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Renal cell carcinoma (RCC) is the most common type of kidney cancer among adults. The exact cause isn't clear, but smokers and people with a family history of renal cancer are at increased risk.
Advances in surgical techniques and targeted therapies are improving the outlook. The median overall survival rate of renal cell carcinoma is greater than two years after the cancer is found, but actual survival duration is highly dependent on the stage at which the diagnosis is made.
Like many other types of cancer, RCC has different stages. The stage describes the size of the primary tumor and the extent to which the cancer has spread. Staging helps doctors determine the best treatment plan. It can also provide a general outlook. Lower stage cancers are easier to treat than higher stage cancers, and the survival rate is also better.
About the Staging Process
Your medical team will determine your stage based on early findings gathered through physical examination and imaging tests such as:
However, clinical staging is subject to change. Surgery and post-surgical pathology tests help to provide a more accurate picture. This additional information is used to provide the pathologic stage.
The TNM system helps provide key information about the cancer:
- T: signifies the size of the primary tumor and whether it has spread nearby.
- N: indicates how much cancer has spread to neighboring lymph nodes.
- M: details whether the cancer has spread, or metastasized, from one part of the body to another.
Within each of these categories, a number from 0 to 4 follows the letter and indicates the degree of severity. "X" means the information is not available. An example diagnosis looks like this: stage 2: T2, N0, M0.
What Are the Stages of RCC?
There are four stages of RCC, ranging from stage 1 to stage 4.
Stage 1
In stage 1 renal cell carcinoma, the tumor is seven centimeters or less and the cancer has not spread outside the kidney. At this stage, surgery is the most common treatment. Depending on the location of the tumor, the surgeon may opt for laparoscopic or conventional surgery. The goal is to remove the tumor while preserving kidney function. This may involve a simple resection, but in some cases it may warrant removal of the kidney and possible lymph node dissection. In patients who cannot have surgery, other targeted treatments, such as radiation therapy and arterial embolization may be used.
Stage 2
In stage 2, the tumor is larger than seven centimeters, but hasn't spread beyond the kidney. An aggressive surgical approach is the most effective treatment. Often, this will include removing the kidney, adrenal gland, and fat (perirenal fat) and tissue (Gerota fascia) surrounding the kidney. This may also involve lymph node dissection.
If all of the cancer is removed during surgery, additional treatments (adjuvant treatment) are not usually needed, but close monitoring is required for several years. According to the Cleveland Clinic, this aggressive surgical approach has a cure rate of 40 to 60 percent.
Stage 3
In stage 3, the tumor is any size and located within the kidney, plus one or more neighboring lymph nodes. Stage 3 can also mean that the cancer has been discovered in a major blood vessel in the kidney or the tissue that surrounds the kidney, but hasn't advanced beyond that.
Treatment usually requires removing the kidney, adrenal gland, perirenal fat, Gerota fascia, and possibly a lymph node dissection. Adjuvant treatment may not be required, but close follow-up care is necessary. About 30 percent of patients with localized tumors relapse in the first five years after surgery.
Stage 4
In stage 4, the cancer is growing outside the fatty tissue around the kidney. It may have entered the adrenal gland or nearby lymph nodes. Stage 4 may also indicate that the cancer has spread into the lymph system or distant places like the liver, lungs, bones, or brain. Treatment depends on many factors, but the outlook is not as favorable for patients in earlier stages of the disease.
Knowing your stage of RCC will help your doctor decide which treatment option is best for you.


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Definition of asteroid in English:
1A small rocky body orbiting the sun. Large numbers of these, ranging in size from nearly 600 miles (1,000 km) across (Ceres) to dust particles, are found (as the asteroid belt) especially between the orbits of Mars and Jupiter, though some have more eccentric orbits, and a few pass close to the earth or enter the atmosphere as meteors.
Example sentences
- Ceres was initially considered to be a planet until other asteroids with similar orbits were found.
- Most of the known asteroids orbit the sun in a belt between Mars and Jupiter.
- These scientists also study the natural satellites of other planets as well as asteroids and comets.
2 Zoology An echinoderm of the class Asteroidea; a starfish.
Example sentences
- The asteroid is preserved with the dorsal surface exposed.
- Available morphological data suggest no ecologic parameters that would be unusual among living asteroids.
- An unpaired commonly enlarged interbrachial ossicle, the axillary, occurs in most Paleozoic asteroids, including those treated here.
- Example sentences
- The Hubble Space Telescope captured a picture of starlit asteroidal and cometary debris encircling the yellow dwarf star HD 107146.
- These satellites range in size from small on the asteroidal scales, to nearly as large as Saturn's moon Mimas.
- Our understanding of astronomy has shown us that cometary and asteroidal impacts are relatively commonplace over timescales of hundreds of millions of years.
Early 19th century: from Greek asteroeidēs 'starlike', from astēr 'star'.
For editors and proofreaders
Syllabification: as·ter·oid
Definition of asteroid in:
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subset: commoncrawl


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23 years of experience
Accepting new patients
25 N Winfield Rd
Winfield, IL 60190 Phone number & directions
Patient Reviews
Patient Reviews ? Write a Review
Overall Rating:
Total Ratings
Total Reviews
Dr. Carsten is one of the best doctors I have ever come into contact with. I have many health issues, and have seen MANY doctors throughout the course of 8 years. Dr. Carsten deserves to be called a doctor. He treats you like an actual human being! He's very intelligent, caring and not just out to make his wallet fatter. I'm very lucky to have found him, and I'm switching my son's dr even just so he can see him. I would recommend him to anyone and everyone.
Dr. Carsten truly cares for his patients! I went to him because my regular doctor was a bit more backed up and I ended up switching to having Dr. Carsten as my doctor instead. He is very thorough and is willing to spend the time you need with him. I asked him something very specific about research on a certain vaccine and he did not know the answer (it was on a very recently published study) but looked it up with me in the room and then we talked about the results. He is truly an intellectual individual that isn't just going to give you his gut feeling or a repetitive response frequently seen on the internet. He's an awesome guy and an even better doctor!
If you find yourself waiting for Dr. Carsten past your appt. time, the evidence will prove that he spends as much time with you as needed to answer and solve your issues. He will hear all of your medical complaints not just the one that you called about! I have had Drs. in the past tell me to not give them a "laundry list" during my appt. Dr. Carsten listens to everything because he knows we do not know, what is or is not, relevent to our ailment. His wonderful nurse responses to phone calls promptly and usually already has the answer when she calls back! Way to reach out Ms. Peggy! 5 stars to Dr. C and Nurse! Follow up on referred-out care is sketchy would like to have better quarterbacking on profile of health plan going forward.
Dr. Carsten knows his stuff. Extremely thorough. First time I've ever had an EKG done within the office, during my yearly check up. My only recommendation is that he speak to you, as opposed to at you - my perception. Otherwise he seems like a very bright guy.
great doctor, very nice personality, professional, great with preventative medicine, very caring.


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- Report: #781988
Report - Rebuttal - Arbitrate
Complaint Review: JoeEllis.net
JoeEllis.net12010 Old 66 Internet United States of America
JoeEllis.net Clean-search.com, HitDetective.com, Joe Ellis Internet Scam artist who operated several scam companies- PICTURE INCLUDED, Internet
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See, he claims that I was mad that his company denied me service? Seriously? I'm not dumb enough to send them a penny, and immediately reported them to the BBB.
Notice how Joe Ellis doesn't deny calling my home, or sending me threatening emails. He can say what he wants about me, I am no choir boy, that's for sure.
But I just saw a picture of the p***k I am looking for, on his own website no less- JoeEllis.net! Thanks you dumb *uck!!!!
If anyone else has been threatened by Joe Ellis, please contact me. It would be hard to do, since he's tried to plaster my info all over the web. I will be happy to tell you where he lives, and what he looks like.
Thanks Joe!
This report was posted on Ripoff Report on 09/27/2011 02:29 PM and is a permanent record located here: http://www.ripoffreport.com/r/JoeEllisnet/internet/JoeEllisnet-Clean-searchcom-HitDetectivecom-Joe-Ellis-Internet-Scam-artist-who-operat-781988. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.
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NewsJanuary 12 2012
Tickets go on Sale for Induction Ceremony
Tickets go on Sale for Induction Ceremony
Pay tribute to the Vivian Dance Hall and witness a moment in Rock and Roll history at the 4th Annual South Dakota Rock & Roll Music Association's Hall of Fame Induction Ceremony set for Saturday, April 21 at the Sioux Falls Ramkota Ballroom.
Reserve tickets go on sale Sunday, January 15 for the event which will feature the induction of 11 Rock and Roll bands, including DJ and The Cats of Presho-Brookings, a radio station, a disc jockey and several other distinguished award winners.
According to information from Don Fristz, chairman of the R&R Music Association Board of Directors, the Vivian Dance Hall was mentioned by a number of musicians from bands that played the venue, and also booking agents that worked with Vivian representatives to book the dances.
Lonis Wendt of Vivian stated that the late Bob Burns was the local contact most booking agents would have been in contact with.
Wendt had the opportunity to review past programs from previous ceremonies that contain the history of bands inducted into the Hall of Fame.
"A number of the bands from the eastern part of the state made reference to the Vivian Dance Hall in their history," said Wendt. "They stated, 'we went as far west as Vivian.'"
Inductee DJ and The Cats band members and brothers Travis and Terry Hutchison has also indicated they will attend the ceremony.
There are several options available for tickets which may be purchased at www.southdaktoarockandrollmusicassociaiton.com
If you would like to sit at a table with a group, order the specific number of tickets at $35 each to fill a table. A section of just chairs will be available in back of the ballroom at a cost of $25 per ticket. VIP tables, with 10 chairs, located right in front of the stage are available for $500, but on a limited basis.
If you would like to be considered in a group purchase of tickets being made by a group from Vivian, contact Lonis Wendt - 280-8097, Linda Perry - 683-4655 or Terry Severyn 683-4141 prior to the 15th.
- Fall sports back in action
- Kennebec to celebrate Lake Byre Day
- Presho Firefighters receive Grain Bin Rescue equipment and training
- Lyman County ACS Survivor celebration event
- Swimming season comes to an end
- County completes rural development analysis
- Swinson named PHS Distinguished Alumni
- Greater Lyman Foundation continues to grow
- Lyman County law enforcement officers recognized
- Presho's Sidewalk Project presented to public
- Lyman Alumni Reunion set for July 30
- New members seated on School Board


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Definition of side bet in English:
side bet
A bet over and above the main bet, especially on a subsidiary issue.
Example sentences
- The proposed jackpot would be awarded, for a side bet, to players receiving both a royal flush and a pair of aces.
- An eleven-a-side heads up match will be contested between England and Australia with A $100,000 per team as the side bet.
- The table games are played Las Vegas Style, and include 4-deck Blackjack, American-style Roulette, and Caribbean Stud poker complete with the $1 progressive side bet that so many players love.
For editors and proofreaders
Syllabification: side bet
Definition of side bet in:
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text:
A vintage gold finish adds old-world elegance to the gothic motif of this ear cuff featuring a dangling row of skulls. Available in gold. Metal.
More Information:
|Wash care:
|Wipe Clean
|Catalog No.:
This cuff fits so well around my ear that I'm not worried I might lose it. It's perfect for anyone who wants to add a bit of that rocker vibe to their outfit.
fits perfectly on my ear ! got quite the few compliments from other people also. the only downside i would say is that they sometimes tend to tangle up from time to time but other than that, if you like skulls, its a keeper (:
Petit et Belle offers a wide range of jewelry and accessories for the young professional who loves color and texture. Boasting contemporary designs with a nod to retro trends, Petit et Belle's items feature an unmistakable European sensibility and an affordable price tag that has young and professional women covered when it comes to the perfect finishing touch.


text: I created another user in my Users menu, and I selected that user as the post author, in the drop-down menu that appeared in my Write post menu. Now the problem is when I enter the edit menu, the user appears as the post author, but nothing shows up on the blog when I view the post. I want it to be something like: by: NAME, under the post title


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We are closed for lunch daily between the hours of 1 and 2 p.m.
Our providers have varied hours. See full availability listing here.
Sign-up for our newsletter to receive updates, latest news and promotions. Please provide your e-mail address below:
"Todd Gegerson has helped me with two major health issues no one else had been able to solve. He found the source of the problem and then used his unique ability to sort through possible treatments and target the one that was best for me. My health and energy has been restored and my quality of life has improved tremendously."
"Many thanks for your tender loving care. Joy to you all."
"I just wanted personally thank you for sharing you knowledge with me. Because of that we are making some major changes in our practice."
Each member of the staff is highly accomplished in their field and shares in this philosophy. Your care will be coordinated by a combination of traditional physicians and practitioners of Functional Medicine, Oriental Medicine, Homeopathy, Nutritional Medicine, and Chiropractic care.
Sangeeta Pati MD, FACOG
President & Medical Director
SaJune Institute for Restorative and Regenerative Medicine
Board Certified American Board of Obstetrics and Gynecology;
Anti-Aging & Regenerative Medicine, Diplomat.
Sangeeta Pati practiced obstetrics-gynecology in the Washington, D.C. and New York area for 13 years before opening an integrative medical center in Orlando, Florida. She graduated at the top of her medical class at the University Of Maryland School Of Medicine, Baltimore, and completed her residency at Georgetown University School of Medicine, Washington, D.C. She has worked extensively internationally as Medical Director for a 350-employee non-profit organization, Engenderhealth, on maternal mortality reduction programs funded by the Gates Foundation. Dr. Pati is multi-lingual and is renowned in her field, having authored numerous scientific articles and being the highest demanded speaker for media interviews and domestic and international workshops on a regular basis. Dr. Pati's special interest and strength has been in helping health care providers learn how to put together and integrate into real practice the vast amount of information in the restorative medicine field. She is the director of a fully pre-booked Clinical Preceptor Program, which trains doctors and health practitioners in restoring optimal body function through protocols for hormonal balance, nutrition and detoxification. She is on the Board of Advisors for MDPrescriptives Supplement Company where she helps develop clinically effective supplement protocols and integrate them into research protocols. She also runs an on-line platform (Peacock Forum) for integrative health practitioners to communicate problem cases.
SaJune Institute for Restorative and Regenerative Medicine offers integrated, evidence-based medical therapies, combining conventional, natural and complimentary modalities (i.e. acupuncture, chiropractic care, massage, homeopathy, oriental medicine, far infra-red therapy and microcurrent). The restorative model used at SaJune aims to restore optimal function to the body through 1) bio-identical hormone restoration, 2) nutritional restoration 3) detoxification 4) mind balance and 5) body balance. SaJune has strong special programs in weight loss, superfoods, plant-based nutrition, IV chelation, integrative cancer therapies, vascular disease reversal and organic skin care. 20% of patients seeking her medical care are from out of the state of Florida. 10% of her patients are medical doctors and nurses. Her medical care has been written about in the fictional book "Feeling Funkabulous" by Ivy Gilbert and "Aging Backwards" by Jackie Silver.
Christelle Renta, ARNP
Christelle is an accomplished nurse / nurse practitioner with a rich history of experience. She brings innovation, excellence and a love for the holistic approach to medicine, qualities that made her a natural choice to join the SaJune Family.
She completed her undergraduate nursing degree at Florida State University in 2006 and received her Master's degree at South University of Tampa in 2012. As a registered nurse, she has extensive experience in hospital settings, both in emergency and intensive care, which gave her experience in intravenous treatment, medications, triage, critical care and so much more. With these valuable skills, Christelle has been able to touch the lives of countless patients, providing care with an emphasis on wellness and prevention.
As a nurse practitioner, she has experience in both women's health and wellness, plus an extensive background in internal medicine. She also brings OB-GYN experience, prenatal care, women's wellness exams, management of chronic disease and diagnosis and treatment of both acute and chronic women's health issues.
Christelle is passionate about a preventative approach to wellness and the holistic treatment of disease and she plays an integrative role at SaJune by providing IV Therapies, Weight Management Programs and generalized patient care with a goal of making a positive impact on the daily lives of her patients and colleagues alike.
Todd E. Gegerson, AP DOM, MSOM
Doctor of Oriental Medicine
Todd Gegerson is a Board Certified and Licensed Acupuncture Physician. He studied at the Florida College of Integrative Medicine, and graduated with a Bachelor's Degree of Science in Professional Health Studies and a Masters of Science in Oriental Medicine.
These studies include specialized training in acupuncture, Chinese and western herbs, nutritional therapy, cupping, moxibustion, and other modalities.
He received additional training from renowned physicians including Dr. Li-Chun Huang OMD in Advanced Auricular Acupuncture, Dr. Richard Tan OMD in the Meridian Balance Method and Dr. Bob Marshall PhD, DACBN in nutrition. Additionally, he has certification in Acupoint Injection Therapy and Homotoxicology as well as training in QRA and pulse diagnosis.
Todd ventured east and completed an internship in China at The Yantai Traditional Chinese Medical Hospital, where he was exposed to a complete understanding of Chinese healing and culture which is integrated into the practice.
Todd is from a long lineage of physicians and has been greatly influenced by three Uncles practicing medicine as well as his own Father in Miami, Fl. The medical journey began for the Gegerson's with Dr. Harry Gegerson who started his career in New York making house calls and then he opened the Pearl River General Hospital in 1949. Todd has evolved in his role as a practitioner and enjoys taking a grassroots approach with integrative medicine - something that has been instilled in him throughout his life.
Bettyann Sahatjian
Bettyann Sahatjian has been in skin care for 30 years, working in some of the most prestigious spas in South Florida and Orlando. In 1992 she received her license in electrology from Orlando Institute of Electrology. Later she started working for a dermatologist. She went to laser school and became a certified medical electrologist to work in laser hair removal. Since then she has worked many modalities in laser and skin care. Constantly, she is keeping up with the latest techniques in this ever changing and exciting industry which she still loves and brings her expertise to SaJune Institute for Restorative and Regenerative Medicine.
Audrey Perryman-Fedrick
Audrey has been working in the field of medical imaging for over 20 years. An Full Body Ultrasound Technologist, she has been actively credentialed by the American Registry of Diagnostic Medical Sonographers since 1987. She is a graduate of SUNY at Downstate Medical Center, Brooklyn, New York with a Bachelor's Degree in Radiologic Sciences and Technology. A certified medical Thermographer, Audrey has been further educated, trained and certified by the Institute for the Advancement of Medical Thermology.
Her passion is wellness; her "prescription" is prevention.
Correct deficiencies and use the most natural method, backed with scientific evidence. Identify and remove the cause of disease. Treat the whole person. This is the essence of our holistic healthcare approach. We encourage our patients to take charge of their own health and work with them on developing preventive medical strategies.


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Get an overview of this hotelHotel in London with free breakfast and indoor pool
Situated in a rural location, this hotel is 4.4 mi (7.2 km) from Levi Jackson Wilderness Road State Park and 11.7 mi (18.8 km) from London Dragway. The Arena at SE KY Agricultural and Expo Complex and Camp Wildcat Battlefield are also within 20 mi (32 km).
Hotel Features
Along with an indoor pool, this hotel has a fitness center and coffee/tea in a common area. Other amenities include a business center, laundry facilities, and a 24-hour front desk.
Room Amenities
All 65 rooms provide conveniences like refrigerators and microwaves, plus coffee makers and satellite TV. Other amenities available to guests include free newspapers, free local calls, and hair dryers.Would you like to give us feedback? Share it! Opens in a new window
Holiday Inn Express And Suites London506 Minton Drive London KY 40741
Hotel Amenities
Hotel Amenities
Holiday Inn Express And Suites London features an indoor pool and a fitness center. A business center is on site. A complimentary breakfast is offered. This London hotel also offers coffee/tea in a common area, complimentary newspapers in the lobby, and laundry facilities.
- 24-hour front desk
- Business center
- Coffee/tea in common areas
- Free newspapers in lobby
- Fitness facilities
- Free breakfast
- Indoor pool
- Laundry facilities
- Number of floors - 3
- Safe-deposit box at front desk
- Total number of rooms - 65
Family Friendly Amenities
- Indoor pool
- Laundry facilities
- Microwave
- Refrigerator
Room Amenities
- Air conditioning
- In-room climate control (air conditioning)
- Coffee/tea maker
- Free newspaper
- Desk
- Free local calls
- Hair dryer
- Iron/ironing board
- Microwave
- Phone
- Premium TV channels
- Refrigerator
- Satellite TV service
Where to Eat
A complimentary breakfast is offered.
Nearby Things to Do
Recreational amenities at the hotel include an indoor pool and a fitness center.
To make requests for specific accessibility needs, complete the "Special or Accessibility Requests" section of "Trip Preferences" when you book your hotel.
- Accessible bathroom
- Roll-in shower
- In-room accessibility
Hotel Policies
Check-in time starts at 3 PM
Check-out time is 11 AM
- Pets not allowed
You need to know
Extra-person charges may apply and vary depending on hotel policy.
Government-issued photo identification and a credit card or cash deposit are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
Hotel Name
- Holiday Inn Express Hotel London
- Holiday Inn Express London
- London Holiday Inn Express
- Holiday Inn Express London Hotel


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Al Sharpton's history of hate is so voluminous and well documented, where does one even begin?
The time he disparaged Jews as "diamond merchants" during the unrest of the infamous Crown Heights riots?
Or when Sharpton tried goading NYC's Jewish community into an all-out fistfight, saying "If the Jews want to get it on, tell them to pin their yarmulkes back and come over to my house"?
How about referring to the Jewish owner of Freddy's Fashion Mart, Fred Harari, as a "white interloper" for seeking to expand his business in Harlem? (You may have heard of Freddy's. It was also known as the Harlem Massacre. One of Sharpton's followers also disapproved of the "white interloper" and burned the store to the ground, murdering eight people including himself.)
But those tirades were just Sharpton's anti-semitic ones. He's also sermonized on "Greek homos" and "crackas" as well as bombarded former NYC Mayor David Dinkins with a barrage of N-bombs.
So if you're Sharpton and you're confronted about some of your "greatest hits," what do you do?
Scoff at the questioning and argue that one of your notorious racial slurs wasn't, in fact, a slur because it was meant for just one Jewish individual.
No, seriously, that was Sharpton's defense.
On the night of the glitzy White House Correspondents Dinner, Daily Surge Publisher Jason Mattera asked the faux Civil Rights leader if he should be banned from television, "in the spirit of Donald Sterling," for all the "racist stuff" he's said over the years. Sharpton, recall, threatened boycotts and protests if the National Basketball Association failed to ban Sterling from the league.
If you can believe it, Sharpton challenged Mattera to produce evidence of racism.
And when that evidence was produced, easily (see above) – in this case, his calling Fred Harari a "white interloper" and David Dinkins a n***** – Sharpton ignored the shot at Dinkins, but ridiculously claimed that "whiter interloper" didn't rise to the level of racism because it was directed at only one Jew, not a neighborhood of them.
"When did I call Jews 'white interlopers'?" Sharpton demanded.
Mattera reminded Sharpton of Freddy's Fashion Mart and followed-up with, "Doesn't it take some serious balls on your end to accuse somebody of racism?"
Sharpton blustered back, "You went from one guy who paid people off the books and was wrong," before the "Reverend " rambled on about 'lies' and 'distortions' as though he's been misinterpreted all these years.
Of course, splitting hairs over anti-semitic comments is probably not the best position to find oneself in.
"One guy!"
In any event, who knows how many Jews Al Sharpton had in mind. When an audiotape surfaced of him disparaging Mr. Harari, his initial reaction was, "What's wrong with denouncing white interlopers?" Sharpton eventually gave one of those half-hearted apologies (a bloodbath ensued at Freddy's, after all) and then carried on with his profession of stoking racial strife.
As idiotic as Donald Sterling's comments were, they were still said in private. Sharpton's tirades, on the other hand, were delivered for public consumption. And not only has Sharpton been rewarded with his own primetime television show on MSNBC, he's a frequent guest at the White House and Obama officials headline his National Action Network conference.
Recently, the Los Angeles chapter of the NAACP honored Sharpton with their "Person of the Year" award, an accolade that was originally slated to be given to — wait for it — Donald Sterling.
Watch the exclusive video above.
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Skip ad and play the game >>
Controls :
mouse, movement - WAD, change weapon - E, opening doors - F, map - M, reload the gun - R, pause - P
This bloody action game is back and you will kill various characters as for example zombies. You can use various weapons and have to go through many levels. Every level offers three modes so there is something to look forward to.
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As cancer survival improves, the long-term risks from treatments including the risk of developing a second cancer after radiotherapy become more important. The proportion of second cancers that may be related to radiotherapy is unknown.
We used the U.S. Surveillance, Epidemiology and End Results cancer registries to conduct a systematic analysis of 15 cancer sites that are treated routinely with radiotherapy. Relative risks (RR) for patients receiving radiotherapy versus patients not receiving radiotherapy were estimated using Poisson regression adjusted for age, stage and other potential confounders.
The cohort included 647,672 five-year adult survivors followed-up for an average of 7 additional years; 60,271 (9%) developed a second solid cancer. For each of the first cancer sites the RR of developing a second cancer associated with radiotherapy exceeded one, and varied from 1.08 (95%CI:0.79–1.46) after eye/orbit cancers to 1.43 (95%CI:1.13–1.84) after testicular cancer. In general the RR was highest for organs likely to have received >5Gy, decreased with increasing age at diagnosis and increased with time since diagnosis. We estimated a total of 3266 (95%CI:2862–3670) excess second solid cancers that could be related to radiation; 8% (95%CI:7%–9%) of the total in all radiotherapy patients (1+yr survivors) and 5 excess cancers/1,000 patients treated with radiotherapy by 15 years after diagnosis. Approximately half (54%) the excess cancers were in organs likely to have received >5Gy.
A relatively small proportion of second cancers are related to radiotherapy in adults, suggesting that most are due to other factors, such as lifestyle or genetics.
Radiotherapy treatment decreases the risk of cancer recurrence, promotes tumor control and improves survival..1 However, with improved survival, the long-term risks from radiotherapy, including the risk of developing a second cancer, become a more important consideration. Subsequent malignancies in cancer survivors now constitute 18% of all cancer diagnoses in the U.S Surveillance, Epidemiology & End Results (SEER) cancer registries making them the 3rd most common cancer diagnosis.2 Compared to the general population cancer survivors have about a 14% higher rate of cancer.3 These increased risks are likely the result of a combination of shared lifestyle and genetic factors, as well as the treatment for the first cancer. Although numerous studies have demonstrated an association between radiotherapy and the risk of developing a second cancer, the proportion of second cancers that might be related to radiotherapy is not known. In two recent studies we used the SEER cancer registries to develop some of the first estimates of the attributable risk for specific first cancers and concluded that about 5–6% of second solid cancers after breast cancer4 and 11% after endometrial cancer5 may be related to radiotherapy. In the current study we extend this analysis to conduct a comprehensive and systematic analysis of all first solid cancer sites in adults that are routinely treated with radiotherapy in the U.S. SEER registries. The large population covered by these registries, combined with more than three decades of follow-up, enables long-term detailed evaluation of the patterns of risk after radiotherapy.
The cohort was composed of adult patients (age 20+) who were diagnosed with a first primary invasive solid cancer reported in the SEER nine registries between January 1 1973 and December 31 2002.2 We included 15 solid cancer sites that are routinely treated with radiotherapy; defined as >20% patients received radiation treatment as part of their first treatment course and with >200 second cancers to enable stable risk estimation. The fifteen first cancer sites were: oral/pharynx, salivary gland, rectum, anus, larynx, lung, soft tissue, breast, cervix, endometrial, prostate, testes, eye/orbit, brain/CNS and thyroid. Because, in general, there is at least a five year lag period between radiation exposure and solid cancer inuction6 we excluded patients who survived less than five years from the analysis. This restriction also ensured that we eliminated any surveillance bias that might result if patients who received radiotherapy were monitored more intensively than other patients in the first five years. The follow-up time (person-years at risk) for second cancers for each individual began five years after the date of initial cancer diagnosis and ended at the date of diagnosis of any second malignant cancer, last known vital status, death or the end of study (December 31, 2007), whichever occurred first. Patients were censored at age 85 years as there is evidence of under ascertainment of second primary cancers after that age in SEER.3 We excluded patients with missing information on radiotherapy or stage, unless the first primary was prostate, brain or lung cancer as stage information was often unavailable for these cancers during the study period. We excluded hematological cancers from both the first and second cancer sites because of potential confounding by chemotherapy, details of which were not available. For similar reasons we also excluded non-seminoma testicular cancers and small-cell lung cancers. Finally, soft tissue sarcomas that occurred in extremities were excluded because radiotherapy for these cancers would be unlikely to result in second solid cancers.
SEER cancer registries collect information on the initial course of treatment. Patients were classified according to whether or not they had received radiotherapy as part of their initial cancer treatment and the type of radiotherapy given: external beam, brachytherapy or combination therapy (external beam and brachytherapy).
In order to provide sufficient statistical power for risk estimation, the analyses were conducted for all second solid cancers combined. In addition, for the first cancer sites with at least 1000 second cancers, the typical radiation doses delivered to each second cancer site were estimated using standard radiotherapy protocols from the period of study. The distance of the second cancer site from the border of the primary radiotherapy field was then used to categorize the second cancer sites into broad groups: <3cm high-dose (>5Gy), 3–10cm medium-dose (1–5Gy) and >10cm low-dose (<1Gy).7 Dose groups for thyroid cancer were based on I-131 treatment assuming an administrated activity of 200 mCi.8–10 The second cancer dose groupings for the nine eligible first cancer sites are available in Webtable 1.
Poisson regression analysis was used to estimate the relative risk (RR) (and 95% confidence intervals) in patients who received radiotherapy compared to those who did not receive radiotherapy. These risks were adjusted for potential confounding factors: stage, age at and year of first cancer diagnosis, and additionally adjusted for calendar period and attained age by using the expected number of second cancers in the general population as an offset.2,12 We examined effect modification of the risk associated with radiotherapy by age at first cancer diagnosis, time since initial diagnosis and calendar year of diagnosis. This analysis was restricted to the outcome of high-dose second cancer sites to maximize power to detect differences. We also conducted a sensitivity analysis where we examined the risk associated with radiotherapy in the sub-group of patients who were surgically treated for their first cancer. All analyses were conducted using EPICURE AMFIT.13
We estimated the number of excess second cancers related to radiotherapy by taking the number of second cancers in those treated with radiotherapy minus the number that would have occurred in these subjects if they had not received radiotherapy (estimated from the Poisson regression models). Although the analysis of excess cancers was restricted to 5+ year survivors (to eliminate potential surveillance bias in the early period of follow-up) the overarching goal of this study was to estimate the proportion of second solid cancers related radiotherapy among all cancer survivors. Therefore, we expressed this excess as a proportion of the total number of second cancers observed in all cancer survivors (defined as 1+ year survivors). We calculated the number of second cancers in 1+ year survivors using the SEER cancer registries database applying the same exclusions as defined above for the 5+ year survivors. This approach assumes that the number of radiation-related cancers in the first five years is zero.
We also estimated the excess number of cancers that occurred by 15 years and divided this number by the total number of patients who received radiotherapy (again using 1+ year survivors). This provided an estimate of the cumulative excess risk by 15 years after diagnosis. The overall excess and attributable risks were then estimated by summing across all 15 first cancer sites.
Role of Funding Source: The study sponsors did not have any role in the design of the study; collection, analysis, and interpretation of the data; writing of the report; or in the decision to submit for publication. AB and REC had access to the raw data. AB has full access to all of the data and the final responsibility to submit for publication.
The study did not require ethics committee approval as the data are publically available.
After the exclusions the cohort included 647,672 five-year adult cancer survivors who were followed for an average of 12 years (SD=4.5, range 5–24). The proportion of patients who received radiotherapy as part of their initial cancer treatment varied from 23% for (non-small cell) lung cancer to 79% for testicular cancer (seminomas) (Table 1). Patterns of radiotherapy varied across the first cancer sites but, in general, receipt of radiotherapy was slightly less common in the oldest patients (age 75–79 years) and for localized stage disease, and was more common in recent calendar time periods. The main exceptions to these patterns were cervical and endometrial cancer where radiotherapy was more common in older women and for more advanced stage disease and was less common in recent time periods.
During the follow-up period (1978–2007) a total of 60,271 (9%) of the five-year survivors developed a second solid cancer. For each of the first cancer sites the relative risk of developing a second solid cancer associated with radiotherapy was greater than one, and for the majority of first cancer sites the increased risk was statistically significant (Figure 1). The adjusted relative risk for radiotherapy varied from 1.08 (95%CI:0.79–1.46) after eye/orbit cancers to 1.43 (95%CI:1.13–1.84) after testicular cancer (seminomas). Adjustment for stage at diagnosis, age at diagnosis, year of diagnosis of the first cancer had a modest impact on the relative risk estimates, generally reducing the risks slightly Webtable 1). Restricting the cohort to patients treated with surgery did not change the relative risks by more than 10% except for eye/orbit cancers, which were based on very small numbers (Webtable 2). When we examined the relative risks associated with radiotherapy treatment for the group of second cancers that are related to smoking we found that these risks were generally higher than the risks for second cancers not related to smoking, possibly indicating confounding by smoking (Webtable 3).
For six of the nine first cancer sites for which we conducted grouped dose-response analyses the relative risk for radiotherapy was higher for the group of high-dose second cancer sites (>5Gy) compared to sites estimated to have received moderate or low radiation doses from the primary field (Figure 2). The RR for the high-dose second cancer sites varied from 1.03 (95%CI:0.71–1.47) after thyroid cancer to 1.78 (95%CI:1.42–2.22) after cervical cancer. For breast, endometrial and prostate cancer there was a highly significant trend across the dose-groups (p<0.0001). There was also a suggestion of a decreasing trend for laryngeal (p=0.13) and cervical cancer (p=0.082). For the remaining sites the patterns of risk were less consistent. Results for each individual second cancer site and each dose-group are available in Webtable 1.
We examined effect modification by age and year of diagnosis and time since diagnosis for high-dose second solid cancers. The relative risks associated with radiotherapy decreased significantly with increasing age at diagnosis for second cancers after breast (p<0.0001), cervical (p=0.00068), endometrial (p=0.036) and prostate cancer (p=0.00070) (Table 2). The RRs increased significantly with increasing time since diagnosis after cancer of the lung (p=0.0079), breast (p=0.0013), cervix (p=0.0032), endometrium (p<0.0001) and prostate (p=0.0031) (Table 3). The RRs decreased with increasing calendar year of diagnosis for second cancers after breast cancer (p<0.001) and endometrial cancer (p=0.064), but for the other sites there were no clear patterns (Webtable 4). As all these time variables are likely to be correlated, these patterns should be interpreted with some caution.
In total there were an estimated 3266 (95%CI: 2862–3670) excess second solid cancers that could be related to radiotherapy in these 5-year survivors (Table 4). Assuming no excess radiation-related solid cancers would occur in the first 5 years of follow-up, we estimated that 8% (95%CI:7%–9%) of the total 42,302 second solid cancers diagnosed in 1+ year survivors could be attributed to radiotherapy. This figure varied from 4% (95%CI:–11%–20%) after eye/orbit cancers to 24% (95%CI: 9%–37%) after testicular cancer (seminomas). Overall, for every 1,000 patients treated with radiotherapy there were an estimated 3 excess cancers by 10 years after first cancer diagnosis, by 15 years this figure was 5 excess cancers (data not shown). Over half the observed (56%, n=23,742) and the excess cancers (55%, n=1791) occurred in breast and prostate cancer survivors.
In the nine first cancer sites for which we assessed risk according to broad dose-groups about half of the estimated excess radiation-related cancers (54%, n=1541) were in the high-dose group (>5Gy) compared to 28% (n=10,535) of observed second cancers (data not shown). In contrast 29% (n=839) of the excess cancers were in the low-dose group compared to 49% (n=18,601) of the observed second cancers. To assess the potential impact of bias in the low-dose group we also estimated the attributable risk for these nine first cancers excluding the low-dose group excess, this decreased the estimate from 7% (95%CI: 6%–8%) to 5% (95%CI: 4%–6%). For the high-dose cancer sites, 37% (n=566) of the excess cases occurred among patients irradiated at ages 45–59 years and 51% (n=812) after treatment aged 60–74 years.
To our knowledge, this is the first study to estimate the proportion of second cancers overall in adult cancer survivors that might be related to radiotherapy treatment. Our results suggest that about 8% (95%CI:7%–9%) of second solid cancers may be related to the radiotherapy treatment for the first cancer. This figure varied according to first cancer site, from 4% for eye/orbit cancers to 24% for testicular cancer. Higher attributable risks were most likely due to younger age at treatment, larger treatment fields and the organs located in those fields. In general the relative risks decreased with increasing age, and increased with increasing time since diagnosis. By 15 years after diagnosis there were an estimated 5 excess cancers per 1000 patients treated with radiotherapy.
Although there have been a large number of studies of second cancers after radiotherapy treatment, few have assessed the attributable risk or cumulative absolute risk. We previously estimated that 5–6% of second solid cancers after breast cancer were related to radiotherapy in the SEER cancer registries.4 Using published results from the pooled analysis of randomized radiotherapy trials for breast cancer we estimated a similar attributable risk (8%), which suggests that our estimate was not subject to strong confounding by indication.14 In an earlier analysis of cervical cancer patients using cancer registries Boice et al estimated an attributable risk of 5%,15 which is considerably smaller than the estimate of 17% (95%CI: 10%–23%) in the current study. One possible reason for this difference was use of the general population as the comparison group in the previous study, due to the small number of patients who did not receive radiotherapy during that study's time period. Also only cancers that were considered to be radiation-inducible were included in the excess, for example rectal cancers were excluded in the previous study but they are now considered to be radiation-inducible6 and were included here. In a previous study of prostate cancer radiotherapy using SEER registries Brenner et al estimated that there were 3 excess cancers/1000 patients in all survivors,.16 which is similar in magnitude to our overall estimate of 5 cancers/1000.
A number of previous studies have estimated the dose-response relationship for specific second solid cancers after radiotherapy based on individual treatment records. One such study of cervical cancer treatment found a positive dose-response relationship for second cancers of the bladder, rectum, bone, stomach and all female genital cancers combined after radiotherapy for cervical cancer.17 In breast cancer patients dose-response relationships have also been observed for lung, bone, connective tissue and contralateral breast cancers after radiotherapy,18–22 and for stomach cancer after testicular cancer and Hodgkin lymphoma.23 Although the site-specific risks were not the focus of the current study, the patterns of the risks were generally consistent with these previous reports (Webtable 1). There is also a large body of evidence from registry based studies with more limited details on the radiotherapy treatment (yes/no and external beam/brachytherapy) and hospital series. These studies include a number of analyses of SEER registries that focused on a single first cancer. Our results were broadly consistent with those previous reports, which found that those treated with radiotherapy have a small (RR=1.1–1.4) increased risk of a second cancer overall compared to those who did not receive radiotherapy (Webtable 5).4,5,24–37
The strengths of the current study include the systematic approach used to assess all first cancer sites, which enabled comparisons of risks across first cancer sites and examination of common patterns of risk. The large sample size and long-term follow-up are also key strengths of the SEER registries for assessing the late-effects of radiotherapy, along with comprehensive coding rules for second cancers, which have changed minimally over time. We assessed the plausibility that the observed relationships were causal by examining the dose-response across groups of second cancer sites and the relationship with age at exposure and latency. Mostly these followed the expected patterns, i.e. higher relative risks for higher dose-sites, for younger ages at exposure and with longer time since diagnosis. Our dose-response analysis, however, was necessarily crude and sites were likely misclassified since we did not have individual treatment data on the radiotherapy fields used.
The main limitation of the SEER data, like any observational study of treatment effects, is the lack of treatment randomization and therefore the potential for confounding by indication. Confounding would occur if factors related to radiotherapy use were also related to the risk of second cancer. We used a number of approaches to try to minimize this and other potential biases. Firstly we excluded the first five years of follow-up from the analyses to reduce the potential impact of surveillance bias. We adjusted all analyses for likely confounding factors that were available including stage, age at diagnosis and year of diagnosis, attained calendar period and attained age. For some cancer sites receipt of radiotherapy rather than surgery may be associated with risk factors for second cancers like smoking if these risk factors are contra-indications for surgery. It was reassuring, therefore, that the results from the analysis restricted to patients who had had cancer related surgery were similar to those for all patients (+/−10%). In general though the relative risks were higher for second cancer sites that are smoking related.38 Lack of data on smoking and other treatments including chemotherapy and hormonal therapy treatment means that it is likely that there is some residual confounding. The level of confounding may vary across the first cancer sites as the characteristics of the patients who do not receive radiotherapy vary, and could have resulted in either over-estimation or under-estimation of the risks related to radiotherapy.
Our results are for patients treated in the U.S. over the last 30 years, and radiotherapy techniques have changed during this time period. For most sites, however, we did not find strong evidence of trends in the risks over calendar time (Webtable 4). An unavoidable limitation of studying the late effects of radiotherapy is that the most recent changes in practice cannot be studied. In particular, as all the patients were treated before 2003 the impact of the widespread introduction of intensity modulated radiotherapy (IMRT) could not be evaluated. There is concern that IMRT might actually increase second cancer risks due to the increased volume of tissue that receives low-level exposure,39 and it will be important to study this question directly in the future. Nevertheless, we estimate that by fifteen years of follow-up the absolute risks for adults are typically only a few excess cancers per 1000 treated. Even if current practice substantially changed radiation doses to some organs, the general message that the second cancer risks from radiotherapy in adulthood are small, especially when compared with the treatment benefits, would remain the same.
In summary we found that a relatively small proportion of second cancers (<10%) in adult cancer survivors are likely to be related to radiotherapy, suggesting that most are due to other factors, such as lifestyle or genetics.
We searched Pubmed with key terms including "radiotherapy", "secondary malignancy" and also terms for each of the fifteen 1st cancer sites of interest. We also searched reference lists in previous articles. All key articles are described in the discussion and articles that had published relative risks for all second cancers or all second solid cancers are shown in Webtable 5. Where more than one article was published from the same cohort we present results from the most recent publication. Only three of the previous studies had published estimates of the attributable risk for radiotherapy and only one had published estimates of the cumulative absolute risk. Our results were generally consistent with the existing evidence, where it was available. None of the previous studies had combined data from multiple first cancer sites.
Our results suggest that a relatively small proportion of second cancers (<10%) in adult cancer survivors are likely to be related to radiotherapy, suggesting that most are due to other factors, such as lifestyle or genetics. These findings can be used by physicians and patients to put the risk of radiation-related cancer into perspective when compared to the likely benefits of the treatment. Studies of the second cancer risks from newer radiotherapy treatments such as IMRT, however, are still required.
Funding: This study was funded by the intramural research program of the US National Cancer Institute.
We would like to thank Nathan Appel from IMS for extensive computing support for this study.
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Authors' Contributions: AB and ER were responsible for the study idea. SK, SL and MS conducted the radiation dosimetry. AB, RC, and EG were responsible for data management and statistical analyses. All authors were responsible for the interpretation of the data. AB wrote the report and all authors reviewed and edited the report.
Conflicts of Interest Statements: The authors declared no conflicts of interest.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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12/29/2008 | 1UP FM - Podcast
Happy New Years-ish! We break from tradition to bring you a 2009 Preview Extravaganza, as Alice, Scooter, and Matt L. join us to chat about all the big publishers and their 2009 game lineups, and we all pick out our most anticipated games. Enjoy, and we'll see you next year!
00:00 -- First Half
57:37 -- Second Half
This one is pretty much how it sounds -- week before last, we dragged the previews team (and Matt, because that cat has his paw on the pulse of the industry like few others) into Podcast Annex #12 to tape this bonus episode, since we're all off of work this week. We'll be doing a Game of the Year show in a couple of weeks when 1UP is ready to run the awards, but we figured a look at next year could be interesting as well. I'm sad that we forgot to mention Henry Hatsworth and a few others, but I think we covered the bases damn well. Anyhow, there won't be a show next week (our first week off since we started, take note) but we'll be back sometime in January -- presumably with a vengeance. Start thinking about ideas you'd like to see implemented for 1UP FM in 2009, and shoot me a PM or leave a comment here. I'll also be blogging about that in more detail soon. For now, enjoy!
- Nick


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We are a product development company that only produces one product...ZOOM. It could be a child's toy. Or a life-changing senior innovation. But at the end of the day, every single idea must contain ZOOM, or it's back to the drawing board. We go back to the drawing board a lot. Sometimes we even bang our head on it. But nothing can leave the lab until it ZOOMS.
Our mission is a terrifying one - to delight the world with products that ZOOM. That means we must fail often. Dream. Fail. Repeat. ZOOM doesn't come any other way.
Founded in 2011, ZOOMWORKS is the sister company of Marketing Architects, one of the leading direct response agencies in the country. This unique relationship offers a treasure trove of experience in
media, creative development, web analytics, and customer service.
Our product launches have a ridiculous track record because we cheat. None of our brands move into retail without having thrived first in national direct-to-consumer advertising. This is our secret sauce. Our products generate millions in revenue before ever stepping into a retailer. In short, we bring ZOOM that WORKS to retailers day one, because we've already done the heavy lifting of creating a profitable, nationally recognized brand.
To our partners, we guarantee working with us is going to be nothing short of a wild ride. If you're excited about launching products that turn industries on their ear and stretch smiles across customers' faces, we have but one question for you...
are you ready to
Where it all begins. Here we mine for ZOOM in all its mysteriousness. Scouring product categories, looking for new ways to delight consumers. We collaborate. We argue. We high-five. We call each other names. We build. We tear down. We build again. And we never stop until the idea ZOOMS.
Every product is one part ingenuity, one part story. So it's at this stage we give birth to branding. What's the product's parable? What's its name? Why will it change someone's life? What clothes should it wear? How should it speak? These are critical elements to ensuring we have a truly complete product we feel is worthy to leave our lab.
Product development isn't just about crazy-making. Survival takes discipline. ZOOMWORKS is built on a backbone of marketing services designed to elevate the brand story to a national level literally overnight. From television production to media buying to web optimization, everything is done under one roof. We're too persnickety to have it any other way.
Logistics is the other side of our discipline. It doesn't matter how great your product is if it never arrives. From manufacturing to warehousing, we have a dedicated team of logistic masterminds who find joy in sweating the excruciating details.
In-market product testing begins. We love to learn, almost as much as we love to create. It's at this stage gate we put on propeller hats and dig deep into the data. What is the market telling about our test launch? How should we change? Everything is on the table. The product. The message. The media. The customer experience. How can we make it better? More interesting? More delightful? Are we reaching the right people? Why are they buying? Why aren't they buying? Most product developers ignore this stage as it's just too much darn work and super nerdy. We think nerds are awesome.
The verdict. The final swing of the gavel. It's time to decide if our hunch of an idea is truly huge. And there's no greater test than the almighty P&L. The financial arm of ZOOMWORKS is a mighty force. They objectively discern between blinded excitement and true profitability if we choose to go full steam. The data never lies. And it's here our product idea sees the green light or the graveyard.
All systems go. Our product delights customers. Not in theory, but in the marketplace. It's time for prime time. We push full throttle on our direct-to-consumer TV, radio, print, and web to achieve mass scale and household name status. In addition, we have an in-house team of retail evangelists who work directly with the greatest names in brick and mortar.
Chuck Hengel
Brent Longval
Steve Lubin
Jeff Clement
Paul Jackson
Rob DeMars
Angela Voss
Katie Scheetz
Chuck loves ideas. He loves them so much he built two companies. The first was Marketing Architects. As one of the nation's leading direct response agencies, Marketing Architects offers a turnkey media and marketing platform to help entrepreneurs transform their ideas into household names. The second is ZOOMWORKS, a product development think tank recognized as one of the nation's fastest-growing of its kind. Chuck's hands-on approach with ZOOMWORKS begins with the initial idea and doesn't let go until it's touched the hearts of customers across America.
Before hanging his own shingle back in 1997, Chuck held key leadership positions at Fingerhut and Novus Marketing. He continues to stay connected in the community by serving on several boards and is an active angel investor. But Chuck is still mostly driven by family. His hope is that one day ZOOMWORKS will create a product so revolutionary, even his kids will think he's cool. One can dream.
Sure, Brent has a gift for numbers. But unlike most CFO's, for him the bottom line is merely the starting line. Brent is passionate about seeing big ideas come to life and recognizes the P&L is only one part of the equation. It takes a CFO with vision to see the true potential of a budding product idea and help nurture it to long-term profitability. There's not much that doesn't cross Brent's to-do list. From patent filings to multi-million dollar purchase orders to next year's product designs, you'll find his fingerprints all over 'em.
Brent's tireless energy can be traced back to his days at the University of St. Thomas, where he led the basketball team to its first Final Four appearance. He is one of only a small handful of players inducted into the school's Hall of Fame. He followed his college years with an equally impressive run at Arthur Anderson, Pillsbury, and Agiliti before joining Marketing Architects as CFO back in 2002. His current role at ZOOMWORKS truly combines all of Brent's experience, both on the court and on the balance sheet.
Steve is an idea guy disguised as a lawyer. As head of Corporate Development for ZOOMWORKS, he's a dreamer that gets things done. Huge product idea that needs ironclad patent protection? Give it to Steve. Need to negotiate a contract that redlines obstacles and underlines opportunities? Give it to Steve. Time to sell our product to a company that will take it to the moon? Yup, Steve's all over it.
Bold thinking in high-octane industries is all Steve knows. As Chief of Staff at the American Society of Composers, Authors and Publishers (ASCAP), he played a critical role in helping to protect the rights of the world's greatest talent. In addition to the music industry, Steve has been a recognized leader in the tech biz both as CEO of MediaGuide and COO of IMRSV, Inc., named one of Time Inc's top 10 start-ups to watch.
A huge music lover, Steve continues to negotiate for the music industry in his off hours. Only now the litigation is confined to his family's car stereo, where he keeps the peace between his love of the "oldies" and his kids' appetite for anything but.
At the crossroads of analytics, media and creative, sits Jeff. Most days you'll find this chief marketing officer at his desk gleefully slicing and dicing large databases of obscure data points, reshaping them into customer insights of jaw-dropping clarity. From frontend advertising response to backend conversion stick rates, if it involves connecting to customers, Jeff and his team of marketing brainiacs are critically evaluating all variables and planning new strategies for even better performance across all channels.
Jeff's knack for marketing and statistics started back at Fingerhut, where he rubbed elbows with another young go-getter, Chuck Hengel. He went on to play a key vice president role at Novus Marketing before becoming president of the database modeling division of Paradyze.
In 2002, Jeff reunited with Chuck at Marketing Architects. As a partner, he has been instrumental in making Marketing Architects a national leader in direct response advertising. He now brings that same marketing horsepower to the world of product development for ZOOMWORKS.
Paul Jackson knows a few things about risk-taking. Ski bum. Rock climber. Fatherhood. Paul has never shied away from the rush of adrenaline. So becoming a disc jockey in college was a perfect fit for this thrill seeker. His voice and wit served him well in his roles as on-air talent, producer and editor for more than 30 mid-to-major markets including his coveted mountains of Denver.
Then came a phone call from Chuck that changed his life.
Paul left Denver behind and joined Chuck in climbing a much higher peak of building the nation's largest network of highly responsive radio inventory at rates nobody else could touch. From scratch. To do this, he invented an inventory management platform for radio stations that partnered with them to create additional revenue beyond spots and dots. Today his team has generated well over 800 billion radio impressions and counting.
One mountain down, one to go.
Television is a key driver for launching any product into the national spotlight. Jackson's now robust team of media black belts set their sights on doing for TV what they did for radio. In just a few short years they've built the most powerful TV platform in the industry with unparalleled access to national cable, local broadcast, national network, syndication, spot cable and satellite.
Most days Paul leaves his motorcycle in storage. Between his time at ZOOMWORKS and raising his young daughter with his lovely wife Reena, Paul is getting all the adventure he needs.
He used to have a full head of hair. But Rob traded in his hairline to head up a team of eclectic crazy-makers responsible for building nationally adored brands from scratch. Rob oversees a department of world-class writers, designers, producers, animators, and engineers responsible for developing every square inch of a product's brand identity and advertising campaign. From logo design to the final television production, everything is done in-house by this team. Rob is too persnickety to have it any other way.
Rob started his career at Campbell Mithun, where his work in television and radio earned him the youngest vice presidency in the company's history. Over the course of eight years, his clients ranged from cellular to cereal, and included such iconic brands as General Mills, Hostess, Burger King, Domino's Pizza, and Hefty. In 2004, Rob joined Marketing Architects, tasked with building the creative division into an industry leader. For him, ZOOMWORKS presents a new challenge of now not only developing the brand for a client, but also being the client.
When most people are faced with a challenge, they run as fast as they can the other way, Scooby-Doo style. Angela, on the other hand, races full speed toward it.
Angela's definitely someone you want in your court...which is why she's so great at fostering the marketing partnerships for ZOOMWORKS. She has spent nearly a decade crafting meticulous campaign strategies that have delivered extraordinary ROI for our partners. Her in-depth TV and radio DR marketing knowledge has not only helped her team overcome industry challenges, but also tenaciously driven profit. Challenges are welcomed and success is demanded. For Angela, it's just another day.
One might ask how she handles it all so well. Angela's college basketball career has a lot to do with it. On the court she learned the true meaning of perseverance. When you pair that with her unflinching focus and dogged desire to succeed, it's easy to understand why she's good at what she does.
While it's no secret that Angela's a fearless leader, not everyone knows she's also a kid at heart. A day with her three daughters spent playing with rainbow hair chalk, glitter tattoos and dress-up clothes is a day well spent in Angela's book.
If you asked anybody about Katie, they'd tell you she's a mover and a shaker. And that's pretty evident if you take a look at everything she's contributed during her years with ZOOMWORKS.
It all started with a spark – a desire to help people find solutions that genuinely worked for them.
As the daughter of an entrepreneur, Katie recognized that her desire to build and create was in her DNA. She needs to be somewhere that values a consultative approach to partnerships. And somewhere that can serve as a well-tilled garden where she can plant her ideas and watch them grow.
Enter ZOOMWORKS.
Any given day, you'll probably find Katie engaging in friendly conversation with new partnership opportunities, discussing how we can together launch products from napkin to #1 brands. Katie's desire to succeed is evident – she doesn't celebrate a win unless she's celebrating it with her partners.
During her tenure, Katie has been involved with some of ZOOMWORKS most formative victories. Her team was solely responsible for Stuffies® and HurryCane® becoming industry tradeshow leaders.
You wouldn't be wrong if you assumed cultivating new partnerships as well as a loving family of four all at once is hard work. So how does Katie do it? Easy. She asks herself each night, "Did I just exist or did I make a difference today?"


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University News
Kurtág-Ligeti masterclass at the Academy of Music
07. July 2016
The course, which is also open for foreign students is provided by two acknowledged professors of the Liszt Ferenc Academy of Music, Gábor Csalog and András Kemenes. As a guest performer, Balázs...
Two gold medals for Kristina Vocetková in Filadelfia
28. May 2016
The violoncello student of the Liszt Academy originally from Prague came first even in two categories – string and duo - of the 8th International Music Competition in Filadelfia, Italy.
Mihály Könyves-Tóth won silver in Prague
27. May 2016
The trumpeter, who graduated from the Liszt Academy last year, came second out of 132 entrants at the 68th Prague Spring International Music Competition held between 7 and 15 May.
77 singers qualified for the II International Éva Marton Singing Competition
20. May 2016
On the basis of the decision of the pre-jury headed by Éva Marton, 50 women and 27 men can test their skills in the 19-25. September live rounds.
II International Éva Marton Singing Competition attracts significant interest
11. May 2016
More than 100 young opera singers representing 25 countries have applied for the second international vocal competition organized by the Liszt Academy.
The Hungarian and international triumphs of our students of composition, violin and tuba
10. May 2016
In April and May, 2016, numerous students of the Liszt Academy were awarded for their performances at Hungarian and international music contests. Two of them came first at our home competitions,...
Clarinet master course by Tibor Réman
26. April 2016
Dance house? Get together!
25. April 2016
The 5th Dance House Day is being held on 7 May 2016. For this occasion, István Pávai has compiled the programme of the concert arranged in the Grand Hall, Liszt Academy from the collection of János...
Percussion master class by Gordon Stout
25. April 2016
The Liszt Academy of Music has been awarded the European Heritage Label
25. April 2016
On 13 April, the Liszt Academy of Music, as one of nine selected sites, was awarded the European Heritage Label, presented by Tibor Navracsics, the European Commissioner for Education, Culture,...


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BBB Accredited Business since
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P.O. Box 30018, Lansing MI 48909
Phone Number: (517) 241-9288
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Contractor - Insulation Home Improvements
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When making any home improvement, the BBB suggests that you obtain all terms of the contract in writing, including, but not limited to: dates when the project is to be started and completed; warranties and guarantees regarding the product and workmanship; and any other terms that you want expressed with the manner in which the job is to be performed.


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© 2016 Speedway Motorsports, Inc.
2017 schedule features continuity, addition of Gateway
Alexander Rossi, the rookie driver from Auburn, California, who returned Honda to Victory Lane at the Indianapolis Motor Speedway in May, can't wait to get to Sonoma Raceway.
Sonoma Raceway is set to host an action-packed weekend of racing, Sept. 16-18, as two series join the Verizon IndyCar® Series Championship weekend at the GoPro Grand Prix of Sonoma.
The racing news of the past weekend and the future...today!
Sonoma Raceway's drag strip heated up last night, Aug. 24, with more than 150 Northern California drag racers competing during the Wednesday Night Drags.


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- Report: #6140
Report - Rebuttal - Arbitrate
Complaint Review: A.V. Concepts
A.V. Concepts1917 W 1sst St.Tempe Tempe, Arizona U.S.A.
Ripped off by A.V. Concepts
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Employed by A.V. Concepts 1917 W 1sst St.Tempe Az(480) 557-6000
Date of injury 053000
Time of injury 10:15 10:30 A.M. . immediately following a safety lecture Two employee's of Rhino Staging were to unload a liftgate style Ryder truckI was to direct them.
When both guys are inside the truck one of them must hold onto the case as the liftgate is moving.
This was not the case.'as the gate began to come down with a case that weighed well over 500 lbs.(closer to 900)the case rolled gaining momenteum and slammed into my right knee at this point I began to yell; What are you doing? The guy's both in the truck, attempting to move another case, immediately turned their attention as well as everyone else's in the warehouse to me and what was about to unfold.
I don't know which one did it but they shut off the liftgate and made it worse. Now not only was the the case against my knee now, stopping the lftgate caused the case to tilt (come up off the rear wheels) all aof its was was now on my knee joint. Now I'm yelling ,hey get this off me, now.
At this point I am really starting to attract attenton of the other staff now, one of them (in the truck) pusheed the button to star the liftgate moving again, but he pushed down instead of up. Their gate began to move downwards as it was crushing my leg with not only the case of equipment, but with hydrolic pressure too. "Stop, stop stop it", I screamed quickly but not quickly enough some one in the truck shut off the liftgate (the controls were notwithin my reach there on the ground) . Still trapped by the liftge and case I thought it was over, no, not yet both young men were about six feet tall 175 lbs they seemed to realizejust what had happened (Danny Hously was first ?) began to come to my aid, realizing I was trapped both guys jumped from inside the truck bed apporx. 4 -5ft off of the on to the lft gate as the youngest one hit first I grabbed for him to get his 200lbs extra off of my knee, The one I worked with before noticed this and jumped off theliftgate as quickly as his weight beared down in addition to what was trapping me there.
I do not know who finally released me but Danny H. lighting dept.) was there and said d**n it you know this wouldn't have happened if we just use are guy's those rhino guys are dangerous.
I tried to stand on my leg for a while , we had a very busy schedule, specially with my boss leaving town and later to have knee surgury of his own we had TRUCKS to load/unload [pull, inspect reurn exchange repair order in, design equipfor] the show must go on. Well, after someone got me a chair and some ice the new lady from HR came down to see if I wanted to go to the Dr. While arranging transportaton for me HR lady obviosly I could ride My HARLEY for a while I called my friends Scott Harkema and Mary to arrange transportatin home for myself.
Dr''sMBI clinic dr. Joe Meloni
Mesa MRI
MBI dr. other than meloni
Dr. meloni req. to creasmen
Dr creasemean Ssurgury sched Surgury cancelled typo at state fund cancells surgury just before it was to begin Rescheduled surgury approx 2-3 weeks later
Call as I was leaving my house surgicenter caught fire
Rescheduled for later same day at good sam no antibiotic that I was not allergic to.
Creaseman elects to operate anyway. described surgury to my sister as needing a great deal more than he expected preps me for further surgury does not remove tumor Creasemen on vacation see PA in his office assures me no infection present
Start phys thearpy in about 1 week Phsy.
Therapist stops program it seems to be doing more harm than good Dr. creaseman re-evaluates talks about further surguries and prescribes unloader brace. August released to modified work AV Concepts was going to train me like they had said to use their compter sys.
Not just the repair restock order and maintaince of their facility I HUNG SIGNS MOVED OFFICES LOADED TRUCKS ORDERED SUPPLIES PICKED UP SUPPLIES YES I WAS WORKING FOR ALL THE DEPTS IN MANY CAPACITIES.
BUT WHEN I RECEIVED A DEMAND LETTER FROM av CONCEPTS TO APPEAR AT WORK AND ONLY WORK 4 HOURS A DAYi WS SHOCKED. THAT'S NOT LIGHT DUTYOF LIMITED DUTY THAT'S UNBELEIVABLE I COULD JUST PAY THE BILLS ON THE 60 + HOURS A WEEK I WAS WORKING I SURELY COULDN'T MAKE IT ON ONLY THE 60% OF A STRAIGHT 40 HOUR THAT WORKERS COMP PAID ME.
NOW It was getting worse. Injune 2000 I took in my first roommate. Here I am at almost 40 yrs old living in a nice house(parents, it was my inheritance) on a golf course with a new Harley, just accepted to law school Well when I got home from MBI clinic with cruthes and in a good deal of pain, how was I to know that I would not be able to even bury my parents poor little dog. She died that evening and I couldn't even buryher I called around and finally found someone who would dig the grave here at my (parents) house. I've never been on workmans comp before and didn't know anyone who hadmoney's tight and now I cant work for two weeks,or dso I though(now it's been over a year.yes ive tried to work even had to leave AV concepts workmans comp said so. You must take a job that will work you for more hours or they will stop paying you. AV concepts would only give me four hours a day , they (H.R.)saidi we don't have any light duty work here, you were just warehouse help what do you mean computer training.)
One day over the few that I wasthere I stayed 15 or 20 minutes late clocked out and was waiting for my ride Karen (HR)came out to the parking lot and started yelling at me. Hey what do you think you're doing while holding my time card. II was stupified until I remembered that AV Concepts had sent me a paid holiday check for 7400 then called me and asked me to please return it, expalination well Sam you didn't work on the preceding day so you don't qualify for it. This was the way everything reguard my caswe has gone.cancel surgury stress related thereto, delay in surgury , surgicenter catching fire on my day, no antibiotics as a prophalactic for all arthroscopic surgury, Creaseman not available to discuss surgury with me (sister Toni) was out of town(creasmanhad explained the procedure to her they did they forget totell me anything else? Now my knee is no better than before the surgury,they sent me to Moscynski,22nd opp. Then to a PHD who said it was obvious that I required further treatment and I had learnecd to accommodate well.
When you cant even shower without this brace on, having sex is almost immpossible you can do the one other thing that can just make everything alright because of that stupid case and thatliftgate truck you get I don't unbeleivably stresssed.. Then they repo my Harley I was physically sick for days it just tore me up hey Creaseman said I could be riding in two weeks before he did the surgury, but it didn't work that way now they say I'll never ride( canthold it up with just 1 knee) again I just want my life back.
Now after selling off almost all of my inheritance, personal belonginmgs collections of guns, knives tools ,toys, cars, jewery, and almost any other thing of value that I could scrape together Ive filed chap 13 can't make the payments and they are forclosing on my home that's right Ill never ride again but that's ok I wont have a place to park it anyway.
This report was posted on Ripoff Report on 08/12/2001 12:00 AM and is a permanent record located here: http://www.ripoffreport.com/r/AV-Concepts/Tempe-Arizona/Ripped-off-by-AV-Concepts-6140. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.
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on October 17, 2013 - 7:58 PM
, updated October 17, 2013 at 8:26 PM
WASHINGTON – CUBRC, a Buffalo-based research and development firm, got a big boost in the federal funding bill passed by Congress this week to end the government shutdown.
The bill contains language inserted by Sen. Charles E. Schumer, D-N.Y., that restores funding for the Biomedical Advanced Research and Development Authority, an agency whose funding had run dry.
That matters to CUBRC because the Buffalo company has a contract from the agency, worth up to $70 million over five years, to develop a new antibiotic to combat biothreats such as anthrax and plague as well as pneumonia and other infections.
"Through the federal funding bill passed last night, we can again feel confident that CUBRC can continue its lifesaving research to develop the next generation treatments for bacterial infections and biothreats," Schumer said. "This shows plain and simple why shutting down the government was such a terrible idea that did real damage to our economy, and why it is such good news that we have moved beyond that."
Six CUBRC employees work directly on the government contract, while another seven provide support for the project.
The company expects to receive approximately $16 million because of the language in the spending bill.


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CSWE Accreditation
Dominican University's Graduate School of Social Work (GSSW) MSW program is accredited by the Council on Social Work Education (CSWE) and is one of the first graduate schools in the nation to offer a globally focused, family centered concentration.
Dominican University in compliance with CSWE accreditation standards has begun the reaffirmation process, which cumulates in 2016 with a site visit. This webpage contains documents that the CSWE uses to evaluate the MSW program. Dominican encourages those who visit this site to read through the materials provided.
Mission, Vision, and Program Goals
The Graduate School of Social Work is centered in the Sinsinawa Dominican tradition, which is committed to truth and compassionate service. We prepare professional social workers for globally-focused, family-centered practice to advocate for human rights, and social and economic justice for all persons including socially excluded populations that promotes human and community well being.
The Graduate School of Social Work aspires to be an innovative global leader in social work through inquiry-based education, ethical engagement and commitment to positive social transformation. Vision
Program Goals
Foundational Knowledge
MSW Program Goal 1: To develop social work practitioners who understand social work knowledge, values, and skills to enhance all levels of client systems.
MSW Program Goal 2: To prepare professional social work practitioners to engage in culturally sensitive practice that encourages active community participation in advancing social and economic justice.
MSW Program Goal 3: To prepare social work practitioners to integrate multidisciplinary bodies of knowledge and skills into their practice in order to empower clients.
Human Dimension
MSW Program Goal 4: To develop social work practitioners who incorporate reflective practices to enhance understanding of self and others within their diverse context.
MSW Program Goal 5: Prepare social work practitioners who embrace core social work values and ethics in service of all people with particular attention to marginalized and disenfranchised persons and communities.
Learning How to Learn
MSW Program Goal 6: To prepare social workers who are life long learners committed to the growth of their own professional knowledge base, ongoing professional development, and self-growth.
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Finance Glossary
Just call us Bond. Amortized bond.
Over 700 finance terms, Shmooped to perfection.
Advertising Prospectus
Have you seen those ads for whatever where lots of people are partying to great music and having the time of their lives?
An advertising prospectus is the opposite of that.
It's an advertisement for a mutual fund, and it usually involves information about how the fund has done in the past and what features it has. It's probably very exciting to financial types (and probably only for those types—the rest of us will stick with Super Bowl ads, thankyouverymuch).


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German giant Mercedes admits it was "a little surprised" when Indian customers snapped up 125 of its new top-of-the-line S-Class luxury cars costing US$250,000 ($300,000) apiece in just 16 days.
India's car industry has skidded on to an icy patch and is set for a second straight year of decline, but one segment still accelerating is luxury cars.
Analysts at India's premier motor fair last week said that for the "really rich", economic downturns have a negligible impact on their luxury spending.
"Luxury car sales are still growing at 15 per cent plus year on year and for the next three years segment growth is expected to continue at 15 per cent upwards," said a report by the Confederation of Indian Industry.
Sales have gone into overdrive for parts of the luxury car segment. Mercedes-Benz, for instance, saw sales rocket 32 per cent year on year in India, despite punitive import tariffs.
Still, "while we believe strongly in our product, we were a little surprised when we sold 125 S-Class cars in 16 days - and this was to customers who bought them sight unseen", Mercedes-Benz India chief executive Eberhard Kern said.
The cars bought were the Indian launch edition of Mercedes' latest luxury S-Class sedan.
In sharp contrast, passenger car sales are set to slump close to 10 per cent in this financial year after years of growing at 30 per cent, said the Society of Indian Automobile Manufacturers.
The market has been hit by high borrowing costs and receding consumer confidence amid economic growth of just 4.5 per cent - half the rate seen during India's boom times.
But while India staggers from its worst downturn in a decade, previous years of rapid growth have created a new moneyed class who are buying prestige marques and keeping the segment above water.
Although World Bank figures show 33 per cent of the planet's poorest call India home, the country also has 65 dollar billionaires and hundreds of thousands of dollar millionaires.
A decade ago, the lone luxury car commonly spotted on India's famously congested, potholed roads was Mercedes, the first premium carmaker to open shop in 1995. But now Audis, Jaguars, Bentleys, Aston Martins, Porsches and other top badges regularly weave through traffic.
The big spenders are top executives, former farmers who sold property for vast sums to developers, and a younger, wealthy generation with different values from their frugal parents who shied away from "conspicuous consumption", analysts say.
"There has been an attitudinal change to spending money - making this a more hospitable place for luxury automakers," says Anil Sharma, senior research analyst at IHS Automotive consultancy.
India's luxury car market is still tiny.
The total sold by the big luxury players in India - Mercedes, Audi, BMW and Jaguar Land Rover - is 30,100. But that number is forecast to climb by 168 per cent by 2018.
The market "is still in its nascent stages," but will be "very important for the future", Mercedes' Kern said.
"Headroom for the market to grow is huge."
In mature markets, luxury cars account for 10 to 15 per cent of sales, while in India "just two out of every 100 cars sold" is a premium vehicle, Audi overseas sales vice-president Terence Johnson says.
"We have 10 top priority markets which are strategic long-term and India is one of them."
Smaller cities and rural areas are also developing strongly as markets.
Delhi and Mumbai account for 45 per cent of Mercedes' sales while the rest come from smaller centres, says Kern, with more women opting for luxury cars, especially sporty, smaller variants.
Analysts say bringing in entry-level luxury cars is a smart move, noting people are usually hooked for life once they buy one.
Sharma says that "when a customer graduates to luxury cars, they don't go back to mass-market nameplates".