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Anti-Gay Extremists Cite Gay Pedophile As Typical Of All Gays
Jim Burroway
June 30th, 2009
Anti-gay extremists are all over this news item from Durham, North Carolina:
A Duke University official has been charged in federal court with offering his 5-year-old adopted son up for sex. Frank Lombard, associate director of the Center for Health Policy, was arrested Wednesday in Raleigh, the FBI said.
An unidentified informant who already faces child porn charges in a different child sex case pointed investigators to Lombard, according to court documents. The informant told investigators he had met Lombard on the Internet four years ago. The informant described in graphic detail how he allegedly observed Lombard molesting an African-American child on four occasions over an Internet video chat service called ICUii.
…During the chats, according to the affidavit, "FL" [Frank Lombard's screen name] told undercover investigators that he had himself molested his child, whom he adopted as an infant, and that he had allowed others to molest his child. "FL" stated that "the abuse of the child was easier when the child was too young to talk or know what was happening, but that he had drugged the child with Benadryl during molestation."
Predictably, anti-gay extremists are already using this horrific crime as "proof" that all gay people are unfit to be parents. They'll tell you that this is how virtually all gay men behave. LifeSite is already eating it up, as are Dakota Voice's Bob Ellis and Town Hall's Mike Adams.
We've seen them equate homosexuality with pedophilia by tagging the Matthew Shepard Hate Crimes Act with the libelous "Pedophile Protection Act" moniker. Adams piled onto that them by following his first post up with another one noting that Lombard was Facebook Fan with Rev. Gene Robinson, the first openly gay Bishop of the Anglican Church. The Right Rev. Robinson has 3,668 other fans, but that didn't deter Adams from asking, "Is this arrest thwarting an effort by Lombard to promote tolerance of pedophilia in the Episcopal Church?"
This episode even gave discredited anti-gay "researcher" Paul Cameron the chance to come out of the woodwork to claim that this sad episode "demonstrates why gays should not be able to adopt."
Kiliann Melloy has a great rundown on anti-gay reactions to Lombard's arrest at EDGE Boston, including a blog which claims to be a "grassroots network of the Republican Party of Virginia." And she reviews the contention by Paul Cameron and another so-called "researcher," Dr. Judith Reisman, that gay men are more likely to molest children. (Reisman's Ph.D. is in Communications, but as Melloy notes, that doesn't stop her from writing about the physiological effects of pornography on the brain without the aid of any research.)
The lesson we ought to learn from Lombard's arrest is that being a horrible, abusive parent is an equal-opportunity crime. Gay individuals are no more immune from engaging in criminal conduct with five-year-olds than straight people. Like this heterosexual couple from Indiana, just to name one tragic example.
But it's gay men in particular which get the blame for molesting children. Anti-gay activists will claim that gay men are guilty of this horrible crime in numbers far exceeding their proportion in the overall population. The problem with that assertion though is that there is absolutely no evidence to support that claim. That's not to say that there are no gay predators. But there is no evidence to suggest that gay men are more likely to molest children than straight men, which is the fear-mongering message that extremists return to again and again.
The real tragedy in this case is that a very young boy has been horribly abused. The crime that anti-gay extremists engage in by slandering all gay people with this episode is, without a doubt, the much lesser crime. But it is a crime nevertheless, and it's one they will have to answer for someday. Just like this Lombard bastard.


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Discipline: Sociology
Credit Hours: 3
Prerequisite: CRM 101 or permission of instructor. This course examines crimes and near-crimes where environmental harm results. With a focus on the U.S.A., the following topics will be examined: the evolving legal and cultural definition of environmental crime; the enforcement of environmental laws by both federal and state regulatory structures and by policing agencies, prosecutors, and courts; types of environmental crimes and types of criminals including motivations, causal factors and conducive conditions. As well, we note the international scope of some environmental crime and the complexity of international responses. Also listed as CRM 325. (Offered every even-year spring semester. (LA) (3)
Consult the Keuka College Course Catalog for additional information and to view other courses.

subset: commoncrawl


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DENVER (KUSA) - It's a dilemma many parents face. Your baby needs a diaper change, but there's no changing table in the restroom.
One mom decided to change her child's diaper out in the open at a Denver Starbucks and what happened next ended with a call to police.
On a coffee run Friday night, Ruth Burgos ran her one-year-old son Thiago to the restroom.
"As a mother, you have to do what you have to do. Wherever you have to do it," Burgos said.
Burgos noticed there was no changing table at the Denver Starbucks on the 7900 block of East 49th Avenue so she changed her son's diaper in the seating area.
"I just kind of wiped him off, cleaned him off as quickly as I could," Burgos said.
Alex Burgos says a Starbucks employee tossed his wife a rag and spoke to her in a "demeaning" tone.
"He said make sure to wipe the seat when you're done," he said. "They started talking amongst themselves and laughing about it."
Burgos says his blood started boiling, hotter than the venti coffee with extra sugar he decided to pour on the floor.
"And I said make sure you clean that," Burgos said.
He says they exchanged strong words and hand gestures.
The store called Denver police to report a "disturbance" and an officer responded around 10 p.m. but nobody was arrested.
Starbucks spokesperson Jaime Riley says the company is "concerned," has "apologized to the Burgos family," and wants all customers treated with "dignity and respect."
We asked Riley if Starbucks is considering installing changing tables and she said she didn't know the answer to that but would look into it.
"It's really frustrating as a parent or as a child care provider," said Jami Dennis, president of Glendale-based ABC Nannies.
Dennis says a lot of family friendly businesses don't have changing tables, but doing a diaper change out in the open should only be a parent's last resort.
"To avoid situations where you make other people uncomfortable, I would try to do it in private," Dennis said.
Burgos says this never would have happened if Starbucks would've had a changing table in the restroom.
"I hope that other families don't get treated the way we did," she said.
What do you think? Is it appropriate to change your child in public, or should businesses be more accommodating to families?
Join the conversation now on our KSDK Facebook page.
(KUSA-TV © 2013 Multimedia Holdings Corporation)


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home > arthritis center > arthritis a-z list > ankylosing spondylitis, neurologic perspective article
Ankylosing Spondylitis, Neurologic Perspective (cont.)
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Deutsch, Español, Français, Hausa, Igbo, Indonesian, Italiano, Kiswahili, Kreyòl, Malagasy, Melayu, Português, Русский, Soomaaliga, Tagalog, Việt, Türkçe, Yorùbá, Ελληνικά, தமிழ், नेपाली, 中文, اردو, 한국어, 日本語, العربية, فارسی, עִברִית, हिन्दी, ไทย, বাংলা, తెలుగు, ગુજરાતી, ລາວ, ਪੰਜਾਬੀ, සිංහල, پښتو
Matthew Rollins is a retired technician and inventor of several things used today world wide. One of the projects he has been working on involves observing the varying performance of a parabolic when it is moved various distances from the 'heating target'. This may provide groundwork for a version of a parabolic solar cooker that uses an easily movable reflector to maximize efficiency.
Recent news and developments
- March 2013: Matthew Rollins has announced the formation of a new company, Applied Green Technology, which will include plastic specialists and business management advisors. They are interested in providing low cost cooking and electrical lighting solutions for developing countries, and up –market "Green" products for quality retail markets. One goal is to find a replacement for the typical cooking bag used with panel cookers and metal cook pot with healthy heat resistant plastic alternatives. They are also examining new ideas for wind driven electrical generation.
- December 2012: War weary citizens in Iraq to receive solar cookers - During a recent visit to villages in the Najaf-Karbala region of Iraq, a trustee of The Lady Fatemah Trust found that villagers were using two methods for cooking: The majority of families, living in abject poverty, use open fuelwood fires for cooking, heating and lighting, while a slightly more affluent minority uses appliances fueled by kerosene. In the first phase of this project, LFT intends to provide families living in the villages surrounding Karbala: Barakat al-Zahra district, Al-Mahdiyeh Village One and Two, the al-Nedhal and al-Wala' neighborhoods, as well as to families living on isolated desert farms with solar cookers. About 7000 solar panel cookers will be needed to provide every family in the region with a cooker. The cookers are an improved version of the standard Cookit solar cooker. They made from plastic fluteboard, and are being manufactured by Matthew Rollins. Total project cost will therefore amount to £105,000.00. Consider being a donor. More information...
- January 2011: Matthew Rollins, a resident of Coventry, England, has been featured in the local newspaper, the Telegraph, promoting the formation of a local inventors club. Their inaugural meeting will take place in City Council offices. Professional physicists, as well as anyone interested in the inventing process have been encouraged to attend. Rollins for his part, has helped to refine the design of a type of solar panel cooker that can be used in areas of the world facing limited fuel supplies, and suffering respiratory disease from indoor air pollution, as well as, working on a movable reflector for the parabolic solar cooker shown above. Also, with two interviews with the BBC, they are on their way to establishing the club.
- October 2010: An article in the Coventry Telegraph discusses Matthew Rollins' efforts to make a more durable CooKit and his intention to form a local inventors' club.
See also
Matthew Rollins


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Field Lab Examples
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Glacial Geology in the Field part of Field Lab Examples
Students describe and interpret glacial features exposed in gravel pits and outcrops. -
Earth System Topics: Atmosphere, Climate, Surface Processes:Glaciers, Solid Earth:Earth Materials, Earth Materials:Rocks
Developing a local stratigraphy part of Field Lab Examples
Students use field lab periods to construct a composite stratigraphic section of the area surrounding their campus. -
Earth System Topics: Time/Earth History, Solid Earth:Earth Materials, Climate, Solid Earth:Earth Materials:Rocks, Atmosphere


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about the Oceanic Blade Stainless Steel Dive Knife. Is this a good knife for just free diving? i dont have a dive knife so would this be a good beginers knife? And how should i care for the knife, I am new to dive knives.
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this wiki
- "You see, Niko, I have been working for the government. I'm afraid it's my job to watch you."
- ―Michelle betraying Niko.
The Snow Storm is a mission for Elizabeta Torres in Grand Theft Auto IV. Niko recieves a phone call from a distressed Elizabeta who is arguing with Little Jacob in the background.
Mission objectives
In order to complete the mission the player must:
- Go to the old hospital and get Elizabeta's coke back
- Find the drugs in the hospital and take out anyone in your way
- You've found Elizabeta's stuff, the coke is on the table
- N.O.O.S.E. are raiding the hospital, get out of there and lose your wanted level
- Go and meet Little Jacob
Niko enters Elizabeta's apartment to find her and Jacob in an argument. Elizabeta has been ripped off by a contact which Little Jacob had told her about, and blames Jacob for the loss of her coke. The buyers that Little Jacob had found was the AOD, who ripped him off because the coke had been stolen from them in the first place.
Niko must go to the old hospital on Colony Island, and search for the cocaine inside it. The building is filled with Angels of Death and the Spanish Lords dealing with each other. The product is located in a room on the far side of the hospital and you are required to eliminate all gang members in the building to get to it.
A quicker and easier method is to go around to the back of the old hospital where you can find a ladder. From there you can reach the second storey of the hospital and take out the gang members below you much more easily. Gas bottles are located around each room which you can shoot to take out the guards quicker. Also from the back entrance you will find yourself closer to where the coke is located and can avoid the gang members from the front of the building.
Once you pick up the bag of coke on the table Niko will ring up Jacob to inform him of the situation. While doing so, NOOSE arrives and raids the building. To escape you must shoot your way to front of the building where you will find vehicles in the carpark to make a getaway in. If you entered the hospital through the back entrance and avoided the guards at the front the NOOSE will have to attack them before they can get to you, making it slightly easier for you. After you lose your wanted level,Niko calls Jacob and Jacob says he's in Chase Point with someone, and you have to meet Little Jacob in an alley in Chase Point.
When you meet up with Jacob, Michelle is there. She reveals her identity as a government agent sent to watch Niko. She confiscates the coke from you and tells you that the agency she is working for needs Niko to do some jobs for them. Niko gets frustrated and Jacob tells Niko that Elizabeta won't be happy about this.
Completion of this mission unlocks the combat shotgun in the gun store and unlocks missions for United Liberty Paper (if you have completed the mission, "Photo Shoot").
Video Walkthrough
- This is the same coke batch that Johnny and Malc stole in the mission Heavy Toll.
- At the north side of the hospital there is a docked speedboat. This can provide you with a much easier alternative for losing the cops.
- Usually, the ending cutscene for this mission can be seen at night, especially when it is raining with thunderstorms as it is quite rare to see this cutscene during the morning, afternoon or even at dusk.
- The mission's name is likely a reference to the cocaine that must be retrieved in the mission, as coke is white and powdery, like snow in it's early fall.


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The Power of Independent Thinking
Clifford Thies on the American Economic Association and Richard T. Ely
Recorded: Monday, November 28, 2011
The American Economic Association (AEA) takes pride in celebrating its founder Richard T. Ely. This pride is strange, given the character of Elys thought, which is revealed in The Independent Review article The Shaping of a Future Presidents Economic Thought: Richard T. Ely and Woodrow Wilson at The Hopkins by Gary M. Pecquet and Clifford F. Thies, as well as the Econ Journal Watch article Richard T. Ely: The Confederate Flag of the AEA? by Clifford F. Thies and Ryan Daza. In this podcast, Thies is interviewed by the economist Lawrence H. White and explores Elys ideas, values, and impact. Thies is the Eldon R. Lindsay Chair of Free Enterprise and Professor of Economics and Finance at Shenandoah University.
Experts: Clifford F. Thies, Lawrence H. WhiteType: RadioIssues: Bureaucracy and Government, Civil Liberties/ Human Rights, Collectivism, Culture/ Society, Economic History and Development (U.S.), Economic Policy, Economists, Government Power, Immigration, Political Ideology and Philosophy, Public Health/ Consumer Protection, Race Issues, Regulation and Deregulation, Religion, Science, Welfare
Charles Peña on the Imperial Presidency
Recorded: Friday, July 15, 2011
Charles Peña, Senior Fellow at the Independent Institute, speaks with Judge Napolitano of Fox Business Network's Freedom Watch on how Presidential war powers have expanded between the White House and Congress.
Experts: Charles V. PeñaType: TelevisionIssues: Defense and Foreign Policy, Government Power


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May 6, 2016
RALEIGH, N.C. (AP) -- An audit of the North Carolina Education Lottery shows the agency took in $1.5 billion in sales in fiscal 2012.
The State Auditor's office released its report Tuesday. It said the take for the previous fiscal years marked an increase of $135.6 million over 2011.
The report said the lottery's four cash transfers for the year reached $456.8 million, the largest transfer in the agency's history. For 2011, the cash transfer totaled $446.9 million.
According to the audit, the lottery awarded $1 million or more for the 110th time. It increased the number of retailers by 2.7 percent to 6,787. Also, the release of 49 new instant scratch-off games into the marketplace generated sales of $960 million.
By law, lottery funds pay for teachers' salaries in grades K-3 to keep class size as small as possible, school construction, need-based college scholarships and financial aid, and academic prekindergarten for at-risk four-year-olds.
To date, the N.C. Education Lottery has raised more than $2.58 billion for these programs statewide.
Copyright 2016 by The Associated Press. All Rights Reserved.
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The South Oldham volleyball team saw their season come to a close Tuesday night as they fell in 3-1 heartbreaker to Simon Kenton.
The Dragons struggled early in the match, dropping the first game 25-20 before rebounding for an important 25-23 win in game two to even the score at 1-1.
Simon Kenton took the wind out of their sails in game three, holding off South in a back and forth game to win 28-26.
From there, it was all Pioneers as they picked up a 25-22 win in the final game to win the match.
South Oldham finished the season with a 22-13 record.
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Weazel News
this wiki
Weazel News Television (Weazel News) is a news branch of Weazel that appears in Grand Theft Auto: Liberty City Stories and Grand Theft Auto IV. The news branch parodies FOX News. The company's slogan & motto tagline is: "Reporting The Right News" (Grand Theft Auto IV) was introduced on 1 January 2008, Later on 1 January 2013, was revamped the change new company slogan & motto tagline is: "Standing Up To The Liberal Agenda One Issue At A Time" (Grand Theft Auto V).
The Weazel News name was first mentioned briefly in Grand Theft Auto: Liberty City Stories, during a closing dialog in "Coq au Vin" in LCFR. It is in Grand Theft Auto IV, however, when its prominence was elevated, reporting events of Liberty City and the exploits of the player.
In GTA IV, Weazel News is a massive news network with 3-news divisions including: Weazel Sports (FOX Sports Central was aired on FOX Sports & FOX Sports News), Weazel Weather Forecast (The Weather Channel) and Weazel Business & Finance (Bloomberg Television). Niko can visit the website, watch it on television or most commonly, listen to it on the radio.
Travellers on the Liberty Transport Authority rail service from Grand Easton Terminal (via Easton LTA at Burlesque Street) to Francis International Airport LTA in full-Liberty City subway stations are also treated to a specially recorded Weazel News bulletin—introduced with a namecheck of "Welcome to Weazel News onboard the Liberty Transport Authority"—during the 15-minute journey. This short bulletin is updated twice a day and is shown in both classes on LCD Digital HDTV throughout the train.
Many airlines from across the world also play pre-recorded extracts of the Weazel News with text headlines from it or have a full bulletin available on the in-flight entertainment systems. Airlines with Weazel World News include FlyUS, Vice City Air and DMAir Rockstar. Travellers can watch the bulletins on Weazel shortly after take-off on FlyUS flights operated from Liberty City-Francis to Los Santos, Liberty City-Francis to San Fierro-Easter Bay, Liberty City-Francis to Las Venturas and Liberty City-Francis to Vice City-Escobar.
Slogan & Motto
|Slogan & Motto
|Start usage
|End usage
|"Reporting The Right News"
|1 January 2008
|31 December 2012
|Grand Theft Auto IV
|"Standing Up To The Liberal Agenda One Issue At A Time"
|1 January 2013
|Grand Theft Auto V
- Jim Harrison, main radio/TV reporter
- Mike Whitley, main radio street reporter
- Jenny Acorn, radio street reporter
- Lori Diangelo-Stockton, TV/radio reporter
- Eric House, radio street reporter
- Callista Brown, radio reporter
- Bryan Wilkinson, radio reporter
- Alison Maybury, radio reporter
- John Chesapeake, website writer
- Leslie Mitchell, website writer
- Eugene White, website writer
Radio stories
The news on the radio will update itself as the player progresses through the story.
- Bridge closings, Mayor Ochoa weapons ban
- Cluckin' Bell claim to have eliminated pigeons in Liberty City, Samantha Muldoon child adoption
- Jingoism Act renewed, the rise of crime in Hove Beach, The Horn deodorant, dead Platypus captain
- Plan to outlaw online poker, Manny Escuela, Lazlow returns
- Tom Goldberg, Yusuf Amir's new apartment complex
- Police brutality, hybrid cars, traffic report of Broker and Dukes, new taxi fare agreement, meth
- Rise in crime with the police blaming the Eastern Europeans, hybrid cars popularity, protest over bridge closures
- BAWSAQ pummels, Congress passes the Jingoism Act, Micheal Graves and John Hunter campaigns, Alderney mob gaining prominence
- Francis McReary, meth, Bryce Dawkins's homophobic rant
- Bryce Dawkins's apology, new border security bill, Europe underperforming
- War on Terror, global warming denials, beheaded victim found in river
- Explosion in Bohan, phone market saturated in cheap phones
- Violent shootout in nightclub in Hove Beach, dealing with rise in Russian organized crime, the Swingers wanting a new stadium
- Littlelacysurprisepageant.com, The Angels of Death and The Lost MC war, online dating sites, Lazlow returns after six years of absence and announcement of Integrity
- Pressure on Ochoa to open bridges, another decapitated and mutilated jogger in Alderney, online dating caution
- Ochoa reopens bridges over Humboldt River, link between drug rings and terrorism, Lazlow launches Integrity 2.0, BAWSAQ
- Illegal street races on the rise, same sex marriage battle, series of violent beatings in Middle Park
- Biker Jason Michaels found dead, biker war, BAWSAQ closes down, two fires started by arson with Molotov Cocktails in Hove Beach
- Pavano capo testifies in court, Bryce Dawkins pushes city ordinance banning gays at fire stations
- Tom Rivas killed, high prices of meds led to influx of cloned meds, Web 2.0
- Deadly helicopter and powerboat racing, BAWSAQ news, Excelsior Extreme 9 promoted in Republican Space Rangers
- Tom Goldberg killed, serial killer strikes man in Dukes has limbs stolen, barroom shootout between Angels of Death and Triads
- Killing in Chinatown in front of arcade, newborn murdered father to marry mother, renovation of Libertonian Museum
- Increase police presence in potential terrorist targets, violent shootout at construction site, libraries nationwide shutting
- Shootout at The Triangle Club, Joshua Hampton wanted, Dave Bosoy found dead,
- Counterfeit bills, serial killer terrorizing city, deadly shootout in Fishmarket
- Aiden O'Malley murdered, NOOSE seizes cociane shipment, video games may cause impotence
- Schlongberg Sachs employees test positive for drugs, BitterSweet Email Device popularity
The Lost and Damned
The Lost and Damned feature stories unique to Johnny Klebitz's storyline but also includes references events from the GTA IV storyline:
- Arthur Stubbs killed in terrorist attack, several prominent stockbrokers arrested for insider trading, Michael Graves illegitimate child
- Stockbrokers freed from prison, Angels of Death and Uptown Riders motorcycle gangs sell merchandise
The Ballad of Gay Tony
The Ballad of Gay Tony features stories unique to Luis Fernando Lopez' storyline, but references events in the other plots as well.
- Evan Moss murder
- Annihilators exploding near Rotterdam Tower
- Bobby Jefferson gives a speech after an attempted assassination. (GTA IV story)
- Mayor Ochoa proposes plan to flood subways to fight rodent infestation and the bad smell of pee from the homeless.
- A British Government offical loses laptop containing private information. The Home Office says nothing to worry and don't panic but images for the Ministry of Defence's christmas party has been found on the internet.
- President Lawton involved in a texting/E-mail scandal with the Italian Prime Minister
- A MyRoom user sets fire to a neighbours' house after being 'de-friended' by the neighbour.
- As explained above, Weazel News mocks Fox News, as both weasels and foxes are native animals to America and Europe, presuming that it's a Red Fox.
- 'Weasel' is also used as a word to show cowardice, 'To weasel out of something' but it is also a Euphemism for a penis.
- Weazel in Weazel News is spelled incorrectly, though, this was maybe intentional.
- The Weazel News Helicopter is a two bladed Maverick even though the GTA IV Maverick is a four bladed variant. The two bladed varient possibly have been removed and replaced with a four bladed one in development.
- There is a humerous Weazel News advertisement on TV that shows a Weazel News Helicopter hovering near a man on fire while asking him to look at the camera on the helicopter.


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Houston Methodist Willowbrook Hospital
Houston Methodist Willowbrook Hospital has been providing the latest research, technology, education, specialized care and best practices to the Northwest Houston community since December 2000. The 277-licensed bed, tertiary care facility is committed to providing quality, cost-effective health care in a compassionate environment for a full range of services, including emergency care, cardiology, orthopedics and sports medicine, comprehensive women's services, neurology, oncology, and primary and general medicine.
Learn more about us
18220 State Highway 249
Houston, TX 77070
Visitors to Houston Methodist Willowbrook will find many dining options at our full-service café, located in the North Pavilion.
Gifts, flowers, greeting cards, books, newspapers and other items are available at our gift shop, Lori's Gifts, located near the elevators on the first floor in both the North Pavilion and Women's & Children's Pavilion.
Upcoming Events
Join us for a free educational seminar to learn your risk factors and how to prevent a stroke.


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Family Cottage (FA3)
|Base Rate *
|Click here to view the activities rates
* The Base Rate amount is charged for any number of guests occupying a unit not exceeding the base number for that activity type (in this case 0)}. Any additional Adults and Children exceeding the base capacity are charged in addition to the base rate amount per persons up to the amount of beds or guests allowed in the unit.
- 3 single beds
- Air-conditioned
- Fully Equipped
- Internal roads not suitable for Sedan Vehicles
- Kitchen includes 2 plate stove and fridge/freezer
- No Smoking
- Open plan unit, kitchen and sleeping area combined
- Wc and shower


text:
Eliminating health disparities high on their agenda
By Robin James
Contributing Writer
Stepping into Spring with the "Minnesota Black Nurses Association" was the joyous theme at the organization's first annual gala on Saturday, March 9, held at the Crown Plaza hotel in Brooklyn Park, co-sponsored by The Minnesota Black Nurses Association (MNBNA) and a number of other local organizations. This special event was dedicated to fundraising for scholarships for the next generation of nurses and was attended by nearly 200 guests, who took part in festivities that lasted over three hours but didn't feel like a long, drawn-out
occasion. According to event organizers, there are approximately 100 Black nurses in the Twin Cities area. The overall polish and organization of the affair gave the distinct impression that the engagement wasn't the MNBNA's first go-around. Familiar faces in the crowd included Ramsey County Commissioner Toni Carter and Roxanne Givens, founder of the Minnesota African American Museum and Cultural Center. Continue Reading →


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With the 86th Map of the Week we continue in the borderlands town of Óðinn's House in the Kingdom of Slovania. This week we take a look at the twin graves area of the subterranean Dwarven Highwy extension.
This area is another riddle that the Northern Circle has failed to solve to date. Two decorated and well-crafted dwarven graves are in this curve in the highway extension. In one grave, the figure of a dwarf clad only in a loin cloth is chiseled. The sage seers of the circle believe that this indicates that the burying clan considered this dwarf to be dishonorable. The second grave shows the figure of an honorably clothed dwarf who points the way eastward with the index finger of the left hand.
The inside of the lid of both gravestones is inscribed with the runic stave Vindrdauði, which will release a pocket of deadly poisonous air, replacing the air in the tunnel woth poisoned air that can stop a living being from breathing. The poisoned air causes 1d6 points damage per round.
Magicians of the Northern Circle succeeded in neutralizing this magic, temporarily keeping it from triggering when they looked inside the graves, but they were unable to dispel it. It is active again. Inside each grave, the circle found the skeleton of a dead male dwarf. There were no signs of battle damage on the bones and no other clue to the cause of the dwarves' deaths or why they were entombed here in the highway extension tunnel.
1. Highway extension. The tunnel is roughly 20 feet/6 m wide and 10 feet/3 m high.
2. Grave with a dwarf in a loin cloth.
3. Grave with a clothed dwarf.
You can get this scenario in two versions:
1. The Fractal Mapper (TM) 8 map in FMP format, fully editable, from our Jörðgarð web page (2.2 MB).
2. As a JPG flat map of 3000 Pixels x 1875 Pixels (2.3 MB), above. below.
Both versions are released for personal and commercial use under the Open Game License Version 1.0a, which you can read on the Jörðgarð website at:
The Jörðgarð World
Next week: Óðinn's Fortress - The Dwarven Highway's Pit and Broken Bridge
Mark Oliva
The Vintyri (TM) Project


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As Target inches closer to swinging its doors open in Brandon, the American retail giant is in the midst of a weeklong hiring blitz.
Company representatives from Canada and the U.S. are holding a job fair at the Victoria Inn, taking applications and interviewing potential retail workers for the Shoppers Mall location, which is slated to open in the spring.
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- Carpet Tiles
- Area Rugs
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Order Toll Free +1 866 952 4093
Home | Modern Mix - Cream
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|Monolithic (Straight) Installation
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|.425 in
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*(PI) Post-Industrial — percentage of recycled content derived from industry scraps.
*(PC) Post Consumer — percentage of recycled content derived from materials recycled
by consumers and businesses.
*To find out more about our recycled content, please visit FLOR's Environmental Efforts.
When I first looked at the modern mix brown colors, I was in love, but afraid to go that bold or that dark..I kept going back and looking at it,then I finally ordered a sample .. Pondered some more and said what the heck I will try it .. I wanted a fresh new and different look . They were easy to put in ourselves ( we had alot of angles). We put it in the entrance way into the kitchen snug against the wood floor in kitchen area (table sits on the carpet tiles) What a statement when you walk in the door, it actually made the area look bigger,if you can believe that,everyday I look at it I love it more and I am glad I decided to go with Flor tiles now I have Flor fever and want more.. Everyone at the company was very helpful and the tiles were shipped with no problems,I highly recommend Flor tiles>>>
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05.16.12 at 07:52 PM
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02.10.11 at 07:36 PM
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We've made it easy and done the math for you. Simply select a rug size below and you are just one click away from adding it your shopping cart or loading it in the FLORbuilder where you can customize your design.
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Batman™ Lunch Bag
No longer available
Super Heroes need gear that's durable, tough and always ready to go – just like they are.
8" wide x 4" deep x 9" high
Shell is woven of tough 600-denier polyester with a moisture-resistant coating inside.
Appliquéd patch features the bat symbol.
Insulated with a PEVA lining – an environmentally friendly, food-safe vinyl that's made without chlorine or plasticizers.
Features an easy-to-clean, molded interior.
Catalog / Internet only.


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Cobblestone Wool Rug
Act fast! Items with prices ending in $0.99 are final sale.
No longer available
On the rocks. Our handwoven Cobblestone Rug is adorned with overlapping ovals inspired by rocks and pebbles found in rivers. Crafted from natural heathered yarn, the mix of neutral tones brings a calming sensibility to any room.
Handcrafted by Craftmark-certified artisans.
Learn more
100% wool in Natural.
Cotton/latex backing.
Rug Pad recommended (sold separately).
To learn how to choose the right rug size, visit our
Rug Guide
Spot clean.
Made in India.
Online/catalog only.


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Boston, MA (Sports Network) - Brandon Bass had 20 points and six rebounds in
the Boston Celtics' 107-96 win over the Washington Wizards.
Paul Pierce finished with 15 points and five assists, while Kevin Garnett
added 12 points and six boards for the Celtics, who have won two of their last
three games and sit 1 1/2 games behind the Atlanta Hawks for the sixth seed in
the Eastern Conference.
John Wall tallied 16 points and 10 assists to lead Washington, which has
dropped two of its last three tilts.
The Celtics led 28-27 after a quarter of play and took a 56-52 edge into the
break, but began to pull away in the third.
After Nene's left-handed dunk pulled the Wizards within 58-57, Boston
countered with a 14-1 run to seize control.
Avery Bradley and Bass had four points apiece during the surge, which was
capped on Bass's driving two-handed dunk to make it 72-58 with 5:00 left in
the third.
The margin swelled to as much as 18 before Boston entered the final frame with
an 87-71 cushion.
Washington never cut the deficit below double digits in the fourth.
Boston has beaten Washington seven straight times ... The Celtics recorded 20
points off of 17 Wizards turnovers ... Boston held a 50-36 points in the paint
The Sports Network


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View my Wish List
$ 85.00
$ 42.50
Available at local Chamilia retailers.
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Article no.: 2025-0933
Sterling Silver,
Crystals and Stones
Fall in love with extreme sparkle and effervescence with the Splendor Briolette bead. Smothered with gorgeous Swarovski crystals paired with a brilliant briolette, this revolutionary bead stands magnificently alone and mixes seamlessly with your existing Chamilia collection. Shown in Pink Swarovski.
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- From 08 Tue Oct 2013 to 10 Thu Oct 2013 October 8, 2013 October 10, 2013 Cheeca Lodge & Spa
Bonefishing World Championship/ Islamorada All-Tackle Bonefish
Only 25 competitors are accepted to participate, with one angler and a licensed captain per boat. The three-day challenge is said to separate great bonefish anglers from the wannabes. Contact e-mail firstname.lastname@example.com.


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Estate planning seminar coming up at Vol State
Submitted on February 26, 2010 at 10:28 AM
Volunteer State Community College is offering a seminar on March 23 to give people basic information about a range of estate planning issues.
David Bate Parsons is presenting the program for the Volunteer State College Foundation. He's a partner in the Nashville law firm of Baker, Campbell and Parsons. He's also the past president of the Nashville Estate Planning Council and practices extensively in areas of estates, wills and trusts.
The two-hour seminar will provide an introduction to estate planning. There will also be information about trusts, tax considerations and IRAs.
The program has been submitted for approval by the Tennessee Commission on Continuing Legal Education for Attorneys (2 hours C.L.E), by the Tennessee Department of Insurance and Commerce (2 hours C.E.) and by the Certified Financial Planner Board of Standards (2 hours C.E.).
Advance reservations are required by March 17 for the March 23 seminar. It will run from 3 p.m. to 5 p.m. The cost is $30. The seminar will be held in the Rochelle Center at the Thigpen Library on the Volunteer State campus at 1480 Nashville Pike in Gallatin. For reservations and more information call 615-230-3506.
A service provided by the Office of Public Relations.


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Topic Contents
- General Information About Chronic Lymphocytic Leukemia
- Stage Information for Chronic Lymphocytic Leukemia
- Treatment Option Overview
- Stage 0 Chronic Lymphocytic Leukemia
- Stage I, II, III, and IV Chronic Lymphocytic Leukemia
- Recurrent or Refractory Chronic Lymphocytic Leukemia
- Changes to This Summary (02 / 13 / 2013)
- About This PDQ Summary
- Get More Information From NCI
Chronic Lymphocytic Leukemia Treatment (PDQ®): Treatment - Health Professional Information [NCI]
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
Chronic Lymphocytic Leukemia Treatment
General Information About Chronic Lymphocytic Leukemia
Incidence and Mortality
Estimated new cases and deaths from chronic lymphocytic leukemia (CLL) in the United States in 2013:[1]
- New cases: 15,680.
- Deaths: 4,580.
CLL is a disorder of morphologically mature but immunologically less mature lymphocytes and is manifested by progressive accumulation of these cells in the blood, bone marrow, and lymphatic tissues.[2] In this disorder, lymphocyte counts in the blood are usually greater than or equal to 5,000/mm3 with a characteristic immunophenotype (CD5- and CD23-positive B cells).[3,4] As assays have become more sensitive for detecting monoclonal B-CLL–like cells in peripheral blood, researchers have detected a monoclonal B-cell lymphocytosis (MBL) in 3% of adults older than 40 years and 6% in adults older than 60 years.[5] Such early detection and diagnosis may falsely suggest improved survival for the group and may unnecessarily worry or result in therapy for some patients who would have remained undiagnosed in their lifetime, a circumstance known in the literature as overdiagnosis or pseudodisease.[6,7]
In two selected series of more than 900 patients followed prospectively for a median of 5 to 7 years, overt CLL requiring chemotherapy occurred in 7% of patients.[5,8] In a database analysis and for up to 77 months before diagnosis, almost all patients with a diagnosis of CLL had prediagnostic B-cell clones that were identified in peripheral blood when available.[4,9]
For patients with progressing CLL, treatment with conventional doses of chemotherapy is not curative; selected patients treated with allogeneic stem cell transplantation have achieved prolonged disease-free survival.[10,11,12,13,14] Antileukemic therapy is frequently unnecessary in uncomplicated early disease.[15] The median survival for all patients ranges from 8 to 12 years in older trials with data from the 1970s through the 1990s.[15,16] There is, however, a large variation in survival among individual patients, ranging from several months to a normal life expectancy. Treatment must be individualized based on the clinical behavior of the disease.[17]
As found in one report, CLL occurs primarily in middle-aged and elderly adults, with increasing frequency in successive decades of life.[18] The clinical course of this disease progresses from an indolent lymphocytosis without other evident disease to one of generalized lymphatic enlargement with concomitant pancytopenia. Complications of pancytopenia, including hemorrhage and infection, represent a major cause of death in these patients.[19] Immunological aberrations, including Coombs-positive hemolytic anemia, immune thrombocytopenia, and depressed immunoglobulin levels may all complicate the management of CLL.[20] Prognostic factors that may help predict clinical outcome include cytogenetic subgroup, immunoglobulin mutational status, ZAP-70, and CD38 (see Prognostic Factors).[2,21,22,23,24,25,26,27,28,29] Patients who develop an aggressive high-grade non-Hodgkin lymphoma, usually diffuse large B-cell lymphoma and termed a Richter transformation, have a poor prognosis.[30] Patients with CLL are also at increased risk for other malignancies, even before therapy.[31]
Confusion with other diseases may be avoided by determination of cell surface markers. CLL lymphocytes coexpress the B-cell antigens CD19 and CD20 along with the T-cell antigen CD5.[32] This coexpression only occurs in one other disease entity, mantle cell lymphoma. CLL B cells express relatively low levels of surface-membrane immunoglobulin (compared with normal peripheral blood B cells) and a single light chain (kappa or lambda).[15] CLL is diagnosed by an absolute increase in lymphocytosis and/or bone marrow infiltration coupled with the characteristic features of morphology and immunophenotype, which confirm the characteristic clonal population.
The differential diagnosis must exclude hairy cell leukemia (refer to the PDQ summary on Hairy Cell Leukemia Treatment for more information), and Waldenström macroglobulinemia (refer to the PDQ summary on Adult Non-Hodgkin Lymphoma Treatment for more information). Waldenström macroglobulinemia has a natural history and therapeutic options similar to CLL, with the exception of hyperviscosity syndrome associated with macroglobulinemia as a result of elevated immunoglobulin M. Prolymphocytic leukemia (PLL) is a rare entity characterized by excessive prolymphocytes in the blood with a typical phenotype that is positive for CD19, CD20, and surface-membrane immunoglobulin and negative for CD5. These patients demonstrate splenomegaly and poor response to low-dose or high-dose chemotherapy.[15,33]
Cladribine (2-chlorodeoxyadenosine) appears to be an active agent (60% complete remission rate) for patients with de novo B-cell prolymphocytic leukemia.[34][Level of evidence: 3iiiDiv] Alemtuzumab (campath-1H), an anti-CD52 humanized monoclonal antibody, has been used for 76 patients with T-cell prolymphocytic leukemia after failure of prior chemotherapy (usually pentostatin or cladribine) with a 51% response rate (95% confidence interval, 40%–63%) and median time to progression of 4.5 months (range, 0.1–45.4 months).[35][Level of evidence: 3iiiDiv] These response rates have been confirmed by other investigators.[36] Patients with CLL who show prolymphocytoid transformation maintain the classic CLL phenotype and have a worse prognosis than PLL patients.
Large granular lymphocytic leukemia is characterized by lymphocytosis with a natural killer cell immunophenotype (CD2, CD16, and CD56) or a T-cell immunophenotype (CD2, CD3, and CD8).[37,38,39] These patients often have neutropenia and a history of rheumatoid arthritis. The natural history is indolent, often marked by anemia and splenomegaly. This condition appears to fit into the clinical spectrum of Felty syndrome.[40] Therapy includes low doses of oral cyclophosphamide or methotrexate, cyclosporine, and treatment of the bacterial infections acquired during severe neutropenia.[37,39,41,42]
Related Summaries
Other PDQ summaries containing information about CLL include the following:
- Adult Non-Hodgkin Lymphoma Treatment
- Hairy Cell Leukemia
Stage Information for Chronic Lymphocytic Leukemia
Staging is useful in chronic lymphocytic leukemia (CLL) to predict prognosis and also to stratify patients to achieve comparisons for interpreting specific treatment results. Anemia and thrombocytopenia are the major adverse prognostic variables.
CLL has no standard staging system. The Rai staging system and the Binet classification are presented below.[1,2] A National Cancer Institute (NCI)-sponsored working group has formulated standardized guidelines for criteria related to eligibility, response, and toxic effects to be used in future clinical trials in CLL.[3]
Rai Staging System
Stage 0
Stage 0 CLL is characterized by absolute lymphocytosis (>15,000/mm3) without adenopathy, hepatosplenomegaly, anemia, or thrombocytopenia.
Stage I
Stage I CLL is characterized by absolute lymphocytosis with lymphadenopathy without hepatosplenomegaly, anemia, or thrombocytopenia.
Stage II
Stage II CLL is characterized by absolute lymphocytosis with either hepatomegaly or splenomegaly with or without lymphadenopathy.
Stage III
Stage III CLL is characterized by absolute lymphocytosis and anemia (hemoglobin <11 g/dL) with or without lymphadenopathy, hepatomegaly, or splenomegaly.
Stage IV
Stage IV CLL is characterized by absolute lymphocytosis and thrombocytopenia (<100,000/mm3) with or without lymphadenopathy, hepatomegaly, splenomegaly, or anemia.
Binet Classification
Clinical stage A*
Clinical stage A CLL is characterized by no anemia or thrombocytopenia and fewer than three areas of lymphoid involvement (Rai stages 0, I, and II).
Clinical stage B*
Clinical stage B CLL is characterized by no anemia or thrombocytopenia with three or more areas of lymphoid involvement (Rai stages I and II).
Clinical stage C
Clinical stage C CLL is characterized by anemia and/or thrombocytopenia regardless of the number of areas of lymphoid enlargement (Rai stages III and IV).
*Lymphoid areas include cervical, axillary, inguinal, and spleen.
The Binet classification integrates the number of nodal groups involved with the disease with bone marrow failure. Its major benefit derives from the recognition of a predominantly splenic form of the disease, which may have a better prognosis than in the Rai staging, and from recognition that the presence of anemia or thrombocytopenia has a similar prognosis and does not merit a separate stage. Neither system separates immune from nonimmune causes of cytopenia. Patients with thrombocytopenia or anemia or both, which is caused by extensive marrow infiltration and impaired production (Rai III/IV, Binet C) have a poorer prognosis than patients with immune cytopenias.[4] The International Workshop on CLL has recommended integrating the Rai and Binet systems as follows: A(0), A(I), A(II); B(I), B(II); and C(III), C(IV).[5] The NCI-sponsored working group has published guidelines for the diagnosis and treatment of CLL in both clinical trial and general practice settings.[3] Use of these systems allows comparison of clinical results and establishment of therapeutic guidelines.
Prognostic factors
New prognostic markers are now available to the clinician and investigator.[6,7] The use of these markers to stratify patients in clinical trials, to help assess the need for therapy, and to help select the type of therapy continues to evolve. Prospective trials to verify and establish the role of these prognostic markers are ongoing. No large multivariable analyses exist as yet to test the relative power of these individual prognostic variables.[8] Prognostic indices are under evaluation and will require prospective validation.[9]
- Immunoglobulin variable region heavy chain gene (IgVH) mutation.[10,11,12,13,14] The finding of significant numbers of mutations in this region is associated with a median survival in excess of 20 to 25 years. The absence of mutations is associated with a median survival of 8 to 10 years.
- ZAP-70. ZAP-70 has been proposed as a surrogate for the mutational status.[15,16,17,18] ZAP-70 positivity for previously untreated and asymptomatic patients (>30%) is associated with a more unfavorable median survival (6–10 years), while a negative ZAP-70 is associated with a median survival of more than 15 years. A prospective evaluation of these markers in a randomized study of fludarabine-based chemotherapy (E2997 [NCT00003764]) failed to show any difference in response rates, response duration, progression-free survival, or overall survival.[19]
- Chromosomal abnormalities by fluorescent in situ hybridization (FISH). FISH chromosomal abnormalities were associated with prognosis in retrospective and prospective studies and clonal evolution has been seen over time.[20,21,22,23] 13q- is favorable (with a 17-year median overall survival [OS] in a prospective study).[23] Trisomy 12 and 11q- have less favorable prognoses (with a 9- to 11-year median OS in a prospective study).[23] In particular, 17p- is associated with mutated TP53 and with poor response rates and short duration of response to the standard therapeutic options.[13] 17p- is associated with the most unfavorable prognosis (with a 7-year median OS in one prospective trial).[19,23,24] The combination of adverse cytogenetics such as 11q- or 17p- (suggesting a worse prognosis) with ZAP-70 negativity (suggesting a better prognosis) in the same patients resulted in a poor prognosis.[18] These findings emphasize the need for prospective studies of combinations of these prognostic markers.[8]
- CD38 immunophenotype.[11,25] CD38 positivity (>30%) correlates with a worse prognosis, but there is a 30% false-positive rate and a 50% false-negative rate using IgVH mutational status as the gold standard for prognosis.
Other prognostic factors include:
- Stage (see Rai staging system and Binet classification above).[1,2]
- Lymphocyte doubling time (doubling of the white blood cell count in excess of 1 year implies a favorable prognosis).[26]
- Beta-2-microglobulin (higher levels imply a worse prognosis).[27]
Treatment Option Overview
Treatment of chronic lymphocytic leukemia (CLL) ranges from periodic observation with treatment of infectious, hemorrhagic, or immunologic complications to a variety of therapeutic options, including steroids, alkylating agents, purine analogs, combination chemotherapy, monoclonal antibodies, and transplant options.[1] Because this disease is generally not curable, occurs in an elderly population, and often progresses slowly, it is most often treated in a conservative fashion.[1] In asymptomatic patients, treatment may be deferred until the patient becomes symptomatic as the disease progresses. Since the rate of progression may vary from patient to patient, with long periods of stability and sometimes spontaneous regressions, frequent and careful observation is required to monitor the clinical course.[2]
A meta-analysis of randomized trials showed no survival benefit for immediate versus delayed therapy for patients with early stage disease, nor for the use of combination regimens incorporating an anthracycline compared with a single-agent alkylator for advanced stage disease.[3][Level of evidence: 1iiA] A variety of clinical factors, including IgVH mutation, chromosomal abnormalities by fluorescent in situ hybridization analysis or cytogenetics, beta-2-microglobulin, and lymphocyte doubling time may be helpful in predicting progression of disease.[1]
Infectious complications in advanced disease are in part a consequence of the hypogammaglobulinemia and the inability to mount a humoral defense against bacterial or viral agents. Herpes zoster represents a frequent viral infection in these patients, but infections with Pneumocystis carinii and Candida albicans may also occur. The early recognition of infections and the institution of appropriate therapy are critical to the long-term survival of these patients. A randomized study of intravenous immunoglobulin (400 mg/kg every 3 weeks for 1 year) in patients with CLL and hypogammaglobulinemia produced significantly fewer bacterial infections and a significant delay in onset of first infection during the study period.[4] There was, however, no effect on survival. Routine chronic administration of intravenous immunoglobulin is expensive, and the long-term benefit (>1 year) is unproven.[5,6]
Second malignancies and treatment-induced acute leukemias may also occur in a small percentage of patients.[7] Transformation of CLL to diffuse large cell lymphoma (Richter syndrome) carries a poor prognosis with a median survival of less than 1 year, though 20% of the patients may live more than 5 years after aggressive combination chemotherapy.[8] (Refer to the PDQ summary on Adult Non-Hodgkin Lymphoma Treatment for more information.)
Autoimmune hemolytic anemia and/or thrombocytopenia can occur in patients with any stage of CLL.[9] Initial therapy involves corticosteroids with or without alkylating agents (fludarabine can worsen the hemolytic anemia). It is frequently advisable to control the autoimmune destruction with corticosteroids, if possible, prior to administering marrow-suppressive chemotherapy because such patients may be difficult to transfuse successfully with either red blood cells or platelets. Alternate therapies include high-dose immune globulin, rituximab, cyclosporine, azathioprine, splenectomy, and low-dose radiation therapy to the spleen.[10,11] Tumor lysis syndrome is an uncommon complication (presenting in 1 out of 300 patients) of chemotherapy for patients with bulky disease.[12]
About 1% of morphologic CLL cases express T-cell markers (CD4 and CD7) and have clonal rearrangements of their T-cell receptor genes. These patients have a higher frequency of skin lesions, more variable lymphocyte shape, and shorter median survival (13 months) with minimal responses to chemotherapy.[13]
Computed tomographic (CT) scans have a very limited role in following patients after completion of treatment; the decision to treat for relapse was determined by CT scan or ultrasound in only 2 of 176 patients in 3 prospective trials for the German CLL Study Group.[14]
Stage 0 Chronic Lymphocytic Leukemia
Because of the indolent nature of stage 0 chronic lymphocytic leukemia (CLL), treatment is not indicated.[1] The French Cooperative Group on CLL randomly assigned 1,535 patients with previously untreated stage A disease to receive either chlorambucil or no immediate treatment and found no survival advantage for immediate treatment with chlorambucil.[2][Level of evidence: 1iiA] A meta-analysis of six trials of immediate versus deferred therapy with chlorambucil (including the aforementioned trial by the French Cooperative Group) showed no difference in overall survival at 10 years.[3][Level of evidence: 1iiA] Whether immediate therapy with the nucleoside analogs or other newer strategies will be superior to a watchful waiting approach is uncertain.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage 0 chronic lymphocytic leukemia. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Stage I, II, III, and IV Chronic Lymphocytic Leukemia
Several decades of large, randomized, prospective trials of previously untreated patients have demonstrated statistically significant improvements in response rates, event-free survival (EFS), and progression-free survival (PFS) with comparison of combinations of drugs versus single-agent alkylators,[1,2] but only two trials have shown statistically significant improvement in overall survival (OS).[3,4]
The first trial, a comparison of chlorambucil versus fludarabine, after 15 years of median follow-up, showed improved median OS for patients on the fludarabine regimen at 63 months versus 59 months (P = .04), and an improved percentage of patients were alive at 8 years (31% vs. 19%, P = .04).[3,5][Level of evidence: 1iiA]
The second trial, which had 817 patients, compared FCR (fludarabine + cyclophosphamide + rituximab) versus FC (fludarabine + cyclophosphamide) with a median follow-up of 38 months and showed improved OS at 3 years for the rituximab combination (i.e., 87% vs. 83%, P = .01.[4][Level of evidence: 1iiA] Yet neither fludarabine nor FCR has been compared in a randomized study against watchful waiting in asymptomatic or minimally affected patients.
The improvements in response rates from more intensive regimens have maximized the clearance of minimal residual disease. In one prospective trial of 493 patients, clearance of minimal residual disease was an independent predictor of overall survival by multivariate analysis.[6] The surrogate endpoint of such clearance of residual disease, however, has not been shown to improve survival in a randomized prospective trial; the necessary study would take patients who fail to completely clear the marrow with induction therapy and randomly assign them to further alternative treatment versus the same treatment later at relapse, looking at OS as the primary endpoint.[1,2]
The sequencing of the following treatment options cannot be determined from the current set of completed clinical trials. When patients become symptomatic or require treatment, FCR has become the most frequently chosen option outside of a clinical trial, mostly on the basis of the previously described prospective study.[4]
Treatment options:
Note: Standard options are roughly ordered by level of toxic effects, starting with the least toxic options. More recently discovered options are mentioned at the end of the list.
|Observation in asymptomatic or minimally affected patients.[7] Outside of the context of a clinical trial, treatment for asymptomatic or minimally affected patients with chronic lymphocytic leukemia (CLL) is observation. No data exist as yet to suggest any harm with a delay in therapy until the patient becomes symptomatic or develops serious cytopenias despite growth factor support. Because the rate of progression may vary from patient to patient, with long periods of stability and sometimes spontaneous regressions, frequent and careful observation is required to monitor the clinical course.
|Rituximab, a murine anti-CD20 monoclonal antibody.[8,9,10,11,12] When used alone, higher doses of rituximab or increased frequency or duration of therapy is required for comparable responses to those seen for other indolent lymphomas.
|Ofatumomab is a human anti-CD20 monoclonal antibody.[13] A trial of 138 patients previously treated with fludarabine and alemtuzumab showed overall response rates around 50% in a patient group that historically showed less than 20% responses to rituximab.[13][Level of evidence: 3iiiDiv]
|Oral alkylating agents with or without corticosteroids.[14] The French Cooperative Group on CLL randomly assigned 1,535 patients with previously untreated stage A disease to receive either chlorambucil or no immediate treatment and found no survival advantage for chlorambucil.[15][Level of evidence: 1iiA] A meta-analysis of six trials of immediate versus deferred therapy with chlorambucil (including the aforementioned trial by the French Cooperative Group) showed no difference in OS at 10 years.[7][Level of evidence: 1iiA]
|Fludarabine, 2-chlorodeoxyadenosine, or pentostatin as seen in the CLB-9011 trial, for example.[16,17,18,19,20,21]
Several randomized trials have compared the purine analogs with chlorambucil; with cyclophosphamide, doxorubicin, and prednisone; or with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) in previously untreated patients.[5,22,23,24,25] All of these trials showed higher or equivalent response rates for the purine analog and most showed an improvement in PFS, with one reaching significance in OS favoring fludarabine.[3,22,23,24,25,26][Level of evidence: 1iiDiii]
A comparison of chlorambucil versus fludarabine, after 15 years' median follow-up, showed patients with improved median OS with fludarabine at 63 versus 59 months (P = .04) and an improved percentage of patients alive at 8 years (31% vs. 19%, P = .04).[3][Level of evidence: 1iiA] All of the trials demonstrated higher toxic effects with the purine analogs, especially granulocytopenic infections, herpes infections, autoimmune hemolytic anemia, and persistent thrombocytopenia.[27] The increased risk of infection may persist for months or years after treatment with a purine analog.[26,28]
Although empiric evidence is lacking, some investigators recommend prophylaxis with trimethoprim-sulfa during therapy and for 6 to 12 months afterwards to prevent pneumocystis infection. In a similar way, other investigators employ prophylaxis (e.g., acyclovir) for the herpes viruses.[28] Purine analogs cause less hair loss or nausea than combination chemotherapy, including alkylators and anthracyclines.[24]
Bendamustine is a cytotoxic agent with bifunctional properties of an alkylator and a purine analogue.[29] In previously treated and untreated patients, bendamustine with rituximab has shown response rates around 70% to 90%.[30,31][Level of evidence: 3iiiDiii]
In a randomized comparison with chlorambucil in 319 previously treated patients, bendamustine showed a better response rate (68% vs. 31%, P < .0001) and PFS (21.6 months vs. 8 months) with a median follow-up of 35 months.[32][Level of evidence: 1iiDiii] The German CLL Study Group is comparing bendamustine plus rituximab versus FCR as first-line therapy in patients with CLL who require therapy.[30]
|Combination chemotherapy.
A trial of 817 patients comparing FCR versus FC with a median follow-up of 38 months showed improved OS at 3 years for the rituximab combination (87% vs. 83%, P = .01).[4][Level of evidence: 1iiA] FCR has never been compared to watchful waiting up front in asymptomatic or minimally affected patients. The improvements in response rates from more intensive regimens have maximized the clearance of minimal residual disease (MRD). However, the surrogate endpoint of MRD clearance has not been proven to be a valid surrogate for improved survival in a randomized prospective trial; the necessary study would take patients who fail to completely clear the marrow with induction therapy and randomly assign them to further alternative treatment versus the same treatment later at relapse looking at OS as the primary endpoint.[1,2] A cumulative incidence of 6% to 8 % for myelodysplasia is seen at 5 to 7 years in patients who received fludarabine plus cyclophosphamide, with or without rituximab.[33,34]
A meta-analysis of ten trials comparing combination chemotherapy (before the availability of rituximab) to chlorambucil alone showed no difference in OS at 5 years.[7][Level of evidence: 1iiA]
|Involved-field radiation therapy. Relatively low doses of radiation therapy will affect an excellent response for months or years. Sometimes radiation therapy to one nodal area or the spleen will result in abscopal effect (i.e., the shrinkage of lymph node tumors in untreated sites).
| Alemtuzumab, the monoclonal antibody directed at CD52, shows activity in the setting of chemotherapy-resistant disease or high-risk untreated patients with 17p deletion or p53 mutation.[49,50] As a single agent, the subcutaneous route of delivery for alemtuzumab is preferred to the intravenous route in patients because of the similar efficacy and decreased adverse effects, including less acute allergic reactions that were shown in some nonrandomized reports.[51,52,53]
In a combination regimen, subcutaneous alemtuzumab plus fludarabine or intravenous alemtuzumab plus alkylating agents have resulted in excess infectious toxicities and death, with no compensatory improvement in efficacy in phase II trials.[54,55][Level of evidence: 3iiiDiv] In a randomized prospective study, 335 previously treated patients received intravenous alemtuzumab plus fludarabine versus fludarabine alone; with a median follow-up of 30 months, the combination of fludarabine plus intravenous alemtuzumab had better PFS, with a median of 23.7 months versus 16.5 months (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.47–0.80; P = .0003); and better OS, with a median not reached versus 52.9 months (HR, 0.65; 95% CI, 0.45–0.94; P = .021).[56][Level of evidence: 1iiA]Profound and long-lasting immunosuppression has been seen, which mandates monitoring for reactivation of cytomegalovirus and prophylaxis for pneumocystis and herpes virus infections.[57,58]
| Bone marrow and peripheral stem cell transplantations are under clinical evaluation.[59,60,61,62,63,64]
In a prospective randomized trial, 241 previously untreated patients younger than 66 years with advanced-stage disease received induction therapy with a CHOP-based regimen followed by fludarabine.[65] Complete responders (105 patients) were randomly assigned to undergo autologous stem cell transplantation (ASCT) or observation, while the other 136 patients were randomly assigned to receive dexamethasone, high-dose aracytin, and cisplatin (DHAP) reinduction followed by either ASCT or fludarabine plus cyclophosphamide. Although the 3-year EFS favored ASCT in complete responders, there was no difference in OS in any of the randomized comparisons.[65][Level of evidence: 1iiDi]
Patients with adverse prognostic factors are very likely to die from CLL. These types of patients are candidates for clinical trials that employ high-dose chemotherapy and immunotherapy with myeloablative or nonmyeloablative allogeneic peripheral stem cell transplantation.[59,60,61,62,63,64,66,67,68,69,70,71,72,73] Although most patients who attain complete remission after autologous stem cell transplantation eventually relapse, a survival plateau for allogeneic stem cell support suggests an additional graft-versus-leukemia effect.[73]
|Single-agent lenalidomide has shown a 50% to 70% overall response in previously treated and untreated patients.[74,75,76][Level of evidence: 3iiiDiv] Combination therapy and long-term toxicities from using lenalidomide (such as increased myelodysplasia, as seen in myeloma patients) remain undefined for patients with CLL.
|Autologous T-cells were modified by a lentiviral vector to incorporate antigen receptor specificity for the B-cell antigen CD19 and then infused into a previously treated patient.[77] A dramatic response lasting 6 months has prompted larger trials of this concept.[77][Level of evidence: 3iiiDiv] Ongoing clinical trials are testing this concept.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I chronic lymphocytic leukemia, stage II chronic lymphocytic leukemia, stage III chronic lymphocytic leukemia and stage IV chronic lymphocytic leukemia. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Recurrent or Refractory Chronic Lymphocytic Leukemia
Clinical trials are appropriate and should be considered when possible.[1] In small studies, response rates of more than 40% have been reported for lenalidomide [2,3,4] and flavopiridol.[5,6][Level of evidence: 3iiiDiv] The addition of the Bcl-2 anti-sense oligonucleotide oblimersen to fludarabine/cyclophosphamide improved complete response rates in a randomized study of 241 patients with relapsed disease.[7][Level of evidence: 1iiDiv] Bone marrow and peripheral stem cell transplantations are under clinical evaluation.[8,9,10,11,12,13,14]
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with refractory chronic lymphocytic leukemia. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Changes to This Summary (02 / 13 / 2013)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
General Information About Chronic Lymphocytic Leukemia
Updated statistics with estimated new cases and deaths for 2013 (cited American Cancer Society as reference 1).
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.
About This PDQ Summary
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of chronic lymphocytic leukemia. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
- be discussed at a meeting,
- be cited with text, or
- replace or update an existing article that is already cited.
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Chronic Lymphocytic Leukemia Treatment are:
- Steven D. Gore, MD (Johns Hopkins University)
- Eric J. Seifter, MD (Johns Hopkins University)
- Mikkael A. Sekeres, MD, MS (Cleveland Clinic Taussig Cancer Institute)
Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
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PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."
The preferred citation for this PDQ summary is:
National Cancer Institute: PDQ® Chronic Lymphocytic Leukemia Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/CLL/healthprofessional. Accessed <MM/DD/YYYY>.
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For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
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Product 115/602
A soft and sweet Kit with 15 texturized and decorated papers and 112 assorted embelishments. Create the most awesome pages with this lovely kit.
Designer: Maria Designs
Product model: md_bouquetdesmeres
File Size: 239 Megs
License: S4H/S4O and Personal use allowed
This product was added to our catalog on Friday 03 May, 2013.


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January 15, 2011
Bobby Deren
Rutgers' Junior Day seems to have been a success on more than one level. Not only did it provide the RU staff with a chance to interact with some of the region's top juniors but it also enabled the top juniors to experience Rutgers. The reactions from those juniors appear to bode well for Rutgers' future. ...More... To continue reading this article you must be a member. Sign Up Now!
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Worked With:
Darren Star
Birth Name: Darren Star
The idea for "Beverly Hills, 90210" was actually spawned in the executive suites at Fox, but Star--hired because of his reputation in writing screenplays about teenage characters--conjured boy-girl twins, Brandon and Brenda, moved by the their parents from Minnesota to Beverly Hills, and forced to attend West Beverly High where they quickly become the social deacons of the "In" crowd. From its debut, "90210" followed its core characters from high school through college into the working world. Meanwhile, Star's second effort produced through Spelling debuted in 1992. A spin-off of "90210", "Melrose Place" followed the ongoing story of a host of twentysomething Los Angelenos trying to find lov... Continue Bio >>
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Job/Internships/Scholarship Opportunities
Presidential Management Internship Program (PMI)
The Presidential Management Intern (PMI) Program is a leadership development program designed to groom outstanding recent graduates of master's or doctoral-level programs for careers in the federal service. Created in 1977, the PMI internship is a stepping stone to highly visible and respected leadership positions in the federal government. This rigorous two-year paid program includes 80-hours of training each year, challenging rotations, accelerated promotions, and opportunities to network between agencies. PMI assignments include domestic and international issues, and many fields in support of public service programs. The PMI Program seeks the best and brightest Americans who want to make a difference in the public service. Students are eligible to apply for the PMI Class if they meet the degree requirements for a master's or doctoral degree. Although any eligible student may apply, only those nominated by their school are eligible to participate in an assessment process to determine PMI Finalists, and ideally hired by federal agencies as PMIs. The PMI Program has launched a NEW online process that will require new procedures. All students will now be able to apply online, although not all will be nominated by their schools. Please refer to the PMI website: www.pmi.opm.gov.
Gubernatorial Fellows Program
The Gubernatorial Fellows Program offers an unparalleled experience in leadership and public service to Florida's best and brightest college and university students. This nonpartisan program provides students interested in public service with the opportunity to gain experience and exposure by working in key areas of government. Fellows travel to Tallahassee for two semesters and are assigned to work in the Executive Office of the Governor or the Governor's agencies, based on their major or area of concentration. Fellows work a minimum of 20 hours per week and are paid for their time on the job, while maintaining full-time status in their academic programs.
Fellows participate in a weekly lecture series, where they meet face-to-face with prominent leaders, including the Governor, Lt. Governor, Cabinet officers, agency heads, or other top officials. Fellows also travel throughout Florida and to Washington, D.C. to meet with local and federal government officials.
This is an outstanding opportunity for students interested in public service and in most cases, Fellows receive free tuition throughout the academic year. The deadline to apply for the class of 2012-2013 is March 2, 2012.
For more information, please visit www.FloridaFellows.com.
Job Opportunity for MPA Students
The Broward County is recruiting budget and management analysts from our school on an ongoing basis. Please click here for the forthcoming recruitment.
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May 5, 2016
WITN spoke with two Marines at Thursday's Marine Ball at the Greenville Convention Center who confirmed celebrity Kim Kardashian attended.
There are USMC balls scheduled tonight through Sunday night at the convention center to celebrate the 237th Birthday of the United States Marine Corps.
Just after 9 p.m. Kardahsian tweeted: "Just left the Marine Corps Ball. Thanks to all of the marines I had the opportunity to meet tonight ! Thank you for all that you do! "
Previous Story
US Weekly is reporting that reality television star and model Kim Kardashian will attend a military ball in North Carolina tonight.
The article stated Kardashian will attend the HQ Battery 10th Marine Birthday Ball but did not give a location.
Reports indicate the ball is being held in Wilmington.
There is no confirmation Kardashian is attending.
There are several military balls in Greenville and New Bern throughout the weekend.
We have also been told Kardashian may have been invited to one of the balls in Greenville at the convention center, but there is no confirmation.
Last year, actress Mila Kunis attended a Marine Corps ball in Greenville.
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Source Naturals Ageless Mind™ is a comprehensive formula for the brain that provides ingredients that support brain health and cognitive function' including memory and concentration. Preliminary research shows that the ingredients in Ageless Mind support natural biochemical cycles of beta-amyloid clearance.
Meriva® is a registered trademark of Indena S.p.A.' Milan.
These statements have not been evaluated by the Food and Drug Administration (FDA). These products are not meant to diagnose' treat or cure any disease or medical condition. Please consult your doctor before starting any exercise or nutritional supplement program or before using these or any product during pregnancy or if you have a serious medical condition.
Serving Size: 2 Tablets
Servings Per Container: 15
Amount Per Serving / % DV
Calories 5
Dietary Fiber 1g / 4%*
Vitamin C (naturally occurring) 1mg / 2%
Vitmain D-3 (as cholecalciferol) 333 IU / 83%
Vitamin B-6 (as pyridoxine HCI & pyrodixal-5'-phosphate [Coenzymated]) 50mg / 2'500%
Folate (as folic acid & calcium folinate) 266mcg / 667%
Vitamin B-12 (as methylcobalamin)330mcg / 5'440 %
Pantothenic Acid (as calcium o-pantothenate & pantethine) 33mg / 333%
Magnesium (as magnesium chelate & malate) 66mg / 17%
Chromium (as chromium polynicotinate [ChromeMate] & chromium picolinate) 66mcg / 55%
Sodium 5mg / <1%
Trimethyloglycine (TMG) 333mg / **
Acetyl L-Carnitine 200mg / **
Malic Acid (as magnesium malate & malic acid) 200mg / **
Meriva Tumeric Complex (turmeric rhizone extract and phosphatidylcholine blend) 166mg / **
L-Pyroglutamic Acid 100mg / **
alpha-Lipoic Acid 100mg / **
Hops Cone Extract 100mg / **
(yielding 30mg Humulex alpha and iso-alpha acids [Perluxan])
Caddia Bark Extract (8% flavones) 100mg / **
Boswella serrata Resin Extract (85% boswellic acid) 50mg / **
Phosphatidylserine (Sharp-PS) 50mg / **
DMAE (as bitartrate) 45mg / **
Ginkgo Leaf Extract (50:1) 40mg / **
Glycerophosphosphatidylcholine (SharpGPC) 33mg / **
Nattokinase (NSK-SO) 16mg / **
Viopocetine 6mg / **
Huperzine A (from Huperiza serreta leaf ext.) 133mcg / **
*Percent Daily Value (DV) are based on a 2'000 calorie diet.
**Daily Value not established.
Other Ingredients:
Silicified microcrystalline cellulose' stearic acid' acacia gum' modified cellulose gum' colloidal silicon dioxide' and magnesium stearate.
(Contains: Soy).
1 to 2 tablets 3 times daily. Do not exceed recommended dosage. Read entire label before using.
Do not use this product if you are pregnant' may become pregnant' or breastfeeding. If you have epilepsy' high blood pressure' heart problems' or are taking anticholinergic drugs' cholinergic drugs' acetylcholinesterase inhibitors' or drugs that affect blood coagulation or blood pressure such as prescription vitamin K' heparin' warfarin (Coumadin®)' diuretics' ACE inhibitors' beta-blockers' aspirin or blood-thinning medications' consult your physician before using this product. If symptoms of nausea' vomiting' diarrhea' incontinence' or muscle twitches occur' discontinue use or reduce dosage and consult your physician.Do not use if either tamper-evident seal is broken or missing. Keep out of the reach of children.Contains soy.
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