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|Key Info
Nestled in the heart of three acres of lush, rolling tropical gardens is Evergreen, a private and secluded estate.
This elegant villa, beautifully furnished with a unique mix of antiques and contemporary Art pieces, is located on the exclusive Sandy Lane Estate.
The property features four sprawling air conditioned bedrooms with the possibility of using an additional room for two children, and five exquisitely designed bathrooms. Each bedroom has its own distinctive feeling, TV and music, and wireless internet. One of the master bedrooms has an unrivalled view of the Estate gardens and two of the very gracious guest suites open onto the tropical gardens.
The villa is truly a treasure, and offers the unique quality of featuring more common areas than any other villa of that size, all designed to suit the guests' every possible mood: from the more formal living room to the expansive patios, the brand new state of the art family room that can sit comfortably a house full of guests for a movie on the 63" flat screen TV, to the "Puncherie" on the roof terrace (so named to reflect its perfect position to enjoy the best rum punch on the Island, while watching the sun set over the Caribbean Sea), without forgetting the Mondrian inspired bar and dancing floor, guests will never want to leave the house! But you might still want to go to the secluded pool, or down to the Sandy Lane beach (where Evergreen has its own cabana), or even stroll through the gorgeous gardens, as this property truly is evergreen!
Complimentary transfers for a maximum of three people from the airport and back in a Rolls Royce for bookings of four bedrooms at the winter rate.
A Butler is included for winter bookings of 4 bedrooms.
This property offers reduced rates for using fewer bedrooms. Exclusive use of the villa is yours regardless of the number of rooms rented. View our rates for pricing per bedroom or request a quote. Rates are based on double occupancy.
Barbados has lots of beautiful beaches and a great climate. It is also easy to get to with many direct flights from Canada, the United States and Europe. The weather is almost always sunny and warm in Barbados, cooled by the northeast Tradewinds. Barbados sightseeing is a photographer's dream. There are many natural wonders, breathtaking scenic views, gorgeous gardens and miles of white, sandy beaches. There's so much to see and many things to do such as duty-free shopping, guided island tours, or visit one of the many beaches, nature reserves or historic landmarks.
|Sleeps up to 8, 4 bedrooms
|4 bedrooms, 5 bathrooms of which 5 Family bathrooms
|Car advised
|Family friendly
|Great for children of all ages
|No pets allowed, No smoking at this property
|Private outdoor pool (unheated)
|TV, CD player, Safe, Satellite TV
|Linen provided, Towels provided
|Private outdoor pool (unheated), Private garden, BBQ
|Not suitable for wheelchair users
|Further details indoors
DVD player
Multiple TV's
Satellite/cable TV
Laundry service included
Wet bar
Well equipped kitchen
Garden view
|Further details outdoors
Gas grill
Outdoor dining
Outdoor furniture
Patio deck or balcony
Pool chairs
Private pool
|Further details
Suitable for children
Barbados offers such an abundance of natural beauty, culture and history that the island is called "The Gem of the Caribbean." Located about 300 miles north of Venezuela and the most Eastern of the Caribbean islands, Barbados portrays a delightful blend of West Indian culture and English Tradition. Independent since 1966, Barbados is the most developed of the Caribbean islands and Bridgetown, the 375-year-old historic capital is its colourful and bustling center of activity. Shopping, excellent dining and a funky nightlife are just a few of the many options available. There is an extensive bus system that is cheap and fast, providing an entertaining way to discover the island.
There are magnificent caves to explore, gorgeous landscapes and tropical gardens to visit, and an abundance of wildlife to see, including the mischievous little "green monkeys" that call Barbados their home. On the South and West coasts, the Caribbean Sea with calm blue waters and endless stretches of fine white sandy beaches invites you to relax, while the Atlantic east coast with cliffs and great waves is ideal for wind and sky surfing.
There is lots to do and the choice is not easy, but whether you enjoy some of the 3,000 hours of annual sunshine or chat with a friendly "Bajan" in one of the numerous little rum shops on the roadsides, make sure to relax in the comfort of your private Rental Butler villa at the end of the day. Take in the breathtaking sunsets, have a delicious local dinner prepared for you or just lean back and dream into the starry skies.


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The Blog
John Tavener, 1944-2013
3:03 PM, Nov 13, 2013 • By JEFFREY GEDMIN
There's a black and white photo, a little grainy and slightly out of focus, of Igor Stravinsky greeting Mstislav Rostropovich at the Royal Academy of Music, London, in June 1964. Standing in the background in the upper left hand corner is a tall lanky figure, a 20-year-old music student named John Tavener. Also in the photo, just to the right, is John's brother Roger who was friendly with Ringo Starr. Roger had done some building work on Ringo's house.
Life is, if nothing else, serendipity.
John Tavener, who died on November 12 at the age of 69 at his home in Dorset in south west England, would see his illustrious career as a composer launched by the Beatles. Ringo admired Tavener's first great work, "the Whale," an avant-garde cantata for orchestra and chorus loosely based on the biblical allegory of Jonah and Whale and premiered in London in 1968. John Lennon and Yoko Ono had dinner with Tavener one evening in Kensington and it was decided, almost immediately, that "the Whale" would be released by the Beatles on their Apple label later that same year.
In Britain, Tavener is celebrated as one of the country's finest composers of the last half century. Fellow composer John Rutter told BBC Radio 3 that Tavener "was absolutely touched by genius at every point". The two had known each other since childhood, having attended Highgate school together in northern London.
Tavener's other well-known works include his setting of William Blake's poem "The Lamb" and "A New Beginning," which was selected to ring in the new century at the end of 1999 in the Millennium Dome in London. His most famous composition, "Song for Athene," was performed at the funeral service of Diana at Westminster Abbey in September 1997. Prince Charles was a long-time friend and supporter. Tavener was one of those rare composers whose work could appeal both to serious musicians and general public alike.
I first met Tavener by phone. He had agreed to a commission by the Legatum Institute as part of our cultural offering. I rang and asked for Sir John (he has been knighted in 2000 for his musical achievements). A soft voice answered at the other end, "This is John." As I got to know him, I was surprised by his warmth and complete lack of pretension. His public persona, at least to me, had projected schoolmasterly aloofness and austerity. John Tavener was nothing of the sort.
Tavener's legacy is a body of work that is, however, an intense expression of a very serious man who was possessed by a deep spirituality. Tavener converted to the Russian Orthodox Church in 1977 and said once that "my way towards God has been to write music." I heard him say, to the question of what kind of music he liked listening to, "only things that offer me an alternative way of thinking about reality." His music has been described as neo-medieval, mystical, and minimalist. During his life, Tavener explored other religious traditions, including Hinduism and Islam, but was left touched throughout by Orthodox Christianity.
He traveled frequently to Greece over the years to meet poets and other creative-types. It was there that he met his wife Maryanne through a mutual friend and painter. He had many influences, but Tavener loved the music of Stravinsky, himself a member of the Russian Orthodox Church. Tavener wrote a short piece for chamber organ, two alto flutes and hand bells in memory of the great Russian composer who died in 1971.
Stravinsky's "Rite of Spring," with its wild percussive elements, its stress and dissonance, surely inspired Tavener's approach in "the Whale." In an improvised section 'In The Belly,' the score instructs the choir to: "clap hands, neigh, grunt, snort, yawn, make vomiting noises, whisper, cough, shuffle, hum and talk to each other — in any order". Tavener also augments traditional orchestra and chorus in "the Whale" by non-musical instruments such as a whip and a football rattle. In 2004, Tavener said: "The Whale is a piece written by an angry young man. I was angry because the world didn't see the cosmos in metaphysical terms."
By the last year of his life that anger had faded.
I came to Tavener through my friend and former music teacher Robert Shafer, the Washington area conductor and composer whose City Choir of Washington and chorus at the Shenandoah Conservatory of Music premiered the work Shafer and I commissioned together. The "Three Hymns of George Herbert," heard by a sell-out audience at Washington National Cathedral last April, were anything but the expression of an angry man. Wrote Anne Midgette, chief music critic for the Washington Post, in her review of the concert:
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White: 'No problem' if Barnett doesn't come to UFC
tags: Josh Barnett (detail) Dana White
Recent Comments »
2/14/13 8:51 PM by Chaelismyhero
It really is a shame Josh is not in the UFC.
2/14/13 8:25 PM by RyannVonReemjob
Lulz fuck your mother
2/14/13 1:18 PM by elysian
2/14/13 1:17 PM by elysian
Nastula was the 1995 and 1997 Judo World Champion, 1996 gold medalist at Olympic Games in Atlanta, Georgia, USA. Whose first fight was with...Antonio Rodrigo Nogueira. He defeated Edson Vieira who was on a 9 fight winning straight prior to his win.Could have been truly great if managed properly.
2/14/13 10:27 AM by Nick Fury
Come on War Master. Sit down and come to an agreement. We want to see you fight the best talent in the sport.
2/14/13 10:24 AM by UGCTT_SidRival
It's not a problem, but it is a shame.
2/14/13 10:15 AM by orcus
"He wouldn't have fought the best in the world in PRIDE if he stayed.. he'd have faced cabbage, Arlovski(great fighter), sylvia and Murr... who else was there for him to fight that was truly great? " How many did he fight in Pride that were truly great? Nog, Crocop, sure...Hunt? Aleksander? Nastula? Nakamura? So basically you're saying he wouldn't have gone 1-4 against the "truly great" and gotten a couple wins over guys who weren't even on the level of the UFC guys you dismissed. Also lol @ listing Arlovski as a "great fighter" but not Sylvia -- who was 2-1 with him -- or possibly even Mir, who has more big wins than Arlovski does.
2/14/13 10:07 AM by KingstonHawkeJr
That fight was 6 years ago!!! That is my point! You can't say a guy is a current top 10 because he had a quality win 6 years ago. Pretty sure Nog avenged that loss. So by your logic Nog is what, top 3? And if you're referring to the Cormier fight, losing every round isn't really considered competitive.
2/14/13 9:23 AM by fightharder
God, This turning from bad to worse. Why is this thing not happening. I do not understand why the UFC is letting Josh go. The did the most buys when the WWF crowd moved into the PPV. Josh has great appeal to this crowd. He is a great character and he genuinely is still one of the better fighters. Its just terrible frustrating. And Kingston,you obviously never watched Pride. Josh won against Big Nog in his prime,he beat guys like Hunt,Schilts and Kharitanov. More importantly he has always been competitive in his loses as well. Its really a shame and frankly from a business standpoint a little strange. I thought the UFC was leaning more towards the entertainment angle. You need real entertainers then. Sonnen is one. Barnett is another. There both great fighters as well. They should have signed them.
2/14/13 7:57 AM by KingstonHawkeJr
For me that's hard to gauge. On one hand, you're right, I don't really recall him ever being offered a lot of money to fight someone tough and saying no. But on the other hand, Barnett seems like a really intelligent guy. He has to understand that not actively seeking the best competition get's you the exact same results as turning down tough competition, except for the bad press.Let's actually analyze some of Barnett's "decisions"...In 2010 he fought Siliga. A 40 year old with 4 mma bouts to his name, coming off of a loss, who's best win was against Villareal?And after that he fought Mondragon who was 1-3 in his last 4 fights. Even him signing onto be in the Strikeforce tourney seemed suspect. How the hell did he draw Rogers in the 1st round and winner of AA and Sergei in the 2nd? AA coming off of 3 consecutive losses, and Sergei who has no ground game at all? This last fight was no better. I watch MMA religiously and have never heard of that guy before. How does a top 10 guy draw "The Hun"? Are we really buying that he was the only guy available? They couldn't of sent Struve over? I'm never going to down an athlete for making his decisions based on what will pay him the most, because as an athlete you never know when your ability to earn will be gone. But calling him a top contender with that resume is just nonsense. He beat Randy 10 years ago and took steroids to do it. Let's all collectively agree to stop rewarding him so much for that one fight.


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What are we looking for?
The pentathletes of the value-investing world. These are stocks that excel not just in one category that appeals to bargain hunters, but in several.
Our search for stocks that can score well on several value tests is inspired by money manager James O'Shaughnessy. In the recent update to his classic What Works on Wall Street, he argues that any single value indicator is likely to go through periods when it doesn't work. A more robust strategy, in his opinion, is to look for stocks that satisfy several criteria.
More on today's screen
One approach Mr. O'Shaugnessy explores is to seek stocks that score highly on five classic tests of value. We applied his suggestion to stocks trading on the Toronto Stock Exchange and adapted his strategy by searching for stocks that:
– have a price-to-book ratio below one;
– have a price-to-sales-ratio below two;
– have a price-to-earnings ratio below 10;
– have a price-to-cash flow ratio below 10;
– have enterprise value to EBITDA of less than six. Enterprise value is the total market value of a company's stock and its net debt. EBITDA is earnings before interest, depreciation and amortization.
What we found
Only 21 stocks met our criteria. Several are small cap or micro-cap firms that may be too risky for some investors' tastes. On the other hand, the list also contained several big to giant firms – notably the smartphone maker Research In Motion and the miner Sherritt International
It's important to note that stocks tend to be cheap for good reasons. You should do your own research before buying any of these value pentathletes. But Mr. O'Shaugnessy's research indicates that stocks that excel in all five categories have a habit of doing better over time than the broad market.
His back test selected U.S. stocks that scored well on all five criteria. Between 1964 and 2009, they produced an annual average return of 17.2 per cent compared to 11.2 per cent for the broad market. In the market marathon, these pentathletes shine.
Full disclosure: I own shares in Algoma Central.
Follow @IanMcGuganon Twitter:
- Sherritt International Corporation$0.80-0.05(-5.88%)
- Updated November 27 4:00 PM EST. Delayed by at least 15 minutes.


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Go for the Gold! at the World Championship Qualifier
The U.S. World Championship Qualifier event isn't just for Duelists who have their invites and want to compete for the chance to represent the United States at the World Championship in August. It's not even just for residents of the United States! The WCQ in Minneapolis, Minnesota is for every Duelist who wants to be a part of the most spectacular (and fun!) event of the year. Players who aren't qualified can show up just to Duel and meet new people by playing in one of the many Public Events that will be offered over the weekend. One event that's sure to be popular this year actually debuted last year and was deemed "totally awesome" by the Duelists who participated in it! It's called "Go for the Gold!" and you'll find nothing else quite like it.
Go for the Gold! is a Sealed Pack event, a lot like the Sneak Previews that are held right before each new Booster Pack comes out. For the Go for the Gold! events that will take place at the U.S. World Championship Qualifier, Duelists will be given 1 pack of Gold Series 3, 1 pack of Duelist Pack – Kaiba, and 2 packs of The Shining Darkness. From those packs, you'll have to build the best 20 card or more Deck you can. It's very different from Dueling with the Deck that you built out of all the cards you own, so here's a quick guide on what to expect!
When you Duel with just the cards you opened up in packs, it's harder to put together combos than it is when you have access to all your cards. Because of that, the easiest strategy is to try and Summon the biggest monster you've got as fast as you can and keep it on the field. Most of the time, the most common Spell and Trap Cards will modify the ATK and DEF of monsters or their battle positions, so you'll want to have another strong monster on board to do battle with your opponent's monsters so you don't have to risk your best one.
On the other end of the spectrum, if your opponent gets the upper hand early on in the Duel, you'll want to either force the opponent into risking his big monster in battle or find a way to Summon your own. It's tougher if you're on the defensive in this situation because if you keep Setting Defense Position monsters they'll keep getting picked off. Since the majority of the cards you'll have to work with are commons, here are some common cards Duelist Pack – Kaiba, The Shining Darkness, and Gold Series 3 you can use to even the odds!
Hunter of Black Feathers
Many of the monsters that you'll encounter in Go for the Gold! Will share the same Attribute. Since your opponent wants to have two monsters on the field, one to battle yours and the other to attack directly, there's a good chance that they'll both be of the same Attribute. There are a lot of Blackwing and Amazoness monsters in Gold Series 3. Both of those monster families all share an Attribute making them vulnerable to Hunter of Black Feathers' effect. (Blackwings are DARK, Amazonesses are EARTH)
Reese the Ice Mistress
Reese is going to be a roadblock that deters the course of victory for many Duelists. She can't be destroyed in battle by any monster that's Level 4 or higher. Since Duelists will naturally pick as many strong monsters for their Decks as possible, there's a good chance that all your opponent's monsters will be Level 4 or higher, rendering Reese impossible to destroy by battle. She's also a Tuner monster, so if you were lucky enough to pull a Synchro Monster for your Extra Deck, Reese can help you Summon it on your next turn!
Interdimensional Matter Transporter
This is the highest-risk card of the bunch, but when it comes to protecting your monster from harm, Interdimensional Matter Transporter is unrivaled. In fact, it's an excellent offensive and defensive card making it a worthy inclusion in almost any Go for the Gold! Deck. It removes one of your face-up monsters from play until the End Phase, and it's a Trap Card. That means you can dodge any Spell, Trap, monster effect, or attack and have your monster return safely in the End Phase. Just be careful, because using it defensively will likely open you up to at least one direct attack!
If your opponent just Summoned a monster that completely outclasses everything you've got, clone it! Synchro Summons will be uncommon because of the scarcity of Synchro Monsters, meaning that the biggest monsters are usually going to be Tribute Summoned. Tribute Summoning is Normal Summoning, so when your opponent busts out the Blue-Eyes White Dragon he pulled from his Duelist Pack – Kaiba, you can use this card to copy it and fight back!
Go for the Gold! Isn't the only awesome public event that'll take place at the WCQ. Favorites from the Yu-Gi-Oh! Championship Series including ATTACK OF THE GIANT CARD!!, Win-A-Mat, and the 16 player Regional Flights will be there as well. If you need more information on the WCQ, check out http://www.yugioh-card.com/en/events/


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Watch live runoff election results as they come in.
The modern Thanksgiving Holiday can be traced back to a 1621 feast in Plymouth, Mass., held by a group of religious separatists commonly referred to as the "Pilgrims.
We have all been here before.
We live in a politically correct world nowadays - a world where everyone gets offended about everything.
It began simply, with a cheesy store-bought costume my mother purchased for me at K-Mart.
When I was 5 years old, I dressed up as Captain America for Halloween.
Dear Teen Me:
First of all, one simple bit of advice: look around. Slow it all down. Savor each moment.
Editor's Note: This column was written before Georgia's loss to Tennessee on Saturday.
They found a dead body on the Truman Parkway the other day. Did you hear about it?
Married to a man who once said his "love is pain," according to court testimony, Lauren Smart endured an ongoing nightmare of brutal beatings that ultimately ended in her death.
Somewhere in my attic, there's a picture of me shaking hands with former President Jimmy Carter.
My mother snapped the picture in Chippewa Square.
Here's a bit of trivia for you: Which number is higher, the number of 2016 declared presidential candidates or the number of states in the union?
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|Polyurethane injected
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|Helmet Compatible
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|Non Eyeglass Compatible
|Face Size:
|Standard Frame
|Recommended Use:
|Manufacturer Warranty:
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Been here? Rate It!
Capitol City Brewing Company: My Favorite Local Brewery
This is one of the only breweries in Washington DC, and they have four locations. Two in DC, 1 in Baltimore, and one is Arlington (VA). It is the first brewery in Washington DC since the days of the Prohition, and it was established in 1992. The location that I have been to is right next to the new Convention Center, and very close to Chinatown.
Favorite Dish: Burger with blue cheese & mushrooms, and sweet potatoe fries.
- Beer Tasting
- Food and Dining
Capitol City Brewing Company: Great food and a glass of Zinfandell -cheers!
Whilst in DC, we were invited out by soccergrrl and her husband who kindly picked us up from our hotel and took us to the Capital City Brewing Co.
This building used to be the federal post office and was built in 1911 and closed as a post office in 1986.
Favorite Dish: I had a chicken meal, my husband had Meatloaf and Joe our son had..........what else but a burger.
We enjoyed the evening here, the place was busy, but in a relaxed way.
Capitol City Brewing Company: Washington DC's first brewpub since prohibition
The company policy is to bring the fine craft of brewing to every person who lives and visits their restaurants as well as treating them to a wonderful meal and a great experience...I must say that they have done that!!!
Favorite Dish: There are many wonderful dishes to choose from, so that makes it difficult to pick just one, so I decided on the Grilled Pork Tenderloin (tender hand cuts of pork brushed with chipotle BBQ sauce and grilled served with garlic-cheddar mashed potatoes and roasted corn relish). For the brew, I tried the Prohibition Porter (a dark colored, roasty flavored beer with a mild maltiness that balances the hop bitterness).
- Beer Tasting
- Food and Dining
Capitol City Brewing Company: Micro Brew
Capital City Brewing Company
This place was just down the street from Hostelling International so it was the first place I stopped on a Friday night.
I was looking for a light beer and thought the Capital Kolsch served was great. They gave me a couple of large warm pretzels that hit the spot and then I had a plate of sweet potato fries because I am a fan of them.
It was a busy place with lots of people there and the service seemed to be very good. One point to make though I guess and that is I thought they actually brewed the beer there.
Apparently they needed more space in the restaurant so they moved all the equipment to their Virginia location and the brew is shipped over in kegs.
Favorite Dish: Capitol Kolsch
A German style golden ale that takes its name from the city of Cologne. This light bodied brew has a clean taste with fruit notes and a restrained hop dryness. Our interpretation is brewed with 10% wheat malt as tradition dictates.
Capitol City Brewing Company: Washington's Foremost Brewpub
Looking for a good brewpub, with its own distinctive lagers, ales, pilseners, porters, and stouts? This is the place. It's a Washington landmark, with excellent food to accompany the beers.
Favorite Dish: It's all good.
- Beer Tasting
- Food and Dining
Capitol City Brewery: Capitol City Brewery
Great place to go after a day of site-seeing and before you either go to a hockey game or go clubbing for the night.
Favorite Dish: Microbrew Beer, Texas nachos, Reuben Sandwich.... anything but the softshelled crab.
Capitol City Brewery: Capitol City Brewery
They brew their own beers (at the DC location you can see some of the vats and other brew equipment)--every one I've tried there has been great. The DC location has a lively happy hour scene but can be very loud for dining.
Favorite Dish: Good burgers and delicious beer!
Capitol City Brewing Company: Capital City Brewing Company was ok
This is an ok place to eat. Very nice and lively place to meet friends and have some drinks. Great atmosphere but a bit noisy. Food was generic. We had the fish fried with their special beer batter. I did not even finsih mine...was not that good. We also had the reuban sandwich and that was good. Warm pretzels were nice.
Capitol City Brewing Company: Beer and Burgers
The Capital City Brewing Company is a good, decent, cheap pub type place with good wholesome American fare. Nothing fancy, a political theme, good burgers and fries. Just a sort of in-town-contractor-within-per-diem type place.
Right next to Union Station. Get off the Metro, go out front, and turn to the right. Head down the arched collonade, run across the street, and there it is.
Capitol City Brewing Company: Good Eats
This is Washington D.C.'s first brewpub since prohibition ended. There are a few Capital City Brewing Co. around the area, but there is one that is right down town at 11th and H st in NW. This brewpub is located in an old historic building , also, so you should check it out even you arent going to eat. the building is beautiful.
Favorite Dish: I usually just get a steak and whatever stout that they are featuring for that month.
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Sun Dolphin 5-Person Pedal Boat With Canopy
Seats 5 people comfortably
High-density polyethylene deck and hull
Built-in drink holders and cooler/storage area
Closed-cell polystyrene foam
Polyester canopy with aluminum frame
Airhead Montana Two-Man Kayak
Lightweight, compact, and portable
Highly visible orange color
Rugged, UV-resistant nylon cover
Inflatable seats with adjustable backrest
Detachable, inflatable floor doubles as mattress
Yak Gear Kayak Outriggers, Standard Orange
Outriggers provide added stability to any vessel
Adjustable outrigger arms are 30" long
Connect to the boat with a Scotty 350 rod holder
Installation instructions and hardware included
California Board Company 9' Soft Stand-Up Paddleboard Set
Paddleboard set with paddle, leash, and roof rack
High-density 100% waterproof EPS core
Polyethylene slick bottom for easy gliding
Removable 9" fiberglass/nylon fin
Beavertail Phantom Waterfowling Kayak
5-year warranty
100% Custom Compound polyethylene structure
Foam-filled inner layer
Molded-in foot rests and handles
Rear water-tight storage compartment
Old Town Predator XL Rudder Kit
Works in unison with Minn Kota motor
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Foot-controlled for hands-free fishing
Fits Predator XL and Predator 13 kayaks
Malone J-Downloader Kayak Carrier w/Bow & Stern Lines
Innovative fold-down design
Convenient overhead clearance
Large kayak transport capability
Universal fit JAWZ mounting hardware
Rotational hubs feature single touch slide locks
Wave Armor Kayak/Canoe Stabilizer Kit
Creates an instant fishing platform
Polyethylene-molded hydrodynamic floats
Can be adjusted up/down and in/out
For beams up to 40"
Malone J-Pro2 Kayak Carrier w/Bow & Stern Lines
Universal mounting system
Tubular frames prepared with a two-layer coating
Steel, injection molded nylon, synthetic rubber
Full-length oversized padding
Includes all hardware, straps and safety tie-downs
Intex Seahawk 2 Boat Set With Oars and Pump
440 Lb. (400 kg) Maximum Weight Limit
Grab Handle on Bow for easy carrying
Inflatable Floor for both comfort and rigidity
Quick-Fill, Fast-Deflate Boston Valves
Deluxe Aluminum Oars and a Hi-Output Hand Pump
Coated Grapnel PWC Anchor System
3.5-lb. grapnel anchor
Holds in mud, sand, gravel, and rock
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25 rope
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Malone SeaWing Kayak Carrier w/Bow & Stern Lines
Two Bow Stern Lines
Two V-Style Cradles
Two 12 Cam Buckle Straps
Two Jawz Universal Fit Mounting Blocks
Four 50mm 60mm Bolts with T-Knobs
Chica Canoe/Kayak Vest
Mesh sides for ventilation
Baja Back seating comfort
Adjustable shoulders and sides
SitBacker Canoe Seat with Lumbar Support
Split-contour seat design
Patented BackComfort Technology
One-sided one-buckle adjustment
2" padded seat cushion
Convenient oversized storage pouch
Scotty Baitcaster Rod Holder w/ Side & Deck Mount
Fits a wide range of combos
Slotted to secure a spinning reel
Side mounted flange
Soft lash strap for added security
YAK Gear Handle Kit
Two marine-grade rubber handles
Double-thick nylon straps for durability
Contour grip for comfortable use
All stainless steel installation hardware
Installation instructions included
Caviness Woodworking 8BL-RT Beavertail Wooden Paddle, 5'5"
Resin-tipped, straight-shaft paddle
Hand-selected hardwood construction
Low cavity, beavertail blade
Durable Tri Coat finish
55" in length
Yak Gear Deluxe Anchor Trolley Kit
Deluxe anchor trolley system with Harken pulleys
Mini zig-zag cleat included to maintain position
Installation instructions and hardware included
Kit also includes 30 of rope
Sun Dolphin Excursion 10' Sit-In Fishing Kayak
Two flush mount rod holders
One swivel rod holder
Adjustable foot braces
Deluxe adjustable seat with high back support
Storage hatch and shock cord deck rigging


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Ankita Lokhande With Her Relative
Ankita Lokhande With Her Relative
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Stereotactic ablative radiotherapy (SABR) has emerged as a new treatment option for patients with oligometastatic disease. SABR delivers precise, high-dose, hypofractionated radiotherapy, and achieves excellent rates of local control. Survival outcomes for patients with oligometastatic disease treated with SABR appear promising, but conclusions are limited by patient selection, and the lack of adequate controls in most studies. The goal of this multicenter randomized phase II trial is to assess the impact of a comprehensive oligometastatic SABR treatment program on overall survival and quality of life in patients with up to 5 metastatic cancer lesions, compared to patients who receive standard of care treatment alone.
After stratification by the number of metastases (1-3 vs. 4-5), patients will be randomized between Arm 1: current standard of care treatment, and Arm 2: standard of care treatment + SABR to all sites of known disease. Patients will be randomized in a 1:2 ratio to Arm 1:Arm 2, respectively. For patients receiving SABR, radiotherapy dose and fractionation depends on the site of metastasis and the proximity to critical normal structures. This study aims to accrue a total of 99 patients within four years. The primary endpoint is overall survival, and secondary endpoints include quality of life, toxicity, progression-free survival, lesion control rate, and number of cycles of further chemotherapy/systemic therapy.
This study will provide an assessment of the impact of SABR on clinical outcomes and quality of life, to determine if long-term survival can be achieved for selected patients with oligometastatic disease, and will inform the design of a possible phase III study.
Trial registration
Clinicaltrials.gov identifier: NCT01446744
Keywords:Oligometastases; Stereotactic radiotherapy; Quality of life; Cancer; Survival
The oligometastatic disease state was first defined in 1995 and refers to an stage of disease where cancer has spread beyond the site of origin, but is not yet widely metastatic [1]. In such a state of limited metastatic disease burden, it is hypothesized that eradication of all sites of metastatic disease could result in long-term survival, or even cure, in a subgroup of patients [2]. Ablation of metastatic deposits can be achieved surgically, or through stereotactic ablative radiotherapy (SABR), a new radiotherapy technology that delivers very large, hypofractionated doses of radiotherapy with high precision to small tumor targets, with high rates of local control.
Clinical evidence to support the presence of an oligometastatic state is emerging in both the surgical and SABR literature, for several tumor types. In a study of over 5200 patients with lung metastases who underwent surgical resection, a 5-year survival of 36% was reported in patients who achieved a complete resection, much higher than would be expected for many patients with disseminated stage IV disease [3]. Similarly, in patients treated with SABR for 1-3 lung metastases from a variety of primary tumors, local control with SABR was 96% at 2-years, and 2-year survival was 39% [4]. Long-term survival has been demonstrated in patients treated for oligometastases with surgery or SABR at several other tumor sites, including liver, brain, bone, and adrenal metastases [2,5-8]. However, even after such treatment, the risk of further metastases after ablative treatment is high, up to 60-80% in some studies [4,5]. In some cases, SABR can be used for further salvage at newly progressive sites [9].
Despite the apparent achievement of long-term survival with ablative treatment for oligometastatic disease, the level of evidence to support such treatments is weak in many cases, often based on single-arm studies without appropriate controls [10]. Patients included in such reports are highly selected, based on good performance status and slow pace of tumor progression. It has been suggested that the long-term survival achieved with treatment of oligometastases is a result of the selection of fit patients with very slow-growing tumors, rather than the result of treatment intervention [11].
Randomized trials are therefore necessary to establish the utility of ablative treatment of oligometastatic disease [10,12], but such randomized trials are rare. One such completed randomized trial, Radiation Therapy and Oncology Group Trial 9508, compared whole brain radiotherapy (WBRT) with WBRT + stereotactic treatment for patients with 1-3 brain metastases, and found an overall survival advantage only in patients with a single metastasis and those patients in the most favorable baseline recursive partitioning analysis (RPA) prognostic group [13]. Patients with inferior baseline prognostic factors did not achieve a survival benefit from stereotactic treatment. At least one other randomized trial investigating the oligometastatic paradigm has recently opened: in 2010, the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) trial was launched, comparing metastatectomy with best supportive care in patients with pulmonary metastases from colorectal cancer [14].
It is unclear if all patients with oligometastatic disease benefit from SABR, in terms of improved local control, improved survival or improved quality of life. Although SABR generally results in ablation of each metastatic target, patients remain at high risk of further metastatic progression. Results from SABR for treatment of oligometastases in published studies appears promising, but these promising results may be due to patient selection, rather than treatment intervention, and are based on comparisons with historical controls. The benefit of comprehensive treatment of oligometastases can only be demonstrated conclusively in the context of a randomized trial.
This study is designed as a randomized phase II study. Patients will be randomized between current standard of care treatment (Arm 1) vs. standard of care treatment + SABR (Arm 2) to sites of known disease (Figure 1). Patients will be randomized in a 1:2 ratio to Arm 1 vs. Arm 2, respectively. This study has been approved by the Ontario Cancer Research Ethics Board (#11-030), in compliance with the Helsinki Declaration.
Figure 1 . Study design. Patients with be randomized in a 1:2 ratio between Arm 1 (Standard of care) vs. Arm 2 (SABR).
The randomized phase II design is required for 3 reasons: First, the randomization will provide an appropriate control group to serve as a comparator for the experimental arm. Historical or contemporaneous non-randomized controls would not be appropriate due to the multitude of biases that could be introduced by patient selection and other confounders. Second, a small sample size will allow for adequate power to assess for an early overall survival difference, quality of life, and to evaluate toxicity in the SABR arm. Third, the results will allow for a decision as to whether a multi-institutional phase III trial is warranted, and inform the design of such a trial.
To assess the impact of a comprehensive oligometastatic SABR treatment program on overall survival and quality of life in patients with up to 5 metastatic cancer lesions, compared to patients who receive standard of care treatment alone.
Primary endpoint
· Overall Survival
· Defined as time from randomization to death from any cause
Secondary endpoints
· Quality of life
· Assessed with the Functional Assessment of Cancer Therapy: General (FACT-G)
· Toxicity
· Assessed by the National Cancer Institute Common Toxicity Criteria (NCI-CTC) version 4 for each organ treated (e.g. liver, lung, bone)]
· Progression-free survival
· Time from randomization to disease progression at any site or death
· Lesional control rate
· Number of cycles of further chemotherapy/systemic therapy
Inclusion criteria
· Age 18 or older
· Willing to provide informed consent
· Histologically confirmed malignancy with metastatic disease detected on imaging. Biopsy of metastasis is preferred, but not required.
· ECOG performance status 0-1
· Controlled primary tumor
· defined as: at least 3 months since original tumor treated definitively, with no progression at primary site
· All sites of disease can be safely treated based on criteria below
· Maximum 3 metastases in any single organ system (i.e. lung, liver, brain, bone), and the total number of metastases must be 5 or less. For example, a patient with two liver metastases and two lung metastases is eligible.
· Life expectancy >6 months
· Not a candidate for surgical resection at all sites: surgery to all sites not recommended by multidisciplinary team, or unfit or declining surgery
· Prior chemotherapy allowed but no chemotherapy (cytotoxic or molecularly targeted agents) therapy 4 weeks prior to first fraction of radiotherapy, during radiotherapy, or for two weeks after last fraction. Hormonal therapy is allowed.
· Patients with metastases that have been previously treated (e.g. prior resection, RFA or radiotherapy):
· If that previously treated metastasis is controlled on imaging, the patient is eligible for this study and that site does not need treatment
· If that previously treated metastasis is NOT controlled on imaging:
· If the previous treatment was surgery, the patient is eligible if that site can be treated by SABR
· If the previous treatment was radiotherapy or RFA, the patient is ineligibile.
· Patient presented at multidisciplinary tumor board or radiotherapy departmental quality-assurance rounds, with consensus opinion that entry into the study is appropriate.
Exclusion criteria
· Serious medical comorbidities precluding radiotherapy
· Bone metastasis in a femoral bone
· Patients with 1-3 brain metastasis and no disease elsewhere (these patients should not be randomized but treated with stereotactic radiotherapy as per results of randomized trials)
· Prior radiotherapy to a site requiring treatment
· Complete response to first-line chemotherapy (i.e. no measurable target for SABR)
· Malignant pleural effusion
· Inability to treat all sites of active disease
· Clinical or radiologic evidence of spinal cord compression OR tumor within 3 mm of spinal cord on MRI.
· Dominant brain metastasis requiring surgical decompression
· Pregnant or lactating women
Evaluation and randomization
Prior to randomization, a complete history and physical examination by the treating radiation oncologist is required. Histologically confirmation of malignancy is required, with metastatic disease detected on imaging. Biopsy of metastasis is preferred, but not required.
Patients must be restaged within 12 weeks prior to randomization, including brain CT or MRI imaging (for tumor sites with propensity for brain metastasis); and CT neck/chest/abdomen/pelvis with bone scan. PET-CT is only required for specific evidence-based indications, as defined by the Ontario Health Insurance Program, and in such cases the CT neck/chest/abdomen/pelvis and bone scan are not required. For other indications, at the discretion of the treating oncologists, PET-CT scans may be done but are not required. MRI spine is required for patients with vertebral or paraspinal metastases.
Patients with liver metastases are also required to have adequate liver function tests (AST, ALT, GGT, alkaline phosphatase). A negative pregnancy test is required for women of child-bearing age.
The study will employ a 1:2 randomization between Arm 1:Arm 2 (Figure 1). The sample size allows for one stratification factor at randomization: number of metastatic sites (1-3 vs. 4-5). Randomization will occur in permuted blocks of nine.
Arm 1
Radiotherapy for patients in the standard arm should follow the principles of palliative radiotherapy as per the individual institution, with the goal of alleviating symptoms or preventing imminent complications. Patients in this arm should not receive stereotactic doses or radiotherapy boosts.
Treatment recommendations for patients in Arm 1 are as follows: For brain metastases, whole brain radiotherapy (i.e. 20 Gy in 5 fractions, 30 Gy in 10 fractions); for lung metastases, palliative radiotherapy as per 2011 consensus guidelines (i.e. 8 Gy in 1 fraction, 20 Gy in 5 fractions, 30 Gy in 10 fractions)[15]; for bone metastases, palliative radiotherapy as per 2011 consensus guidelines (i.e. 8 Gy in 1 fraction (most common), 20 Gy in 5 fractions, 30 Gy in 10 fractions)[16]; for liver metastases, 20 Gy in 5 fractions if standard institutional practice.
For Arm 1, Treatment planning is to be done using CT simulation or conventional simulation (fluoroscopy) as per individual institutional practice. Simple beam arrangements, such as parallel opposed beams, are favored wherever possible.
Arm 2
For Arm 2, all treatments in this study are based on current protocols in clinical use at the LRCP and VUmc for treatment of lung [17], liver [18], brain [19,20], and spinal column [21] metastases. The guiding principle for radiotherapy is to achieve disease control but to minimize any potential adverse impact on quality of life. Concurrent chemotherapy or targeted therapy at the time of radiotherapy is not permitted within the 4 weeks prior to SABR. Hormone therapy is permitted.
Doses and fractionations by tumor site are shown in Table 1. Treatment will be setup using reproducible positioning, verified using an on-line protocol, for all patients in this study. Immobilization may include a custom immobilization device, such as thermoplastic shell or Vac-lokTM bag, as per individual institutional practice when delivering SABR. Some centers do not use immobilization devices and have demonstrated high degrees of accuracy; this is acceptable in this study.
Table 1. Dose and fractionations by site
All patients in Arm 2 will undergo planning CT simulation. 4-dimensional CT will be used for tumors in the lungs or liver. Axial CT images will be obtained throughout the region of interest. For all lesions, the gross tumor volume (GTV) will be defined as the visible tumor on CT and/or MRI imaging +/- PET. No additional margin will be added for microscopic spread of disease, consistent with current protocols (i.e. Clinical Target Volume [CTV] = GTV). For vertebral lesions, the entire vertebral body may be considered the CTV, as per institutional practice. A Planning Target Volume (PTV) margin of 2-5 mm will be added depending on site of disease, immobilization, and institutional set-up accuracy: 2 mm margins may be used for spinal stereotactic treatments, 2 mm for brain tumors, and 5 mm for other sites. Organs at risk visible in the planning CT scan will be contoured. Constraints for 1-, 3- and 5-fraction regimens are taken from Timmerman et al. 2008 [22], whereas equivalent doses were calculated for other fractionation schemes.
For spinal lesions, a pre-treatment MRI is required to assess the extent of disease and position of the cord. This must be fused with the planning CT scan. A Planning Organ at Risk Volume (PRV) expansion of 2 mm will be added to the spinal cord, and dose constraints for the spinal cord apply to this PRV.
It is strongly recommended that dose constraints not be exceeded. If a dose constraint cannot be achieved due to overlap of the target with an organ at risk, the fractionation can be increased or the target coverage compromised in order to meet the constraint. It is strongly recommended that in cases where the target coverage is compromised in order to meet the constraint, the mean dose delivered to the GTV should be at least 80% of the nominal dose in Table 1. All such cases of dose reduction or target coverage compromise must be approved by the local PI prior to treatment. For vertebral tumors, an adequate PRV of 2 mm must be added to the spinal cord, and the dose constraints apply to this PRV.
For lung tumors, doses are prescribed to approximately the 80% isodose line surrounding the PTV, resulting in a hotspot of 120-140%; the latter should fall within the GTV. 95% of the PTV should be covered by the prescription dose, and 99% of the PTV should be covered by 90% of the prescription dose.
For other tumor sites, doses are prescribed to approximately the 100% isodose level and 95% of the PTV should receive 95% of the prescription dose. Doses will be corrected for tissue inhomogeneity. Several non-overlapping 6/10 MV beams (on the order of 7-11 beams) or 1-2 VMAT arcs combined possibly with a few non-coplanar beams is recommended. Non-coplanar beams can be used to reduce 50% isodose volume for un-gated treatments. Coplanar beams are recommended for respiratory-gated treatment.
For lung or liver metastases, each metastasis can be treated with a separate isocenter if metastases are well-separated. Since most metastases are treated every other day (Table 1), when two metastases are treated, these can be done on alternating days to reduce the daily time required on the linear accelerator (e.g. Monday/Wed/Friday for one target, and Tues/Thurs/Mon for another). For brain metastases, all the metastases should be treated at the same time. For bone metastases, if multiple metastases can be imaged and localized at the same time, they can be treated at the same time, otherwise, they can be treated on alternate days.
The sequencing of tumor sites is at the discretion of individual physicians, but in general should begin with the brain, due to risks associated with progression, followed thereafter by liver, lung, and bone.
Quality assurance (Arm 2)
In order to ensure patient safety and effective treatment delivery, a robust quality assurance protocol is incorporated. The following requirements must be completed for each patient:
· Prior to treatment, each patient must be discussed at quality assurance (QA) rounds.
· All radiotherapy plans must meet target dose levels for organs at risk (Tables 2). Prior to plan approval, the dose to each organ at risk must be verified by the physicist or treating physician. It is strongly recommended that dose constraints not be exceeded.
· All dose delivery for intensity-modulated plans (including arc-based treatments) will be confirmed before treatment by physics staff.
· Cone-beam CT (CBCT) will be used to verify patient positioning immediately prior to treatment. Ideally, direct tumour localization should be performed for stereotactic treatments of soft tissues. For gated SABR treatments, direct tumour localization will be performed by matching the tumour position with the ROI defined by IGTV_CBCT. This will be followed by a gated 2D-kV in the AP plane to verify the gating window. In the absence of direct tumour localization, reliable soft tissue surrogates are recommended. A repeat CBCT will be done 25 minutes after the first, if delivery requires more than 25 minutes. A final CBCT may be done after completion of treatment.
Table 2. Follow-up schedule
Quality assurance for centres joining study
Prior to opening the study, each participating research centre will be required to send to one of the Principal Investigators a mock treatment plan for the anatomic sites that will be treated (e.g. lung, brain, liver, adrenal), to ensure that the treatment plans are designed in compliance with the protocol. The principal investigators will provide pertinent CT datasets. Each participating research centre can choose which tumor sites will be treated at their individual centre (i.e. some centres may only choose to treat a subset of the eligible metastatic sites).
Patients treated with prior chemotherapy are eligible for this study, however, no chemotherapy agents (cytotoxic, or molecularly targeted agents) are allowed within the period of time commencing 4 weeks prior to radiotherapy (conventional or SABR) lasting until 2 weeks after the last fraction. Hormonal therapy is allowed. Use of chemotherapy schemes containing potent enhancers of radiation damage (e.g. gemcitabine, adriamycin) are discouraged within the first month after SABR.
Further radiotherapy for progressive disease at new metastatic sites
Patients in Arm 1 who develop new, untreated metastatic deposits can receive palliative radiotherapy for any new such sites of progression. Patients in Arm 2 who develop new, untreated metastatic deposits should be considered for SABR at those sites, if such deposits can be treated safely with SABR, and if the treating institution offers SABR for that body site. If SABR is not possible, then palliative RT can be delivered if indicated.
Patients will be seen every three months post-randomization for the first two years, and every six months until 5 years after treatment (Table 2). At each visit, a history and physical examination will be conducted by the oncologist, and CTC-AE toxicities recorded. The FACT-G Quality of life questionnaire is to be completed at each visit.
CT head, chest, abdomen and pelvis, and bone scans will be repeated at 3 and 6 months, then every six months. Patients randomized to Arm 2 will be considered SABR for salvage if new sites of disease develop. Additional Imaging or laboratory investigations should be carried out at the discretion of the oncologist, based on findings in the history or physical, and additional treatment (e.g. further chemotherapy) is at the discretion of the oncologists.
Measurement of response
Overall survival will be measured as time until death from any cause, and progression-free survival as time to either progression or death, whichever occurs first. Lesion response will be evaluated in this study using the international criteria proposed by the Response Evaluation Criteria in Solid Tumors (RECIST) Committee (http://ctep.info.nih.gov/guidelines/recist.html webcite). The sum of the longest diameter (LD) for all target lesions will be calculated and reported as the baseline sum LD. The baseline sum LD will be used as reference by which to characterize the objective tumor response.
Statistical analysis
Sample size
This study will employ a randomized phase II design, to conduct a preliminary and non-definitive randomized comparison between the control and experimental arms. The study will aim to detect a signal in improved overall survival that would be used to design a phase III study to definitely compare survival outcomes between the two groups. The study will therefore be designed with alpha = 0.20 and beta = 0.20 (as recommended for phase II randomized studies [23]). It is estimated that the median survival of the control group after randomization in this study will be 9 months.
There will be a 1:2 randomization between Arm 1 and Arm 2. In order to detect a 6-month improvement in median survival from 9 months to 15 months with SABR, a total of 93 patients (31 in Arm 1 and 62 in Arm 2) will be needed. Assuming a 5% rate of loss to follow-up, a total of 99 patients will be accrued (33 in Arm 1 and 66 in Arm 2). The study projects accrual over 48 months with 12 months of additional follow-up. Accrual targets are as follows: 20 patients in year 1, and 25-30 patients in years 2, 3, and 4.
Data analysis
Patients will be analyzed in the groups to which they are assigned (intention-to-treat).
Primary endpoint
Survival will be calculated using the Kaplan-Meier method with differences compared using the stratified log-rank test. Pre-planned subgroup analysis will occur based on stratification variables. A Cox multivariable regression analysis will be used to determine baseline factors predictive of survival and allow for assessment of time to failure data important in this patient group.
Secondary endpoints
Quality of life at 6 months will be measured using FACT-G scores, with differences between groups tested using the Student's t-test. Differences in rates of grade 2 or higher toxicity between groups will be tested using the Fisher's Exact Test. Differences in progression free survival will be tested using the stratified log-rank test. Differences in the number of cycles of further chemotherapy/systemic therapy will be tested using the Student's t-test.
Data safety monitoring committee
The DSMC will meet annually after study initiation and after 50 patients are accrued to review toxicity outcomes. If any grade 3-5 toxicity is reported, the DSMC will review the case notes to determine if such toxicity is related to treatment. If the DSMC deems that toxicity rates are excessive (>25% grade 3 toxicity, or >5% grade 4 or 5 toxicity), then the DSMC can, at its discretion, recommend cessation of the trial, dose adjustment, or exclusion of certain treatment sites that are deemed as high-risk for complications.
The DSMC will conduct one interim analysis once 50 patients are accrued. For this analysis, the DSMC will be blinded to the identity of each treatment arm, but OS data will be presented for each arm. The DSMC will recommend stopping the trial if there is an OS difference that is statistically significant with a threshold of p < 0.001 using the log-rank test. Furthermore, if the median OS among all patients is substantially different than estimated in the sample size calculation, the DSMC can recommend increasing or decreasing the target accrual in order to maintain statistical power.
Although the aggressive treatment of patients with oligometastatic disease has become more common over the last decade [24], considerable equipoise still exists as to whether such aggressive treatments improve overall survival, or whether the long-term survival seen in single-arm studies is due to patient selection and treatment of slow-growing, favorable tumors [25]. Although SABR and surgical resection of oligometastases are generally safe, there is a risk of toxicity, and a small risk of treatment-related mortality [26,27]. Since patients with metastatic disease have traditionally been considered to be best served by palliative treatments, it is incumbent upon physicians to demonstrate that the escalation of treatment (with attendant risks of side effects or complications) is associated with gains in survival and/or quality of life.
This multicenter, international study aims to accrue 99 patients and aims to provide preliminary evidence to assess the impact of a comprehensive oligometastatic SABR treatment program on overall survival and quality of life. Data from this study may be used to inform the design of a phase III study, and will lead to a better understanding of the oligometastatic paradigm.
SABR, Stereotactic ablative radiotherapy; WBRT, Whole brain radiotherapy; RPA, Recursive partitioning analysis; PulMiCC, Pulmonary metastasectomy in colorectal cancer; FACT-G, Functional assessment of cancer therapy: general; NCI-CTC-AE, National Cancer Institute Common Terminology Criteria for Adverse Events; CT, Computed tomography; PET, Positron emission tomography; MRI, Magnetic resonance imaging; AST, Aspartate transaminase; ALT, Alanine transaminase; GGT, Gamma glutamyl transpeptidase; LRCP, London regional cancer program; VUmc, Vrije University medical center; GTV, Gross tumor volume; CTV, Clinical target volume; PTV, Planning target volume; PRV, Planning organ at risk volume; PI, Principal investigator; VMAT, Volumetric modulated arc therapy; QA, Quality assurance; CBCT, Cone Beam CT; ROI, Region of interest; IGTV, Internal GTV; RECIST, Response evaluation criteria in solid tumors; LD, Longest diameter; DSMC, Data safety monitoring committee; OS, Overall survival.
Competing interests
The authors declare that they have no competing interests.
Author's contributions
Study conception: DAP, CJAH, GBR, MD, ML, SS. Initial study design: DAP, CJAH, GBR, MD, ML, BY, RO, JP, BS, SS. Revision of study design and protocol: All authors Drafting and approval of final protocol and manuscript.
This study funded by grants from the Ontario Institute for Cancer Research through funding provided by the Government of Ontario, and the London Regional Cancer Program Small Grants Program. The granting bodies are not involved in data collection or analysis.
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Inoue T, Katoh N, Aoyama H, Onimaru R, Taguchi H, Onodera S, Yamaguchi S, Shirato H: Clinical Outcomes of Stereotactic Brain and/or Body Radiotherapy for Patients with Oligometastatic Lesions.
Jpn J Clin Oncol 2010, 40(8):788-794. PubMed Abstract | Publisher Full Text
Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, Werner-Wasik M, Demas W, Ryu J, Bahary JP, et al.: Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial.
Lancet 2004, 363(9422):1665-1672. PubMed Abstract | Publisher Full Text
Treasure T, Fallowfield L, Lees B: Pulmonary Metastasectomy in Colorectal Cancer: The PulMiCC Trial.
J Thorac Oncol 2010, 5(6):S203-S206.
210.1097/JTO.1090b1013e3181dca1239PubMed Abstract | Publisher Full Text
Rodrigues G, Videtic GMM, Sur R, Bezjak A, Bradley J, Hahn CA, Langer C, Miller KL, Moeller BJ, Rosenzweig K, et al.: Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline.
Practical Radiat Oncol 2011, 1(2):60-71. Publisher Full Text
Lutz S, Berk L, Chang E, Chow E, Hahn C, Hoskin P, Howell D, Konski A, Kachnic L, Lo S, et al.: Palliative Radiotherapy for Bone Metastases: An ASTRO Evidence-Based Guideline.
Int J Radiat Oncol*Biol*Phys 2011, 79(4):965-976. PubMed Abstract | Publisher Full Text
Hurkmans CW, Cuijpers JP, Lagerwaard FJ, Widder J, van der Heide UA, Schuring D, Senan S: Recommendations for implementing stereotactic radiotherapy in peripheral stage IA non-small cell lung cancer: report from the Quality Assurance Working Party of the randomised phase III ROSEL study.
Radiat Oncol 2009, 4:1. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text
Lock M, Gaede S, Sinclair K, Fisher B, Perera F, Ahmad B, Sexton T, Rodrigues G, D'Souza D, Wong E: Phase I Study of Image-Guided and Radiobiologically-Guided Stereotactic Body Radiotherapy for Hepatic Lesions.
In: Canadian Association of Radiation Oncologists Annual Meeting Abstract 2010, 38:2010.
Lagerwaard FJ, van der Hoorn EAP, Verbakel WFAR, Haasbeek CJA, Slotman BJ, Senan S: Whole-Brain Radiotherapy With Simultaneous Integrated Boost to Multiple Brain Metastases Using Volumetric Modulated Arc Therapy.
Int J Radiat Oncol*Biol*Phys 2009, 75(1):253-259. PubMed Abstract | Publisher Full Text
Rodrigues G, Yartsev S, Yaremko B, Perera F, Dar AR, Hammond A, Lock M, Yu E, Ash R, Caudrelier J-M, et al.: Phase I Trial of Simultaneous In-Field Boost With Helical Tomotherapy for Patients With One to Three Brain Metastases.
Int J Radiat Oncol*Biol*Phys
In Press, Corrected Proof
Kuijper IT, Dahele M, Senan S, Verbakel WFAR: Volumetric modulated arc therapy versus conventional intensity modulated radiation therapy for stereotactic spine radiotherapy: A planning study and early clinical data.
Radiother Oncol 2010, 94(2):224-228. PubMed Abstract | Publisher Full Text
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Rubinstein LV, Korn EL, Freidlin B, Hunsberger S, Ivy SP, Smith MA: Design issues of randomized phase II trials and a proposal for phase II screening trials.
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Pfannschmidt J, Dienemann H, Hoffmann H: Surgical resection of pulmonary metastases from colorectal cancer: a systematic review of published series.
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Pre-publication history
The pre-publication history for this paper can be accessed here:


text: > * In message <AOENJKDECJBPGIGJDAALKECPCBAA.dave@...> > * On the subject of "RE: Re[2]: [clisp-list] TCP-based Network Server in CLISP" > * Sent on Sat, 28 Sep 2002 18:00:14 -0700 > * Honorable "Dave Richards" <dave@...> writes: > > > > - SOCKET-STATUS retries upon reception of EINTR. > > > Time passage events are orthoginal, for the most part, but do > > impact how we > > > handle select() EINTRs. Time passage can be handled in one of > > two ways: (1) > > > polling, or (2) via signals. Either way, this impacts how we > > handle EINTR > > > in select(). My current C code uses polling. The last set of > > gprof data I > > > collected showed me in gettimeofday() 3% of the time! My > > goal/desire would > > > be to use an interval timer in the next version. > > > > I am not sure I understand this. > > would you prefer CLISP to signal an error on EINTR? > > C-c does interrupt SOCKET-STATUS already, right? > > Well, rather than dictate a solution (since there are several possibilities) > let me state the problem: > > 1. select() for each socket until network traffix events occurs, i.e. > :input, :output, :io, :error. > 2. Every second execute a LISP function which handles time-based work. > > In a single-threaded environment like CLISP, network traffic and time events > must be multiplexed in such a way that both needs are met (more or less > efficiently). One approach (the one my C code uses) is to pass the time > value (1 second) to select(). This ensures that we'll exit select() in time > to meet our next time event. Unfortunately, with many users connected, we > can exit select() many times per second. Which means we must call > gettimeofday() every loop iteration to see how much longer before we should > process our time events. We subtract the "next time period" from the > current time and pass the difference to select(). This approach, although > simple and seemingly elegant, is also pretty expensive. in CLISP you will be using GET-INTERNAL-REAL-TIME, right? > The second approach would be to use a 1 second interval timer. When > the timer expires, the signal handler would increment a variable. At > the next loop iteration we can use the variable to decide whether to > handle time events (and how many). > > If we poll, EINTR handling isn't very important. In general, CLISP doesn't > receive signals. Therefore, who really cares how we handle EINTR? > > However, in the second (interval timer) case, signals are important. We use > signals to keep track of time. If socket-status re-select()s in the EINTR > case, our time event processing may lag. > > So, the bottom line is, if we poll for time, re-select()ing isn't a big > deal. But if we use setitimer() to handle time, EINTR becomes an issue. > > Make sense? yes. but since I vaguely recall that CLISP uses alarms for other things, I think the first way is the right way. besides, the only reasonable thing to do on EINTR is to signal an error. I hope more OS-savvy people will weigh in here. Bruno, Arseny, please! -- Sam Steingold (http://www.podval.org/~sds) running RedHat7.3 GNU/Linux <http://www.camera.org> <http://www.iris.org.il> <http://www.memri.org/> <http://www.mideasttruth.com/> <http://www.palestine-central.com/links.html> Growing Old is Inevitable; Growing Up is Optional.


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Happy Birthday Sandra
Hope you have a fantastic day
Happy Birthday Sandra
Hope you have a fantastic day
If ever there is a tomorrow when we're not together.......
there is something you must always remember.
You are braver than you believe, stronger than you seem, and smarter than you think.
But the most important thing is, even if we're apart...... I'll always be with you.
Winne the Pooh - A A Milne
A friend is a hand that is always holding yours,
no matter how close or far apart you may be.
A friend is someone who is always there and will always, always care.
A friend is a feeling of forever in the heart.


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Aeromax 2000 Tangle Free Toy Parachute
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bill perretti
Tuesday, Jul 12 2011 (about 4 years ago)
Aeromax 2000 Tangle Free Toy Parachute
I use it in rockets as a payload. Upon ejection charge it opens nicely and floats down in the breeze. Funny but I haven't retrieved one yet. LoL!
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text:
Yawning: Everyone does it (even animals!), but no one really knows why.
In general, researchers tend to fall into one of two camps, WebMD reports. There are those who believe yawning must have some physical cause and purpose and those who believe yawning is a form of social communication.
Both sides have recent research supporting their opinions. A 2011 study suggested that yawning could be the body's way of cooling down the brain. "Brains are like computers," Princeton University researcher Andrew Gallup, told Discovery News. "They operate most efficiently when cool, and physical adaptations have evolved to allow maximum cooling of the brain." A gaping, open-mouthed yawn draws in air (which is more often than not cooler than our internal body temperatures) and turns the brain's thermostat down a few notches.
But there's no denying the social nature of the yawn. Notoriously catchy -- how many times have you yawned just reading this? -- yawning is even more contagious between close friends and family members, according to research from earlier this year.
In the attempt to explain why we yawn, however, let's not neglect the fact that most of us really do need more sleep. About one in five adults don't get enough shut-eye, according to the American Academy of Sleep Medicine. But whether it's hectic work schedules, an active night life, early-morning workouts or one-too-many cups of coffee cutting into your sleep, skimping can have serious effects, on everything from your cardiovascular health to your waistline.
Despite their glamorously busy schedules, sleep is important to many celebrities, too. In fact, some have even spoken openly about their problems catching enough winks. Plenty more haven't spoken openly about the importance of sleep, but judging by these photos, we're willing to bet quite a few could use some more sleep. Check out the 30 celebs below trying to stifle (or not!) a big yawn.
Recording artist Miley Cyrus yawns during an early-morning appearance at the 16th annual EIF Revlon Run/Walk for Women on May 9, 2009 in Los Angeles, California.
Actress Lucy Liu attends the premiere of "Kill Bill Vol. II" at the Arclight's Cinerama Dome April 8, 2004 in Hollywood, California.
Serena Williams of the USA yawns during the men's final match between Fernando Gonzalez of Chile and Roger Federer of Switzerland on day fourteen of the Australian Open 2007 at Melbourne Park on January 28, 2007 in Melbourne, Australia.
John Paul II yawns as he presides over his traditional weekly general audience at the Vatican, January 14, 2004.
Tibetan spiritual leader The Dalai Lama yawns while at the Central School for Tibetans in Kalimpong on December 14, 2010.
The NBA's Shaquille O'Neal yawns as he sits on the bench during a Lakers-Jazz game in Inglewood, California.
Former President Bill Clinton yawns before teeing-off during a golf tournament to benefit Martha's Vineyard Hospital at Farm Neck Country Club, August 22, 1993.
Actress Kirsten Dunst yawns on the movie set of "Mona Lisa Smiles" January 13, 2003 in the West Village, New York City.
Charles Barkley yawns during Live TNT NBA Studio Show Media Opportunity for TNT 2004 NBA All-Star week at Magic Johnson Theatres in Compton, California, United States.
Brett Favre, of the Minnesota Vikings, yawns during warmups prior to an NFL preseason game against the Denver Broncos at the Mall of America Field at Hubert H. Humphrey Metrodome, on September 2, 2010 in Minneapolis, Minnesota.
Jerry Seinfeld takes a break while filming a promo October 26, 2004 in New York City.
Venus Williams of the United States yawns during the opening ceremony on day one of the World Team Challenge 2009 tournament held at Victoria Park, January 7, 2009 in Hong Kong, China.
Kate Moss yawns at a West Village restaurant in New York City, April 6, 2006.
Rafael Nadal of Spain yawns during practice on Day Ten of the Wimbledon Lawn Tennis Championships at the All England Lawn Tennis and Croquet Club on June 30, 2011 in London, England.
Apolo Anton Ohno of the United States yawns after the Short Track Speed Skating Men's Semi-Final on day 9 of the Vancouver 2010 Winter Olympics at Pacific Coliseum on February 20, 2010 in Vancouver, Canada.
Newt Gingrich yawns as he leaves the stage after taking part in The Republican Presidential Debate at University of South Florida in Tampa, Florida, January 23, 2012.
Sasha Obama yawns during her father Barack Obama's speech as Michelle Obama holds her head on day four of the Democratic National Convention (DNC) at Invesco Field at Mile High, August 28, 2008, in Denver, Colorado.
FC Barcelona's Argentinian player Lionel Messi yawns during a training session at the Athens Olympic stadium, one day before a Champions League football game against Panathinaikos on November 23, 2010.
Nomar Garciaparra, formerly of the Chicago Cubs, pauses to yawn during the game against the New York Mets on September 26, 2004 at Shea Stadium in New York City.
President of Cuba Fidel Castro yawns during discourse of President Nicanor Duarte on August 15, 2003 in Asuncion.
Former President George Bush yawns as former President Gerald Ford, former First Lady Barbara Bush and former First Lady Nancy Reagan listen to speeches at the Republican National Convention at the First Union Center in Philadelphia, Pennsylvania, August, 1 2000.
Former British Prime minister Margaret Thatcher yawns on November 19, 1990 in Paris, as she attends the Conference on Security and Cooperation in Europe.
British actor and director Charlie Chaplin stretches and yawns in a full-length promotional portrait for his film "The Tramp".
Michelle Wie of the USA yawns on the 18th hole during day one of the LPGA Thailand at Siam Country Club on February 17, 2011 in Chon Buri, Thailand.
German Chancellor Angela Merkel yawns during the 67th sitting of the Bundestag, the lower house of parliament in Berlin, October 27, 2010.
O.J. Simpson yawns during a break in his trial in District Court at the Clark County Regional Justice Center September 25, 2008 in Las Vegas, Nevada.
Brazilian President Dilma Rousseff yawns during the launching of PRONACAMPO -- a Federal Government program to improve education policies in rural areas where the illiteracy rate is high, at Planalto Palace in Brasilia, on March 20, 2012.
For more on sleep, click here.


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Did the contractor skimp on insulation when your new headquarters facility was built? Why is the accounting department complaining about drafts? What's between the walls of the building you want to purchase? An infrared (IR) thermographic survey can help answer these (and many other) questions. The nondestructive assessment can provide a roadmap for building improvements that increase efficiency and safety, as well as improve business continuity. "Building and energy costs are on the rise; by inspecting a building with IR and other techniques, the owner can determine what needs to be done to manage the building asset better, use less energy, and save money," explains Gregory R. Stockton, founder of Randleman, NC-based Stockton Infrared Thermographic Services Inc., in the Infrared (IR) Thermography for Building Managers white paper.
An infrared camera is a diagnostic tool that can be used to conduct analyses of building conditions and systems. "[It] generates a digital image, where the different colors in the image represent different temperatures," says Flemming Lund, certified thermographer and president, Infrared Diagnostic LLC, Sudbury, MA. Differences in temperature, or anomalies, can be cues to problems that aren't visible to the naked eye. "It could be moisture, it could be lack of insulation or a building material that should be there, [or] it could be an electrical condition, too," explains Ken Goodman, partner and environmental scientist, Garland, TX-based RME.
In addition to assessing mechanical and electrical systems, IR thermography can help improve the thermal performance of your building envelope by identifying air leakage and other deficiencies. "Insulation and draft issues in commercial buildings can significantly increase the utility cost," says Lund. "By doing an infrared energy audit, we can pinpoint areas that need sealing or insulation, and make the building more energy efficient."
According to Hal Smith, owner and thermographer, C&I Inspections, South Jordan, UT, the cost of infrared cameras has dropped over the last 10 years, which may have you wondering if it's better to buy a camera and conduct a do-it-yourself survey, or to hire a pro. Consider the following as you make this decision:
When hiring the work out to a professional thermographer, ask about the level of training and certification he/she has received. If the survey is being conducted because your insurance mandates it, be sure to check with your insurance company about the level of certification it requires. Additionally, if the survey and its results will be used as evidence in a lawsuit, using a third-party thermographer will lend credibility to the results – just make sure the firm you hire has the experience and training to back up its assessment.
A professional thermographer will supply you with a complete report once the survey is finished. The report should include not only photographs, but also draw conclusions about the problems or deficiencies that were discovered. It should recommend the urgency with which the problem should be addressed, too. "I give them a priority," explains Smith, citing an electrical problem as an example. "I say, 'This is Level 4,' which means that it's critical and needs immediate attention because it could fail at any time."
Jana J. Madsen is former editor at Buildings magazine.
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has clearly double topped. the breakout needs to approach double bottom at 3.10 for cash. cant wait looking forward to getting in on jan contract next month


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After a rainy travel, the warm welcome in the hotel was cheering us up. A freshly baked cake, apples, chocolate and water were offered. Furthermore, the way to the big spa cassiopeia was explained and a tourist card given, which gives 2 Euro discount for the entrance of the spa. The breakfast next morning was also just amazing. Warm bread,... More
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Yergenson, Bruce "Yergy", 80, of McCall, died November 24, 2015 at a Boise hospital. A Memorial Service will be held at the McCall Nazarene Church on November 28, 2015 at 2:00 p.m. Arrangements are with Boise Funeral Home.More info Email a friend
James, Leonard L., 74, of Middleton, passed away on Thursday, November 19, 2015 at home of natural causes. A graveside service will be held at 10:30 AM on Saturday, November 28, 2015 at Hillcrest Memorial Gardens, 15862 So. Indiana Ave., Caldwell, ID...More info Email a friend
Leader, Charles H., 46, of Caldwell, died Friday, November 20, 2015 of natural causes. Memorial services will be held at CitySide Life Center, 8366 W. Northview, Boise, on Saturday, Nov, 28th at 10:30 a.m. Arrangements are under the care of Dakan Funeral...More info Email a friend
Loop, Susan Ritchie, 55, of Emmett, will be having a Visitation and Open House on Wednesday, November 25, 2015 at the Cloverdale Funeral Home Chapel from 5:00 8:00pm.More info Email a friend
Drake, Harold A., 90, of Twin Falls, died Monday, November 23, 2015 at Heritage Assisted Living of Boise. A celebration of life will be held at 10:00am, Wednesday, November 25, 2015 at Heritage Assisted Living, 1777 S. Curtis Rd, in Boise. Cremation is...More info Email a friend
Johnson, Keith Ardell, 83, of Mountain Home, passed away on November 19, 2015, after over a year long struggle from a stroke. A viewing will be held from 4:00 PM to 6:00 PM on Friday, November 27, 2015 at Rost Funeral Home, McMurtrey Chapel, in Mountain...More info Email a friend
Guyette, Sr., Robert L., 70, of Meridian, died Saturday, October 17, 2015 at his home. A graveside service will be held at 10:00 AM on Wednesday, November 25, 2015 at the Idaho State Veterans Cemetery. There will be a memorial service to follow at 11...More info Email a friend
Odermott Jr., Otto R., 57, of New Plymouth, Idaho, died Tuesday, November 17, 2015 at home. Services will be held Saturday, November 28, 2015 at 2 pm at 2717 12th Ave. Rd in Nampa. A viewing will be held the night before from 6-8 pm, 2543 SW 4th Ave. Ontario...More info Email a friend
Payne, Willard Otis, 89, of Nampa, died Saturday, November 14, 2015 at his home. A graveside service will be held on Wednesday, November 25, 2015 at 3:00pm at the Idaho State Veterans Cemetery in Boise. In lieu of flowers, please make memorial contributions...More info Email a friend
The Family of Lee Moberly wishes to express their thanks for all the cards, calls, flowers, thoughts, prayers, food and the numerous memorial donations in Lee's memory. It was all appreciated so much.More info Email a friend
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Horticulture Professor Nina Bassuk leads a campus walk for CCE educators attending the annual Agriculture and Food Systems In-Service Conference last week. More than 325 CCE educators from around the state gathered to exchange research findings and information from the field. The conference, which brings together faculty, educators, industry and community partners, consisted of more than a dozen tracks this year including farm management, invasive species, fruit, dairy, agroforestry and agricultural economic development.
A New York City urban gardening symposium in mid-October was organized in collaboration with CUCE-NYC, Randall's Island Park Alliance and the American Museum of Natural History. Its purpose was to identify resources for people wanting to start an urban garden or to take their existing gardens to the next level. Read more.
More New Yorkers will soon benefit from regional agriculture program Harvest New York as it grows beyond its roots in western New York to support farmers in the northern reaches of the state. Read more.
From Buffalo to Long Island, the North Country to the Southern Tier, our interns partnered with faculty members and association staff to put knowledge to work all around the state. Working in programs connected to the College of Human Ecology and College of Agriculture and Life Sciences, students conducted wide-ranging research on invasive species, improving rural food opportunities, bolstering parental education, enhancing food safety at yogurt producers, sparking scientific interest among summer camp girls.
Cornell Cooperative Extension links the research and extension efforts at Cornell University, the Cornell University Agricultural Experiment Station and the New York State Agricultural Experiment Station, providing the knowledge to maximize New York State's agricultural and natural resources.
Cornell Cooperative Extension's community and economic vitality programs build the capacity of New York State communities to engage in and direct their own futures. Associations partner with campus faculty and staff, local officials, not-for-profits, colleges, planners, policymakers, and community leaders.
Cornell Cooperative Extension's environment and natural resources programs are designed to help individuals and communities engage in long term plans to sustain the quality and diversity of the natural assets in New York State.
Partnering with the College of Human Ecology outreach centers, institutes and departments, Cornell Cooperative Extension nutrition programs connect research and practice, are highly collaborative, build on community strengths, and provide knowledge for policymakers.
Cornell Cooperative Extension programs are designed to improve the quality of life for all New York State residents. 4-H Youth Development programs align with the national 4-H mission mandates. Family programming addresses support and care at all stages in the life course.
She leads Food and Nutrition Education in Communities programs, including the Expanded Food and Nutrition Education and the Supplemental Nutrition Assistance Program.
In New York, 4-H reaches 170,000 youth. Campus researchers partner with 4-H community educators to develop programs and test new ideas...
More than a dozen students produced delicious cheese at Cornell's sixth Science of Cheese Making and Vat Pasteurization workshop.
Apple varieties Cortland, Empire and Jonagold were favorites of President Elizabeth Garrett long before she took the helm at Cornell....
Broome County CITIZEN U leader Nosa Akol and Jamila Simon, NYS 4-H citizenship and civic engagement specialist, spoke to a national...
Cornell Cooperative Extension is an equal opportunity, affirmative action educator and employer.


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November 30, 2015
The message hit me during the National Anthem. Moments earlier, we "celebrity" guests had been tooling around the basketball court in wheelchairs, getting the feel for shooting the ball from a seated position and figuring out how to turn, wheel and dribble at the same time. But when we headed court side for the National Anthem, we unbuckled and stood to face the flag. The Kansas Wheelhawks players did not - because they could not. Point taken. The Kansas Wheelhawks held their first-ever celebrity wheelchair basketball challenge this week to help us all appreciate those abilities we may take for granted. It was also to celebrate making the most of the abilities we have. Let me tell you - the Wheelhawks have some skills! Drew Switzer and I were among several area people asked to take part. While our arms and shoulders ached after our ten-minute stint, the Wheelhawks were still going full tilt. They are as competitive as any ball team you'll find, and it was amazing to watch them in action - and I did a lot of watching, often left in the dust by their speed and not quite able to get position for a rebound. If you ever have a chance to catch them in action, go for it - find out when and where at www.kansasaccessiblesports.com. More than anything, you'll walk away realizing that no one is disabled - just differently abled. And that's just fine.
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