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AIDS-Related Lymphoma Treatment (PDQ®): Treatment - Patient 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.
AIDS-Related Lymphoma Treatment
General Information About AIDS-Related Lymphoma
AIDS-related lymphoma is a disease in which malignant (cancer) cells form in the lymph system of patients who have acquired immunodeficiency syndrome (AIDS).
AIDS is caused by the human immunodeficiency virus (HIV), which attacks and weakens the body's immune system. The immune system is then unable to fight infection and diseases that invade the body. People with HIV disease have an increased risk of developing infections, lymphoma, and other types of cancer. A person with HIV disease who develops certain types of infections or cancer is then diagnosed with AIDS. Sometimes, people are diagnosed with AIDS and AIDS-related lymphoma at the same time. For information about AIDS and its treatment, please see the AIDSinfo Web site.
Lymphomas are cancers that affect the white blood cells of the lymph system, part of the body's immune system. The lymph system is made up of the following:
- Lymph: Colorless, watery fluid that travels through the lymph system and carries white blood cells called lymphocytes. Lymphocytes protect the body against infections and the growth of tumors.
- Lymph vessels: A network of thin tubes that collect lymph from different parts of the body and return it to the bloodstream.
- Lymph nodes: Small, bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes are located along the network of lymph vessels found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, abdomen, and groin.
- Spleen: An organ that makes lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. The spleen is on the left side of the abdomen near the stomach.
- Thymus: An organ in which lymphocytes grow and multiply. The thymus is in the chest behind the breastbone.
- Tonsils: Two small masses of lymph tissue at the back of the throat. The tonsils make lymphocytes.
- Bone marrow: The soft, spongy tissue in the center of large bones. Bone marrow makes white blood cells, red blood cells, and platelets.
Anatomy of the lymph system, showing the lymph vessels and lymph organs including lymph nodes, tonsils, thymus, spleen, and bone marrow. Lymph (clear fluid) and lymphocytes travel through the lymph vessels and into the lymph nodes where the lymphocytes destroy harmful substances. The lymph enters the blood through a large vein near the heart.
There are many different types of lymphoma.
Lymphomas are divided into two general types: Hodgkin lymphoma and non-Hodgkin lymphoma. Both Hodgkin lymphoma and non-Hodgkin lymphoma may occur in AIDS patients, but non-Hodgkin lymphoma is more common. When a person with AIDS has non-Hodgkin lymphoma, it is called an AIDS-related lymphoma.
For more information, see the following PDQ summaries:
- Adult Non-Hodgkin Lymphoma Treatment
- Childhood Non-Hodgkin Lymphoma Treatment
- Primary CNS Lymphoma Treatment
AIDS-related lymphomas grow and spread quickly.
Non-Hodgkin lymphomas are grouped by the way their cells look under a microscope. They may be indolent (slow-growing) or aggressive (fast-growing). AIDS-related lymphoma is usually aggressive. There are three main types of AIDS-related lymphoma:
- Diffuse large B-cell lymphoma.
- B-cell immunoblastic lymphoma.
- Small non-cleaved cell lymphoma.
Possible signs of AIDS-related lymphoma include weight loss, fever, and night sweats.
These and other symptoms may be caused by AIDS-related lymphoma. Other conditions may cause the same symptoms. Check with your doctor if you have any of the following problems:
- Weight loss or fever for no known reason.
- Night sweats. (For more information, see the PDQ summary on Fever, Sweats, and Hot Flashes.)
- Painless, swollen lymph nodes in the neck, chest, underarm, or groin.
- A feeling of fullness below the ribs.
Tests that examine the body and lymph system are used to help detect (find) and diagnose AIDS-related lymphoma.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
- The number of red blood cells, white blood cells, and platelets.
- The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
- The portion of the sample made up of red blood cells.
Complete blood count (CBC). Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions.
Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells. One of the following types of biopsies may be done:
- Excisional biopsy: The removal of an entire lymph node.
- Incisional biopsy: The removal of part of a lymph node.
- Core biopsy: The removal of tissue from a lymph node using a wide needle.
- Fine-needle aspiration (FNA) biopsy: The removal of tissue from a lymph node using a thin needle.
Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
Bone marrow aspiration and biopsy. After a small area of skin is numbed, a Jamshidi needle (a long, hollow needle) is inserted into the patient's hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.
- HIV test: A test to measure the level of HIV antibodies in a sample of blood. Antibodies are made by the body when it is invaded by a foreign substance. A high level of HIV antibodies may mean the body has been infected with HIV.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage of the cancer.
- The number of CD4 lymphocytes (a type of white blood cell) in the blood.
- Whether the patient has ever had AIDS-related infections.
- The patient's ability to carry out regular daily activities.
Stages of AIDS-Related Lymphoma
After AIDS-related lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.
The process used to find out if cancer cells have spread within the lymph system or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment, but AIDS-related lymphoma is usually advanced when it is diagnosed. The following tests and procedures may be used in the staging process:
- Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it. The blood sample will be checked for the level of LDH (lactate dehydrogenase).
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the lung, lymph nodes, and liver, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap. A pathologist views the cerebrospinal fluid under a microscope to look for signs of cancer.
Lumbar puncture. A patient lies in a curled position on a table. After a small area on the lower back is numbed, a spinal needle (a long, thin needle) is inserted into the lower part of the spinal column to remove cerebrospinal fluid (CSF, shown in blue). The fluid may be sent to a laboratory for testing.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
Stages of AIDS-related lymphoma may include E and S.
AIDS-related lymphoma may be described as follows:
- E: "E" stands for extranodal and means the cancer is found in an area or organ other than the lymph nodes or has spread to tissues beyond, but near, the major lymphatic areas.
- S: "S" stands for spleen and means the cancer is found in the spleen.
The following stages are used for AIDS-related lymphoma:
Stage I
Stage I AIDS-related lymphoma. Cancer is found in one lymphatic area (lymph nodes, tonsils, thymus, or spleen). In stage IE (not shown), cancer is found in one organ or area outside the lymph nodes.
Stage I AIDS-related lymphoma is divided into stage I and stage IE.
- Stage I: Cancer is found in one lymphatic area (lymph node group, tonsils and nearby tissue, thymus, or spleen).
- Stage IE: Cancer is found in one organ or area outside the lymph nodes.
Stage II
Stage II AIDS-related lymphoma is divided into stage II and stage IIE.
Stage II AIDS-related lymphoma. Cancer is found in two or more lymph node groups, and both are either above (a) or below (b) the diaphragm. Stage II: Cancer is found in two or more lymph node groups either above or below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
Stage IIE AIDS-related lymphoma. Cancer is found in one or more lymph node groups either above or below the diaphragm and outside the lymph nodes in an organ or area on the same side of the diaphragm as the lymph nodes with cancer (a). Stage IIE: Cancer is found in one or more lymph node groups either above or below the diaphragm. Cancer is also found outside the lymph nodes in one organ or area on the same side of the diaphragm as the affected lymph nodes.
Stage III
Stage III AIDS-related lymphoma. Cancer is found in one or more lymph node groups above and below the diaphragm (a). In stage IIIE, cancer is found in lymph node groups above and below the diaphragm and outside the lymph nodes in a nearby organ or area (b). In stage IIIS, cancer is found in lymph node groups above and below the diaphragm (a) and in the spleen (c). In stage IIIE plus S, cancer is found in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ or area (b), and in the spleen (c).
Stage III AIDS-related lymphoma is divided into stage III, stage IIIE, stage IIIS, and stage IIIE+S.
- Stage III: Cancer is found in lymph node groups above and below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
- Stage IIIE: Cancer is found in lymph node groups above and below the diaphragm and outside the lymph nodes in a nearby organ or area.
- Stage IIIS: Cancer is found in lymph node groups above and below the diaphragm, and in the spleen.
- Stage IIIE+S: Cancer is found in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ or area, and in the spleen.
Stage IV
Stage IV AIDS-related lymphoma. Cancer is found throughout one or more organs that are not part of a lymphatic area (lymph nodes, tonsils, thymus, or spleen) (a); or in one organ that is not part of a lymphatic area and has spread to lymph nodes far away from that organ (b); or cerebrospinal fluid (not shown), the liver, bone marrow, or lungs.
In stage IV AIDS-related lymphoma, the cancer:
- is found throughout one or more organs that are not part of a lymphatic area (lymph node group, tonsils and nearby tissue, thymus, or spleen) and may be in lymph nodes near those organs; or
- is found in one organ that is not part of a lymphatic area and has spread to organs or lymph nodes far away from that organ; or
- is found in the liver, bone marrow, cerebrospinal fluid (CSF), or lungs (other than cancer that has spread to the lungs from nearby areas).
Patients who are infected with the Epstein-Barr virus or whose AIDS-related lymphoma affects the bone marrow have an increased risk of the cancer spreading to the central nervous system (CNS).
For treatment, AIDS-related lymphomas are grouped based on where they started in the body, as follows:
Peripheral/systemic lymphoma
Lymphoma that starts in lymph nodes or other organs of the lymph system is called peripheral/systemic lymphoma. The lymphoma may spread throughout the body, including to the brain or bone marrow.
Primary CNS lymphoma
Primary CNS lymphoma starts in the central nervous system (brain and spinal cord). Lymphoma that starts somewhere else in the body and spreads to the central nervous system is not primary CNS lymphoma.
Treatment Option Overview
There are different types of treatment for patients with AIDS-related lymphoma.
Different types of treatment are available for patients with AIDS-related lymphoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Treatment of AIDS-related lymphoma combines treatment of the lymphoma with treatment for AIDS.
Patients with AIDS have weakened immune systems and treatment can cause further damage. For this reason, patients who have AIDS-related lymphoma are usually treated with lower doses of drugs than lymphoma patients who do not have AIDS.
Highly-active antiretroviral therapy (HAART) is used to slow progression of HIV (which is a retrovirus). Treatment with HAART may allow some patients to safely receive anticancer drugs in standard or higher doses. Medicine to prevent and treat infections, which can be serious, is also used.
AIDS-related lymphoma usually grows faster than lymphoma that is not AIDS-related and it is more likely to spread to other parts of the body. In general, AIDS-related lymphoma is harder to treat.
For more information about AIDS and its treatment, please see the AIDSinfo Web site.
Three types of standard treatment are used:
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid (intrathecal chemotherapy), an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Intrathecal chemotherapy may be used in patients who are more likely to have lymphoma in the central nervous system (CNS).
Intrathecal chemotherapy. Anticancer drugs are injected into the intrathecal space, which is the space that holds the cerebrospinal fluid (CSF, shown in blue). There are two different ways to do this. One way, shown in the top part of the figure, is to inject the drugs into an Ommaya reservoir (a dome-shaped container that is placed under the scalp during surgery; it holds the drugs as they flow through a small tube into the brain). The other way, shown in the bottom part of the figure, is to inject the drugs directly into the CSF in the lower part of the spinal column, after a small area on the lower back is numbed.
Colony-stimulating factors are sometimes given together with chemotherapy. This helps lessen the side effects chemotherapy may have on the bone marrow.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
High-dose chemotherapy with stem cell transplant
High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.
|Stem Cell Transplant
|Stem cell transplant (Step 1). Blood is taken from a vein in the arm of the donor. The patient or another person may be the donor. The blood flows through a machine that removes the stem cells. Then the blood is returned to the donor through a vein in the other arm.
|Stem cell transplant (Step 2). The patient receives chemotherapy to kill blood-forming cells. The patient may receive radiation therapy (not shown).
|Stem cell transplant (Step 3). The patient receives stem cells through a catheter placed into a blood vessel in the chest.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibody therapy is one type of targeted therapy being studied in the treatment of AIDS-related lymphoma.
Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. These may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Treatment Options for AIDS-Related Lymphoma
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
AIDS-Related Peripheral/Systemic Lymphoma
There is no standard treatment plan for AIDS-related peripheral/systemic lymphoma. Treatment is adjusted for each patient and is usually one or more of the following:
- Combination chemotherapy.
- High-dose chemotherapy and stem cell transplant.
- A clinical trial of monoclonal antibodies.
- A clinical trial of different treatment combinations.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with AIDS-related peripheral/systemic lymphoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
AIDS-Related Primary Central Nervous System Lymphoma
Treatment of AIDS-related primary central nervous system lymphoma is usually radiation therapy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with AIDS-related primary CNS lymphoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
To Learn More About AIDS-Related Lymphoma
For more information from the National Cancer Institute about AIDS-related lymphoma, see the following.
- AIDS-Related Cancers Home Page
- Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation
- Understanding Cancer Series: Blood Stem Cell Transplants
- Understanding Cancer Series: Targeted Therapies (Advances in Targeted Therapies and Targeted Therapies for Lymphoma)
- Targeted Cancer Therapies
For general cancer information and other resources from the National Cancer Institute, see the following:
- What You Need to Know About™ Cancer
- Understanding Cancer Series: Cancer
- Cancer Staging
- Chemotherapy and You: Support for People With Cancer
- Radiation Therapy and You: Support for People With Cancer
- Coping with Cancer: Supportive and Palliative Care
- Questions to Ask Your Doctor About Cancer
- Cancer Library
- Information For Survivors/Caregivers/Advocates
Changes to This Summary (02 / 26 / 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.
Editorial changes were made to this summary.
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About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
Images in the PDQ summaries are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in the PDQ summaries, along with many other cancer-related images, are available in Visuals Online, a collection of over 2,000 scientific images.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
Last Revised: 2013-02-26
If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.
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I don't think it looks bad at all. But I do have some critique that I hope might help.
The sea looks horrid to be blunt. =P It has more texture than the rest of the map put together which is sort of the opposite of how it should be in my mind. The sea should have less texture than the land. You should aim for a flatter blue colour I think.
On the topic of the sea - your river (not sure if it should divide like that at the end either - but anyway) is a completely different colour which makes it look entirely divorced from the ocean it is feeding in to. Also I think that thick black coastal outline isn't appropriate for the style you are aiming for.
I am not sure if you should increase the scale - it depends on how detailed or close up you want your map to be really. This scale is fine I think even though I prefer something more up close for my own maps - but that is also more work which can be uneeded.


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New Year in Amsterdam
3 countries \ 4 days \ from US$589 per person
Bring in the New Year in the free-wheeling city of Amsterdam. This 4 day New Year's Eve package means there's plenty of time to get to know this cultural, café-filled & canal-lined city in depth this winter. Take time to explore before seeing in the New Year with some included drinks & snacks. There's also an optional canal cruise as well as city tours, traditional Dutch dinners & more.
Egypt & The Nile
1 country \ 8 days \ from US$1319 per person
Travel back in time to the days of the Pharoahs with this action packed trek around Egypt. You'll be guided through the craziness of Cairo with an expert Egyptian Tour Manager, who'll be at your side for the entire tour. See the Great Pyramids & Sphinx in Giza & Valley of the Kings in Luxor. Sail on a traditional Felucca & enjoy shopping in the bazaar! No sitting on a coach for 8 days either ...
Berlin & Prague
2 countries \ 7 days \ from US$1055 per person
Experience 2 of the most popular eastern European cities in depth with this tour. Three nights in both Berlin & Prague gives you the opportunity for day trips out of the city, as well as lots of city sightseeing. In Berlin, visit the Berlin Wall, walk through the Brandenburg Gate or shop in the Alexanderplatz. In Prague, everywhere you turn is a picture perfect moment. Stunning architecture, r...
Berlin & Prague plus Vienna
3 countries \ 9 days \ from US$1305 per person
Cover three of the most popular eastern European cities in more depth with this tour. Three nights each in Berlin and Prague affords you the opportunity for day trips out of the city centre as well as the obligatory 'tick the box' sightseeing. Why not extend your experience and travel to Budapest as well on our Berlin to Budapest tour?
Vietnam Highlights
1 country \ 10 days \ from US$1395 per person
Vietnam Highlights is the perfect way for a taste of Vietnam's best in a short amount of time. Experience the hustle and bustle of Ho Chi Minh City & Hanoi, relax and soak up the rays on a beach in Nha Trang, hit Hoi An by bike & chill out in the amazing scenery of Hue. Later, sit back & discover the amazing limestone formations of Halong Bay aboard a traditional junk boat as you indulge in Vie...
European Whirl
10 countries \ 19 days \ from US$2655 per person
If you've been dreaming of going to Europe but don't know exactly where to start, the European Whirl is your best option. Taking in the usual destinations of Paris, Rome and Amsterdam, it also ventures out east to Prague and Berlin. Both of which are currently on Europe's 'must see' list. The perfect combination of culture, relaxation and of course, good times!
England & Scotland
3 countries \ 10 days \ from US$1719 per person
Hit the highlights of England & Scotland for a full dose of sightseeing, history & culture. Follow in the footsteps of The Beatles, stroll Edinburgh's Royal Mile & look for 'Nessie' on a boat cruise across Loch Ness.
London & Paris plus Amsterdam
4 countries \ 9 days \ from US$1765 per person
Spend your time discovering London & Paris with this action-packed tour. No need to negotiate maps, guidebooks, or public transport - leave that to us! Your 3 days in London include a city tour of the major sites, London Tube passes, a 'Jack the Ripper' Walking Tour, tickets to a West End musical & plenty of free time. And then its onto Paris for a tour of the city by night, a visit to a French...
London & Paris plus Paris extension
3 countries \ 9 days \ from US$1545 per person
Spend your time discovering London & Paris with this action-packed tour. No need to negotiate maps, guidebooks, or public transport - leave that to us! Your 3 days in London include a city tour of the major sites, London Tube passes, a 'Jack the Ripper' Walking Tour, tickets to a West End musical & plenty of free time. And then its onto Paris for a tour of the city by night, a visit to a French...
Winter Wanderer
12 countries \ 25 days \ from US$3515 per person
The Winter Wanderer is like a leisurely stroll through Europe's top destinations. Some of the highlights of the tour include: driving along the French Riviera, exploring the Eternal City of Rome (it's never too cold for Gelato!) and sampling traditional Spanish tapas in Barcelona not to mention retracing the history of WW2 and the Cold War in Berlin and Prague. Winter in Europe is not only magi...
England & Scotland (Winter)
3 countries \ 10 days \ from US$1489 per person
The England & Scotland tour will take you away to a whirlwind of sightseeing, medieval history and culture. Rolling green hills and cosy pubs are what England & Scotland are all about.
Road to Athens plus 3 day Greek Island Cruise
11 countries \ 22 days \ from US$4329 per person
Why fly direct to Athens when you can take your time exploring the cities of Europe on the way? Paris, Venice, Florence & Rome with a little of Switzerland, Germany and the Austrian Tyrol thrown in for good measure. The Road to Athens tour will definitely satisfy your travel taste buds. When you go Greek, chill out on the Isle of Corfu before exploring the capital city of Athens. You'll finish...
Road to Athens
10 countries \ 18 days \ from US$2300 per person
Anyone can fly direct to Athens but why fly over Europe when you can take your time & explore the cities at leisure? That's exactly what the Road to Athens tour offers. Paris, Austrian Tyrol, Venice, Florence & Rome with a little bit of Switzerland & Germany thrown in for good measure. Relax on the island of Corfu in Greece before reaching your final destination & the birthplace of democracy, A...
London Explorer (2 nights)
1 country \ 3 days \ from US$345 per person
Why come all the way to Europe and not spend some quality time in the English capital? Add this self-guided package onto your other Contiki holidays and use the time to discover museums, shop on Oxford Street, eat curry on Brick Lane, see a West End show or listen to some of the hottest music coming out of England's famous nightlife. Our Contiki Representatives in central London are on hand to...
Spotlight on Greece
1 country \ 4 days \ from US$835 per person
Discover Athens, Olympia and Delphi in more depth with this 4 day Spotlight on Greece tour. Visit the Acropolis and Parthenon in Athens, the first Olympic stadium in Olympia and the Temples of Hera and Zeus in Delphi, all with your local Greek guide. A great add-on to the beginning or end of your Contiki adventure.
European Explorer plus Greek Island Cruising
16 countries \ 34 days \ from US$6219 per person
The European Explorer is the ultimate holiday for those wanting to travel to all the major destinations and do it with a little luxury! Make your way through 17 countries in a little over a month with all the big names being accounted for - Paris, Barcelona, Florence, Rome and Amsterdam - as well as some of the lesser known through Albania, Croatia, Montenegro and Bosnia. And if you think tha...
Russia Plus (Start Helsinki)
5 countries \ 12 days \ from US$2129 per person
The name might just be Russia, but with 5 countries on the cards, there's much more to this tour. Starting in Helsinki, make your way through colourful cities of the former Soviet Union. From 'Venice of the North' to the economic hub of Moscow, there's loads of history & stories to discover. Do as the Romans (or Russians) do & sample vodka, see the famous Moscow Circus & tour the Kremlin. You'l...
Turkey & Greek Island Odyssey
2 countries \ 10 days \ from US$1769 per person
Travel to the edge of Europe with this Turkish & Greecian adventure. Hang out in the cool city of Istanbul, see the sombre memorials at Gallipoli, visit the port towns of Canakkale & Kusadasi, & dip in the thermal pools of Pamukkale. Later it's on to the islands for a taste of Greece. Check out the fortified town of Rhodes before topping it all off with a visit to paradise - Santorini. There's ...
Asian Adventure
3 countries \ 14 days \ from US$2129 per person
Get into the best of Thailand, Laos & Cambodia in 14 incredible days. Be part of the buzz & bright lights of Bangkok before a change of scene in the Mekong with its rice paddy & sugar fields & coconut palms. The low key vibes of Laos, with its small villages, saffron robed monks & French colonial past are up next, before Angkor Wat & Ta Prohm in Cambodia's jungle & a slice of Phnom Penh.
ANZAC Classic
1 country \ 4 days \ from n/a per person
Walk in the footsteps of the ANZAC's on our moving & memorable Gallipoli experience. Pay tribute & join fellow Aussies & Kiwis on our 4 day trip to commemorate the ANZAC arrival at Gallipoli in 1915. Starting in Istanbul, you'll tour the battlefields & sleep under the stars before attending the Dawn Service at Gallipoli. Visit Lone Pine & Chunuk Bair to pay your respects, before heading back to...
European Spirit
9 countries \ 22 days \ from n/a per person
The European Spirit is THE sightseeing tour. Start in Paris, finish in Rome and in between.....let your imagination run wild! Cruise the canals in Amsterdam, wander the cobbled streets of Prague and watch the sun set from a cliffside bar in Dubrovnik.
European Vista (Winter)
11 countries \ 22 days \ from US$3045 per person
If you're looking for a leisurely yet adventurous holiday around Europe then the European Vista fits the bill. 10 countries in 21 days means time to really get acquainted with each city while fantastic destinations like Lucerne and Vienna as well as the essential Paris, Rome and Amsterdam stops mean all your sightseeing bases are covered. Options for your free time include a Tuscan dinner, Moza...
Ultimate European plus Egypt
17 countries \ 46 days \ from US$7139 per person
This tour is THE Ultimate European experience! Visit 17 countries, hit up all the major European destinations in the first half of the tour then travel to camel riding Egypt & see the pyramids. The second half is all about uncharted territory before exploring Germany, Switzerland & the Netherlands. After this, your hardest decision will be finding somewhere new to visit on your next trip!
Peru Uncovered (Until December 2016)
1 country \ 14 days \ from US$3185 per person
Experience the best of Peru on this adventure into the country's ultimate hotspots. From ancient Inca culture, the Andes & Amazon jungle to awesome locals, Peru has it all. See the floating islands of Lake Titicaca, the cultural-hub of Cusco, the Colca Canyon & our highlight, Machu Picchu. When you're done, sit back & re-live the memories over a perfect Pisco Sour. You can choose to either trek...
Eastern Road
5 countries \ 13 days \ from US$2055 per person
This is Eastern Europe at its best! From Berlin to Warsaw, the history and beauty of each country will captivate the imagination. Additional stops in Dresden, a city devastated by fire bombing in World War II, Banska Bystrica in Slovakia and an unforgettable visit to the Auschwitz memorial all combine to make this a holiday with a distinct difference. Want to end your trip in Berlin? Feel fre...
Best of Europe (start Amsterdam)
5 countries \ 10 days \ from US$2225 per person
Short on time? Got lots to check off your 'things to see' list? The Best of Europe is the tour for you. Get straight into holiday mode with sightseeing in Amsterdam before driving to Berlin & Prague, finishing in style with a flight to Rome. As the name suggests, we've taken all the best parts of Europe, the most convenient forms of travel & combined them all into one action packed trip. Get yo...
Andes & Amazon Highlights (Until October 2016)
1 country \ 8 days \ from US$2235 per person
Let the good times roll as you go deep into some of Peru's ultimate spots on this 8 day adventure. Get your culture fix at Machu Picchu, with its unbeatable views & ancient Inca history. Feel an adrenalin rush in Cusco, with rafting & mountain biking at the ready, before heading to the mighty Amazon. Try fishing for piranha, spotting Amazonian Caiman & sleeping at a luscious lodge in the rainfo...
Learn to Dive
1 country \ 5 days \ from US$905 per person
The 5 day PADI 'Open Water' dive course is by far the most popular way to learn to dive. The adventure of learning to dive combined with staying out on the reef for 2 nights onboard a boat is really unique. The course takes you to 9 of the Great Barrier Reef's best dive sites & features two days of classroom & in-pool training, then it's onto the live aboard boat for the actual reef diving. The...
Dive to Adventure
1 country \ 3 days \ from US$625 per person
Go Down Under at the world's premiere underwater playground, the Great Barrier Reef. See the flora & fauna that call this natural wonder home for the next 3 days. Live aboard a ship & dive or snorkel your way around magnificent coral formations, you can participate in up to 11 dives at 16 exclusive dive sites. The value is unmatched!
Mediterranean Highlights (Start Rome)
5 countries \ 13 days \ from US$2345 per person
Beginning in Rome, your 2 week adventure takes you to all the hotspots along the Mediterranean coast. Flamenco dance in Barcelona, rub shoulders with the rich & famous on the French Riviera, enjoy the delights of Tuscany, walk in the footsteps of Roman Emperors & soak up the Spanish flavour of Madrid. Plus heaps more in between!
European Discovery
9 countries \ 13 days \ from US$2479 per person
If trips were like courses at a dinner party, the European Discovery would be the appetiser. 8 countries in one shot gives you a taste of all the big cities plus some hidden treasures, so you know where to go next time! From Amsterdam to Rome to Paris, you won't want to miss a thing. In fact, sleep will probably be the last thing on your mind!
Alice and Kakadu (Start Alice Springs)
1 country \ 7 days \ from US$1205 per person
Time for Vegemite & kangaroos mate! Australia's Northern Territory offers spectacular scenery, wildlife, fabulous flights over waterfalls & a bit of culture with a visit to the N.T. Museum in the historic city of Darwin. From Aboriginal art to a Territorial feast & a visit to the areas oldest watering holes, we'll see it all & call it a day with a stop off at Devil's Marbles.
Grand Northern
2 countries \ 26 days \ from US$4115 per person
With 20 states & 2 Canadian provinces, get ready to go local. Start in the Big Apple before it's all about Canada, America's Great Lakes & Chicago en route to the American West. Chill at 4 National Parks before LAS Vegas.
European Adventurer
16 countries \ 38 days \ from US$5505 per person
The European Adventurer is just that, an adventure. From the cosmopolitan sights of Paris, to the romance and passion of the Italians, even out into uncharted tourist territory in Albania and Croatia, there aren't too many boundaries left to cross. There's even a mini holiday within a holiday when you get down to Greece! The perfect way to see most of Europe without wasting a moment.
European Adventurer
16 countries \ 38 days \ from US$5505 per person
The European Adventurer is just that, an adventure. From the cosmopolitan sights of Paris, to the romance and passion of the Italians, even out into uncharted tourist territory in Albania and Croatia, there aren't too many boundaries left to cross. There's even a mini holiday within a holiday when you get down to Greece! The perfect way to see most of Europe without wasting a moment.
European Experience
10 countries \ 21 days \ from US$2815 per person
Experience Europe, Contiki style! A great trip itinerary for those wanting quality time in Italy without skipping anything important on the way there. The second half of the trip is all about beautiful scenery with stops in the Austrian Tyrol as well as the Swiss Alps. Of course, with the beautiful scenery comes some amazing opportunities to raft, ride and climb your way to must have memories.
European Experience
10 countries \ 21 days \ from US$2815 per person
Experience Europe, Contiki style! A great trip itinerary for those wanting quality time in Italy without skipping anything important on the way there. The second half of the trip is all about beautiful scenery with stops in the Austrian Tyrol as well as the Swiss Alps. Of course, with the beautiful scenery comes some amazing opportunities to raft, ride and climb your way to must have memories.
The Northern Trek
15 countries \ 26 days \ from US$2549 per person
Head into the great unknown with this 26 day camping tour. Meet up in Athens and begin your adventure with stops in places like Turkey, Macedonia and Croatia before getting back on the mainstream track through Germany and Switzerland - these are just a few of the amazing countries you'll visit! The best bit though, has to be doing it the way Contiki started - a bunch of new friends, two perso...
The Northern Trek
15 countries \ 26 days \ from US$2549 per person
Head into the great unknown with this 26 day camping tour. Meet up in Athens and begin your adventure with stops in places like Turkey, Macedonia and Croatia before getting back on the mainstream track through Germany and Switzerland - these are just a few of the amazing countries you'll visit! The best bit though, has to be doing it the way Contiki started - a bunch of new friends, two perso...
Places I've Been (?)
- Austria
- England
- France
- Germany
- Holy See (Vatican City State)
- Italy
- Netherlands
- United Kingdom
Places I'd Like to Visit
- Albania
- Australia
- Austria
- Belarus
- Bulgaria
- Cambodia
- Canada
- Croatia
- Czech Republic
- Egypt
- England
- Finland
- France
- Germany
- Greece
- Holy See (Vatican City State)
- Hungary
- Ireland
- Italy
- Lao People's Democratic Republic
- Liechtenstein
- Macedonia
- Monaco
- Netherlands
- Northern Ireland
- Peru
- Poland
- Russian Federation
- Scotland
- Serbia
- Slovakia
- Slovenia
- Spain
- Switzerland
- Thailand
- Turkey
- United Kingdom
- United States
- Vietnam


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Publications Library
Topic: Gas, Bloating, Belching
Fact Sheet: Why Does Milk Bother Me?218
By: Information Adapted from the National Diseases Information Clearinghouse NIH
Lactose intolerance means that you cannot digest foods with lactose in them. Lactose is the sugar found in milk and foods made with milk. This sheet reviews what you need to know about lactose intolerance.Topics: Diarrhea, loose stools, Diet, Foods, Food intolerance, Malabsorption, Gas, Bloating, Belching
Fact Sheet: A Noisy Tummy: What Does it Mean?234
By: W. Grant Thompson, MD, FRCPC
While seldom of medical importance, for some people a rumbling, growling stomach can be a source of profound embarrassment. Picturesquely dubbed "borborygmi," bowel sounds seem loudest to the owner, who is sometimes mistakenly convinced they are obvious to all. This article explains the causes of bowel sounds, discusses when the sounds become a cause for medical concern, and offers some tips that may help reduce bowel noises.Topics: Digestive System, FAQs, Gas, Bloating, Belching, Other Disorders/Symptoms, Symptoms, Working with your healthcare provider
Fact Sheet: Is Constipation and Bloating Related to Menstrual Periods?239
This Clinical Corner article discusses how constipation and bloating are affected by menstruation, especially in women with IBS, and offers some tips for controlling the bowel symptoms and the pain.Topics: Clinical Corner, Constipation, difficult to pass stools, Gas, Bloating, Belching, Gender, Irritable Bowel Syndrome (IBS), Lower Abdominal Pain, Pelvic Pain, Pain Management
Fact Sheet: Understanding Bloating and Distension262
Bloating can be described as the feeling that there is an inflated balloon in the abdomen. It is a commonly reported symptom and is sometimes associated with distension, or the visible increase in the width of the area between your hips and chest (abdominal girth). Both bloating and distension cause discomfort, and sometimes pain, and have a negative impact on the quality of life for some individuals.Topics: bloating, distension, Gas, Bloating, Belching
Fact Sheet: Talking To Your Doctor About Incontinence316
By: William F. Norton, Communications Director, IFFGD
Most people feel uneasy talking about their stool, intestinal gas, or bowel movements. But doctors understand that these are very normal and necessary processes in all of us. Doctors and other therapists are there to help when bodily processes go wrong. So the first very important step is to talk plainly about the problems you are experiencing.
Fact Sheet: Belching: Is it Normal?511
By: W. Grant Thompson, MD, FRCPC
Belching can be a serious and difficult matter for some people; they are plagued by sudden attacks of belching which is both intrusive and embarrassing. Causes and treatments for belching is discussed. Reviewed and updated 2009.Topics: Gas, Bloating, Belching
Fact Sheet: Antacids520
By: W. Grant Thompson, MD, FRCPC
Antacids seem to help many of those with bloating or nonulcer dyspepsia, as well as heartburn. A discussion of various antacids.
Fact Sheet: Confusing or Ambiguous Upper Gut Symptoms524
By: W. Grant Thompson, MD, FRCPC
By choosing the appropriate test, a doctor can make a precise diagnosis of a structural upper gut disorder, such as esophagitis or peptic ulcer, by recognizing the diseased area through testing. The patient's history provides the information that permits the doctor to choose the right test. In the case of the disorders of gastrointestinal function, such as dyspepsia or non-cardiac chest pain, there is no structural abnormality and no diagnostic test. Hence diagnosis of these disorders depends even more upon how the patient describes his or her symptoms. But many people use words to describe symptoms that are vague or misliading to a doctor. Examples are explained – such as indigestion, gas, nausea, chest pain, or vomiting.
Fact Sheet: Indigestion538
By: Information Adapted from the National Diseases Information Clearinghouse NIH
Indigestion, also known as upset stomach or dyspepsia, is discomfort or a burning feeling in the upper abdomen. It is often accompanied by nausea, abdominal bloating, belching, and sometimes vomiting. Revised and updated 2009.
Fact Sheet: Gastritis542
By: Information Adapted from the National Diseases Information Clearinghouse NIH
Gastritis is not a single disease, but several different conditions that all have inflammation of the stomach lining. Symptoms, tests, and treatments are described.
Documents listed on this page are available for download in Adobe's PDF format. If you don't have Adobe Reader, please visit Adobe's site to download it. It's free!


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- Jan 27:
- Season to Share: Project PAVE aims to end teen dating violence
- Jan 24:
- Community Health Services giving families a path to healthier living
- Jan 20:
- Denver's Lambuth Center helps parents move toward stability
- Jan 17:
- OpenWorld Learning helps kids study, rewards them with computers
- Jan 13:
- "I Have a Dream" program prepares Boulder elementary kids for college
- Jan 10:
- Adams 14 Education Foundation supports mentoring program for needy
- Dec 27:
- Goodwill Industries of Denver offers different path for troubled youth
- Dec 23:
- Peer mentoring program builds students' skills
- Dec 20:
- Gateway provides help to domestic violence victims
- Dec 16:
- Bridge Project carries kids toward success
- Dec 13:
- Boulder's Intercambio helps 8,000 immigrants find their way
- Dec 9:
- Smart-Girl tackles tween angst with team building
- Dec 2:
- CityWILD outdoors programs help Denver kids find a better path
A former convent near Curtis Park, the Sacred Heart House of Denver blends into its surroundings.
There's no sign out front or even near the doorbell.
But over the past 32 years, the emergency shelter inside has helped thousands of homeless women and their children start on the path to self-sufficiency.
"Homelessness is very isolating," said Janet Morris, the agency's longtime executive director. "Once they realize there is a world around them with the support of the organizations and other people, that isolation goes away, and they can become part of the community."
Sacred Heart provides a continuum of services to homeless women, including its signature initiative, the In-House Stabilization Program. Over 30 days, the program provides homeless women and their children temporary shelter, food, clothing and transportation as the women work with an in-house case manager to find more permanent housing.
Up to six women with children and three single women can be housed at one time at the shelter, and graduates get continued support through a follow-up program.
"The month they spend here, even if they end up leaving without being able to move into housing, they are exposed to things here that help them keep moving forward," Morris said.
The Sacred Heart House is one of many organizations that have received funding through Denver Post Charities Season to Share in the past.
Mandatory, twice-weekly living skills classes are a vital part of the Sacred Heart program, Morris said. Volunteers lead the one-hour classes on topics that include anger management, self-esteem, parenting skills, financial literacy, nutrition and interview skills.
During the women's stay, the in-house case manager also helps connect them with housing options, government aid, counseling and education programs.
Case manager Maureen Brabec said the women take the lead during their sessions together, identifying for themselves their goals for their stay.
"We're really committed to helping women change the patterns they've established that put them out of a home," Brabec said.
Women end up homeless and at Sacred Heart for many reasons, Brabec said.
Some are trying to get out of bad relationships, while others have lost a job and couldn't make rent. Some women have been formally evicted; others wore out their welcome with family or friends.
They've also seen a number of women who came to Denver without a support system, looking for opportunities, Brabec said.
One of the benefits of being a small program, Morris said, is being able to provide clients with a lot of one-on-one support in just 30 days. Sacred Heart shelters 180-210 people a year.
"By the time they come here, they've pretty much burned their bridges. They don't have a lot of family and friend support," Morris said.
"We become the support."
Emilie Rusch: 303-954-2457 or email@example.com
Sacred Heart House of Denver
In operation since: 1980
Number served last year: 1,051 (All Programs); 180 individuals (In-House Stabilization Program); 50 mothers with 87 children; and 43 single women
Staff: two full time, seven part time
Yearly budget: $425,054
Percentage of funds given directly to clients and services: 83%


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Bal du Moulin de la Galette, Montmartre
Giclee Print
Item #: 8096806613A
Size and print type
21" x 16.5" without border
Ships in 1-2 days
This artwork is the officially approved image from Paris's Musée d'Orsay as part of the French Museum Collection (RMN). This collection, representing artwork from over 400 top European museums and private sources, honors the very best of the world's curated original art by making these works available for the first time as museum-approved, high-quality giclee prints and canvas reproductions that can be personalized to suit any decorating style and vision.
This giclée print offers beautiful color accuracy on a high-quality paper (235 gsm) that is a great option for framing with its smooth, acid free surface. Giclée (French for "to spray") is a printing process where millions of ink droplets are sprayed onto the paper's surface creating natural color transitions.
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Photos To ART
Decorate with photos you love. With Photos to Art, you can transform your favorite snapshots into one-of-a-kind works of art that you'll be proud to hang on your wall. Choose from artistic canvas, custom framing, wood mounting and more to update your décor with art that is totally you.
Custom Framing
Each piece of custom framed art is handcrafted and hand-signed by a professional artisan. Our assortment of high quality frames includes classic styles and the latest design trends, allowing you to fully personalize your art. Choosing a frame is fun, easy and affordable, and your satisfaction is 100% guaranteed.
- The Print
- The Artist
Living in the moment and indulging in life's temporal pleasures were among Pierre Auguste Renoir favorite themes, and he expressed them more than any other Impressionist. A renowned leader of the Impressionist movement, Renoir (1841 – 1919) enjoyed depicting his friends and lovers with expressive candor, conveying a youthful exuberance and intimate charm that suggests visions of an earthly paradise. By focusing on the 'here and now' of his time, these fleeting moments become relished nostalgic memories. Renoir's portrayal of luminous color, skillfully varied brushstrokes, nuances of light and shadow all worked together to form a warm sensuality.
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Emtek 1173
CONCORD PLATES 1.5" X 11" - NON-KEYED, AMERICAN STYLE THUMBTURN INSIDE #1- Multi Point non-Keyed Set with American Style Thumbturn on the Inside.
- Configuration #1
- Solid Brass
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Breakfast: All You Can Eat
About The Inn
A History of Hampton Terrace
Experience Hampton Terrace
Media Coverage
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Historic Sites and Museums
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Record-Breaking Summer at Hampton Terrace in Lenox
A HUGE THANK YOU - especially to our loyal multi-repeat guests - for helping us set records at Hampt...
Hampton Terrace Earns TripAdvisor "Certificate of Excellence" Again
TripAdvisor is the #1 website in the world for accommodation reviews.
Spring Upgrades at Hampton Terrace in Lenox
We have owned Hampton Terrace for fifteen years, and not a year goes by when we don't inplement a ma...
Wicked Tuna. Bob Newhart. Hampton Terrace
Gonna connect the dots here. Susan and I LOVE Wicked Tuna - which is a National Geographic Channel ...
The Best Berkshire Party of the Year
In this forum I have often mentioned the IS-183 annual costume "ball" as the best party of the year ...
Hampton Terrace Guest Feedback
Lisa G. found us through a Living Social coupon a couple of years ago. Since then, she has been bac...
Oscar-Winning Composer Alan Menken Wows A Crowd at Hampton Terrace
Last week here at Hampton Terrace, we welcomed Academy Award-winning theatre and film composer Alan ...
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I used to go to my grandparents' house all the time and play the piano – the 1929 Steinway – that wa...
What is Wynton Marsalis doing in our back yard?
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Best Small Towns In America: Great Barrington, MA
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Updated Photography at Hampton Terrace
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USA Today Travel Editor: Hampton Terrace
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Updated Photography at Hampton Terrace, Lenox MA
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text:
Search Swinburne Research Bank
Please use this identifier to cite or link to this item: http://hdl.handle.net/1959.3/239662
- Title
- Auditor selection: what influences decisions by listed companies?
- Author(s)
- Houghton, Keith A.; Jubb, Christine A.
- Abstract
- Major business failures, including Enron and World Com in the United States and Harris Scarfe and HIH in Australia, and related alleged audit failures, have put the choice of auditor on the agenda. The choice of the 'right' auditor has economic consequences for an auditee and implications for corporate governance. This paper discusses factors important to explaining auditor choice, including institutional factors (pertaining to the auditee and auditor) and newer emerging criteria as well as networking between directors and auditors. The paper discusses the relevant research and the policy implications for good corporate governance of auditor choice in publicly listed companies.
- Publication type
- Journal article
- Source
- Australian Accounting Review, Vol. 13, no. 31 (Nov 2003), pp. 67-72
- Publication year
- 2003
- FOR Code(s)
- 1501 Accounting, Auditing and Accountability
- Keyword(s)
- Auditor choice; Auditors; Corporate governance
- Publisher
- Blackwell
- 1835-2561
- Publisher URL
- Copyright
- Copyright © 2003 CPA Australia.
- Peer reviewed


text:
Paul Graener: Orchestral Works, Vol. 1 / Werner Andreas Albert
1 CD / CPO / 2012-04-24Works: Paul Graener: Comedietta, for orchestra, Op. 82; Variations on a Russian folksong for orchestra, Op. 55; Musik am Abend, for orchestra, Op. 44; Sinfonia breve, for orchestra, Op. 96
Conductors: Albert, Werner Andreas
Ensemble: ; North German Radio Symphony Orchestra
Graener joined the Nazi Party and the Kampfbund für deutsche Kultur in 1933. His early happy years (professionally and personally) in London motivated him to...continue...
Recording information: Groáer Sendesaal, NDR Hannover (01/19/2009-01/23/2009)....continue...
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text:
May 4, 2016
One man is now behind bars, another is in the hospital after a shooting outside a mini-mart in Atlantic Beach Friday night.
Police say officers were dispatched to the Island Cove Mini-mart located at the corner of West Fort Macon and Lee Street around 7 p.m. Friday. They say while officers were gathering information from people inside the store they heard gunshots coming from outside the store.
Officers say Danny Haas got into an argument with James Purser IV. They say Haas ended up shooting Purser with a hand gun.
Purser was transported to Carteret General Hospital and later transported to Pitt County Memorial Hospital where he is being treated for multiple gunshot wounds according to police.
Haas was taken into custody and charged with assault with a deadly weapon with intent to kill and discharging a firearm with town limits. Haas was transported to the Carteret County Magistrates Office where he was given a $45,000.00 bond.
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"Never send a human to do a machine's job."
When Star Wars (now titled Star Wars Episode IV: A New Hope) debuted in May of 1977, it forever changed sci-fi — and Hollywood's perception of the genre — with its epic fantasy story and groundbreaking technology. It quickly became the highest grossing movie of all time and garnered numerous accolades, winning six of the ten Academy Awards categories for which it was nominated. Star Wars continually ranks near the top of just about every movie list category out there, including our own recent Best Sci-Fi Movies of the 1970's and '80s, as voted by you, the Reelz.com readers.
The long-awaited prequel trilogy that was launched in May of 1999 with Star Wars: The Phantom Menace was a huge success for Lucasfilm, but, even though it boasted far superior special effects, it failed to make the same sort of impact on moviegoers as the original. Was Jar Jar Binks really the source of the ambivalence that many fans felt toward The Phantom Menace or was it that they had already had their minds blown by The Matrix, which opened two months prior? And how do the Star Wars prequels and The Matrix trilogy stack up against other sci-fi movies with next-level special effects like Avatar or more cerebral movies like Donnie Darko? Sit down, jack in and upload your choices of the best sci-fi movies from 1990 to today.
Rate the Top 10 Best Sci-Fi Movies (1990s - 2010s) >>


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The local Black press continues to publish stories "from our own lens"
By Charles Hallman
Staff Writer
This year, 2013, was historic as well as a year-long full of highs and lows: Two MSR reporters were among the national and international press that covered America's first Black president's second inauguration in January. Said Atlanta Daily World reporter Kenya King, a member of the Black press who was covering the Obama inauguration for the second time, "I'm here to capture…the moment of this historic occasion [and] to make sure that the message that should get across, does get across."
A 'new Black agenda' was discussed by the Council on Black Minnesotans and others during the organization's Lobby Day at the State Capitol on March 19. The MSR asked several Blacks in attendance that day if they felt new voices and perhaps a new message is needed from Black Minnesotans. "I think it is time for new voices to be heard," believed Greater Friendship Missionary
Baptist Church Pastor Rev. Billy Russell in our March 28 front-page story. The MSR also continued its coverage of the Affordable Care Act (ACA), and the introduction of MNsure, the state's new health-insurance exchange program and how the new healthcare law will benefit Blacks. Continue Reading →


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Snapshots are a type of collectibles in Grand Theft Auto: San Andreas. As its name implies, they are obtained using the Camera. Snapshots exist only in San Fierro, San Andreas, and each appears as a rotating circular camera icon above a particularly interesting scenic spot. Snapshots are one of four collectibles along with Hidden Packages, Horseshoes, and Oysters, and as with them, completing all 50 grants the player a significant reward. The reward for each snapshot correctly taken is $100, making a total of $5,000 for collecting all the set. The reward for capturing all 50 snapshots is 4 weapons spawns becoming available at the Doherty Garage; namely the Micro Uzi, Grenades, Pump Action Shotgun, and Sniper Rifle, and $100,000.
To successfully capture a snapshot, the snapshot icon must be within the camera viewfinder. Sometimes zooming is required to capture a more distant icon. The point of interest above which the icon sits is not required to be in the viewfinder, simply the icon itself. The photograph can be saved, if desired, by taking the photo using the save mode on the camera, however the snapshot icon will not appear in the photograph unless the snapshot doesn't register due to the icon being too far out. Between the hours of 00:00 and 05:00, snapshots can be spotted without the use of a camera due to a bright pinky-orange glow where the snapshot is located.
There is a minor glitch involving the snapshot icons; sometimes, CJ can be too far away for the icon to be visible but it will register as a snapshot if the camera viewfinder is zoomed in enough and pointing towards the general location of the icon. It is possible to catch a glimpse of the icon without the need of a camera if you speed towards one, it will be visible for a second before disappearing.
Most of the snapshot icons can be easily photographed once San Fierro is opened, with the exception of one on the Garver Bridge that can't be seen until the bridge opens for crossing. Another snapshot icon is located within the Easter Basin Naval Station, though accessing the area and getting close enough to view the icon will trigger a 5-star wanted level, you can keep your distance in a boat and get close enough to take it without attaining a wanted level. Nevertheless, all snapshots can be taken at the beginning of the game without even using aircrafts if you take pictures of the icons from far away. Most will not be visible, but as long if you aim correctly at them you will get the snapshot.
- Avispa Country Club (2)
- Calton Heights (3)
- Chinatown (1)
- City Hall (2)
- Cranberry Station (1)
- Doherty (2)
- Downtown (4)
- Easter Basin (3)
- Easter Bay International Airport (2)
- Esplanade North (3)
- Financial (2)
- Foster Valley (2)
- Gant Bridge (1)
- Garcia (2)
- Garver Bridge (2)
- Hashbury (2)
- Juniper Hill (1)
- King's (3)
- Missionary Hill (1)
- Ocean Flats (1)
- Palisades (1)
- Queens (5)
- Red County (2)
- San Fierro (1)
- San Fierro Bay (1)
Video Walkthrough
See Also
| San Andreas | Los Santos | San Fierro | Las Venturas
Red County | Flint County | Whetstone | Tierra Robada | Bone County
|Carl Johnson (CJ) | Sean "Sweet" Johnson | Big Smoke | Frank Tenpenny | Cesar Vialpando | Wu Zi Mu | Mike Toreno
|Radio Stations
|K-Rose | Radio X | Radio Los Santos | Playback FM | SF-UR | K-JAH Radio West | WCTR | K-DST | Master Sounds 98.3 | CSR 103.9 | Bounce FM
|Driving School | Pilot School | Bike School | Boat School
|Gang Tags | Snapshots | Horseshoes | Oysters | Unique Stunt Jumps
|Other Resources
|Missions | Weapons | Safehouses | Cheats
|Related titles and mods
|Hot Coffee | Multi Theft Auto | San Andreas Multiplayer


text:
By Charles Hallman
Staff Writer
Fixing U.S. schools must be a top priority, says award-winning singer-songwriter John Legend, who spoke last week at the Fitzgerald Theatre in St. Paul in the second Minneapolis Foundation RESET Education event this year. RESET is an acronym for "Real-Time Use of Data, Expectations not Excuses, Strong Leadership, Effective Teaching and Time on Task." The nine-time Grammy Award winner is a strong education reform proponent and serves on several boards, including Teach for America and the Harlem Village Academies. The singer asked the estimated 900 people who attended his nearly one-hour speech, including two groups of Minneapolis youngsters, why they would come to hear "a R&B singer" talk about education. "I'm a musician, not a [school] superintendent," he said, strongly pointing out that the present educational system in this country is failing too many kids. Continue Reading →


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Ack! I've done it again. With all of the craziness of Thanksgiving and my life in general, I completely forgot that Saturday was the reveal date for the November Daring Bakers challenge. It wasn't until I opened my reader last night and saw all of the DB posts that I realized it. The 2010 November Daring Bakers' challenge was hosted by Simona of briciole. She chose to challenge Daring Bakers' to make pasta frolla for a crostata. She used her own experience as a source, as well as information from Pellegrino Artusi's Science in the Kitchen and the Art of Eating Well. So, I frantically rooted around in my kitchen to see what I could find to throw my crostata together. Better late than never, I guess.
A crostata is basically an Italian tart. The base of a crostata is made with pasta frolla, a sweet short crust pastry or sweet tart dough. The filling is traditionally made with either jam, fruit preserves, pastry cream or any combination of them, but you can use anything your little heart desires. Since I was flying by the seat of my pants, I used what most might probably consider a very unorthodox filling – my leftover cranberry chutney from Thanksgiving. Yes, you read that right. I spread a thick layer of cranberry chutney over that short crust dough and tossed it right in my oven. The chutney was full of fresh cranberries, dried cherries, raisins, jam and sugar. It looked like thick fruit preserves and it tasted delicious, so why not use it! Actually, I think the choice totally embodies the spirit of the Daring Bakers, don't you? Just call me Kitchen Ninja! read more >>
Filed Under: Baking, Daring Bakers, Holiday Dishes, Italian, Pies and Tarts, Recipes


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May 6, 2016
Visibilities this morning dropped as low as 0 miles and a similar situation could be in the works for Monday morning. Like Saturday, high temperatures this afternoon will be much lower where the fog has lingered. Fog will redevelop late this evening.
Locations that have seen the sun by 10/11am will warm to the mid 70s this afternoon. Conversely, locations still in the fog through the noon hour will only warm to the mid 60s for the day. No rain is in the forecast until the first half the week as we track a cold front into eastern Carolina.
School Delays
Heather and Jim will alert you to any school delays in the area tomorrow morning starting at 5am. Additionally, the information can also be found right here on witn.com
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text:
Changes related to "Make changes to an article automatically using a plugin"
← Make changes to an article automatically using a plugin
This is a list of changes made recently to pages linked from a specified page (or to members of a specified category). Pages on your watchlist are bold.
No changes during the given period matching these criteria.


text:
$4 Gas? What a Bargain! (And, No, We're Not Kidding)
Most Americans say that if the price of gas rises to between $4 to $6 a gallon, they're going to make "major" changes in lifestyle. Well, get ready to change, America: In some states prices have already touched the $4 mark. But it could be ever so much worse.


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Showing 1-24 of 88 items found in Outdoors & Play
- Sort by:
Mudline Lodging LLC
Mudline Lodging Cabin, RV & Campsite Rental in Southern Illinois is one of the closes rentals to Kinkaid Lake and in the heart of Southern Illinois in a quiet country setting. We currently have 1 fully stocked Cabin (Whitetail), 1 Rental RV (Fully stocked) & 1 full hook-up Campsite. Mudline Lodging is the perfect location for your Hunting, Fishing, Family Vacation, Romantic Weekend, or Girls Get-A-Way. We are able to fit your every need.
South Marcum Campground
South Marcum Campground sits along the banks of Rend Lake in the heart of Southern Illinois. With plenty of unobstructed views of the water, campers are able to take in scenic sunsets as well as enjoy activities such as bank fishing, right from the campground.
Camp Manitowa
A retreat center and summer residential camp with 1 and 2 week summer sessions for 2nd-8th graders just 2 miles southeast of Rend Lake.
Rend Lake Marina
Prepare for a summer adventure at the full-service marina offering long term slip rentals and transient rentals. Water-ski, cast a line from a fishing boat or join friends on a pontoon boat.
Pirate Pete's Family Entertainment Center
Pirate Pete's is an arcade with a large snack bar, pool tables, laser tag, and redemption prizes. Features a 2000 square foot laser tag room. Fun for kids and adults alike!
South Sandusky Campground
120 camping sites with electricity and 8 tent sites on beautiful Rend Lake. Full hookups on selected sites. Beach.
North Sandusky Campground
Beautiful campground on Rend Lake with 118 sites with electricity. Full hookups available on selected sites. Three picnic shelter areas (wheelchair accessible). One group area with 21 wooded campsites for $100 a day.
Dunn's Sporting Goods
Locally owned sporting goods store opened in 1980. Specializes in hunting and fishing accesories, apparel, and much more. Find decoys, ammunition, and archery supplies all in one stop.
Old Bates Campground
Located on the west side of Rend Lake off of Route 148 at the intersection of Peach Orchard Road. Offers electricity, water and sewer, shower house, bottle gas filed, dumping stations as well as campers to rent. Owners: Robert and Angela Holder.
Macedonia Game Preserve
A state-licensed hunting preserve, we provide hunters with a good environment and quality deer management. Also quail, pheasant,chukar and dove hunting available. Package prices available upon request for walk-in hunts, corporate & business hunts.
Lake of Egypt Country Club
Include a golf course, swimming pool, and clubhouse. The dining room overlooks the pool and number nine green.
Herrin Bowl
This 16 lane bowling alley boasts a pro shop with drilling, snack bar, arcade and billards room, and Glow Bowling. Also available are party packages, 9 pin bowling and league play.
Burns Hunting Club
Located 1.7 miles west of Illinois Route 148 on Grassy Road just south of the Crab Orchard Wildlife Refuge. Waterfowl hunting on 960 acres. Guides available. One of the top three harvest clubs in the southern Illinois quota zone.
Sherwood Camping Resort
Camper and tent sites, approx. 60 hookups; shaded, family-oriented camping. Only 2 mi. to Rend Lake.
Ralls Grove Hunting Club
Duck and goose hunting, 1 blind, waterfront, decoys available. Lunch provided.
CITY:Creal Springs
Pike's Hunting Club
Hunt from heated pits over flooded corn, natural wetlands, food plots, and over 2 miles of levee controlled water on 100 acres. 530 total acres devoted to waterfowl hunting, excellent duck hunting. Corporate rates and custom packages available. Located 1 mile south of Marion on the west side of Route 37.
Rend Lake State Fish and Wildlife Area
Anglers looking for crappie, catfish and bass drop their lines at this area, located on the 18,900-acre Rend Lake. A comprehensive management program provides habitat for a variety of wildlife, including great blue herons and many species of shorebirds.
Riverside Park
This 34-acre park located next to the Big Muddy River includes a public boat ramp, picnic areas, ball fields, hiking trails, a pavilion, historic band shell and playground areas.
Best Holiday Trav-L-Park-Benton
A private, family-oriented RV campground with 120 sites from tents to huge recreational vehicles. Peaceful, wooded setting close to all the activities at Rend Lake.
Gun Creek Campground
Campground with 100 sites with electricity located on Rend Lake. The Seasons Lodge Restaurant, the Rend Lake Gold Course, and the Southern Illinois Artisans Shop are all within walking distance.
Crab Orchard Golf Club
Located between Marion and Carbondale, this 18-hole, semi-private par 70 course features lush zoysia fairways and a practice area with target greens. Crab Orchard made Golf Digest's 2008/09 "Best Places to Play" list.
Little Egypt Public OHV Recreational Area
Little Egypt Off Road MC is a young club that aims to pursue, promote, and protect interest of motorcyclists in a social and athletic setting. They offer a public off road riding area. They have 860 Acres to ride, miles of trails, mud areas to play, hill climbs, scenic areas to stop and enjoy, and two MX tracks to play on.
Stardust Golf and Country Club
Stardust offers 9 holes of golf with a par of 36. Winter golf is available. Amenities include club and cart rental and a snack bar.
CITY:Johnston City
Odum Stables
Offers private lessons on gaited horses, indoor and outdoor facilities, lessons for all ages and skill levels and lesson packages available. Beginners, refreshers, pleasure or show. Home of several world champion walking horses. Call for reservations.
CITY:Creal Springs


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Is Egypt's new parliamentary election law constitutional?/
The following post was contributed by Nathan Brown of GWU and Carnegie — see Brown's previous posts on Egyptian constitutional matters here and here. (Updated with further commentary after the jump.)
The short answer is: Maybe. We'll have to wait and see.
The quick retort: Not again?
The quick answer: Yes, it could be déjà vu all over again. But it might not.


text: This handbag is in overall gently loved condition. There are a few small marks on the leather and a section of the leather has peeled off on one of the bottom corners. There are large stains on the lining as well. It does not ship with a designer dust bag.


text:
Making Lotions, Balms, and Lotion Bars
Date: 10/23/2013
Time: 5:30pm - 7:00pm
Cost: $35.00
Lotions, Balms & Lotion Bars. Learn how to make your own natural moisturizers from
scratch using healing vegetable and seed oils. Topics include everything from the
chemistry of emulsion to how to preserve your moisturizers safely (or avoid
preservatives altogether). Class is taught by Sellwood Soap Company owner Rachael
Gruen. Includes written procedure, recipes, lotion and a lotion bar to take home.
Pre-registration is required.
Cost $35/student
Check out Rachael's website: www.sellwoodsoap.com.
To register for this class, please call the shop at 503-233-8691.


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Interesting Factoids about Hemp:
- Hemp can displace cotton which is grown with massive amounts of chemicals harmful to people and the environment. Fifty percent of the world's pesticides are sprayed on cotton.
- Hemp fibers are longer, stronger, more absorbent, and more mildew-resistant than cotton. The original Levi Strauss jeans made for the Sierra gold miners were made of hemp sailcloth.
- At a volume level of 81%, hemp oil is the richest known source of polyunsaturated essential fatty acids (the "good" fats). It is quite high in some essential amino acids, including gamma linoleic acid (GLA), a very rare nutrient also found in mother's milk.
- Hemp is good for the soil in which it's grown, as opposed to other crops that deplete the soil of nutrients.
- You can't get high from industrial hemp.
- Industrial hemp actually poses a threat to marijuana growers by cross-pollinating with their high THC plants, and greatly reducing the THC level in subsequent generations.
- George Washington and Thomas Jefferson both grew hemp.
- Ben Franklin owned a mill that made hemp paper.
- Jefferson drafted the Declaration of Independence on hemp paper.


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Here are three of our faculty members teaching in the massage therapy certification and associate of applied science degree in massage therapy programs here at National University. They are just a sampling of the several dozen professors and instructors that are part of massage therapy instruction in our College of Allied Health Sciences. View Faculty Directory »
"Students not only learn how to give a Swedish massage, but they also learn pregnancy massage, trigger point therapy, sports massage, chair massage. There's also a course for special populations which includes geriatrics and pediatrics."
"The clinical experience at national is real-world. Students in massage therapy work alongside students in the DC, ND, AOM programs, so they can get to know better what each of them does. They work as an integrated team for the benefit of the patient or client."
"I love my job. I get to teach; I get to know these students for an entire year and be part of their professional training. I enjoy the opportunity to see them from the first week, work with them one-on-one, and watch them come into their own as massage therapists."
"At National University, you'll have a great opportunity to get into the cadaver lab and touch what you'll actually be working on. It reinforces what you just learned sitting in a lecture for two hours. National goes above and beyond what I've seen from other schools, and beyond what you'll find on any board exam."


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That's right, this year's Black Friday sale is so special, it's EX: BLACK FRIDAY!
EX Cards will be on sale! As in cheaper! For ONE DAY only!
Not only that, but we've got options...
EX: Black Friday Pack
300 Gran for 5 random EX Cards - That's 60% of the cost of the EX: Lotto!!!
500 Gran for 5 Refess EX Cards - That's 83% of last year's special Sphere EX Lotto!
500 Gran for 5 Lawtia EX Cards
500 Gran for 5 Gowen EX Cards
500 Gran for 5 Falkow EX Cards
We are also having a Hyper Rarity up Lotto, with the "you get Set X" cards all weekend!
That means chances of getting rare cards in the Lotto is up, AND if you get one of the special present cards, you get AN ENTIRE CARD SET (60 cards)!
As always, sales made for any Gran purchase will be treated as a donation. We will be reporting our monthly finances, and spending as much as possible of any income on new development. That means spending on sales events like this one translate into a better Alteil for everyone!