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The Partnerka - What Is It, and Why Should You Care?
Date Added: Sep 2009
Format: PDF
Scareware, 'Canadian Pharmacy' spam, adult sites, comment spam on forums and blogs - the authors have seen these plaguing the web and email experience over the past few years. What links them together? What makes them grow in volume and complexity? Who is behind them? What business model drives their profits to millions of dollars annually? The answer is hundreds of well-organized affiliate networks. They're known as 'Partnerka' in Russia, where they form a booming business, yet exist in other places as well. Thousands of affiliates, each calling themselves a 'Webmaster', work day and night to drive as much user traffic to their partners' stores as possible.

subset: commoncrawl


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Learn more about Elenco MX-902 4-in-1 Electronic Project Lab:
Manufacturer: Elenco
Mfg Part#: ELNC067
Sku: 208142628
Package Weight: 8 lbs
Batteries: Not Applicable
See more in Electronic Learning
|Building this kit is safe, solderless, educational, and fun! Includes an easy-to-read, illustrated, lab-style manual. Discover how an electric bell is contructed and how it's made to ring. Build your own operating motor and find out how a generator makes the electricity that makes things work. The meter measures the amount of electricity used in your experiments. Requires 2 "AA" batteries.


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RUSA Awards, 2003
The RUSA Awards program recognizes outstanding achievement by members of the library profession. These awards honor librarians, publishers, libraries, and authors for significant current or past achievements such as publications, program development, and leadership in the profession. RUSA has established the following awards for which the 2003 recipients are listed.
(Virginia) Boucher-OCLC Distinguished Ill Librarian Award
An annual award consisting of $2,000 and a citation recognizing a librarian for outstanding professional achievement, leadership, and contributions to interlibrary loan and document delivery through publication, during the previous two years, of significant professional literature, participation in professional associations, and/or innovative approaches to practice in individual libraries.
Mary A. Hollerich, Associate Director for Access Services, Pritzker Legal Research Center, Northwestern University.
Dartmouth Medal
A medal that honors the creation of a reference work of outstanding quality and significance. Medal designed by Rudolph Ruzicka and donated by Dartmouth College.
The Garland Encyclopedia of World Music (Routledge, 1977-2002).
Dun and Bradstreet Public Librarian Support Award
Annual award of $1,000 to support the attendance at Annual Conference of a public librarian who has performed outstanding business reference service and who requires financial assistance to attend the ALA Annual Conference.
Bryce Thornton, Business Reference Assistant, Hoover Public Library, Hoover, Alabama.
Dun and Bradstreet Award For Outstanding Service to Minority Business Communities
Annual award of $2,000 (up to half of which can be used to cover expense of attending ALA Annual Conference to receive award) that recognizes one librarian who, or library that has created an innovative service for a minority business community, or has been recognized by that community as an outstanding service provider.
The New York Public Library's St. George Library Center.
Gale Group Award For Excellence in Business Librarianship
A citation and $3,000 cash award to an individual who has made a significant contribution to business librarianship.
Anne Mintz, Director of Knowledge Management with Forbes.
Gale Group Award for Excellence in Reference And Adult Library Services
Given to a library or library system for developing an imaginative and unique resource to meet patrons' reference needs.
The Richmond Public Library, Richmond, British Columbia.
Genealogical Publishing Company/History Section Award
A citation and $1,000 cash award to a librarian, library or publisher to encourage professional achievement in historical reference and research librarianship.
Charles F. Cummings, Assistant Director of the Newark Public Library, Newark, New Jersey.
(Margaret E.) Monroe Library Adult Services Award
A citation to honor a librarian who has made significant contributions to library adult services.
Miriam Pollack, Assistant Director of the North Suburban Library System, Wheeling, Illinois. …


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About Body Politic
Melinda Wenner Moyer writes about science, health and food for Scientific American, Nature Medicine, Slate, Popular Science, Gilt Taste, Bon Appetit, Glamour and Redbook. She lives in Brooklyn and tweets as @Lindy2350.
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- Walk the walk, talk the talk: Implications of dual-tasking on dementia research in Body Politic
- Down with time changes plus the NY Times hearty series on cardio developments in Body Politic
- PLOS Recommended Data Repositories in Body Politic
- Aicardi Syndrome: Genome Sequencing Illuminates Another Rare Disease in Body Politic
- Fossil Lizard Showcases Wyoming's Tropical Wonderland in Body Politic
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Locals honored at tennis HOF banquet
DALLAS - Five Corpus Christi residents were honored during the annual joint meeting of the United States Professional Tennis Association Texas Division and United States Tennis Association Texas Section. The awards presented during the Texas Tennis Hall of Fame Awards Banquet in Dallas.
Susan Torrance, the director of tennis for the Al Kruse Tennis Center, was named the USPTA Texas Division's Facility Manager of the Year. Torrance, who has been the director for 18 years, earned the award for offering programs and events that spur activity and growth of tennis at the facility.
Ronald Elizondo, the director of the Tennis Success program for youth in Corpus Christi, received the USTA Texas Section Community Service Award. The award honors a person who has provided outstanding contributions in promoting and conducting recreational tennis programs for adults and/or juniors.
Ben Eshelman, delegate of the national executive committee for the USTA representing the USTA Texas Section, won the W.T. Caswell Service Award. The award is given to the Texas resident who has made valuable contributions to the growth and development of tennis in Texas, working as a volunteer.
Punam Kersten, director of tennis at Northshore Country Club, won the USPTA Texas Division Drills Contest, winning round trip air fare to the USPTA World Conference on Tennis in La Quinta, Calif.
Ron Woods, president of the Corpus Christi Tennis Association, was installed as a member of the USTA Texas Section's Executive Committee. Woods will serve a three-year term representing the Southwest Zone of the USTA Texas Section.
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You can now invite anyone to meet at your favorite Starbucks.
Limited-time feature
46 year old man | Odessa, FL, USA | Seeking women 32-43 within 35 miles
Love being around a girl when she's happy, and usually find that wit, banter, and adventure are a good recipe to help get us there. Right?!
Random stuff about me: I'm a writer. I don't know you. (But maybe I should...) I love chili. And I think it's about the only food that's impossible to screw up. It's chili, that's like Latin for "all ingredients allowed". (it may not actually be Latin for that, I don't know. I don't speak Latin.) Read between the lines: I love to cook. I'm a marketing director for a finance company, which is way more fun than it sounds. You should try it. I like teammates. Everything enjoyable in life is more enjoyable *together*. WIth teammates, our victories are sweeter, our defeats softened, our challenges more manageable, all because we did them together. I like semicolons. Because no one uses them. I feel bad for them. There are few things in life that cripple me more instantly than an amazing smile. I love making girls smile. And I'm good at it, too! I like absinthe. It's not that I think it tastes good, I just love the idea of drinking something that was banned for 100 years. Smart is unbelievably sexy. It's the best quality because just about every other good quality flows from it: confidence, generosity, class, ambition and success. Plus when you have all those things going, crappy things like jealousy and selfishness disappear. I know that the most influential person in your life is the guy who invented air conditioning. C'mon, think about it...wouldn't we ALL be outdoors a whole lot more if it wasn't such a comfy A/C world inside? I think kindness is the best investment...and it's free. There are only two things worth hating in life: cowardice and stupidity. I want to be around the girl who makes me think that "I'd better bring my A-game today or she's making me eat dust". Challenge me, tease me, question me, flirt. This is the stuff that makes our time together fun. I'm all upside. Even if things don't work out on the boy/girl level, I'm totally worth knowing. If you've read this far, admit you've had fun, and reach out to me. Show me your silly, fun side and we'll take it from there.
Coffee and conversation , Cooking , Dining out , Movies/Videos , Museums and art , Music and concerts , Nightclubs/Dancing , Political interests , Watching sports
Baseball, Basketball, Football, Golf, Running, Weights / Machines
I exercise 3-4 times per week.
Don't display my sign
I like Dogs
Middle of the Road
Bora Bora. No, never been. But it looks *great* in my head. And room service brought to you in a canoe? C'mon, how cool is that?
Washington University in St. Louis, St. Louis, MO
Great ideas. A really killer supernova-like smile (you know the kind). Um, soap maybe? The platypus (it takes cajones to leave the house looking so stupid). And pizza.
I enjoy writing and have written three books, and more articles than I can count. Movies are a big passion of mine too, of all stripes. Oh, and kayaking, too. And the Celtics, Cardinals (baseball, the football team sucks) and Redskins.
Some Cormac McCarthy novel, either The Road or Blood Meridian, or possibly some scripts. I forget! I reread The Great Gatsby recently, too, and it wasn't even assigned!
Z{{Cta}} {{#if HasMoreInfo}} ?{{CtaSecondary}} {{/if}}
|What he is looking for
|5'9" (175cms)
|5'0" (152cms) to 5'6" (167cms)
|Body type:
|About average
|Slender, About average, Athletic and toned
|Black, Blue, Brown, Grey, Green, Hazel
|Dark brown
|Black, Light brown, Dark brown, Blonde, Dark blonde
|No Way
|No Way, Occasionally
|Social Drinker
|Social Drinker
|Financial / Accounting / Real Estate
|Executive / Management, Financial / Accounting / Real Estate, Legal, Medical / Dental / Veterinary / Fitness, Political / Govt / Civil Service / Military, Retail / Food services, Sales / Marketing, Self-Employed / Entrepreneur, Education / Teacher / Professor, Technical / Science / Computers / Engineering, Travel / Hospitality / Transportation, Other profession, Architecture / Interior design
I can't pick more than one occupation? Lame, lame, lame! I listed my day gig here, which isn't as much fun as my not-day-gig: writer. Got three books published (so far).
|$100,001 to $150,000
|$35,001 to $50,000, $50,001 to $75,000, $75,001 to $100,000, $100,001 to $150,000, $150,001+
|Never Married, Widow / Widower, Currently Separated, Divorced
|Have kids:
|Yes, and they sometimes live at home (2)
|Yes, and they live at home
|Wants kids:
|No, but it's OK if my partner has kids
|No, but it's OK if my partner has kids
|White / Caucasian
|Asian, Black / African descent, East Indian, Latino / Hispanic, Middle Eastern, Native American, Pacific Islander, White / Caucasian, Other
|Spiritual but not religious
|No preference
I gave up religion for Lent.
|Graduate degree
|Some college, Associates degree, Bachelors degree, Graduate degree, PhD / Post Doctoral


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After you use askalo to find local tips and recommendations, its nice to share your new discoveries with your local community. In this way we can all learn about to best things to do and see in your city.
We invite you to also share your local experiences in a guest post on the askalo blog.
Our guest author Diane Morgan is the creator of the blog American in Exile, where she writes about living in Wellington, the "coolest little capital in the world."
We invite you to also share your local experiences in a guest post on the askalo blog.
Our guest author Diane Morgan is the creator of the blog American in Exile, where she writes about living in Wellington, the "coolest little capital in the world."
My name is Diane Morgan and I'm originally from Bergen County, New Jersey, USA. I've been living outside of America for nearly 10 years now but have been in New Zealand for the past four of those. I came to New Zealand with my boyfriend (now husband!) in 2007 because it was easier for us both to get work visas in NZ than it was to migrate to each other's countries!
Before I came to NZ, I had never really worked in an office but I completed a master's degree in political science in 2006 so my husband and I thought coming to Wellington would provide more job opportunities for me because the main government agencies are located here.
Within a few days of arriving in Wellington, a recruitment agency had found me short term work and had also lined up several interviews with large government departments. After my first interview, I was offered a 7 month contract as a project administrator with one of the bigger departments. I've been there ever since but have moved up the ranks to become a business improvement advisor. Working for the government has its ups and downs but provides a relatively good work-life balance which allows me time to go explore the amazing surroundings I find myself in.
My husband and I love Wellington because it offers an incredible combination of culture, wilderness and job opportunities. It's a relatively small city but still offers a great mix of restaurants and nightlife, yet there's a surf beach just down the road from my house!
Some of my favourite things to do in town are eating out and going to the movies. If you're looking for top notch restaurants, my recommendations are Martin Bosley's, Logan Brown, and the Boulcott Street Bistro. If you're looking for mid-range, I'd go for Chow, which is Asian fusion, or the General Practitioner for more traditional fare - the lamb pie is always fantastic!
As for cinemas, you must check out the iconic Embassy at the end of Courtenay Place. It's a refurbished theatre with some of the most comfortable seats in town. Most new films coming out of the world-renowned Weta studios are premiered at the Embassy. If you're interested in film-making, you can actually head out to Miramar in the Eastern suburbs of Wellington to see where Peter Jackson created some of his masterpieces like Lord of the Rings and Avatar.
There are some smaller cinemas peppered around Wellington which I'd also recommend, such as the Brooklyn Penthouse Cinema and Island Bay's Empire Cinema. They're both extremely cosy cinemas and you can bring a glass of wine in with you!
So that's my two cents on Wellington. Of course there's plenty more on offer such as great walks along Wellington's wild south coast, surfing in Lyall Bay or having brunch in one of the many cafes in town. If you'd like to read more about the "coolest little capital in the world", check out my blog: www.americaninexile.com.
Discover things to do in Wellington now with askalo. Discover Roulette Online


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EI-LO offers designers, manufacturers, and apparel brands the perfect T-shirt at the perfect price point. We combine quality blank knit apparel with easy ordering, no minimums and immediate delivery. As a completely vertical manufacturer, we control every aspect of the process to ensure the highest quality products. Using 100% USA Cotton & Ring-spun Yarn our fabrics are softer, more stable and are USDA and NAFTA Certified. For more info please visit
I find Shop-Eat-Surf to be a very useful and informative site that I enjoy browsing daily. Shop-Eat-Surf is the first thing I look at every morning to keep up-to-date on the latest talk, events, and happenings in the industry. I must say I am a fan of Shop-Eat-Surf.- By Bobby Abdel, Partner, Jack's Surfboards
Being an Executive Edition member allows me to not miss a beat when it comes to the Industry business news. Definitely keeps me in the loop plus goes great with my morning joe.- By Tony Perez, Surfer and Surfing magazines
ISPO: Shanghai trade show runs July 2 - 4.
SIA: Debuts new "Snow Source" email and blog.
Details on Industry Insight.
I stopped by the Hurley Pro this weekend at Lower Trestles in San Clemente, Calif. to chat with Hurley's Evan Slater about all the effort the brand put behind the contest.
Besides producing live video feeds, video heats on demand and social media web updates, Evan said Hurley put a lot of effort into creating an event that catered to the athletes.
At the event, all the athletes had valet parking. Their spaces were numbered in order of their tour ranking. There were "mules," or large golf carts to take athletes from the parking lot to the beach.
There was an athlete lounge with designated spaces for each athlete and a place for each of them to store their boards overnight. Hurley provided the athletes hot showers (not easy to do given the location), catered food, Pacifico on tap and each athlete's jersey was printed with their names on back, a first for an ASP contest.
Not only was the event catered to athletes, but for the athletes' friends and families and other VIPs, there was a large section with flat screen TVs showing the heat breakdowns and an array of coffee, hot food, fruits and drinks flowing all day long.
"We have the greatest athletes and we want to treat them at the highest level," said Evan. "When you do that, they seem to perform at the highest level as well and that's how they have been performing all week."
Besides the Hurley Pro, Hurley also sponsored the US Open this past August, but the events are quite different.
The US Open is a Men's Prime event whereas the Hurley Pro is a World Tour stop, the only ASP World Tour stop on the mainland USA.
The US Open draws a lot bigger crowd than the Hurley Pro, which draws a maximum of about 15,000 to 20,000 people for the weekend.
Trestles is a tough location to get to for a spectator. It's located at the bottom of a dirt trail at a state beach. There is not a lot of parking. Spectators either have to park in San Onofre and take a shuttle to the event or park on the street and walk down a long trail to get to the beach.
There are no convenience stores, restaurants, or surf retailers, like there are by the Huntington pier where the US Open is held.
While both boost record-breaking prize purses, Evan said, "The US Open is more of an action sports festival, and the Hurley Pro is less about mass consumer and more about showcasing and elevating athletes at the highest level."
Because the US Open is so much more consumer-friendly and accessible, there are more brands, more booths and more live events like music shows and fashion shows.
The Hurley Pro is more of a core event that relies on web coverage to reach consumers.
Evan said the Hurley Pro live web videos and heats on demand draw about 400,000 to 500,000 unique visits during the entire contest.
The US Open was also webcast and received a similar amount of hits, but Hurley boosted their multimedia efforts even more at the Hurley Pro.
The prize purse for the Hurley Pro ($460,000) is also bigger than the US Open ($340,000).
See Page 2 for the strategy behind having two contests close together, cost


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About Bernardo Houssay Bernardo Alberto Houssay was an Argentine physiologist who in 1947 with Carl Ferdinand Cori and Gerty Cori received Nobel Prize for Physiology or Medicine for their discovery of the role played by pituitary hormones in regulating the amount of blood sugar (glucose) in animals. He is the first Argentine and Latin American Nobel laureate in the Sciences. After graduating, he quickly developed and presented his M.D. thesis on the physiological activities of pituitary extracts, published in 1911, a theme he would pursue for the rest of his scientific career. Since 1908 he was already an assistant lecturer in the same department, and immediately after his doctorate he took up the post of Professor of Physiology in the University's School of Veterinary Medicine. Simultaneously, he started a private practice and as assistant physician at the municipal hospital of Buenos Aires.In 1913 he became Chief Physician at the Alvear Hospital, and, in 1915, Chief of the Section of Experimental Pathology at the National Public Health Laboratories in Buenos Aires. In 1919 Houssay was appointed to the chair of physiology at the University of Buenos Aires Medicine School, and, until 1943, he transformed and directed it into a highly respected research department in experimental physiology and medicine of international class. In that year, however, the military dictatorship deprived him of his university posts, due to his liberal political ideas and Houssay was forced to re-establish his research lines and staff at a privately funded Instituto de Biología y Medicina Experimental. This situation, reinforced by a second dismissal by the Peronista government in 1945, was prolonged until 1955, when Peron was ousted from power and Houssay was reinstated in the University of Buenos Aires, where he remained till he died. His retirement. After this he was also director of the National Scientific and Technical Research Council, from 1957 on. Houssay's worked in many fields of physiology, such as the nervous, digestive, respiratory and circulatory systems, but his main contribution, which was recognized by the Nobel Prize in Physiology or Medicine of 1947, was on the experimental investigation of the role of the anterior hypophysis gland in the metabolism of carbohydrates, particularly in diabetes mellitus. Houssay demonstrated in the 1930s the diabetogenic effect anterior hypophysis extracts and the decrease in diabetes severity with anterior hypophysectomy. These discoveries stimulated the study of hormonal feedback control mechanisms which are central to all aspects of modern endocrinology. Houssay's many disciples along his years of activity became also influential by themselves as they spread around the world; such as Eduardo Braun-Menéndez, and Miguel Rolando Covian (who went to become the "father" of Brazilian neurophysiology, as chairman of the Department of Physiology of the Medical Faculty of Ribeirão Preto of the University of São Paulo). Houssay wrote with them the most influential textbook of Human Physiology in Latin America, in Spanish and Portuguese (the latter was translated by Covian and collaborators), which, since 1950 has been published in successive editions and used in almost all medical schools of the continent. Houssay published more than 600 scientific papers and several specialized books. Besides the Nobel, Houssay won many distinctions and awards from the Universities of Harvard, Cambridge, Oxford and Paris and 15 other universities, as well as the Dale Medal of the London Society for Endocrinology in 1960
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32 CFR 228.8 - Prohibition on photographic or electronic recording or transmitting equipment.
No person entering or while on protected property shall bring or possess any kind of photographic, recording or transmitting equipment (including but not limited to cameras, cellular telephones, or recorders), except as specially authorized by the NSA Director of Security or his designee at each Agency facility.
Title 32 published on 2014-07-01.
No entries appear in the Federal Register after this date, for 32 CFR Part 228.


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Friday, October 8, 2010
© Copyright 2015 Clayton News Daily
I have had the privilege of talking with a great number of people about spiritual things, and the matter of sin always comes up.
Some ask, just what is sin? They don't really know exactly what sin is, and what it isn't.
I point them to the Bible, which tells us in Exodus, Chapter 20, ten ways we have sinned:
* 1. Thou shall have no other gods before me.
* 2. No carved images/idols.
* 3. Thou shall not take God's Name in vain.
* 4. Keep the Sabbath day Holy.
* 5. Honor your parents.
* 6. Thou shall not murder.
* 7. Thou shall not commit adultery.
* 8. Thou shall not steal.
* 9. Thou shall not bear false witness.
* 10. Thou shall not covet.
These are the 10 Commandments God gave to Moses and the Israelite people. They still apply today, and are excellent to guide our lives.
Most people know they have sin in their lives, and readily admit their sin. They agree that all humans are sinful and are prone to sin.
Romans 3:23 says: "All have sinned and fall short of the glory of God."
I tell them the first thing they should do is to ask God for forgiveness through Jesus Christ, because He is the only way one can get forgiveness of sins.
Sin's pathway in our lives is always the same -- You see something, or someone, that appeals to you, and although you know it would be the wrong thing to do, you feel it would be so good, so enjoyable. You tell yourself it's OK, and besides, no one will ever know.
Next, we want it with our hearts, we desire it greatly. Then, we take it with our hands, we possess it. Then, after sin has run its full course, we are convicted by our conscience, and are ashamed.
Then, we try to cover our sin up through lies and denials. We dig a deeper hole, and are in the clutches of the devil.
The penalty for sin is death. In Romans 6:23, we read: "The wages of sin is death."
If we continue in a life of sin, and die in this condition, we will be condemned to suffer in hell forever!
How terrible and awful that would be, but we can escape from this sentence. The rest of the verse says, "but the gift of God is eternal life." We receive God's gift only through the Lord Jesus' death on the cross and our faith and trust in Him.
In John 14:6, Jesus says: "I am the way, the truth and the life, no one comes to the Father except through me."
So, how should one deal with sin in his life? Confess your sins to God in Jesus' Name and ask for forgiveness. He will forgive your sins and forget them; He will not hold them against you!
His promise is to give you a home in Heaven! In John 14:2-3, Jesus says: "In my Father's house are many rooms -- I am going there to prepare a place for you. I will come back and take you to be with me that you also may be where I am."
Yes! Jesus will come again to get His church (Christians) and take us to Heaven! What we must do is to stay in relationship with Him, and follow His teachings. All people should claim Jesus as their Savior, but how will they know how to do this, if we do not tell them?
The way to avoid sin and its consequences is as simple as A.B.C.-- Admit your sin; Believe in God through Jesus Christ; and Confess your sins, which means "ask God to forgive your sins."
I pray you will!
More like this story
- Sin's pathway is the road to destruction - James C. Bell ( October 8, 2010 )
- Just what is sin, anyway? - Jim Bell ( August 5, 2011 )
- God can change your past and your future ( July 23, 2010 )
- God hears the sinner's prayer - James Bell ( January 8, 2010 )
- 'Blessed are those who believe without seeing' - James C. Bell Jr. ( April 29, 2011 )


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Ho, SY; Muriago, M; Cook, AC; Thiene, G; Anderson, RH; (1998) Surgical anatomy of aorto-left ventricular tunnel. Annals of Thoracic Surgery , 65 (2) 509 - 514.
Full text not available from this repository.
|Surgical anatomy of aorto-left ventricular tunnel
|Additional information:
|Cited By (since 1996): 13 Export Date: 19 May 2011 Source: Scopus
|UCL classification:
|UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
Archive Staff Only: edit this record


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Thank you for visiting NiteDreamerDesigns! Every tutorial here is created by me personally using detailed color photos and written step by step instructions. Along with beautiful new projects, your ...
Thank you for visiting NiteDreamerDesigns! Every tutorial here is created by me personally using detailed color photos and written step by step instructions. Along with beautiful new projects, your purchase will go a step further. 10% of every sale is donated to Shark Savers, a fantastic organization working on conservation efforts to put a stop to finning. Thank you so much for your support! :)Read More » View all patterns by designer (28) »
This listing includes 6 tutorials:
Swarovski Crystallized Glass Pearl Stretch Seed Bead Ring Tutorial
Swarovski Crystal Rondelle Flower Stretch Cocktail Ring Tutorial
Swarovski Crystal Embellished Ring Tutorial
Pillow Top Swarovski Crystal Cocktail Stretch Ring Tutorial
Star Burst Swarovski Crystal Cocktail Ring Tutorial
Celestial Crystal Rivoli Cocktail Ring Tutorial
Each of these tutorials can be completed by a beader of any level. Some projects are perfect for beginners, while others may challenge a beginning beader. Intermediate and Advanced beaders will enjoy adding these projects to their skill set.
If you were to purchase each of these tutorials separately, you'd be spending $36.00. Purchase the bundle and save 50%!
Upon completed payment you'll receive your confirmation from Etsy and be able to download your tutorial.
10% of EVERY sale goes to Shark Savers to help preserve these amazing creatures and put an end to finning!
NOTE ON COPYRIGHT: When you purchase these instructions, you are agreeing to use it for personal use only. You do have permission to sell the item the pattern creates. I only ask that you give credit to me as the designer. You may not copy the pattern or distribute it. You may print one copy for personal use but may not print multiples to distribute, nor may you share the digital file with others. Please direct your friends to this store so that they can purchase their own copy.


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34 year old man | Lakewood, CO, USA | Seeking women 23-33 within 50 miles
Normal isn't the norm anymore.
What to say in these boxes. I'm always a talkative person, and now feel put on the spot. I would say my hobbies include normal, everyday stuff. Spending time with friends, happy hour, baseball games, steak, sushi, weekend BBQ, snowboarding, etc. I have always been a big traveler, and am constantly adding to my list of places I'd like to visit. Whether a road trip across the country with with no destination in mind, to a month-long tour of Europe or Asia, I'm game. I've been in sales and real estate for the last 10 years, and now sort of in transition, deciding if I want to stay in it or try something different. A paragraph about yourself doesn't do anyone justice. Want to know something? Ask. Maybe we'll click. Who knows?
Camping , Coffee and conversation , Business networking , Cooking , Dining out , Fishing/Hunting , Movies/Videos , Museums and art , Music and concerts , Exploring new areas , Playing cards , Playing sports , Travel/Sightseeing , Watching sports , Wine tasting
Basketball, Billiards / Pool, Bowling, Other types of exercise, Walking / Hiking, Weights / Machines
I exercise 5 or more times per week.
Don't display my sign
I have Cats, Dogs
Z{{Cta}} {{#if HasMoreInfo}} ?{{CtaSecondary}} {{/if}}
|What he is looking for
|6'1" (185cms)
|5'0" (152cms) to 6'0" (182cms)
|Body type:
|Slender, About average, Athletic and toned
|No preference
|Dark blonde
|No preference
|I'll tell you later
|No preference
|Social Drinker
|No preference
|Sales / Marketing
|No preference
|$35,001 to $50,000
|No preference
|Never Married
|No preference
|Have kids:
|Yes, and they live at home (2)
|No preference
|Wants kids:
|Probably not
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|White / Caucasian
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|Christian / Other
|Christian / Catholic, Christian / Protestant, Christian / Other
|Some college
|No preference


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Get It Now On iTunes
Get in touch with us for CDs
Here it is folks, "Sweet, Sweet Rain" will serve you your latest dose of Flumery.
We're very happy to say that the 1st two tracks from this soundcloud playlist received Highly Commended inthis year's QLD Music Awards.
"Flyin' Colours" Official Video
Produced and Directed by Bonnie Jenkins. Filmed at Casa del Flumes and Rippletin Studio Eudlo.


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Search for jobs in Alaska, Seattle, and the Yukon.
Server Assistant (seasonal) — Fairbanks Westmark Hotel
Job Duties: Set up and serve food and beverages in a friendly, courteous and professional manner according to the Westmark Hotel standards of quality. Job Requirements: Ability to communicate with groups of customers and /or employees. Ability to solve practical problems. High school education preferred. Experience preferred, but not necessary. Experience in the hospitality environment considered a plus or some exposure to customer service. Must be eligible to work in the United States.
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Learn more about Intel BOXD525MW Atom D525 Desktop Motherboard/CPU Combo (1.8GHz) - Dual Core - Mini ITX:
The Intel Desktop Board D525MW is designed to unleash the power of the new Intel Atom processor D525 which supports the new revolutionary two-chip layout. This new chipset layout reduces the package footprint by 70 percent, enabling easier routing and better heat flow. The Intel NM10 Express Chipset also provides additional flexibility and upgradability with two slots of single channel DDR3 memory at 1066/800 MHz supporting up to 4GB maximum.
With breakthrough low-power silicon, the Intel Desktop Board D525MW can be used with a passive thermal solution based on the recommended boundary conditions. The Intel Desktop Board D525MW represents a fundamental shift in system design-small, yet powerful enough to enable a big Internet experience for all.
Customer Reviews of Intel BOXD525MW Atom D525 Desktop Motherboard/CPU Combo (1.8GHz) - Dual Core - Mini ITX
I use this Atom CPU/Motherboard combo as a personal web/svn/file server. It runs Ubuntu 10.04 LTS. So far it has been great and I highly recommend it. I put it in a M350 case, which makes it an extremely compact passively-cooled box. As I needed some disk space I decided to use a conventional 2.5 HDD. If you don't need hundreds of gigabytes for file storage, it might be a good idea to consider an SSD instead. In the latter case it will be a completely noise-free design.
Nice and fast4/7/2011
Very Fast with an Atom.. wish it would have a PCI Express slot .. installed a NVidia pci with 512 mb ram with bluray rom drive.. plays bluarays at 1080P on an LG 47" TV connected DVI to HDMI on video card.. Must use an older driver for video card to play blurays but everything works great.. Doesnt skip a beat..
View all buying options for Intel BOXD525MW Atom D525 Desktop Motherboard/CPU Combo (1.8GHz) - Dual Core - Mini ITX
+ $6.95 shipping
Shipping: Usually ships in 1 to 2 business days
Condition: Brand New


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Connect With Us800-299-9470
How Will My Product(s) Be Delivered?When purchasing a large appliance from AppliancesConnection, a representative will contact you 48 hours prior to arriving to your location to schedule a delivery date and a 4 hour time window. Upon delivery, your product will be unloaded and ready for you to open and inspect. If you have chosen White Glove service, the item will be placed in your room of choice and the debris will be removed.
Learn more about our shipping policy.
Free Scheduled DeliveryDelivery will be scheduled when item reaches your local distribution center. Signature will be required.
The Carter dining collection is constructed to create the ultimate in functional, comfortable, and aesthetically pleasing dining room furniture in your home. Faux marble table tops, a sophisticated, dark wood finish, and plush upholstered chairs, all combine to make smart, and interesting dining options. Three different upholstery colors and two different table types offer a multitude of combination options in order to create the perfect option for the desired gathering space in your home.
Create that extra bit of storage, done in a classy style with this buffet style server. Featuring an amalgam of storage options including three drawers, two doors, and a 12 bottle wine storage rack, this buffet style server is a functional addition to your dining room. Completed in a dark brown finish with silver knob pull hardware, combine this server with the coordinating tables and side chairs to finish the smart and functional look.
Dimensions: 36H x 18W x 52D inches
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Patsy Plunge Balcony Bra
Item "#AA1221
fresh ideas
Freya Patsy Plunge Balcony Bra (AA1221):
- 3-part cups provide support and shape
- Polka dot mesh construction
- Decorative bow at center
- Underwire support
Patsy returns with a gold spot print, coordinated straps, and embroidered bows. All in a flirty, playful peacock. The Patsy plunge bra has a flattering low center front and semi-sheer cups for a sexy, light look with all the support.


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Fast Five will push all your action buttons, and some you haven't thought of. So what if you hate yourself in the morning. show more
It's a movie for audiences who think exuberance in movies is more important than sense or logic and who can laugh at a movie and like it at the same time. show more
Inventive action sequences, deft stunt work and breathtaking cinematography make for revved-up fun. show more
October 18, 2011 rshe177629
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Adreniline Pumping ,Butt Stompin, Bullets Flying -Superfied Demolish of over 100 Vehicles-Multiplied by Arm bustin Skull Breaking Fights With Superb Action Killer Fast Cars ....Just Doesn\'t get any Better Than This....Must See Flik ...
September 02, 2011 yd00000000100340
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I love Fast Five!
July 11, 2011 faithspbxwmn
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It was a jun ride . Do not know what the critics expect sometime.


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State of Independence: 15 Artists Impacting the Indie Scene
Every indie artist, band and label is independent in its own way. The strategies for success are as varied as the styles of music, the executives and the attitudes -- these are the very states of independence. Labels and artists from Texas to Denver to Missouri to Los Angeles; genres from folk to metal to hip-hop to country to jazz are all serious about amazing music, engaging with fans and doing the most forward kind of business. Synchs, indie record stores and the resurgence of of heritage artists -- it's all a part of the indie universe. Everyone's paths are different -- but the goals are the same: figuring out ways to have the most people experience the most music.
The Head and the Heart
One day last spring, Tyler Williams lost his cell phone on the streets of Seattle.
The drummer for folk band the Head and the Heart never expected to get it back, let alone within the prophetic series of events that followed.
Williams' bandmate Charity Thielen got a call that day from a stranger who found the phone. Thielen connected the two, and they arranged to meet at the man's office, around the corner from Seattle's Pike Place Market.
What seemed, at first, to be a chance encounter with a good Samaritan instantly became something more, when Williams found himself on the doorstep of Sub Pop Records.
"I had to hold back from saying, 'My band is recording an album right now, let me get you a demo!' " Williams recalls with a laugh. "I called Charity the second I left the building and said, 'This is an omen. My phone was just picked up by a Sub Pop employee.' "
He held his tongue at the time, but the drummer's Sub Pop premonition materialized several months later, when the Head and the Heart signed with the seminal Seattle label, after a veritable feeding frenzy in which both majors (Warner Bros. and RCA among them) and indies (like Glassnote) vied for their affections. Still, it's no accident that got the Head and the Heart where it is now, with 45,000 units sold (according to Nielsen SoundScan) and slots on national and international tours opening for the Decemberists, Iron & Wine and Death Cab for Cutie.
Nor is the sextet your average flash-in-the-pan buzz band. Though the group had every opportunity to blow up-by the end of 2011, it'll have played Sasquatch, Bonnaroo, Newport and Austin City Limits, not to mention the late-night trifecta of "Letterman," "Conan" and "Fallon"-the Head and the Heart prefer to play low- and mid-capacity venues. The band tours small towns and chats with fans on Twitter and at its merch table. The act concentrates on local, noncommercial radio stations and plays in-store sets to support independent record shops. The Head and the Heart is taking care to leave no stone unturned, and this grass-roots approach-coupled with a hotbed local scene and a universal appeal-has enabled the band to realize an uncompromising, independent career path that works-and works well. -Devon Maloney


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'I've served three Alaafin of Oyo and worked in the palace for 67 years'
He has spent 67 years in the palace of the Alaafin of Oyo. He has worked with three successive Alaafin in the palace, yet he looks strong and agile.
Ironically, very few people in the palace where he has lived for three scores and seven know him by his real name. Indeed, many of them would tell you there is no one by that name in the palace, even though they see and interact with him on a daily basis. They know Pa Lasisi simply as Baba Keji.
He walks with the agility of a teenager and years of walking around the expansive palace bare-footed do not seem to have taken any toll on the soles of his feet.
He shows no sign of pain or fatigue when he walks.
He has a height that makes it impossible for one not to notice him. Some think his being unusually short is a disadvantage, others believe it is a positive attribute because it makes people to notice him easily. Pa Lasisi himself thinks it is a disadvantage because it makes him to attract attention.
There is no way a first time visitor to the Alaafin's palace would miss him. His shrill voice, big eyeballs and dark skin are a combination that could give one a chill. But your impression of him is bound to change for better on getting close to him–a jolly good fellow having the best of time.
"I have lived in the palace for a long time," he said. "The current Alaafin met me here. When his father ascended the throne in 1945, he brought me to the palace."
He had been a farmer and a fisherman before he joined Oba Adeyemi II in the palace. Although he considers himself an indigene of Oyo town, he said his roots could be traced to outside Oyo town.
According to him, his father was a Nupe man. But he was born in Oyo town. He has a family compound in Oyo. He is the only person alive among his siblings. His rich knowledge of Oyo history and events around the palace is enviable. If his knowledge of Oyo history is commendable, he finds his difficult to know his actual age. Asked how old he was, he took a long pause and said: "I can't tell you my real age. There is no record of my birth. My parents did not record it, unlike what I did for my children. I won't hazard any guess about my age because I believe in records. And since there is no written record, I won't say I am of a certain age."
Pa Lasisi is certainly a lucky man. With the demise of Oba Adeyemi II, who reigned between 1945 and 1955, his successor, Alaafin Bello Gbadegesin, Ladigbolu II, who reigned between 1956 and 1970, could not resist his charm. So, he allowed him to remain in the palace.
He is as influential in the palace as he is friendly. Anyone who ignores him in the palace could be doing so at his or her own peril, because he is one of Alaafin's favourites.
He said: "I do two types of work, I am a hunter and I am also the head of butchers here. I inspect the cow the butchers want to slaughter and I go to the abattoir with them every day.
"I was in charge of the former Alaafin's fish pond. My job for the former Alaafin was to dig fish ponds for him. But things have changed. What I do mainly is to go to the abattoir and get offal for Oba Adeyemi III."
He admires Oba Lamidi Adeyemi to great lengths and says he cares less when people accuse him of treating the Alaafin like a god.
He attributed the source of his strength to Oba Adeyemi 111, saying: "It is the grace of the Alaafin that gives me strength. If you put your trust in the Alaafin, you won't lack anything."
He uses no drugs to sustain his health. "Each morning I wake up, I say 'may the Alaafin live long.' As I pray for the Alaafin to live long, the prayer returns to me.'"
Pa Lasisi has one wife and five children who all live in the palace. As sharp as he looks, however, he found it difficult to give the age of his first child offhand, saying he would have to consult his son's birth certificate to be sure of the age of his child.
Like a man who was love-struck, he smiled merrily when The Nation asked about his wife. "My wife is from Ilora, a town beside Oyo. We first met at the Sawmill area in Ilora. The Alaafin played a major in my getting a wife.
How much the Alaafin spent or what transpired between the family of my wife and the Alaafin, I don't know," he said.
Till date, he said, his wife's family maintains a close contact with the palace.
Incidentally, some members of his wife's family were feasting in the palace during the interview.
Pa Lasisi admits being a lover of good food, especially pounded yam and amala prepared by his wife.
As old as he is, going to abattoir on a daily basis is an integral part of his life. "Every morning, I go to the abattoir to inspect the cow that is about to be slaughtered for the day. After they might have slaughtered the cow, I bring the offal to Kabiyesi, because that is what the Kabiyesi eats. Then I move to the fish pond to collect fish."
But how does he determine the health of a cow when he is not a veterinary doctor?
"You don't have to be a veterinary doctor to determine whether a cow is healthy to be slaughtered or not," he argued. "Yes, I am not a vet doctor. But before the advent of vet doctors, there was a way we determined the health of animals."
Considering his age, one would fear that death might knock at his door anytime soon. But he does not share the sentiment. "If death comes, I will go. I'm not afraid.
Why should I be afraid of death?" he defiantly. Reiterating his belief in the efficacy of juju, otherwise called African magic, he said: "When I was young, I could stay under water and travel up to seven kilometres. There was this pot then that my father had. Inside it was a cream. Anytime we wanted to swim, we would rub the cream on our body and go deep down the water. Fishes, snakes and crocodiles would just be looking at you. None of them would attempt to attack any of us that had rubbed the cream."
The oldest man in the Alaafin's palace regrets that while he was a beneficiary of the magic cream, he has not been able to pass it to his children.
He said: "My son, you won't pray to pass your hardship to your children. It is a profession that has no record. If it had been recorded, I would have put this into practice for you to know what I'm talking about.
Interestingly, while Pa Lasisi is a dwarf, none of his children is." God never allowed that to happen. God compensated me with tall children. Mind you, my wife is not a dwarf," he said.
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'I used my three children for blood money'
RESIDENTS of Asaba and Oko towns in Oshimilli South Local Government Area of Delta State were stunned last weekend when a popular akara (bean cake) ... Full story


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The girls let loose with more tie dyeing this weekend!
Saturday, June 14, 2014
Together Projects
Posted by Delighted Hands at 9:03 PM
5 comments:
- benita said...
Everything in your post just screams "Summer!!" Ella is a lovely little model. It's more fund to make something or someone who appreciates it. right?
- June 17, 2014 at 8:13 AM
- Loree Jackson said...
The babies are so cute!
- June 17, 2014 at 2:14 PM
- Marsel said...
Lots of fun stuff in this post! The picture of Will "sharing" his hose water with Ella is a riot...they will laugh over that one someday. :)
The dress/hat is even more adorable on her than it already looked in the previous picture.
- June 18, 2014 at 7:12 AM
Thank you for the pictures of the kids-big and small. I have been having great grandparent withdrawal! How they grow! Love, Mom
- June 21, 2014 at 9:16 AM
- Lynne said...
As they grow, they become more like their grandfather! I guess that means they look like their dads!
- September 17, 2014 at 2:33 AM
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A Russian crime ring has got its hands on more than a billion stolen Internet credentials, according to a New York Times report.
Citing records discovered by Hold Security, the New York Times reported on Tuesday that the stolen credentials include 1.2 billion password and username combinations and more than 500 million email addresses.
Research specialist Hold Security, which has a strong track record of uncovering data breaches, says that the stolen data was gathered from 420,000 websites. Organizations affected range from household names to small Internet sites, it said.
Citing nondisclosure agreements and a reluctance to identify companies still at risk, Hold Security would not name the victims of the hack that resulted in more than a billion stolen Internet credentials.


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What seems like millions of forest tent caterpillars are being found throughout Minnesota in recent weeks, but experts say this year's defoliation is not yet "the big one." Department of Natural Resources officials say it's leading up to a bigger outbreak in a few years. The DNR is seeing an uptick in the forest tent caterpillar population across the state, especially in Minnesota's northern counties this year. In west-central counties, the insects have been in outbreak mode for several years, and they are turning up throughout southern Minnesota as well, including in New Ulm. The DNR's Jana Albers says the caterpillars are native to Minnesota, and usually begin defoliating trees in early spring through mid-June. The caterpillars develop in cycles over the course of decades or more. They set a record in 2002 and 2003 when they stripped 7.5-million acres of trees of their leaves in Minnesota. Fortunately, affected trees almost always recover. The DNR will begin aerial surveys of the state next week to track the caterpillars and other pests.
MN Caterpillar Infestation


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what power supply do i need to get for this board. I believe I bought the wrong item. I got Ultra 600w X-Finity Power Supply w/2 80mm but I notice the fan is not spinning in the power supply.
Take the 2-minute tour ×
Super User is a question and answer site for computer enthusiasts and power users. It's 100% free, no registration required.
migrated from serverfault.com Jul 21 '09 at 16:37
This question came from our site for system and network administrators.
Fan is not spinning on the power supply? It could be DOA. Or you may have not set it up correctly. Do the motherboard fans/lights start up?
Power Information for the DG965WH MB
To know what your motherboard needs (power wise) you should read your motherboard manual. (Link below)
Important links:
600w should be enough to run your MB but also take consideration into what other components require power too.
The fan inside the power supply is usually not controlled by the motherboard. As long as the motherboard make the powersupply 'on' then the fan should spin. Sound like it is broken


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Allogeneic Hematopoietic Stem-Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms
Effective Date January 28, 2015
Revision Date(s) 01/13/15; 01/13/14; 01/14/13; 01/06/12; 03/08/11; 03/10/09; 10/09/07, 07/12/05; 07/13/04; 11/12/02; 02/01/00
Myeloablative allogeneic HSCT may be considered medically necessary as a treatment of
Reduced-intensity conditioning allogeneic HSCT may be considered medically necessary as a treatment of
Placental and Umbilical Cord Blood as a Source of Stem Cells
Hematopoietic Stem-Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma
Allogeneic Hematopoietic Stem-Cell Transplantation for Genetic Diseases and Acquired Anemias
Hematopoietic Stem-Cell Transplantation for Miscellaneous Solid Tumors in Adults
Hematopoietic Stem-Cell Transplantation for Autoimmune Diseases
Hematopoietic Stem-Cell Transplantation for Hodgkin Lymphoma
Hematopoietic Stem-Cell Transplantation for Solid Tumors of Childhood
Hematopoietic Stem-Cell Transplantation for Acute Lymphoblastic Leukemia
Hematopoietic Stem-Cell Transplantation for Non-Hodgkin Lymphomas
Hematopoietic Stem-Cell Transplantation for Primary Amyloidosis
Hematopoietic Stem-Cell Transplantation for Waldenstrom Macroglobulinemia
Hematopoietic Stem-Cell Transplantation in the Treatment of Germ Cell Tumors
The myeloid neoplasms are categorized according to criteria developed by the World Health Organization. They are risk-stratified according to the International Prognostic Scoring System (IPSS).
2008 WHO Classification Scheme for Myeloid Neoplasms
2008 WHO Classification of MDS
Risk Stratification of Myelodysplastic Syndromes
Risk stratification for MDS is performed using the IPSS. This system was developed after pooling data from 7 previous studies that used independent, risk-based prognostic factors. The prognostic model and the scoring system were built based on blast count, degree of cytopenia, and blast percentage. Risk scores were weighted relative to their statistical power. This system is widely used to divide patients into two categories: (1) low -risk and (2) high-risk groups. The low-risk group includes low -risk and Int-1 IPSS groups; the goals in low-risk MDS patients are to improve quality of life and achieve transfusion independence. In the high-risk group—which includes Int-2 and high-risk IPSS groups— the goals are slowing the progression of disease to AML and improving survival. The IPSS is usually calculated on diagnosis. The role of lactate dehydrogenase, marrow fibrosis, and beta 2-microglobulin also should be considered after establishing the IPSS. If elevated, the prognostic category becomes worse by one category change.
IPSS: MDS Prognostic Variables
IPSS: MDS Clinical Outcomes
AML: acute myelocytic leukemia.
Given the long natural history of MDS, allogeneic HSCT is typically considered in those with increasing numbers of blasts, signaling a possible transformation to acute myeloid leukemia. Subtypes falling into this category include refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, or chronic myelomonocytic leukemia.
Patients with refractory anemia with or without ringed sideroblasts may be considered candidates for allogeneic HSCT when chromosomal abnormalities are present or the disorder is associated with the development of significant cytopenias (e.g., neutrophils <500/mm3, platelets <20,000/mm3).
Patients with MPNs may be considered candidates for allogeneic HSCT when there is progression to myelofibrosis or when there is evolution toward acute leukemia. In addition, allogeneic HSCT may be considered in patients with essential thrombocythemia with an associated thrombotic or hemorrhagic disorder. The use of allogeneic HSCT should be based on cytopenias, transfusion dependence, increasing blast percentage over 5%, and age.
Some patients for whom a conventional myeloablative allogeneic HSCT could be curative may be considered candidates for RIC allogeneic HSCT. These include those patients whose age (typically >60 years) or comorbidities (e.g., liver or kidney dysfunction, generalized debilitation, prior intensive chemotherapy, low Karnofsky Performance Status) preclude use of a standard myeloablative conditioning regimen. The ideal allogeneic donors are HLA-identical siblings, matched at the HLA-A, B, and DR loci (6 of 6). Related donors mismatched at one locus are also considered suitable donors. A matched, unrelated donor identified through the National Marrow Donor Registry is typically the next option considered. Recently, there has been interest in haploidentical donors, typically a parent or a child of the patient, where usually there is sharing of only 3 of the 6 major histocompatibility antigens. The majority of patients will have such a donor; however, the risk of GVHD and overall morbidity of the procedure may be severe, and experience with these donors is not as extensive as that with matched donors.
Clinical input suggests RIC allogeneic HSCT may be considered for patients as follows:
Myelodysplastic syndromes and myeloproliferative neoplasms refer to a heterogeneous group of clonal hematopoietic disorders with the potential to transform into acute myelocytic leukemia (AML). Allogeneic Hematopoietic stem-cell transplantation (HSCT) has been proposed as a curative treatment option for patients with these disorders.
Hematopoietic stem cells may be obtained from the transplant recipient (autologous HSCT) or from a donor (allogeneic HSCT). They can be harvested from bone marrow, peripheral blood, or umbilical cord blood shortly after delivery of neonates. Although cord blood is an allogeneic source, the stem cells in it are antigenically "naive" and thus are associated with a lower incidence of rejection or graft-versus-host disease (GVHD). Cord blood is discussed in greater detail in a separate policy. (see Related Policies)
Immunologic compatibility between infused hematopoietic stem cells and the recipient is not an issue in autologous HSCT. However, immunologic compatibility between donor and patient is a critical factor for achieving a good outcome of allogeneic HSCT. Compatibility is established by typing of HLA using cellular, serologic, or molecular techniques. HLA refers to the tissue type expressed at the HLA -A, B, and DR loci on each arm of chromosome 6. Depending on the disease being treated, an acceptable donor will match the patient at all or most of the HLA loci.
Conventional Preparative Conditioning for HSCT
The conventional ("classical") practice of allogeneic HSCT involves administration of cytotoxic agents (e.g., cyclophosphamide, busulfan) with or without total -body irradiation at doses sufficient to destroy endogenous hematopoietic capability in the recipient. The beneficial treatment effect in this procedure is due to a combination of initial eradication of malignant cells and subsequent graft-versus-malignancy (GVM) effect that develops after engraftment of allogeneic stem cells within the patient's bone marrow space. While the slower GVM effect is considered to be the potentially curative component, it may be overwhelmed by extant disease without the use of pre-transplant conditioning. However, intense conditioning regimens are limited to patients who are sufficiently fit medically to tolerate substantial adverse effects that include pre-engraftment opportunistic infections secondary to loss of endogenous bone marrow function and organ damage and failure caused by the cytotoxic drugs. Furthermore, in any allogeneic HSCT, immune suppressant drugs are required to minimize graft rejection and GVHD, which also increases susceptibility of the patient to opportunistic infections.
RIC for Allogeneic HSCT
RIC refers to the pre-transplant use of lower doses or less intense regimens of cytotoxic drugs or radiation than are used in conventional full-dose myeloablative (MA) conditioning treatments. The goal of RIC is to reduce disease burden but also to minimize as much as possible associated treatment-related morbidity and non-relapse mortality (NRM) in the period during which the beneficial GVM effect of allogeneic transplantation develops. Although the definition of RIC remains arbitrary, with numerous versions employed, all seek to balance the competing effects of NRM and relapse due to residual disease. RIC regimens can be viewed as a continuum in effects, from nearly totally MA to minimally MA with lymphoablation, with intensity tailored to specific diseases and patient condition. Patients who undergo RIC with allogeneic HSCT initially demonstrate donor cell engraftment and bone marrow mixed chimerism. Most will subsequently convert to full-donor chimerism, which may be supplemented with donor lymphocyte infusions to eradicate residual malignant cells. For the purposes of this Policy, the term "reduced-intensity conditioning" will refer to all conditioning regimens intended to be nonmyeloablative, as opposed to fully MA (conventional) regimens.
MDS can occur as a primary (idiopathic) disease or can be secondary to cytotoxic therapy, ionizing radiation, or other environmental insult. Chromosomal abnormalities are seen in 40% to 60% of patients, frequently involving deletions of chromosome 5 or 7, or an extra chromosome as in trisomy 8. Most MDS diagnoses occur in individuals older than age 55 to 60 years, with an age-adjusted incidence of approximately 62% among individuals older than age 70 years. Patients either succumb to disease progression to acute myelocytic leukemia (AML) or to complications of pancytopenias. Patients with higher blast counts or complex cytogenetic abnormalities have a greater likelihood of progressing to AML than do other patients.
MDS Classification and Prognosis
For the past 20 years, the French-American-British (FAB) system has been used to classify MDS into 5 subtypes as follows: (1) refractory anemia (RA); (2) refractory anemia with ringed sideroblasts (RARS); (3) refractory anemia with excess blasts (RAEB); (4) refractory anemia with excess blasts in transformation; and, (5) chronic myelomonocytic leukemia. However, the FAB system has been supplanted by that of the World Health Organization (WHO), which records the number of lineages in which dysplasia is seen (unilineage vs multilineage), separates the 5q- syndrome, and reduces the threshold maximum blast percentage for the diagnosis of MDS from 30% to 20% (see Policy Guidelines for WHO classification scheme for myeloid neoplasms).
The most commonly used prognostic scoring system for MDS is the International Prognostic Scoring System (IPSS), which groups patients into 1 of 4 prognostic categories based on the number of cytopenias, cytogenetic profile, and the percentage of blasts in the bone marrow (see Policy Guidelines). This system underweights the clinical importance of severe, life-threatening neutropenia and thrombocytopenia in therapeutic decisions and does not account for the rate of change in critical parameters, such as peripheral blood counts or blast percentage. However, the IPSS has been useful in comparative analysis of clinical trial results and its utility confirmed at many institutions. A second prognostic scoring system incorporates the WHO subgroup classification that accounts for blast percentage, cytogenetics, and severity of cytopenias as assessed by transfusion requirements. The WHO Classification-based Prognostic scoring system (WPSS) uses a 6-category system, which allows more precise prognostication of overall survival (OS) duration, as well as risk for progression to AML. This system, however, is not yet in widespread use in clinical trials.
MDS Treatment
Treatment of smoldering or non-progressing MDS has in the past involved best supportive care including red blood cell (RBC) and platelet transfusions and antibiotics. Active therapy was given only when MDS progressed to AML or resembled AML with severe cytopenias. A diverse array of therapies are now available to treat MDS, including hematopoietic growth factors (e.g., erythropoietin, darbepoetin, granulocyte colony-stimulating factor), transcriptional-modifying therapy (e.g., U.S. Food and Drug Administration [FDA]‒approved hypomethylating agents, nonapproved histone deacetylase inhibitors), immunomodulators (e.g., lenalidomide, thalidomide, antithymocyte globulin, cyclosporine A), low-dose chemotherapy (e.g., cytarabine), and allogeneic HSCT. Given the spectrum of treatments available, the goal of therapy must be decided upfront, whether it is to improve anemia; thrombocytopenia; or neutropenia, eliminate the need for red blood cell transfusion, achieve complete remission, or cure the disease. Allogeneic HSCT is the only approach with curative potential, but its use is governed by patient age, performance status, medical comorbidities, the patient's risk preference, and severity of MDS at presentation.
Chronic MPNs
Overview of Chronic Myeloproliferative Neoplasms
Chronic MPNs are clonal bone marrow stem-cell disorders; as a group, an approximate total of 8400 MPNs are diagnosed annually in the United States. Like MDS, MPNs primarily occur in older individuals, with approximately 67% reported in patients aged 60 years and older.
MPNs are characterized by the slow but relentless expansion of a clone of cells with the potential evolution into a blast crisis similar to AML. They share a common stem cell-derived clonal heritage, with phenotypic diversity attributed to abnormal variations in signal transduction as the result of a spectrum of mutations that affect protein tyrosine kinases or related molecules. The unifying characteristic common to all MPNs is effective clonal myeloproliferation resulting in peripheral granulocytosis, thrombocytosis, or erythrocytosis that is devoid of dyserythropoiesis, granulocytic dysplasia, or monocytosis.
MPN Classification
In 2008, a new WHO classification scheme replaced the term chronic myeloproliferative disorder with the term myeloproliferative neoplasms (MPN). These are a subdivision of myeloid neoplasms that includes the 4 classic disorders: chronic myeloid leukemia (CML), polycythemia vera, essential thrombocytopenia, and primary myelofibrosis; the WHO classification also includes chronic neutrophilic leukemia, chronic eosinophilic leukemia/hypereosinophilic syndrome, mast cell disease, and MPNs unclassifiable (see Policy Guidelines section).
MPN Treatment
In indolent, nonprogressing cases, therapeutic approaches are based on relief of symptoms. Supportive therapy may include prevention of thromboembolic events. Hydroxyurea may be used in cases of high-risk essential thrombocytosis and polycythemia vera and intermediate- and high-risk primary myelofibrosis.
In November 2011, FDA approved the orally-administered selective Janus kinase 1 and 2 inhibitor ruxolitinib for the treatment of intermediate- or high-risk myelofibrosis. Ruxolitinib has been associated with improved OS, spleen size, and symptoms of myelofibrosis when compared with placebo.1 The COMFORT-II trial compared ruxolitinib to best available therapy in patients with intermediate- and high-risk myelofibrosis, and demonstrated improvements in spleen volume and OS.2 In a randomized trial comparing ruxolitinib with best available therapy, including antineoplastic agents, most commonly hydroxyurea, glucocorticoids, and no therapy, for myelofibrosis, Harrison et al demonstrated improvements in spleen size and quality of life, but not OS. (3)
MA allogeneic HSCT has been considered the only potentially curative therapy, but because most patients are of advanced age with attendant comorbidities, its use is limited to those who can tolerate the often severe treatment-related adverse effects of this procedure. However, the use of RIC of conditioning regimens for allogeneic HSCT has extended the potential benefits of this procedure to selected individuals with these disorders.
Medical policies are systematically developed guidelines that serve as a resource for Company staff when determining coverage for specific medical procedures, drugs or devices. Coverage for medical services is subject to the limits and conditions of the member benefit plan. Members and their providers should consult the member benefit booklet or contact a customer service representative to determine whether there are any benefit limitations applicable to this service or supply. This medical policy does not apply to Medicare Advantage.
This policy was originally created in December 1999 and updated periodically with literature reviews, most recently through September 30, 2014. Following is the summary of the key literature to date.
Myelodysplastic Syndromes
Conventional Preparative Conditioning Hematopoietic Stem-Cell Transplantation for Myelodysplastic Syndromes
Despite the successes seen with new drugs now available to treat myelodysplastic syndromes (MDS; e.g., decitabine, azacitidine, lenalidomide), allogeneic hematopoietic stem-cell transplantation (HSCT) is the only treatment capable of complete and permanent eradication of the myelodysplastic syndrome (MDS) clone. (4)
A 2009 review of HSCT for MDS evaluated the evidence for allogeneic HSCT with myeloablative (MA) conditioning for MDS.5 The authors included 24 studies (prospective and retrospective) published between 2000 and 2008 that included a total 1,378 cases with an age range of 32 to 59 years. Most patients (n=885) received matched -related donor allogeneic HSCT, with other donor types including syngeneic, matched, unrelated donor, mismatched unrelated donor, and umbilical cord blood. Most studies included de novo and secondary MDS, chronic myelomonocytic leukemia (CML), MPNs, de novo and secondary AML, and transformed AML. Peripheral blood and bone marrow stem-cell grafts were allowed in most studies. The most commonly used conditioning regimens were busulfan plus cyclophosphamide (BU/CY) and CY plus total body irradiation (CY/TBI), with cyclosporine A (CYA) used for graft-versus-host disease (GVHD) prophylaxis. Length of follow-up ranged from 5 months to approximately 8 years. Grades II to IV acute GVHD varied from 18% to 100%. Relapse risk ranged from a low of 24% at 1 year to 36% at 5 years. Overall survival (OS) ranged from 25% at 2 years to 52% at 4 years, with nonrelapse mortality (NRM) ranging from 19% at day 100 to 61% at 5 years.
A review from the American Society for Blood and Marrow Transplantation (ASBMT) in 2009 assembled and evaluated the evidence related to HSCT in the therapy of MDS, with associated treatment recommendations.6 The authors conclude that outcomes are improved with early HSCT for patients with an International Prognostic Scoring System (IPSS) score of intermediate-2 or high-risk at diagnosis, who have a suitable donor, and meet the transplant center's eligibility criteria, and for selected patients with a low or intermediate-1 risk IPSS score at diagnosis who have a poor prognostic feature not included in the IPSS (i.e., older age, refractory cytopenias, etc.)
Reduced Intensity Conditioning HSCT for MDS
Evidence from a number of largely heterogeneous, uncontrolled studies of reduced-intensity conditioning (RIC) with allogeneic HSCT shows long-term remissions (i.e., longer than 4 years) can be achieved, often with reduced treatment-related morbidity and mortality, in patients with myelodysplastic syndromes/acute myelocytic leukemia (MDS/AML) who otherwise would not be candidates for MA conditioning regimens. (7-18) These prospective and retrospective studies included cohorts of 16 to 215 patients similar to those in the MA allogeneic HSCT studies. The most common conditioning regimens used were fludarabine -based, with CYA and tacrolimus used for GVHD prophylaxis. The reported incidence of grades II to IV GVHD was 9% to 63%, with relapse risk of 6% to 61%. The OS rates ranged between 44% at 1 year to 46% at 5 years, with a median follow-up range of 14 months to over 4 years.
In 2013, Kim et al. published a randomized Phase III trial to compare the toxicities of 2 different conditioning regimens (reduced cyclophosphamide [Cy], fludarabine, and antithymocyte globulin [ATG]; standard Cy-ATG). (19) Four (of 83) patients had MDS, and the remaining study patients had severe aplastic anemia. Overall, the incidence of toxicities were reported to be lower in patients receiving the reduced-conditioning regimen (23% vs. 55%; p=0.003). Subgroup analyses showed no differences in the overall results based on differential diagnosis.(19)
In general, these RIC trials showed a low rate of engraftment failure and low NRM but at the cost of a higher relapse rate than with MA allogeneic HSCT. However, in the absence of prospective, comparative, randomized trials, only indirect comparisons can be made between the relative clinical benefits and harms associated with MA and RIC regimens with allogeneic HSCT. Furthermore, no randomized trials have been published in which RIC with allogeneic HSCT has been compared with conventional chemotherapy alone, which has been the standard of care in patients with MDS/AML for whom MA chemotherapy and allogeneic HSCT are contraindicated. Nonetheless, given the absence of curative therapies for these patients, coupled with clinical input (see next), RIC allogeneic HSCT may be considered medically necessary for patients with MDS who could benefit from allogeneic HSCT but who for medical reasons (see Policy Guidelines) would be unable to tolerate a MA conditioning regimen.
The 2009 ASBMT systematic review previously described addressed the evidence to support RIC compared with MA conditioning regimens and makes the following conclusions, "There are insufficient data to make a recommendation for an optimal conditioning regimen intensity. A range of dose intensities is currently being investigated, and the optimal approach will likely depend on disease and patient characteristics, such as age and comorbidities."
Other recent reviews concur with the ASBMT recommendations. (20-25)
Smaller studies continue to report outcomes from HSCT for MDS in variety of patient populations and to evaluate the impact of specific patient, conditioning, and donor characteristics on outcomes; representative studies are summarized in Table 3.
Table 3: Case Series of HSCT Treatment for MDS
AML – acute myelogenous leukemia; AZA – azacitidine; BSC – best supportive care; DFS – disease-free survival; HMA – hypomethylating agents; HSCT – hematopoietic stem-cell transplantation; IPSS – International Prognostic Scoring System; MA – myeloablative; MDS – myelodysplastic syndrome; NRM – nonrelapse mortality; OS – overall survival; RIC – reduced-intensity conditioning; RFS – relapse-free survival
Myeloproliferative Neoplasms (MPN)
Data on therapy for MPN remain sparse. (15,33,34) As outlined previously in this policy, with the exception of MA chemotherapy and allogeneic HSCT, no therapy has yet been proven to be curative or to prolong survival of patients with MPN. However, the significant toxicity of MA conditioning and allogeneic HSCT in MPN has led to study of RIC regimens for these diseases. One recent series included 27 patients (mean age, 59 years) with MPN who underwent allogeneic HSCT using an RIC regimen of low-dose (2 Gy) total -body irradiation alone or with the addition of fludarabine.(13) At a median follow-up of 47 months, the 3-year relapse-free survival was 37%, and OS was 43%, with a 3-year NRM of 32%. In a second series, 103 patients (median age, 55 years; range, 32-68 years) with intermediate to high risk (86% of total patients) primary myelofibrosis or post- essential thrombocythemia and polycythemia vera myelofibrosis were included on a prospective multicenter Phase II trial to determine efficacy of a busulfan plus fludarabine-based RIC regimen followed by allogeneic HSCT from related (n=33) or unrelated (n=70) donors. (35) Acute grade II-IV GVHD occurred in 27%, and chronic GVHD in 43% of patients. The cumulative incidence of NRM at one year in all patients was 16% (95% confidence interval [CI], 9% to 23%) but reached 38% (95% CI: 15% to 61%) among those with a mismatched donor versus 12% (95% CI: 5 to 19%) among cases with a matched donor (p=0.003). The cumulative relapse rate at 3 and 5 years was 22% (95% CI: 13% to 31%) and 29% (95% CI: 16% to 42%), respectively. After a median follow-up of 33 months (range, 12-76 months) 5-year estimated disease-free survival (DFS) and OS was 51% (95% CI: 38% to 64%) and 67% (95% CI: 55% to 79%), respectively.
The largest study of allogeneic HSCT for primary myelofibrosis comes from analysis of the outcomes of 289 patients treated between 1989 and 2002, from the database of the Center for International Bone Marrow Transplant Research (CIBMTR). (36) The median age was 47 years (range, 18-73 years). Donors were HLA-identical siblings in 162 patients, unrelated individuals in 101 patients, and HLA non-identical family members in 26 patients. Patients were treated with a variety of conditioning regimens and GVHD prophylaxis regimens. Splenectomy was performed in 65 patients before transplantation. The 100-day treatment-related mortality was 18% for HLA identical sibling transplants, 35% for unrelated transplants, and 19% for transplants from alternative related donors. Corresponding 5-year OS rates were 37%, 30%, and 40%, respectively. DFS rates were 33%, 27%, and 22%, respectively. DFS for patients receiving reduced-intensity transplants was comparable: 39% for HLA identical sibling donors and 17% for unrelated donors at 3 years. In this large retrospective series, allogeneic transplantation for myelofibrosis resulted in long-term relapse-free survival in about one-third of patients.
Gupta et al. reported better disease-free survival rates in a more recent analysis of 233 patients with primary myelofibrosis who underwent RIC HSCT from 1997 to 2010. (37) Five-year OS was 47% (95% CI: 40% to 53%). Conditioning regimen was not significantly associated with OS.
Data from direct, prospective comparison of outcomes of MA conditioning and allogeneic HSCT versus RIC and allogeneic stem-cell support in MPN are not available. However, a recent retrospective study analyzed the impact of conditioning intensity on outcomes of allogeneic HSCT in patients with myelofibrosis (MF). (38) This multicenter trial included 46 consecutive patients treated at three Canadian and four European transplant centers between 1998 and 2005. Twenty-three patients (median age, 47 years; range, 31-60 years) underwent MA conditioning, and 23 patients (median age, 54 years; range, 38-74 years) underwent RIC. The majority in both groups (85%) were deemed intermediate- or high-risk. At a median follow-up of 50 months (range, 20-89), there was a trend for better progression-free survival at 3 years in RIC patients compared with MA-conditioned patients (58%; range, 23-62 vs 43%; range, 35-76, respectively; p=0.11); there was a similar trend in 3-year OS (68%; range, 45-84 vs 48%; range, 27-66, respectively; p=0.08). NRM rates at 3 years trended higher in MA-conditioned cases than RIC cases (48%; range, 31-74 vs 27%; range, 14-55, respectively; p=0.08). The results of this study suggest that both types of conditioning regimens have curative potential in patients with MF. Despite the RIC patients being significantly older with longer disease duration and poorer performance status than those who received conventional conditioning, the groups had similar outcomes, supporting the use of RIC allogeneic HSCT in this population.
In a retrospective study in 9 Nordic transplant centers, a total of 92 patients with myelofibrosis in chronic phase underwent allogeneic HSCT. (39) MA -conditioning was given to 40 patients, and RIC was used in 52 patients. The mean age in the 2 groups at transplantation was 46±12 and 55±8 years, respectively (p<0.001). When adjustment for age differences was made, the survival of the patients treated with RIC was significantly better (p=0.003). Among the RIC patients, survival was significantly (p=0.003) greater for patients younger than age 60 years (a 10-year survival close to 80%) than for patients older than 60 years. The stem-cell source did not significantly affect the survival. No significant difference was found in NRM at 100 days between the MA- and the RIC-treated patients. The probability of survival at 5 years was 49% for the MA-treated patients and 59% in the RIC group (p=0.125). Patients treated with RIC experienced significantly less acute GVHD compared with patients treated with MA conditioning (p<0.001). The OS at 5 years was 70%, 59% and 41% for patients with Lille score 0, 1 and 2, respectively (p=0.038, when age adjustment was made). Twenty-one percent of the patients in the RIC group were given donor lymphocyte infusion because of incomplete donor chimerism, compared with none of the MA-treated patients (p<0.002). Nine percent of the patients needed a second transplant because of graft failure, progressive disease or transformation to AML, with no significant difference between the groups.
Ongoing and Unpublished Clinical Trials
A search of online database ClinicalTrials.gov in October 2014 identified the following phase 3 trials of hematopoietic stem-cell transplant for MDS.
Clinical Input Received from Physician Specialty Societies and Academic Medical Centers
In response to requests, input was received from 2 Academic Medical Center specialists prior to review for May 2009. While the various Physician Specialty Societies and Academic Medical Centers may collaborate with and make recommendations during this process, through the provision of appropriate reviewers, input received does not represent an endorsement or position statement by the Physician Specialty Societies or Academic Medical Centers, unless otherwise noted.
There was consensus among reviewers that RIC allogeneic HSCT was of value in patients with MDS or MPN who would be medically unable to tolerate an MA HSCT.
Summary of Evidence
Hematopoietic stem-cell transplantation (HSCT) is at present the only potentially curative treatment option for patients with myelodysplastic syndromes and myeloproliferative neoplasms. The absence of other curative therapies coupled with clinical data and input permit the conclusion that allogeneic HSCT using either a myeloablative or reduced-intensity conditioning regimen is medically necessary in appropriately selected patients with these conditions. Patient selection is guided by age and disease risk factors, as outlined in the Policy Guidelines section.
Practice Guidelines and Position Statements
National Comprehensive Cancer Network Guidelines
The 2015 National Comprehensive Cancer Network (NCCN) clinical practice guidelines for myelodysplastic syndromes (v.1.2015) (40) makes the following recommendation regarding HSCT in general: "For patients who are transplant candidates, the first choice of a donor has remained an HLA-matched sibling, although results with HLA-matched unrelated donors have improved to levels comparable to those obtained with HLA-matched siblings. With the increasing use of cord blood or HLA-haploidentical related donors, HSCT has become a viable option for many patients. High-dose conditioning is typically used for younger patients, whereas RIC for HSCT is generally the strategy in older individuals."
Specific NCCN guidelines related to HSCT for MDS are outlined in Table 4.
Table 4: NCCN Guidelines for HSCT for MDS
U.S. Preventive Services Task Force Recommendations
Allogeneic stem-cell transplantation is not a preventive service.
Medicare National Coverage
There is no national coverage determination (NCD). In the absence of an NCD, coverage decisions are left to the discretion of local Medicare carriers.
Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection, allogeneic
Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest
thawing of previously frozen harvest with washing
specific cell depletion with harvest, T cell depletion
tumor cell depletion
red blood cell removal
platelet depletion
plasma (volume) depletion
cell concentration in plasma, mononuclear, or buffy coat layer
Blood-derived peripheral stem cell harvesting for transplantation, per collection
Bone marrow harvesting for transplantation; autologous
Bone marrow or blood-derived peripheral stem cell transplantation, allogeneic
HLA typing; A, B, or C (e.g., A10, B7, B27), single antigen
A, B, or C, multiple antigens
DR/DQ, single antigen
HLA typing; DR/DQ, multiple antigens
Lymphocyte culture, mixed (MLC)
Lymphocyte culture, primed (PLC)
Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (e.g., using flow cytometry); first serum sample or dilution
Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (e.g., using flow cytometry); each additional serum sample or sample dilution (List separately in addition to primary procedure)
Bone marrow, modification or treatment to eliminate cells (i.e., T-cell depletion)
ICD-9 Procedure
Allogeneic bone marrow transplant with purging
Allogeneic bone marrow transplant without purging
Allogeneic hematopoietic stem cell transplant
Aspiration of bone marrow from donor for transplant
Other therapeutic apheresis (includes harvest of stem cells)
Percutaneous transfusion, central vein, bone marrow or stem cells, nonautologous, code list
Surgical, lymphatic and hemic systems, extraction, bone marrow, code list
Bone marrow or blood-derived peripheral stem-cell harvesting and transplantation, allogeneic or autologous, including pheresis, high-dose chemotherapy, and the number of days of post-transplant care in the global definition (including drugs; hospitalization; medical surgical, diagnostic and emergency services)
Type of Service
Place of Service
Inpatient / Outpatient
Add to Therapy Section - New Policy. Policy represents revision of 7.03.10 to focus on myelodysplasia and myelofibrosis. New policy statement on HDC for myelofibrosis.
Replace policy - Policy reviewed with no criteria changes.
Replace policy - Policy reviewed with literature; policy statement also now includes "mini-transplant." References added; cross-reference to BC.8.01.38 on mini-transplants added.
Replace policy - Policy reviewed with literature search; no change in policy statement. No further review scheduled.
Codes updated - No other changes.
Disclaimer and Scope Updates - No other changes.
Replace policy - Policy updated with literature review. Status changed from AR to BC. References added. No change in policy statement.
Codes updated - CPT code 86817 deleted as directed by RPIW.
Cross Reference Update - No other changes
Replace policy - Policy updated with literature search. Minor terminology changes to policy statements; the intent of the policy statements remain unchanged. Additional policy statements include Reduced intensity conditioning allogeneic SCT is considered investigational as a treatment of myeloproliferative disorders and myelodysplastic syndrome. References and codes added. "High-Dose Chemotherapy" removed from the title and throughout the body of the policy and "myeloproliferative" diseases added to the policy title.
Code Update - 86817 code added back to the policy.
Code Update - New 2010 codes added.
Replace policy - Policy updated with literature search, reference numbers 14-17 added. Myeloproliferative Disorders" replaced with "Myeloproliferative Neoplasms" in title and text. Policy statements revised to indicate that RIC HSCT, previously investigational, may now be considered medically necessary as a treatment of myelodysplastic syndrome and myeloproliferative neoplasms in patients who for medical reasons would be unable to tolerate a myeloablative conditioning regimen. Reviewed and recommended by OAP in February 2011.
Related Policies updated; links refreshed.
Replace policy – Policy updated with literature search; references 15-18 and 20 added. Policy statements unchanged. ICD-10 codes added.
Code 38232 added.
CPT code 38204 was removed from the policy.
Minor update: Related Policies updated; 8.01.17 replaced 8.01.507 effective June 12, 2012.
Update Related Policies Titles: 8.01.17, 8.01.22, 8.01.30, 8.01.35, and 8.01.520. Removed Related Policy 8.01.38 as it was archived.
Update Coding Section – ICD-10 codes are now effective 10/01/2014.
Replace policy. Title revised with addition of the word "Hematopoietic". Policy rationale updated based on a literature review through September 2012. Reference 26 added; others renumbered or removed. Policy statements unchanged.
Update Related Policies. Change title to 8.01.31.
Update Related Policies. Change title to 8.01.17.
Replace policy. Policy updated with literature search through October 8, 2013; reference 14 added. Policy statements unchanged. CPT code 38230 removed from policy; it does not apply.
Update Related Policies. Change title to 8.01.30.
Update Related Policies. Add 8.01.15 and delete 8.01.514.
Update Related Policies. Remove 8.01.20 and add 8.01.529.
Update Related Policies. Remove 8.01.35, 8.01.42 and 8.01.54, then add 8.01.530, 8.01.531 and 8.01.532.
Update Related Policies. Remove 8.01.21 and 8.01.26.
Annual Review. Policy updated with literature review through September 30, 2014. References 1-3, 5-6, 26-32, and 37 added. Policy statements unchanged. Remove ICD-9 and ICD-10 diagnosis codes; these are not utilized in policy adjudication.
Disclaimer: This medical policy is a guide in evaluating the medical necessity of a particular service or treatment. The Company adopts policies after careful review of published peer-reviewed scientific literature, national guidelines and local standards of practice. Since medical technology is constantly changing, the Company reserves the right to review and update policies as appropriate. Member contracts differ in their benefits. Always consult the member benefit booklet or contact a member service representative to determine coverage for a specific medical service or supply. CPT codes, descriptions and materials are copyrighted by the American Medical Association (AMA).


text:
Known to us as the "father of French detective fiction", Emile Gaboriau preferred the term "judiciary novel" to describe the crime stories that brought him widespread success in the 1860s. Indeed, his best-known works – L'Affaire Lerouge (1865), Le Crime d'Orcival (1866), and Monsieur Lecoq (1868) – owe as much to the titillating exposure of the French justice system as to the deductive skills of his detectives Lecoq and Tabaret. But it was Gaboriau's narrative formula of crime-investigation-discovery, inspired directly by Edgar Allan Poe's founding tale The Murders in the Rue Morgue (…
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Goulet, Andrea. "Emile Gaboriau". The Literary Encyclopedia. First published 13 April 2007
[http://www.litencyc.com/php/speople.php?rec=true&UID=1662, accessed 07 July 2015.]