEARCH ARTICLEOpen Access
Can treatment with Cocculine improve the
control of chemotherapy-induced emesis in
early breast cancer patients? A randomized,
multi-centered, double-blind, placebo-controlled
Phase III trial
David Pérol1, Jocelyne Provençal2, Anne-claire Hardy-Bessard3, David Coeffic4, Jean-Phillipe Jacquin5,
Cécile Agostini6, Thomas Bachelot1, Jean-Paul Guastalla1, Xavier Pivot7, Jean-Pierre Martin8, Agathe Bajard1
and Isabelle Ray-Coquard1,9*
Background: Chemotherapy induced nausea and vomiting (CINV) remains a major problem that seriously impairs
the quality of life (QoL) in cancer patients receiving chemotherapy regimens. Complementary medicines, including
homeopathy, are used by many patients with cancer, usually alongside with conventional treatment. A randomized,
placebo-controlled Phase III study was conducted to evaluate the efficacy of a complex homeopathic
medicine, Cocculine, in the control of CINV in non-metastatic breast cancer patients treated by standard
chemotherapy regimens.
Methods: Chemotherapy-naïve patients with non-metastatic breast cancer scheduled to receive 6 cycles of
chemotherapy including at least three initial cycles of FAC 50, FEC 100 or TAC were randomized to receive standard
anti-emetic treatment plus either a complex homeopathic remedy (Cocculine, registered in France for treatment of
nausea and travel sickness) or the matching placebo (NCT00409071 clinicaltrials.gov). The primary endpoint was
nausea score measured after the 1stchemotherapy course using the FLIE questionnaire (Functional Living Index for
Emesis) with 5-day recall. Secondary endpoints were: vomiting measured by the FLIE score, nausea and vomiting
measured by patient self-evaluation (EVA) and investigator recording (NCI-CTC AE V3.0) and treatment compliance.
Results: From September 2005 to January 2008, 431 patients were randomized: 214 to Cocculine (C) and 217 to
placebo (P). Patient characteristics were well-balanced between the 2 arms. Overall, compliance to study treatments
was excellent and similar between the 2 arms. A total of 205 patients (50.9%; 103 patients in the placebo and 102
in the homeopathy arms) had nausea FLIE scores > 6 indicative of no impact of nausea on quality of life during the
1stchemotherapy course. There was no difference between the 2 arms when primary endpoint analysis was
performed by chemotherapy stratum; or in the subgroup of patients with susceptibility to nausea and vomiting
before inclusion. In addition, nausea, vomiting and global emesis FLIE scores were not statistically different at any
time between the two study arms. The frequencies of severe (Grade ≥ 2) nausea and vomiting were low in our
study (nausea: P: 17.6% vs C: 15.7%, p=0.62; vomiting: P: 10.8% vs C: 12.0%, p=0.72 during the first course).
(Continued on next page)
* Correspondence: firstname.lastname@example.com
1Centre Léon Bérard, 28 rue Laennec, Lyon Cedex 08 69373, France
9Centre Léon Bérard, 28 rue Laennec, Lyon 69008, France
Full list of author information is available at the end of the article
© 2012 Pérol et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Pérol et al. BMC Cancer 2012, 12:603
Page 2
(Continued from previous page)
Conclusion: This double-blinded, placebo-controlled, randomised Phase III study showed that adding a complex
homeopathic medicine (Cocculine) to standard anti-emetic prophylaxis does not improve the control of CINV in
early breast cancer patients.
Keywords: Early breast cancer, Adjuvant chemotherapy, Homeopathy, Nausea and vomiting, Quality of life
Chemotherapy induced nausea and vomiting (CINV) are
among the most severe and feared collateral effects
of chemotherapy [1-3] associated with a significant
deterioration in quality of life (QoL) and patients' ability
to carry out daily activities [4,5]. Poor QoL can influence
the patient's willingness to continue with and suc-
cessfully complete cancer treatment. Therefore, it is
essential to prevent and treat these side effects optimal-
compliance [5,6].
Over the past few years, selective serotonin type 3 re-
ceptor (5-HT3) antagonists and the neurokinin-1 (NK-1)
antagonist aprepitant have substantially improved the
management of acute CINV (occurring within 24 hours
of chemotherapy) and to a lesser extent delayed
CINV (occurring more than 24 hours post-chemother-
apy) [7-12]. Nevertheless, 75% percent of patients with
nausea and 50% of those with vomiting reported a nega-
tive impact on the performance of daily living activities
when queried with the Functional Living Index–Emesis
(FLIE) questionnaire despite modern prophylactic anti-
emetic treatment [13]. To date, CINV remains a signifi-
cant problem contributing to patient withdrawal from
potentially curative chemotherapy [5,8-10].
In an attempt to alleviate collateral effects of cancer
therapies, complementary and alternative medicines are
increasingly used by cancer patients [14,15]. In an Euro-
pean survey, 35.9% of cancer patients have reported
using some form of complementary or alternative medi-
cines (CAM) to reduce cancer treatment-related adverse
events (AEs) [15]. Homeopathy was in the top five of the
most commonly used CAM in 7 out of 14 European
countries [15]. Overall, homeopathic approaches are
used by cancer patients to alleviate their pain resulting
from the disease itself or from conventional anti-cancer
treatment [15]. Homeopathic medicines efficacy have
been studied in the treatment of adverse effects of radio-
therapy and chemotherapy in breast cancer patients.
However, large, randomized, placebo-controlled trials
with powered statistical analysis are needed to generate
evidence-based data on the value of complementary
Different homeopathic practices coexist: the "classical"
or "individualised" homeopathy using single homeopathic
medicine that is prescribed according to the individual's
toencourage patient
condition and history, (ii) the "clinical" homeopathy that
uses the same homeopathic medicine for a group of
patients with the same disease and (iii) the "complex"
homeopathy that uses more than one homeopathic medi-
cine, in a fixed combination or concurrently, for a particu-
lar condition. Cocculine is a homeopathic medicinal
product registered in France for treatment of nausea and
travel sickness composed of 4 homeopathic components
(Cocculus indicus 4 CH, Tabacum 4 CH, Nux vomica 4
CH, Petroleum 4 CH produced by Boiron, France, accord-
ing to European Pharmacopoeia). A recent study has
demonstrated that Cocculine has a potential interest for
the management of CINV with a 30% reduction of nausea
under Cocculine treatment compared to placebo in breast
cancer patients treated by chemotherapy (overall n=80: in-
cidence of nausea 61.5% in Cocculine arm versus 87.5%
with placebo [16]). The main objective of the present
study was to evaluate if this complex homoepathic medi-
cine can improve the control of CINV in non-metastatic
breast cancer patients in a large, randomized, multicenter
Phase III trial.
adults with non metastatic, histologically proven breast
cancer and an Eastern Cooperative Oncology Group
performance status (ECOG PS) of ≤ 2, scheduled to re-
ceive 6 cycles of standard adjuvant chemotherapy. The
first 3 cycles were required to be FAC50 (5-Fluoruracil
500 mg/m [2] + adriamycin [doxorubicin] 50 mg/m [2] +
cyclophosphamide 500 mg/m [2]), FEC100 (5-Fluoruracil
500 mg/m [2] + epirubicin 100 mg/m [2] + cyclophosphamide
500 mg/m [2]) or TAC (Taxotere [Docetaxel] 75 mg/m
[2] + adriamycine 50 mg/m [2] + cyclophosphamide
500 mg/m [2]). Patients with previous malignancies (ex-
cept those in complete remission for more than 5 years),
contraindications to corticoids or 5-HT3 receptor
antagonists, or prior treatment with Cocculine or other
anti-emetics within the previous 15 days were ineligible.
Pregnant or lactating patients, those who could not be
followed up for social, geographical, familial or psycho-
logical reasons or unavailability by phone were also
excluded. The protocol was approved by a French eth-
ical committee (CPP Sud Est IV) and registered with
Pérol et al. BMC Cancer 2012, 12:603
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Page 3
clinicaltrials.gov as NCT00409071. All included patients
have signed an inform consent form before study entry.
Randomisation and blinding
Randomisation was conducted centrally via a computer-
generated system, using permuted blocks of four
patients (the Jadad/Oxford score was ≥ 3/5). Patients
were stratified by participating centre and type of
chemotherapy regimen (FAC50 or FEC100 versus TAC).
Allocation list was generated by the study statistician be-
fore the beginning of the study. Investigators asked the
coordinating center by fax for a treatment allocation
number. Both investigator and patient remained blind to
the assignment of individuals to either active treatment
or placebo throughout the study.
Study treatments
The trial used a randomized, multicenter, double blind
phase III design in which patients were randomly
assigned to receive placebo or Cocculine (CocculineW,
Boiron- France) plus standard anti emetic treatment.
Cocculine is a complex of four active elements incorpo-
rated in the same tablets. The placebo tablets were iden-
tical seemingly in the active tablets (packaging, colour,
shape...). The placebo tablets were inert and contained
only (Saccharose (75%), lactose (24%), and Magnesium
stearate (1%)) without any homeopathic components. All
patients received a box containing six * two blister packs
of ten tablets corresponding to the treatment number
allocated at randomisation (Cocculine or matching pla-
cebo). Patients had to return boxes and tablet blisters to
the investigator at the end of treatment. Two tablets
were to be taken in the evening before chemotherapy, 6
on the day of chemotherapy and 4 tablets the next day
(see Table 1). A standard anti-emetic treatment was
given to patient: ondansetron 8 mg (or granisetron 3 mg
in case of intolerance to ondansetron) and methylpredi-
nosolone 80 mg. While this trial was being conducted,
consensus guidelines were updated to recommend the
use of a three-drug combination of steroids plus 5-HT3
receptor antagonist plus the NK-1 receptor antagonist
aprepitant [7,17]. At the time of patient enrolment, apre-
pitant was not recommended and so was not used dur-
ing the study. The study flow chart is presented in
Table 1.
The primary objective was to evaluate the efficacy of
Cocculine versus Placebo when added to conventional
corticoid plus setron prophylaxis in the control of
chemotherapy-induced nausea during the 1stcycle of
chemotherapy. The secondary objectives were to evalu-
ate the efficacy of Cocculine during the 2ndand 3rd
cycles, the contribution of Cocculine in the treatment of
nausea and vomiting, and compliance to Cocculine
treatment. To evaluate the impact of homeopathy rem-
edy in the control of CINV based on patients' assess-
ment: a self-assessment booklet composed of the FLIE
questionnaire [18,19] and a specific diary were given to
patients. In addition, CINV were also evaluated based
on investigators' assessment using the CTCAE V3.0
grading scale.
The self–administered FLIE questionnaire is composed
of two dimensions (nausea and vomiting) each with 9
items. Each item consists of a horizontal Visual Ana-
logical Scale (VAS) of 100 mm graduated from 1 (a lot)
to 7 (not at all). The first question in each domain asks
the patient to rate how much nausea or vomiting she
has experienced over the past 5 days. The remaining
eight questions specifically address the impact of CINV
on daily activities (i.e. physical abilities, social and emo-
tional function) [18,19]. No or minimal impact on daily
life was defined as an average FLIE item score > 6.
Patients completed the FLIE questionnaire on Day 6 of
the first 3 chemotherapy cycles.
Patients were also provided with a daily diary to rec-
ord i) intake of study drug ii) the occurrence and inten-
sity of nausea during the first 24 hours and over days 2
to 5 following chemotherapy and the number of vomit-
ing episodes, and iii) use of any rescue antiemetic medi-
cations. All patients were contacted by telephone on the
day before the start of chemotherapy and (if they
Table 1 Study flow-chart (per chemotherapy cycle)
Day-1Day 1Day 2Day3Day4Day 5Day 6
Tablets of Cocculine or placebo EveningMorningNoonEveningMorningNoon EveningMorning
Antiemetic treatment2
Phone callX*XX**
FLIE questionnaire
Patients diaryX
Po: per os; IV: intraverious; P: Prednisolone; M: Methyprednisolone; S: Ondansetron.
1: 60 mg po (TAC only);2: 8 mg IV;3: 60mg IV;4: 8 mg po; *: all patients; **: on patients' request.
Pérol et al. BMC Cancer 2012, 12:603
Page 3 of 9
Page 4
requested this) on day 5 of the first cycle to ensure that
the diary and FLIE questionnaire had been completed
accurately. In addition, the incidence and severity of AEs
(NCI-CTCAE v3.0, ctep.cancer.gov/protocolDevelopment/
vomiting were recorded by the investigator at the end
of each chemotherapy cycle. Data were collected until
either the cessation of chemotherapy or the administra-
tion of a maximum of 6 cycles of treatment.
including nauseaand
Statistical analysis
The study was powered to detect a 0.5 point difference
between treatment arms in the FLIE nausea score after
the 1stCT cycle. Accepting a two-sided type I error of
5% and a type II error of 15%, 198 patients were
required per group. The statistical analysis was per-
formed by intent-to-treat.
The primary endpoint was the mean of 9 first FLIE
items (at least 5 out of 9 items had to be completed).
Scores were compared between the two arms using the
non parametric Mann–Whitney U test. The number of
patients with a mean score > 6 versus the number of
patients with a mean score ≤ 6 were compared using
Fisher's exact test.
The emesis score after the 1st, 2ndand 3rdchemother-
apy cycles and the nausea score after the 2ndand 3rd
chemotherapy cycles were calculated in order to evaluate
the efficacy of Cocculine over the first 3 CT cycles.
Vomiting frequency reported on the VAS during the
1st, 2ndand 3rdCT courses was compared between the
two arms by a Pearson's chi-square test (or a Fisher's
exact test, if appropriate).
Compliance was compared between the 2 arms using
the diary and by counting the amount of drug that
remained in its packaging. AEs were compared between
the two arms over the 6-cycle period with particular at-
tention to nausea or vomiting.
All analyses were performed using the SAS software,
version 9.1 (SAS Institute, Cary, NC).
Assignment of patients and treatment compliance
From September 2005 to January 2008, 431 non meta-
static breast cancer patients were enrolled in 8 centres;
214 patients were randomly assigned to Cocculine (C)
and 217 to placebo (Figure 1). A total of 266 patients
(61.7%) were in the FAC/FEC stratum and 165 (38.3%)
in the TAC stratum. Major patient characteristics
at baseline are detailed in Table 2. The two arms
were well-balanced, with no statistically significant dif-
ferences between them. Median age was 52.8 years
(range 20–74); 237 patients (55.6%) were T1 a-b-c and
258 patients (60.6%) were pN+; and 35.3% of the
patients had susceptibility to nausea or vomiting. Treat-
ment compliance as estimated using patient diary and
tablet count was largely acceptable: according to the
diary, 71% of patients had taken the study drug per
protocol, and this figure was 81% according to the count
of remaining tablets (data not shown). Compliance was
similar between arms. A total of 263 patients (63.2%)
had taken standard anti-emetic treatment per protocol
during cycle 1. A total of 384 patients (90.8%) had
received chemotherapy for the entire study period but
146 patients (34.5%) had to delay CT (mainly due to
haematological toxicity) and 34 patients (8.0%) had at
214 assigned to Cocculine group
213 received Cocculine as allocated
1 received Placebo (dispensation mistake)
217 assigned to Placebo group
217 received Placebo as allocated
15 patients were non evaluable
15questionnaires not received
431 patients were included between September,2005 to
January 2008 and underwent randomisation
202 included in primary endpoint analysis
per ITT
201 included in primary endpoint analysis per
13 patients were non evaluable
13 questionnaires not received
Figure 1 CONSORT diagram.
Pérol et al. BMC Cancer 2012, 12:603
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Page 5
least one dose reduction over the 6-cycle period. The
number of delays and/or dose reductions was similar
between the two arms (data not shown). There was no
impact of Cocculine treatment on compliance to chemo-
therapy regimen. Of note, there was no statistical differ-
ence in the use of concomitant anti-emetic rescue
medication between the 2 study arms at any time during
the study period (data not shown).
CINV assessed by patients using FLIE scores [Table 3] or
daily diaries [Table 4]
In total, 403 of 431 patients (93.5%) were assessable
for the primary endpoint (FLIE nausea score during 1st
CT course): 28 patients were non evaluable, 15 in the
placebo and 13 in the Cocculine arms (Table 3). Non-
assessable patients were accounted for 7 who withdrew
consent, 17 from whom
received, and 4 who returned questionnaires that were
not evaluable.
Using the FLIE questionnaire, nausea scores after the
1stchemotherapy cycle were 6.02 and 6.07 for placebo
and Cocculine arms, respectively (p = 0.84). A total
of 205 patients (50.9%; 103 patients in the placebo and
102 in the Cocculine arms) had scores > 6 indicative of
no impact of nausea on quality of life. FLIE analysis
results are reported in Table 3. There was no difference
between the 2 arms when analysis was performed by
chemotherapy stratum; and there was no difference in
the subgroup of patients with known susceptibility to
nausea and vomiting (Table 3).
questionnaires were not
Nausea, vomiting and global emesis FLIE scores were
not statistically different at any time between the two
arms (data not shown).
Based on daily diaries, the intensity of nausea reported
by patients over the first 3 cycles of chemotherapy was
very low (median nausea severity: 1stcycle: 0.56 [P] vs.
0.58 [C], p = 0.61 [Table 4]; 2ndcycle: 0.52 [P] vs. 0.60
[C], p=0.36; and 3rdcycle: 0.93 [P] vs. 0.40 [C]; p=0.45,
data not shown) with no significant difference between
the two arms. Patient had few vomiting episodes of low
intensity (medians were 0 for the 3 cycles). More
patients reported vomiting episodes during the 3rdCT
course in the placebo (34.2%) than in the Cocculine
arms (23.4%), p = 0.03 (data not shown). However, these
observations were not maintained over the 4, 5 and 6th
cycles of CT and had no impact on FLIE vomiting score.
CINV assessed by investigators (NCI –CTCAE V3.0 grading)
Based oninvestigators assessments
V3.0, nausea occurred in 51.1% versus 47.4% of the
patients treated with placebo and Cocculine respectively
(p = 0.48) during the 1stCT cycle (Table 5), in 42.3%
(P) versus 48.9% (C) (p = 0.21) during the 2ndCT cycle;
and in 43.2% (P) versus 45.8% (C) (p = 0.63) during the
3rdCT cycle (data not shown). No significant differences
were noted during cycles 4 to 6.
Frequency of vomiting was also similar between the 2
arms: 19.7% versus 21.1% (p = 0.72) for Placebo and
Cocculine respectively during the 1stCT cycle (Table 5);
Table 2 Patient characteristic
Patient characteristicsPlaceboCocculineAll patientsp
Age, years 0.56*
Median (min-max) 52.8 (20–74) 53.3 (30–74)52.8 (20–74)
Delay from surgery (days)
Median (min-max)27.50 (4.00–70.0)27.0 (1.0–72.0)27.0 (1.0–72.0)0.90*
ECOG Performance Status
n = 197n = 198n = 3950.64†
0, n (%)
177 (89.8) 175 (88.4)352 (89.1)
1, n (%)
20 (10.2)23 (11.6) 43 (10.9)
Nausea and vomiting susceptibility
n = 188n = 189 n = 3770.47†
Yes n (%)
63 (33.5)70 (37.0)133 (35.3)
pT grade
n = 215n = 211n = 4261.00††
T1 a-b-c, n(%)
119 (55.3)118 (55.9) 237 (55.6)
T2, n(%)
87 (40.5)85 (40.3)172 (40.4)
T3, n(%)
7 (3.3)7 (3.3) 14 (3.3)
T4, n(%)
2 (0.9) 1 (0.5)3 (0.7)
pN grade
n = 213n = 213n = 4260.84†
N-, n(%)
85 (39.9)83 (39.0)168 (39.4)
N+, n(%)
128 (60.1) 130 (61.0)258 (60.6)
*: Mann–Whitney U test; † : Person's chi-square test; †† : Fischer test.
Pérol et al. BMC Cancer 2012, 12:603
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13.7% (P) versus 15.2% (C) (p = 0.7) during the 2ndCT
cycle; and 22.2 (P) versus 16.9% (C) (p = 0.22) during
the 3rdCT cycle (data not shown). The incidence of se-
vere nausea and vomiting (i.e. Grade ≥ 2) reported by
the investigators during the 1stCT cycle was also similar
between the 2 treatment groups (Table 5): severe nausea
occurred in 17.6% versus 15.7% of patients receiving Pla-
cebo versus Cocculine (p = 0.62) and severe vomiting in
10.8% versus 12.0% of patients receiving Placebo versus
Cocculine (p = 0.72).
Four serious adverse events (SAEs), including 1 cuta-
neous papular eruption, 2 cases of anxiety/depression
syndrome and 1 cholecystectomy for biliary colic, were
reported but none were related to Cocculine. The overall
incidence of AE (any type any grade) was similar be-
tween the 2 arms.
This study evaluates the potential clinical benefit of a
complex homeopathic medicine for the control of CINV
Table 3 Impact of nausea on quality of life during cycle 1 of chemotherapy: nausea dimension of the FLIE score in ITT
Placebo CocculineAll patientsp
All patients
n=217 n=214n=431
missing data**1513 28
number of patients evaluable202201 403
Median nausea Score (Min-Max) 6.02 (1.11 – 7) 6.07 (1.22 – 7)6.02 (1.11 – 7)
Mean ± sd 5.43 ± 1.57 5.45 ± 1.575.44 ± 1.57
Patients with no impact of nausea on daily life (i.e. a median score > 6), n (%) 103 (51.0)102 (50.7)205 (50.9)0.96†
Stratum FAC-FEC
n=135n=131 n=266
missing data **9716
number of patients evaluable 126124250
Median nausea score (min-max) 5.93 (1.11–7)6.08 (1.65–7)6.03 (1.11–7)0.69*
Mean ± sd5.37 (1.66)5.48 (1.52)5.42 (1.49)
Patients with no impact of nausea on daily life (i.e. mean score > 6), n (%)63 (50.0)63 (50.8) 126 (50.4) 0.90†
Stratum TAC
missing data**6612
number of patients evaluable
Median nausea score (min-max) 6.07 (1.90-7)6.02 (1.22-7)
Mean ± sd5.54 (1.43)5.39 (1.66) 5.47 (1.55)
Patients with no impact of nausea on daily life (i.e. mean score > 6), n (%)40 (52.6)39 (50.6)79 (51.6)0.81†
Patients with susceptibility to NV (Yes)
missing data**246
number of patients evaluable5962121
Median nausea score (min-max)5.85 (1.11–7)5.81 (1.22–7)5.83 (1.11–7)0.36*
Mean ± sd5.29 (1.66)5.04 (1.71)5.16 (1.69)
Patients with no impact of nausea on daily life (i.e. mean score > 6), n (%)30 (49.2)28 (42.4)58 (45.7) 0.45†
*: Mann–Whitney U test †: Person's chi-square test.
**: missing data i.e. number of patients with more than 5 missing items in the FLIE questionnaire.
n: number of patients.
Pérol et al. BMC Cancer 2012, 12:603
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Page 7
in a large homogenous randomized population of early
breast cancer patients receiving uniform protocols of
chemotherapy. Overall, adding thiscomplex homeopathic
medicine to standard anti-emetic regimen did not im-
prove the control of CINV in early breast cancer
patients under chemotherapy regimen. FLIE nausea
scores after the first chemotherapy course were 6.02 and
6.07 for placebo and Cocculine arms, respectively (p =
0.84, Table 3).
Our study was initially performed to confirm the effi-
cacy of Cocculine in control of CINV in early breast
cancer patients as reported by Genre et al., [16]. How-
ever, our data showed no superiority of Cocculine over
placebo. Several aspects of methodology may explain
this discrepancy. Firstly, Genre et al. performed a small,
single-centre study whereas more than 400 patients were
enrolled in our multi-center clinical trial. Secondly, our
prospective investigation was based on the FLIE score
derived from a validated 18-item, patient-reported ques-
tionnaire. As CINV is frequently underestimated by
caregivers, the FLIE questionnaire is an essential and
better patient-reported tool to assess the functional im-
pact of CT on patients' daily lives. Relevant to our nega-
tive results, it should be noted that in the current study
the percentage of patients with no or minimal impact of
CINV on their daily life was particularly high (51% of
patients in both placebo and Cocculine arms) and the
incidence of severe nausea and vomiting were low (nau-
sea: 17.6-15.7%, and vomiting 10.8-12%, Table 5). In con-
trast, Genre et al. have reported that 87.5% of patients
enrolled in placebo arm have experienced nausea epi-
sodes during the first cycle of chemotherapy [16]. Of
note, the emetyogenic properties of the chemotherapy
Table 4 Patient self -evaluation of nausea and vomiting
during the 1stCT cycle (ITT population)
n = 217
n = 214
All patients
n = 431
Nausea frequency
missing data161935
number of patients
201 195396
Number of patients
with at least 1 episode
of nausea, n (%)
164 (81.6) 155 (79.5) 319 (80.6)
Nausea severity
missing data16 1935
number of patients
201 195396
Median (min-max)0.56 (0–8.5) 0.58 (0–8.3) 0.56 (0–8.5)
Vomiting frequency
missing data311950
number of patients
Number of patients
with at least 1 episode
of vomiting, n (%)
51 (27.4)42 (24.7) 93 (26.1)
Vomiting severity
missing data 2225 47
number of patients
Median (min-max) 0.00 (0–7.60) 0.00 (0–5.0) 0.00 (0–7.60)
*: Mann–Whitney U test †: Person's chi-square test.
Table 5 Frequency of nausea and vomiting AEs during 1stcycle of chemotherapy
Frequency of nausea and vomiting AE (all grade) during 1stcycle of chemotherapy
Placebo n = 217CocculineWn = 214All n = 431p †
Missing data392059
Number of patients evaluable178194372
Number of patient with at least 1 AE nausea (%)91 (51.1)92 (47.4)83 (49.2)0.48
Missing data392059
Number of patients evaluable178194372
Number of patient with at least 1 AE vomiting, n (%)
Frequency of severe nausea and vomiting AE (Grade ≥ 2) during 1stcycle of chemotherapy
35 (19.7)41 (21.1)76 (20.4)0.72
Placebo n = 217Cocculine n = 214All n = 431p †
Missing data472976
Number of patients evaluable, n
Number of patient with at least 1 severe nausea AE (i.e. Grade ≥2), n (%)
30 (17.6)29 (15.7)59 (16.6)0.62
Missing data412263
Number of patients evaluable
Number of patient with at least 1 severe vomiting AE (i.e. Grade ≥ 2), n (%)
19 (10.8)23 (12.0)42 (11.4)0.72
†Person's chi-square test.
Pérol et al. BMC Cancer 2012, 12:603
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used in our study as well as the standard anti-emetic
treatment were similar. For additional comparison, the
prevalence of CINV in previously reported clinical trials
was around 65% (depending on chemotherapy regimen,
and/or anti-emetic treatment used) [10,12,13]. Of note,
one limitation of our study is the absence of data collec-
tion related to patients' belief as to group allocation (Coc-
culine or placebo), patient's belief of homeopathy efficacy,
comfort of homeopathy, pre-existing anxiety, history of
alcohol consumption. Therefore, no comparison between
groups for such patient-related factors, which may have
influenced the development of CINV, was performed.
Considering that patients' expectancies are largely
influenced by the attention and information they
received from clinicians, and are predictors, and, likely,
contributing factors to the development of treatment-
related emesis [20,21], we have followed 34 breast cancer
patients during their 1stcycle of chemotherapy (FAC50,
FEC100 or TAC) in a post-study cohort. In contrast to
patients enrolled in our Phase III, these patients were
requested to complete a FLIE questionnaire without a
recall on Day 5. Interestingly, at the end of the 1stcycle,
the proportion of patients with no or minimal impact of
nausea on QoL (FLIE score >6) in this post-study cohort
was only 31% (data not shown) versus 51 % in our Phase
III population. Therefore, it is possible that extra atten-
tion provided to the patients enrolled in this study (i.e.
with 5-day recall) may have change their perception of
may be beneficial in terms of the occurrence and inten-
sity of treatment-related side effects [6,22].
Our study has evaluated the effect of a complex
homeopathic medicine in a large randomized study. This
strategy was chosen for the following reasons: (i) first of
all, the management of side effects related to conven-
tional treatment need to be integrated in the routine of
daily clinical practice thus not allowing time-consuming
individual homeopathic prescription, (ii) secondly, the
use of homeopathy with an individualized remedy is ex-
pensive and required the implication of the same experi-
encedhomeopaththat is
multicenter trial and (iii) finally, individualized prescrip-
tion is not easily compatible with double-blind rando-
mized trials [23].
Although controversial, homeopathy is increasingly
used worldwide as a complementary medicine and has
been largely investigated in clinical trials [24-27]. How-
ever, no definitive conclusions can be drawn due to the
low methodological quality of clinical trials, the small
number of patients involved, lack of replication and pre-
sumed publication bias [28]. More and higher quality
clinical trials, unbiased by belief or disbelief in the prin-
ciples of homeopathy, need to be performed to assess
the potential effect of such alternative medicines in con-
trolling the side effects of cancer treatment [29].
difficult to setupin
In conclusion, this double-blinded, placebo-controlled,
randomised Phase III study showed that adding a com-
plex homeopathic treatment to standard anti-emetic
prophylaxis does not improve the control of CINV in
early breast cancer patients.
Competing interests
The authors declare that they have no competing interests. The study
was partially funded by Boiron laboratories. The study treatments
(Cocculine and placebo) were also provided by Boiron Laboratories.
However, no representative from the funding sources participated at any
stage of the trial, from either design to publication.
Authors' contributions
JP, AC H-B, TB; DC, J-P J, J-P G, CA, XP, IRC recruited and treated patients. DP,
AB and IRC contributed to the design of the trial. DP and AB did the
statistical analysis of the trial. All authors reviewed the manuscript before
submission. All authors read and approved the final manuscript.
We thank Nathalie Girerd-Chambaz, Aurélie Belleville for the monitoring of
the study, Giovanna Barone for the coordination, and all clinical research
associates from investigator sites (Julien Gautier, Thierry Hardy, Nadine
Cadoux, Véronique Alcalay and Séverine Marchand).
We are grateful to all investigators (Drs Thomas Bachelot, Jean-Paul Guastalla,
Paul Rebattu, Laura Zufferey, Jocelyne Provençal, Laetitia Stephani, Xavier
Pivot, Cristian Villanueva, Cécile Agostini, David Coeffic, Claire Garnier, Cécile
Leyronnas, Anne-claire Hardy-Bessard, Dominique Besson, Jean-Pierre
Jacquin, Dominique Mille and Jean-Pierre Martin) and to all patients whose
participation made this study possible.
We thank Boiron France for providing homeopathy and Naoual Boujedaini
for fruitful scientific collaboration.
Author details
1Centre Léon Bérard, 28 rue Laennec, Lyon Cedex 08 69373, France.2Centre
hospitalier de la région d'Annecy, 1 avenue de l'hôpital, Annecy BP90074,
74374, France.3Clinique armoricaine de Radiologie, 21 rue du Vieux
Séminaire, Saint Brieuc 22 000, France.4UMGEC, Service Institut Daniel
Hollard, 12 Rue Docteur Calmette, Grenoble 38028, France.5Institut de
cancérologie de la Loire, 108, avenue Albert-Raimond, Saint-Priest-en-Jarez
42270, France.6Centre hospitalier Général, Chambéry BP1125, 73011, France.
7Centre Hospitalier Universitaire, Boulevard Fleming, Besançon 25030, France.
8Hôpital Jean Mermoz, 55 avenue Jean Mermoz, Lyon 69008, France.9Centre
Léon Bérard, 28 rue Laennec, Lyon 69008, France.
Received: 11 May 2012 Accepted: 5 December 2012
Published: 17 December 2012
1.Coleman MP: Trends in breast cancer incidence, survival, and mortality.
Lancet 2000, 356(9229):590–591.
2. Glaus A, Fah B, Hornung R, Senn H, Stiefel F: [Breast cancer prevention
behaviour: a perspective of women from three language regions of
Switzerland]. Pflege 2004, 17(6):385–394.
3.Lohr L: Chemotherapy-induced nausea and vomiting. Cancer J 2008,
4.Gralla RJ, Kris MG, Tyson LB, Clark RA: Controlling emesis in patients
receiving cancer chemotherapy. Recent Results Cancer Res 1988,
5.Rusthoven JJ, Osoba D, Butts CA, Yelle L, Findlay H, Grenville A: The impact
of postchemotherapy nausea and vomiting on quality of life after
moderately emetogenic chemotherapy. Support Care Cancer 1998,
6.Bernhard J, Maibach R, Thurlimann B, Sessa C, Aapro MS: Patients'
estimation of overall treatment burden: why not ask the obvious?
J Clin Oncol 2002, 20(1):65–72.
7.Grunberg SM, Rolski J, Strausz J, et al: Efficacy and safety of casopitant
mesylate, a neurokinin 1 (NK1)-receptor antagonist, in prevention of
chemotherapy-induced nausea and vomiting in patients receiving
Pérol et al. BMC Cancer 2012, 12:603
Page 8 of 9
Page 9
cisplatin-based highly emetogenic chemotherapy: a randomised,
double-blind, placebo-controlled trial. Lancet Oncol 2009,
Borjeson S, Hursti TJ, Tishelman C, Peterson C, Steineck G: Treatment of
nausea and emesis during cancer chemotherapy. Discrepancies
between antiemetic effect and well-being. J Pain Symptom Manage 2002,
Grunberg SM, Osoba D, Hesketh PJ, et al: Evaluation of new antiemetic
agents and definition of antineoplastic agent emetogenicity–an update.
Support Care Cancer 2005, 13(2):80–84.
Kris MG, Hesketh PJ, Herrstedt J, et al: Consensus proposals for the
prevention of acute and delayed vomiting and nausea following
high-emetic-risk chemotherapy. Support Care Cancer 2005,
Feyer P, Jordan K: Update and new trends in antiemetic therapy: the
continuing need for novel therapies. Ann Oncol 2011,
Roila F, Herrstedt J, Aapro M, et al: Guideline update for MASCC and
ESMO in the prevention of chemotherapy- and radiotherapy-induced
nausea and vomiting: results of the Perugia consensus conference.
Ann Oncol 2010, 21(Suppl 5):v232–v243.
Glaus A, Knipping C, Morant R, et al: Chemotherapy-induced nausea and
vomiting in routine practice: a European perspective. Support Care Cancer
2004, 12(10):708–715.
Ernst E, Cohen L, Gerner J, et al: 'Alternative cancer cures': looking for
common ground. Lancet Oncol 2000, 1(1):54–59.
Molassiotis A, Fernadez-Ortega P, Pud D, et al: Use of complementary and
alternative medicine in cancer patients: a European survey. Ann Oncol
2005, 16(4):655–663.
Genre D, Tarpin C, Braud AC, Camerlo J, Protiere C, Eisinger F, Viens P:
Randomized, double-blind study comparing homeopathy (cocculine) to
placebo in prevention of nausea/vomiting among patients receiving
adjuvant chemotherapy for breast cancer. Breast Cancer Research and
Treatment 2003, 82(sup 1):637.
Kris MG, Hesketh PJ, Somerfield MR, et al: American Society of Clinical
Oncology guideline for antiemetics in oncology: update 2006. J Clin
Oncol 2006, 24(18):2932–2947.
Decker GM, DeMeyer ES, Kisko DL: Measuring the maintenance of daily
life activities using the functional living index-emesis (FLIE) in patients
receiving moderately emetogenic chemotherapy. J Support Oncol 2006,
4(1):35–41. 52.
Martin AR, Pearson JD, Cai B, Elmer M, Horgan K, Lindley C: Assessing the
impact of chemotherapy-induced nausea and vomiting on patients'
daily lives: a modified version of the Functional Living Index-Emesis
(FLIE) with 5-day recall. Support Care Cancer 2003, 11(8):522–527.
Montgomery GH, Bovbjerg DH: Expectations of chemotherapy-related
nausea: emotional and experiential predictors. Ann Behav Med 2003,
Roscoe JA, Bushunow P, Morrow GR, et al: Patient expectation is a strong
predictor of severe nausea after chemotherapy: a University of
Rochester Community Clinical Oncology Program study of patients with
breast carcinoma. Cancer 2004, 101(11):2701–2708.
Griffin AM, Butow PN, Coates AS, et al: On the receiving end. V: Patient
perceptions of the side effects of cancer chemotherapy in 1993.
Ann Oncol 1996, 7(2):189–195.
Rostock M, Naumann J, Guethlin C, Guenther L, Bartsch HH, Walach H:
Classical homeopathy in the treatment of cancer patients–a prospective
observational study of two independent cohorts. BMC Cancer 2011,
Kassab S, Cummings M, Berkovitz S, Van HR, Fisher P: Homeopathic
medicines for adverse effects of cancer treatments. Cochrane Database
Syst Rev 2009, (2). CD004845.
Thompson EA, Reillly D: The homeopathic approach to symptom control
in the cancer patient: a prospective observational study. Palliat Med
2002, 16(3):227–233.
Moschen R, Kemmler G, Schweigkofler H, et al: Use of alternative/
complementary therapy in breast cancer patients–a psychological
perspective. Support Care Cancer 2001, 9(4):267–274.
27.Eisenberg DM, Davis RB, Ettner SL, et al: Trends in alternative medicine use
in the United States, 1990–1997: results of a follow-up national survey.
Jonas WB, Kaptchuk TJ, Linde K: A critical overview of homeopathy.
Ann Intern Med 2003, 138(5):393–399.
Frenkel M: Homeopathy in cancer care. Altern Ther Health Med 2010,
Cite this article as: Pérol et al.: Can treatment with Cocculine improve
the control of chemotherapy-induced emesis in early breast cancer
patients? A randomized, multi-centered, double-blind,
placebo-controlled Phase III trial. BMC Cancer 2012 12:603.
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Pérol et al. BMC Cancer 2012, 12:603
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text:
First mini
grammypAugust 19, 2011
While making Sharon's B'day block, I ended up with a bunch of small HSTs and decided, why not. So I put them together, added a few extras, and made my first mini quilt. It is 11 inches square, I guess that still qualifies as a mini. I'll send it along with the b'day block. Hope this doesn't spoil the surprise, but I wanted to share.