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It has been a pretty solid line of upper resistance the past week or more. If it breaks I think there will be enough momentum behind the move to take up back to the 52 week high to retest that upper point and maybe pull back to see if $46 becomes a new support level.
Any thoughts?
Obama Sees a Middle Class Tax of $I.7 Trillion Increase as a Victory read this and vote for Obama if you like it.
–Obamacare law contains 20 new or higher taxes on American families and small businesses–
The Largest Tax Hike in US History has just been upheld by the Supreme Court of the United States and President Obama sees this assault on the middle class as a victory.
The already unpopular 2010 health care reform law has been converted by the court into a $1.76 trillion tax increase funded by escalating taxes to be paid the vast majority of taxpayers. The high court's ruling leaves in place 20 tax increases in the health-care law, of those, 12 tax hikes would affect families earning less than $250,000 per year, including a "Cadillac tax" on high-cost insurance plans, a tax on insurance providers, and an excise tax on medical device manufacturers. By formally converting 'Obamacare' into 'Obamatax,' the court allows Obama to raise taxes on the middle-class.
The decision is a distressing blow to taxpayers and represents the single largest tax increase on young people in the nation's history. When it takes full effect, the Internal Revenue Service will have immense new power and authority to persecute and prosecute a whole new group of taxpayers.
If the law takes full effect, it will devastate small businesses and destroy any chance for a sustainable economic recovery. It will add trillions of dollars to the national debt and push the country toward bankruptcy even faster than current projections. Any individual who believes that
this decision must be overturned must do everything possible to undo the damage that has been done, especially at the ballot box on November 6.
47 I have not see this for YEARS. HORRAY FOR VERIZON
overvalued now
Pretty steady climb from 32 for the past two years. Plus a nice dividend to boot.
Think I'll hold this on for a while.
sewers and drains seem to have moved on, eh ?
Possibly, maybe gonna stay above $46. Come on $46.50.
IT says on the board that Verizon was up well over $48 on Monday. Is that a misprint on the 52 week high?


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Honored to be a "Huggable People" even if reading about my life feels more chaotic than living it was (I think lol). @Carla Deter is kind and generous to "hug" me like this.
Hugs are VERY important to cancer patients and survivors, so Hug a cancer survivor today and remember to never take the magic carpet ride of life for granted.
Appreciate mentions of @Scoop.it and forgot to thank @Guillaume Decugis and @Ally Greer. Thanks always to you and Marc for letting me play with your wonderful toy. Your toy is why I'm a Huggable People :). Marty
|Scooped by Martin (Marty) Smith

subset: commoncrawl


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European football's governing body UEFA confirmed the sanctions following a meeting of its control and disciplinary body.
"Manchester United FC midfield player Nani has been suspended for one match by UEFA's Control and Disciplinary Body, following the red card he received at the UEFA Champions League round of 16 second leg against Real Madrid CF at Old Trafford on 5 March," a UEFA statement read.
"Manchester United head coach Sir Alex Ferguson has been fined 10,000 for non-fulfilment of the post-match media obligations at the same match."
- Soccer
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- Sir Alex Ferguson


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All hotels in Frascati, Italy
1 room, 2 adults
Via Cisternole 204, Frascati, RM, 00044, Italy, 1-877-214-4288
Villa Maria Luigia - Frascati
Lowest price$40
Villa Maria Luigia offers low-cost Frascati hotel accommodations 2.8 mi (4.5 km) from Frascati Cathedral and 3 mi (4.9 km) from Villa Aldobrandini. Fontana Candida and Papal Palace of Castel Gandolfo are also within 9 mi (15 km).
Along with free buffet breakfast, this hotel offers free WiFi and free self parking.
Along with free buffet breakfast, this hotel offers free WiFi and free self parking.
See all 12 Venere.com reviews
Awesome vibe
Fantastic service
Rather comfortable
Bad internet service
TripAdvisor Traveller Rating: 4
From 51 reviews
Villa Maria Luigia - Frascati
Hotel Info: 1-877-214-4288from $40
- Triple Room
- Double Room
- Family Room
- Quadruple Room
- Single Room
- Economy Double Room
Also popular with travelers from the USA
At a glance
Key facts
Hotel size
- This hotel has 14 rooms
- This hotel is arranged over 3 floors
- Check-in time 1 PM-midnight
- Check-out time is 10 AM
If you are planning to arrive after midnight please contact the property in advance using the information on the booking confirmation. Reception is open until 11 PM. Guests arriving after hours must contact the property in advance to make check-in arrangements. Guests can contact the property using the number on the reservation confirmation received after booking.
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
- Minimum check-in age is 18
Travelling with others
- No cribs (infant beds)
- Pets stay free
- Specific rooms only *
- 2 per room
- Free WiFi in public areas
- Free WiFi in rooms
- Free self parking
- Free RV/bus/truck parking
In the hotel
Food and drink
- Free buffet breakfast daily
- Room service (during limited hours)
- Free reception
- Coffee/tea in a common area
- 24-hour front desk
- Concierge services
- Luggage storage
- Wedding services
- Porter/bellhop
- Number of buildings/towers - 1
- Designated smoking areas
- Rooftop terrace
- Garden
- Terrace
- Fireplace in lobby
- Television in common areas
In the room
Home comforts
- Ceiling fan
- Coffee/tea maker
Freshen up
- Private bathroom
- Shower only
- Bidet
- Free toiletries
- Hair dryer
Be entertained
- Cable TV channels
Stay connected
- Desk
- Free WiFi
Food and drink
- Free bottled water
- Daily housekeeping
Villa Maria Luigia - Frascati's small print
Also known as
- Villa Maria Luigia Frascati
- Villa Maria Luigia Hotel
- Villa Maria Luigia Hotel Frascati
Cash transactions at this property cannot exceed EUR 2999.99, due to national regulations. For further details, please contact the property using information in the booking confirmation.
Pet-friendly rooms can be requested by contacting the property at the number on the booking confirmation.
Only registered guests are allowed in the guestrooms.
This property does not have elevators.
We have included all charges provided to us by this hotel. However, charges can vary, for example, based on length of stay or the room you book.


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2 colors
The North Face 'Motivation' Quarter Zip Pullover
Women's Alo 'Burn' Shorts, Size Medium - Grey
Inspired by cycling but adapted to the studio, these supportive StretchFlex shorts are designed with a wide waistband and longer inseam to provide ample coverage as you move from pose to pose. Color(s): arrow print, berry, black, dark krystal black, modernist multi, volcano space print. Brand: ALO. Style Name:Alo 'Burn' ... Learn More
Women's Nike 'Premier Maria' Dri-Fit Skort, Size Large
Lightweight, moisture-wicking Dri-FIT fabric provides cooling comfort in this flirty skort designed with a pleated hem for ease of movement. Built-in shorts offer coverage as you jump, run and move on the tennis court. Color(s): cosmic purple/ black, deep royal blue/ white. Brand: NIKE. Style Name:Nike 'Premier Maria' Dri-Fit Skort. ... Learn More
Women's Anita 'Extreme Control' Sports Bra, Size 40F
Get maximum support for the highest-impact activities in a highly structured sports bra built from advanced moisture-wicking piqué fabric that keeps you cool, dry and comfortable. The three-part cups and side support work to ensure minimal movement and bounce. Color(s): anthracite, black, camouflage, desert, white. Brand: Anita International. Style Name:Anita ... Learn More
Women's Patagonia 'Happy Hike' Shorts, Size 10 -
These easy-care shorts are ideal for hiking, thanks to a lightweight abrasion-resistant fabric boasting four-way stretch that offers a comfortable range of motion. A low-rise belted waistband features a hidden drawcord that cinches a perfect-for-you fit. Color(s): el cap khaki, forge grey, glass blue. Brand: PATAGONIA. Style Name:Patagonia 'Happy Hike' ... Learn More
Women's Brooks 'Chaser 7' Running Shorts, Size Small
Ultra-lightweight stretch-woven fabric allows for breathable, high-endurance training while moisture-wicking Drilayer lining keeps you cool and refreshed throughout the day. Side split hems offer a flattering fit and ensure maximum mobility with every leap and bound, and the wide, mid-rise waistband slims and stays in place. Color(s): black. Brand: Brooks. ... Learn More
Women's Under Armour 'Play Up' Track Shorts, Size
Weightless training shorts are made to go the extra mile with a stay-put elasticized waistband, flattering track-style dolphin hems and durable, sweat-wicking tech fabrication that resists odor. Color(s): aqua, black/ black, black/ rebel pink, black/ verve violet, dynamo blue/ high-vis yellow, grey/ harmony red, heron/ heron/ midnight navy, magenta/ magenta/ ... Learn More
Women's Zella 'Speedster' Running Shorts, Size X-Small -
A space-dyed knit forms the wide, nonbinding waistband that tops classic running shorts cut from a silky stretch-woven fabric that won't weigh you down on even the longest runs. Color(s): black animalia print, black triangle print, blue petrol, coral sun, grey graphite, orange yuzu, purple spark. Brand: Zella. Style Name:Zella ... Learn More
Women's Alternative Pull On Stretch Shorts, Size X-Small
Slim stripes style soft, stretchy shorts topped with a wide fold-over waistband and designed for active pursuits. A high back rise helps keep you covered when you bend down, while keyhole cutouts provide ventilation and a hidden waist pocket conceals a key ring. Great for running, yoga, spinning, Pilates, barre ... Learn More


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The Browning Youth Buck Eyes Short Sleeve T Shirt is a 100% cotton tee that will make your little hunter feel special. This sand colored short sleeve tee shirt features a large black lab centered on the back of the shirt. This hunting buddy has a Browning Buckmark glistening in his eyes. On the left chest of the tee is a Buckmark with the Browning logo. This youth tee has a regular fit with standard crew neckline.
Mack's Prairie Wings is not responsible for typographical errors in pricing or product specification inaccuracies in our web site. Prices are subject to change without notice.
Copyright © 2016 - Mack's Sport Shop LLLP - All rights reserved. Site Developed and Maintained by Ability Commerce
Copyright © 2004-2013 - Mack's Prairie Wings, Inc. - All rights reserved. Site Developed and Maintained by Ability Commerce


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Grand Theft AutoFree
Quick Specs
Version:Not available
Total Downloads:3,229,589
Date Added:Mar. 06, 1998
Price:Free to try
File Size:9.09MB
Downloads Last Week:509
Product ranking:#6 in Driving Games
From Take 2 Interactive: Grand Theft Auto is all about maintaining your street cred as a criminal. The local crime bosses send you out on missions ranging from carjacking to kidnapping to drug running. The more missions you complete successfully, the longer you retain and/or advance your criminal status. This demo version includes the first four missions of the game, and imposes a six-minute time limit on gameplay.
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- Play 12 solitaire card games on your PC.Throw your weight around in a heavy-duty tank.Add new features to your Red Alert 2 game.Join in this scrolling arcade shoot-em-up.


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It's scarynearly 1.4 million New Yorkers face hunger and 1 in every 4 kids doesn't always know where their next meal will come from. This October, children in your community can help!
City Harvest's Truck or Treat empowers kids to fight hunger by collecting coins and bills in support of our work and teaches them that when many people come together, we can have a big impact.
Every $1 raised will help City Harvest feed four people for a day. There's no trick to it.
Sign up and get your school, building, block, family, or company involved. City Harvest will provide you with a toolkit and tips so you can get the word out that you're fighting hunger this fall. Join with City Harvest and make a real impact on hunger in our city!


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Since upgrading to 3.1.2, WP is not allowing me to embed video, despite my doing exactly what I did for posts under 3.1.1, that did work. I tested it out by attempting to update existing posts that did work... and then they didn't.
The videos I need to embed aren't YouTube and the rest, they are all from non-public sources. So the various plug-ins aren't going to do the job. This is a pain as I really need to be able to embed like before, as it's for work purposes!


text: I had an SEO plugin that crashed my site and decided to try Yoast SEO. Seriously, I should have gone with it in the first place because for being a FREE plugin, it's really packed with some great features and tools. Thanks so much and I'll never leave you :)


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Proliferation protein goes rogue in lung cancer
Rac1b could be treatment target
A defective protein might be a key go-between in the string of terrible molecular events that lead to lung cancer. The protein, called Rac1b, gets activated by other compounds and launches cells in smokers' lungs toward malignant behavior, experiments in human cells and mice suggest.
The findings open the door for lung cancer researchers to investigate the molecular chain reaction, or pathway, in which Rac1b is involved. Since Rac1b seems to show up early in lung cancer, it might also make a target for diagnosis or early-stage treatment, researchers report in the July 11 Science Translational Medicine.
"This is really comprehensive work," says Farrah Kheradmand, a pulmonologist at Baylor College of Medicine in Houston, who wasn't part of the study team. "This gives us ammunition to go after Rac1b, an inconspicuous molecule, to try to inhibit it."
Rac1b is a variant of Rac1, a protein involved in cell proliferation. But while the gene that encodes Rac1 routinely turns itself off after producing its protein, the variant gene making Rac1b doesn't. "It's not meant to be on all the time," says study coauthor Derek Radisky, a cell biologist at the Mayo Clinic in Jacksonville, Fla. So the aberrant version of the protein gets made in excess.
Because earlier work hinted that Rac1b might play a role in some cancers, Radisky and his colleagues examined lung tissue from smokers with lung cancer and found consistently high concentrations of the rogue protein in cancer cells.
Tests in mice revealed that Rac1b gets activated by an enzyme called MMP3, which is involved in the breakdown and rebuilding of tissues such as collagen and elastin. These strong connective tissues hold organs and other body parts in place.
The mouse experiments indicated that MMP3 activation of Rac1b triggers a process by which lung-lining cells called epithelial cells abandon their posts and change behavior. While the process helps in wound healing — when cells are called upon to take on emergency roles — it has also been linked to cancer. Some work suggests it is a way for tumors to create space for themselves, Radisky says.
But the process, especially when it involves Rac1b, still remains hazy. For instance, it's not clear how MMPs activate Rac1b, he says. Nevertheless, says Sandra McAllister, a cancer biologist at Harvard Medical School, Rac1b does help to fill in one of the gaps in the understanding of lung cancer progression. "It seems to be adding a function beyond the normal Rac1 protein," she says, "turning epithelial cells in this context into cancer cells."
According to the American Cancer Society, smoking accounts for 80 percent of lung cancer deaths. Carcinogens from tobacco smoke are known to cause mutations in lung cells that limit their ability to stop dividing. McAllister hypothesizes that smoke hitting lung cells could draw attention in the same way a wound would, triggering a signal to heal. "That might be part of a normal response," she says, "but it's an unregulated process here, and Rac1b might be at the heart of that."
M.L. Stallings-Mann et al. Matrix Metalloproteinase Induction of Rac1b, a Key Effector of Lung Cancer Progression. Science Translational Medicine. Volume 4, July 11, 2012, p. 142. [Go to]
L. Sanders. Closest look yet at lung cancer genes. Science News. Volume 174, November 22, 2008, p. 15. [Go to]
K.J. Greenlee, Z. Werb and F. Kheradmand. Matrix metalloproteinases in lung: Multiple, multifarious, and multifaceted. Physiological Reviews. Volume 87, January 2007, p. 69. doi:10.1152/physrev.00022.2006. [Go to]
N. Seppa. Gene linked to some smokers' lung cancer. Science News Online, December 15, 2010. [Go to]


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Schaefer Confirms Mayweather-Canelo PPV Price as 64.95
By Luis Sandoval
Pound for pound king Floyd Mayweather and undefeated Mexican champion Saul "Canelo" Alvarez will put on the biggest fight of the year when they clash on September 14th at the MGM Grand in Las Vegas, NV. It is indeed the biggest fight that can currently be made in the sport as the demand for tickets caused the event to sell out in less than 24 hours.
One of the things fans who won't be attending the fight live have been wondering is how the pay per view will be priced. Given the magnitude of the bout, many expect the price tag to be astronomical but Golden Boy CEO Richard Schaefer brought some good news to the fans.
"You see a lot of people said it's such a big fight it's going to be a $80 or $90 pay per view. $100 I even heard but we don't want to do that. We priced the tickets the same way we priced the De La Hoya-Mayweather tickets and for the Pay Per View we are going to go with $64.95" Schaefer would tell BoxingScene, Mike Coppinger and Michael Rosenthal.
Schaefer confirmed the high definition would be $10 more which is customary for all boxing pay per view events.
While most expected a higher price tag, Schaefer explained that this fight and promotion is not about trying to take as much money as they can from the public but rather provide them with what they want.
"I have to tell you the cable systems and satellite operators when we were meeting and discussing with them the price, they were very surprised that we didn't go for a higher price. But this is not about squeezing out every last dime. This is a fight for the masses and for the people and I want people to be able to buy that fight and watch that fight. And those who are not yet boxing fans, will become boxing fans because I have a feeling this is going to be a great fight because Canelo really, really wants and he's going to come to fight" said Schaefer.
For those who still want to make the trip to Las Vegas but can't attend the sold out fight, closed circuit tickets have already gone on sale for $100 each and Schaefer informed they are selling fast.
You can follow Luis Sandoval on Twitter @Truewest007. You can also tune in to BoxingScene Radio, Boxingscene's official audio show every Tuesday from 6-8PM PST with hosts Ernest Gabion, Luis Sandoval, and Ryan Burton.
is the main supporting bout, is the ppv worth the 75$ now?Comment by Albeerto on 07-04-2013
LMAO @all you cheap @sses here. I loved it when people complained about pac-marquez4 and dinamita knocked him out cold. Please tell me u are the same people that were too cheap to buy ppv n not watch it live…Comment by Rosenlicht on 07-03-2013
I'll be watching with a few others and I'll be streaming it onto my flat screen.Comment by toolegit on 07-03-2013
i will have a good dinner for that price with my wife, then wait for the result at midnight.Comment by mercadojglb on 07-03-2013
[QUOTE=uniquehump;13528598]True. It pays for itself when you invite some people over and you pay $5 to watch it at someone else's home. I enjoyed going to the movies to watch it, but me and my wife went so it was…Post a Comment - View More User Comments (60)


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Glucosamine & Chondroiton. I use it for my joints and it helps.Carlson's Orange Flavor Fish Oil (high concentration of Omega 3, EPA and DHA and no fish burps). 2 Tbl a day. Cuts down on inflammation. My body really feels it when I go through periods of not taking fish oil.


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Intermediate Algebra / Edition 1by Julie Miller, Molly O'Neill, Nancy Hyde
View All Available Formats & Editions
Pub. Date: 01/28/2007
Publisher: McGraw-Hill Companies, The
Intermediate Algebra offers a refreshing approach to the traditional content of the course. Presented in worktext format, Intermediate Algebra offers a review of problem solving, solving equations in two and three variables, a chapter devoted to functions, polynomials, radicals and complex numbers, factoring and quadratic functions, rational expressions, and/i>
Intermediate Algebra offers a refreshing approach to the traditional content of the course. Presented in worktext format, Intermediate Algebra offers a review of problem solving, solving equations in two and three variables, a chapter devoted to functions, polynomials, radicals and complex numbers, factoring and quadratic functions, rational expressions, and inequalities. Other topics include exponential and logarithmic functions and conic sections. The text reflects the compassion and insight of its experienced author team with features developed to address the specific needs of developmental level students.
Product Details
- 9780073309361
- Publisher:
- McGraw-Hill Companies, The
- Publication date:
- 01/28/2007
- Edition description:
- Older Edition
- Pages:
- 984
- Product dimensions:
- 8.50(w) x 11.10(h) x 1.55(d)
Table of Contents
Chapter R Review of Basic Algebraic Concepts
Section R.1 Study Tips Group Activity: Becoming a Successful Student Section R.2 Sets of Numbers and Interval Notation Section R.3 Operations on Real Numbers Section R.4 Simplifying Algebraic Expressions Chapter R Summary Chapter R Review Exercises Chapter R Test
Chapter 1 Linear Equations and Inequalities in One Variable
Section 1.1 Linear Equations in One Variable Problem Recognition Exercises: Equations versus Expressions Section 1.2 Applications of Linear Equations in One Variable Section 1.3 Applications to Geometry and Literal Equations Section 1.4 Linear Inequalities in One Variable Section 1.5 Compound Inequalities Section 1.6 Absolute Value Equations Section 1.7 Absolute Value Inequalities Problem Recognition Exercises: Identifying Equations and Inequalities Group Activity: Understanding the Symbolism of Mathematics Chapter 1 Summary Chapter 1 Review Exercises Chapter 1 Test
Chapter 2 Linear Equations in Two Variables and Functions
Section 2.1 Linear Equations in Two Variables Section 2.2 Slope of a Line and Rate of Change Section 2.3 Equations of a Line Problem Recognition Exercises: Characteristics of Linear Equations Section 2.4 Applications of Linear Equations and Modeling Section 2.5 Introduction to Relations Section 2.6 Introduction to Functions Section 2.7 Graphs of Basic Functions Problem Recognition Exercises: Characteristics of Relations Group Activity: Deciphering a Coded Message Chapter 2 Summary Chapter 2 Review Exercises Chapter 2 Test Chapters 1-2 Cumulative Review Exercises
Chapter 3 Systems of Linear Equations and Inequalities
Section 3.1 Solving Systems of Linear Equations by the Graphing Method Section 3.2 Solving Systems of Linear Equations by the Substitution Method Section 3.3 Solving Systems of Linear Equations by the Addition Method Problem Recognition Exercises: Solving Systems of Linear Equations Section 3.4 Applications of Systems of Linear Equations in Two Variables Section 3.5 Linear Inequalities and Systems of Linear Inequalities in Two Variables Section 3.6 Systems of Linear Equations in Three Variables and Applications Section 3.7 Solving Systems of Linear Equations by Using Matrices Group Activity: Creating a Quadratic Model of the Form y = at2 + bt + c Chapter 3 Summary Chapter 3 Review Exercises Chapter 3 Test Chapters 1-3 Cumulative Review Exercises
Chapter 4 Polynomials
Section 4.1 Properties of Integer Exponents and Scientific Notation Section 4.2 Addition and Subtraction of Polynomials and Polynomial Functions Section 4.3 Multiplication of Polynomials Section 4.4 Division of Polynomials Problem Recognition Exercises: Operations on Polynomials Section 4.5 Greatest Common Factor and Factoring by Grouping Section 4.6 Factoring Trinomials Section 4.7 Factoring Binomials Problem Recognition Exercises: Factoring Summary Section 4.8 Solving Equations by Using the Zero Product Rule Group Activity: Investigating Pascal's Triangle Chapter 4 Summary Chapter 4 Review Exercises Chapter 4 Test Chapters 1-4 Cumulative Review Exercises
Chapter 5 Rational Expressions and Rational Equations
Section 5.1 Rational Expressions and Rational Functions Section 5.2 Multiplication and Division of Rational Expressions Section 5.3 Addition and Subtraction of Rational Expressions Section 5.4 Complex Fractions Problem Recognition Exercises: Operations on Rational Expressions Section 5.5 Solving Rational Equationsv Problem Recognition Exercises: Rational Equations vs. Expressions Section 5.6 Applications of Rational Equations and Proportions Section 5.7 Variation Group Activity: Computing the Future Value of an Investment Chapter 5 Summary Chapter 5 Review Exercises Chapter 5 Test Chapters 1-5 Cumulative Review Exercises
Chapter 6 Radicals and Complex Numbers
Section 6.1 Definition of an nth Root Section 6.2 Rational Exponents Section 6.3 Simplifying Radical Expressions Section 6.4 Addition and Subtraction of Radicals Section 6.5 Multiplication of Radicals Problem Recognition Exercises: Simplifying Radical Expressions Section 6.6 Division of Radicals and Rationalization Section 6.7 Solving Radical Equations Section 6.8 Complex Numbers Group Activity: Margin of Error of Survey Results Chapter 6 Summary Chapter 6 Review Exercises Chapter 6 Test Chapters 1-6 Cumulative Review Exercises
Chapter 7 Quadratic Equations and Functions
Section 7.1 Square Root Property and Completing the Square Section 7.2 Quadratic Formula Section 7.3 Equations in Quadratic Form Problem Recognition Exercises: Quadratic and Quadratic Type Equations Section 7.4 Graphs of Quadratic Functions Section 7.5 Vertex of a Parabola: Applications and Modeling Section 7.6 Nonlinear Inequalities Problem Recognition Exercises: Recognizing Equations and Inequalities Group Activity: Creating a Quadratic Model of the Form y = a(x – h)2 + k Chapter 7 Summary Chapter 7 Review Exercises Chapter 7 Test Chapters 1-7 Cumulative Review Exercises
Chapter 8 Exponential and Logarithmic Functions and Applications
Section 8.1 Algebra and Composition of Functions Section 8.2 Inverse Functions Section 8.3 Exponential Functions Section 8.4 Logarithmic Functions Problem Recognition Exercises: Identifying Graphs of Functions Section 8.5 Properties of Logarithms Section 8.6 The Irrational Number and Change of Base Problem Recognition Exercises: Logarithmic and Exponential Forms Section 8.7 Logarithmic and Exponential Equations and Applications Group Activity: Creating a Population Model Chapter 8 Summary Chapter 8 Review Exercises Chapter 8 Test Chapters 1-8 Cumulative Review Exercises
Chapter 9 Conic Sections
Section 9.1 Distance Formula, Midpoint Formula, and Circles Section 9.2 More on the Parabola Section 9.3 The Ellipse and Hyperbola Problem Recognition Exercises: Formulas and Conic Sections Section 9.4 Nonlinear Systems of Equations in Two Variables Section 9.5 Nonlinear Inequalities and Systems of Inequalities Group Activity: Investigating the Graphs of Conic Sections on a Calculator Chapter 9 Summary Chapter 9 Review Exercises Chapter 9 Test Chapters 1-9 Cumulative Review Exercises
Chapter 10 Binomial Expansions, Sequences, and Series
Section 10.1 Binomial Expansions Section 10.2 Sequences and Series Section 10.3 Arithmetic Sequences and Series Section 10.4 Geometric Sequences and Series Problem Recognition Exercises: Identifying Arithmetic and Geometric Sequences Group Activity: Investigating Mean and Standard Deviation Chapter 10 Summary Chapter 10 Review Exercises Chapter 10 Test Chapters 1-10 Cumulative Review Exercises
Additional Topics Appendix
Section A.1 Determinants and Cramer's Rule
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Recipe: Panzanella With Roasted Squash and Tomatoes
If firing up the oven is the last thing you'd do this time of year, you might try grilling the squash and quickly broiling the tomatoes. We use our countertop oven to avoid heating the whole kitchen.
1 pound summer squash, cut into 1-inch cubes
1 tablespoon chopped rosemary leaves
7 tablespoons extra virgin olive oil, divided
Kosher salt
Freshly ground black pepper
1 pint (about 2 cups) cherry tomatoes
2 cloves garlic, thinly sliced
4 cups (1-inch) whole-grain bread cubes
1/2 sweet red onion, thinly sliced
1 tablespoon lemon juice
1 teaspoon Dijon mustard
Preheat oven to 375°F.
Toss summer squash, rosemary, 1 tablespoon olive oil, a pinch of salt and a crack of black pepper together in a bowl. Arrange squash in a single layer on a baking sheet and place in oven for 10 minutes.
Meanwhile, toss cherry tomatoes, garlic, 1 tablespoon olive oil, a pinch of salt and a crack of black pepper together in a bowl.
Using a spatula, turn the squash over and then add cherry tomatoes to the pan. Roast until tomatoes just burst, about 20 more minutes.
While vegetables are roasting, heat 2 tablespoons olive oil in a large skillet over medium-low heat. Add bread cubes and a pinch of salt and toss to coat. Cook, turning frequently, until bread is golden and crispy. Remove from heat.
When vegetables are done, remove from pan oven and let cool.
About 20 minutes before serving, combine the remaining 3 tablespoons olive oil, lemon juice, and mustard to make dressing. Toss the roasted vegetables, red onion, bread cubes, and dressing together in a large bowl. Let sit so flavors can combine. Taste and season with additional salt and pepper, if desired.
Related: Weeknight Recipe: Panzanella
(Images: Emily Ho)


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Definition of Simpson, Wallis in English:
Simpson, Wallis
(1896–1986), American wife of Edward, Duke of Windsor (Edward VIII); born Wallis Warfield. Her relationship with the king caused a scandal in view of her impending second divorce and forced the king's abdication in 1936.
For editors and proofreaders
Line breaks: Wal¦lis Simp|son
Definition of Simpson, Wallis in:
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What to Consider When Choosing A Premium WordPress Theme
A WordPress premium theme is a gathering of files that functions collectively to create a graphical interface through an original merging design for a website. These documents or files are also known as template files. A premium WordPress themes is not free to buy.
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|8 Reviews
|Half Baths
|Property type
|Minimum Stay
|7 nights
Located on one acre of beautiful lawned gardens in the countryside of Tal Balal,'Casa Giarda' is only a ten
minute drive from St. Julians. The accommodation
comprises of three double bedrooms and two twin bedrooms, a
bathroom and two shower rooms. The well equipped kitchen
includes an oven/hob/microwave and fridge/freezer. The air conditioned, open plan living and dining room
overlook the lawned luscious gardens. The house also offers a
200 year old den with an open fireplace where one can
relax, read from the small library and watch TV.
The roman style pool is surrounded by a bbq area and a large sun terrace. There is also a covered pergola for those hot summer days! A separate annex located away from the main building is set in its own gardens, comprising of a double bedroom and single bedroom, shower room and a small kitchenette. The spectacular 360 degree views enable you to feast your eyes over the island, including fantastic festa firework displays in the summer.
Getting Married!: For couples getting married in Malta, we also offer wedding planning services.
I cannot recommend Casa Giarda highly enough. If you are visiting Malta with 8 to 14 people, then there is no better place to stay. Located in the center of everything, yet secluded on its own very large plot of land with beautiful landscaped gardens, the villa is truly one of a kind. During our 2 week stay in May with 5 adults and 3 kids, not a single person could fault it.
The pool was huge, clear and lovely. Water was perfect even in May. The barbeque area was spacious, clean, had lots of shady areas and comfortable seating for 20 or more people! Everyone could do exactly what they wanted. Relax and read in the sun. Sleep in the shade. Play cards or enjoy a drink under the covered verandah. Or swim! The grounds and views were stunning. You can see for 6 or more miles in almost every direction. There is not an 'ugly' side to the 360 degree vista. In summer, you will be able to see fireworks from all over the island. The kids had a blast exploring every part of the yard. Did I mention it's huge? You just don't find this in Malta!
The house itself is large, comfortable and has every amenity you need. It is beautifully decorated, and the owners have spared no expense and paid attention to every detail to make your stay extremely enjoyable in a luxurious setting that embraces its farmhouse character. The owners could not have been more courteous or helpful. They even met us at the house and stayed on the phone with us to make sure we found the house 'ok'.
Although the villa is located very close to 2 great supermarkets, many good restaurants, and shopping, you truly feel like you are in the middle of nowhere. It is quiet, you don't have to worry about finding a parking spot, don't have to mess with neighbors (the villa is surrounded by 48 acres of farmland as we discovered when we talked to a local farmer), and I don't think any of us have ever slept so soundly on a vacation. The house is at the very end of a scenic alley that sees no traffic night or day. As a base to explore Malta itself, L'Iklin could not be more central. You can be at Busy Bee's in Msida (only place to get ricotta cannoli) in 5 minutes. St. Julians, Sliema, Paceville or Valletta are all just a quick 10 minute (or shorter) drive. Mellieha Bay (our favorite beach), and Paradise Bay can be reached in just 20 minutes.
Whenever we visit Malta in the future, this is definitely where we will be staying! Thanks again Damian and Monique!
Stephen and Shelley, USA
The villa is quite remote, although bus stops are only a 10 minute walk. With the supermarket being nearer 20 minutes, I would highly recommend hiring a car. Driving on the island is a pleasure, the local drivers are patient and seem to give hire cars a wide berth.
There were 13 of us for our stay including four children. There is plenty of space, at no point were we on top of one another inside or out. The children thoroughly enjoyed the pool and basketball hoop. However there is a considerable amount of flies in the area, probably because there's a pig farm a five minutes away. Fortunately the farmland smells are restricted to the lane approaching the villa. The fantastic looking grass area at the top of the steps was just soil with a few shoots, apparently ruined by an infestation – prior warning of this would have been appreciated as it gave a very disappointing first impression. However the disappointment continued with the general maintenance of the property and grounds being pretty poor and the pictures advertised are not recent. To list a few, the pool house door was off its runners and immovable, the pool lights didn't work with one having no casing and exposed connections, the pond was half full with green sludge, lounge furniture is threadbare, the water pump constantly turns off causing water pressure to drop off, many of the lights in the main villa didn't work or had bulbs missing, the light diffuser in the kitchen was half full of dead insects, the table lamp in the reading room had exposed wiring, we were unable to get the air conditioning working, kitchen was slightly under equipped only two knives (a bread knife and a chopping knife that was as sharp as a spoon)and several of the showers are a dribble at best (regardless of water pressure). The annex didn't fare much better with the same shower and lighting issues, as well a bedroom door that sticks shut!! Which left one of our party trapped for nearly 15 minutes.
We made the most of what we had and enjoyed ourselves, but would not return to Casa Giarda due to additional charges that in my opinion should be included for an accommodation that is already over priced for the actual product received. I don't doubt this was a fantastic place when it was first let, but standards have most definitely slipped.
August being peak season we opted to stay away from the coast, we certainly made the right decision! Casa Giarda provided us with ideal accommodation for a family of 11 - all with different expectations! The accommodation is not luxurious by any means - if you are looking for luxury I would suggest a hotel. The accommodation was comfortable and very spacious providing us all with privacy when required! Endless hours of fun where spent in the pool which was fabulous and a good size. There is plenty of outdoor seating and the garden is gorgeous with the most incredible views across Malta.
The one thing we missed was a dishwasher - but just a small thing.
We called the owners a couple of times over various things and they were always there at the drop of a hat, incredibly helpful which we were grateful for.
The property is difficult to find and is located up a very narrow lane which some taxi drivers are not happy to drive up - it is just a short walk but be aware if you have lots of luggage on arrival. There is enough parking for 3 cars and it is very secure behind a locked gate.
Overall we were very pleased with our accommodation and would certainly recommend to other family groups looking to escape the coast during peak season! And the views really are amazing!
Thank you very much Monica and Damian for making our stay so comfortable.
Our family of nine people, including older teenagers, has just returned from Casa Giarda after spending an unforgettable two weeks there. Everything about the villa was perfect; there was ample room for all of us and the pool was just amazing! The views were wonderful and we soon found our way around the area. We did hire cars whilst there; I think that without this our holiday might not have been quite so idyllic. Many thanks to Damian and Monique and the staff who discreetly visited the villa to clean, garden etc. I only hope we can return one day!
We just came back from a two week stay at Casa Giarda, and we loved the place. Big house with all the amenities you need. Huge outdoor area with beautiful garden and a big swimming pool. The house is situated on a quiet spot on the countryside, yet it is still close to supermarkets, shopping, restaurants and the sea. It is recommended to rent a car, but there is a bus stop just 5 min. walk from the house. I would recommend this house to anyone.
Myself and 11 other twenty somethings came over from London to see some sun, have a party but still kick back and chill out. Casa Giarda was the perfect platform for anything we could have wanted to do.
The location is pretty much perfect, being really close to St Julians, Paceville and Valetta in the East, then just a short drive to Melieha, Paradise Bay and the Gozo/Comino ferries in the North and Mdina and Rabat in the West.
The house itself is awesome! The garden is big and the pool is huge, both crucial as we hardly spent any time indoors. The pool area became central to the house as any time we spent at the house was spent lazing in or around it. Almost every night we would fire up a barbeque poolside, put on some music and crack a couple of cold beers after a 'hard' day's beaching, diving or sighteseeing. There are some amazing viewpoints on the property of the surrounding landscape but none better than on the roof of the annex, where you can see practically the whole island and in particular gives you a front row seat for the fireworks every evening.
We hired cars and once we had safely negotiated the narrow gauntlet of Giarda Lane, there was ample parking. When we wanted to go out and have a few drinks there is a cab service just up the road from the house with very reasonable rates and was particularly handy (Ask for Mario - a super-cool dude who put up with our drunken shenanigans like a trooper and is not averse to a bit of harmless bartering).
All in all I cannot say enough how ideal Casa Giada was. It made our fantastic Maltese holiday that much better. Monique, the owner/supervisor was really cool too, directing us to the house and even setting us up with some basics like tea, coffee, milk, cheese, etc. I got the feeling that she would have been happy to help in any way possible during the week, but everything at the house was in such good condition that we didn't have any reason to contact her with any problems.
Speaking as the King of Casa Giarda, on behalf of my minions, book it now and you won't regret it.
Mr I
Malta is very small.... cyrstal blue sea beaches, great restaurants and amazing nightlife are not more than a 10 minute drive away!
|Rate Period
|Weekend Night
Jun 29 2016 - Sep 27 2016
7 night minimum stay
My Standard Rate
7 night minimum stay
|No additional mandatory fees
Please note that the above quoted prices are for use of the main house only, which accommodates a maximum of ten persons. Additional 520 Euro's is charged for use of the annex which accommodates a further 3 persons.
A free of charge 'Welcome Pack' will be provided at the villa on your arrival. This would typically include some local Maltese delicacies, fresh bread, milk, water and a bottle of Malt


text:
Island of Vice
Theodore Roosevelt's Quest to Clean Up Sin-Loving New York
by Richard Zacks
- #52 in Nonfiction, History, Americas, United States, 19th Century
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A ROLLICKING NARRATIVE HISTORY OF THEODORE ROOSEVELT'S EMBATTLED TENURE AS POLICE COMMISSIONER OF CORRUPT, PLEASURE-LOVING NEW YORK CITY IN THE 1880s, AND HIS DOOMED MISSION TO WIPE OUT VICE
In the 1890s, New York City was America's financial, manufacturing, and entertainment capital, and also its preferred destination for sin, teeming with 40,000 prostitutes, glittering casinos, and all-night dives packed onto the island's two dozen square miles. Police captains took hefty bribes to see nothing while reformers writhed in frustration.
In Island of Vice, bestselling author Richard Zacks paints a vivid picture of the lewd underbelly of 1890s New York, and of Theodore Roosevelt, the cocksure crusading police commissioner who resolved to clean up the bustling metropolis, where the silk top hats of Wall Street bobbed past teenage prostitutes trawling Broadway.
Writing with great wit and zest, Zacks explores how Roosevelt went head-to-head with corrupt Tammany Hall, took midnight rambles with muckraker Jacob Riis, banned barroom drinking on Sundays, and tried to convince 2 million New Yorkers to enjoy wholesome family fun. In doing so, Teddy made a ruthless enemy of police captain "Big Bill" Devery, who grew up in the Irish slums and never tired of fighting "tin soldier" reformers. Roosevelt saw his mission as a battle of good versus evil; Devery saw prudery standing in the way of fun and profit.
When righteous Roosevelt's vice crackdown started to succeed all too well, many of his own supporters began to turn on him. Cynical newspapermen mocked his quixotic quest, his own political party abandoned him, and Roosevelt discovered that New York loves its sin more than its salvation.
Zacks's meticulous research and wonderful sense of narrative verve bring this disparate cast of both pious and bawdy New Yorkers to life. With cameos by Stephen Crane, J. P. Morgan, and Joseph Pulitzer, plus a horde of very angry cops, Island of Vice is an unforgettable portrait of turn-of-the-century New York in all its seedy glory, and a brilliant portrayal of the energetic, confident, and zealous Roosevelt, one of America's most colorful public figures.
From the Hardcover edition.
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eBook Details
- Knopf Doubleday Publishing Group, March 2012
- Imprint:
- 9780385534024
- Language:
- English
- Download options:
- EPUB 2 (Adobe DRM)
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The process of buying a new Nissan car or truck can seem overwhelming if you don't know where to begin. Edmunds.com can get you started on the right track with a convenient directory of Nissan car dealerships in and around Lakeshore, Florida. Compare online price quotes on the new or used car, truck, SUV, minivan, or wagon of your choice to locate the best deals. Edmunds.com makes it easy to find trusted Nissan car dealers in Lakeshore, saving car buyers time and money on what will be an important purchase.
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I am attempting to integrate this plugin to my website (http://www.beecaveyoga.com) but when subscribers click on the confirmation link in their email it takes them to the webpage indicating their subscription has bee confirmed. However, the following message is also there:
WARNING - Weaver II is not designed to use sidebar.php directly.
This message is most likely caused by an invalid child theme calling the standard WordPress function get_sidebar('sidebar-name') with an invalid sidebar-name. It is also possible this is called by an incompatible plugin.
Please advise.


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Boasting a luxurious design, the Joules Women's Evedon Wellies - French Navy feature a classic, tall style and are made from a durable rubber mix. These stunning wellies combine style with practicality. Providing excellent grip and cold weather resistance, the back of the wellies fall away for an elegant look. - L.M.
|Footwear Style:
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You can also check the status of your order and individual items by accessing My Account details and following the prompts.
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D70 Manual
Somewhere I came across a place to download the manual for Nikon D70's SLR camera. Does anyone know where or even if I can get one.
I'm going on vacation about the time I'll get the camera and want to be able to study the manual before then.
#1. "RE: D70 Manual" | In response to Reply # 0Covey22 Charter MemberWed 25-Feb-04 03:03 PM
All posts/links to the D70 manual to date have been considered pre-production and therefore is proprietary to Nikon. When Nikon officially releases the camera and/or posts the manual for public use and download, then it's okay to post links to that information (i.e., an official link on Nikon USA or Japan website). We're currently prohibiting the posting of such information because the Nikonians site might be implicated in "enabling" the release of pre-production information, and that would be detrimental to our operation and standing within the Nikon community. I would strongly advise waiting for the official release of information - it's not too far off if Nikon keeps to it's mid-March release dates for the D70 kit. I am locking this thread now. Thanks!


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Home > Wellness > Health Library > Renal Cell Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI]
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
Incidence and Mortality
Estimated new cases and deaths from renal cell (kidney and renal pelvis) cancer in the United States in 2015:[1]
Follow-up and Survivorship
Renal cell cancer, also called renal adenocarcinoma, or hypernephroma, can often be cured if it is diagnosed and treated when still localized to the kidney and to the immediately surrounding tissue. The probability of cure is directly related to the stage or degree of tumor dissemination. Even when regional lymphatics or blood vessels are involved with tumor, a significant number of patients can achieve prolonged survival and probable cure.[2] When distant metastases are present, disease-free survival is poor; however, occasional selected patients will survive after surgical resection of all known tumor. Because a majority of patients are diagnosed when the tumor is still relatively localized and amenable to surgical removal, approximately 73% of all patients with renal cell cancer survive for 5 years.[3] Occasionally, patients with locally advanced or metastatic disease may exhibit indolent courses lasting several years. Late tumor recurrence many years after initial treatment also occasionally occurs.
Renal cell cancer is one of the few tumors in which well-documented cases of spontaneous tumor regression in the absence of therapy exist, but this occurs very rarely and may not lead to long-term survival.
Treatment Modalities
Surgical resection is the mainstay of treatment of this disease. Even in patients with disseminated tumor, locoregional forms of therapy may play an important role in palliating symptoms of the primary tumor or of ectopic hormone production. Systemic therapy has demonstrated only limited effectiveness.
Related Summaries
Other PDQ summaries containing information related to renal cell cancer include the following:
Approximately 85% of renal cell cancers are adenocarcinomas, and most of those are of proximal tubular origin. Most of the remainder are transitional cell carcinomas of the renal pelvis. (Refer to the PDQ summary on Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment for more information.) Adenocarcinomas may be separated into clear-cell and granular-cell carcinomas; however, the two cell types may occur together in some tumors. Some investigators have found that granular-cell tumors have a worse prognosis, but this finding is not universal. Distinguishing between well-differentiated renal adenocarcinomas and renal adenomas can be difficult. The diagnosis is usually made arbitrarily on the basis of size of the mass, but size alone should not influence the treatment approach, since metastases can occur with lesions as small as 0.5 centimeter.
The staging system for renal cell cancer is based on the degree of tumor spread beyond the kidney.[1,2,3] Involvement of blood vessels may not be a poor prognostic sign if the tumor is otherwise confined to the substance of the kidney. Abnormal liver function test results may be caused by a paraneoplastic syndrome that is reversible with tumor removal, and these types of results do not necessarily represent metastatic disease. Except when computed tomography (CT) examination is equivocal or when iodinated contrast material is contraindicated, CT scanning is as good as or better than magnetic resonance imaging for detecting renal masses.[4]
Definitions of TNM
The American Joint Committee on Cancer has designated staging by TNM classification to define renal cell cancer.[5]
Current treatment cures more than 50% of patients with stage I disease, but results in patients with stage IV disease are very poor. Thus, all patients with newly diagnosed renal cell cancer can appropriately be considered candidates for clinical trials, when possible.
Stage I renal cell cancer is defined by the American Joint Committee on Cancer's TNM classification system:[1]
Surgical resection is the accepted, often curative, therapy for stage I renal cell cancer. Resection may be simple or radical. The latter operation includes removal of the kidney, adrenal gland, perirenal fat, and Gerota fascia, with or without a regional lymph node dissection. Some, but not all, surgeons believe the radical operation yields superior results. In patients who are not candidates for surgery, external-beam radiation therapy (EBRT) or arterial embolization can provide palliation. In patients with bilateral stage I neoplasms (concurrent or subsequent), bilateral partial nephrectomy or unilateral partial nephrectomy with contralateral radical nephrectomy, when technically feasible, may be a preferred alternative to bilateral nephrectomy with dialysis or transplantation.[2] Increasing evidence suggests that a partial nephrectomy is curative in selected cases. A pathologist should examine the gross specimen as well as the frozen section from the parenchymal margin of excision.[3]
Standard treatment options:
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I renal cell cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Stage II renal cell cancer is defined by the American Joint Committee on Cancer's TNM classification system:[1]
Radical resection is the accepted, often curative, therapy for stage II renal cell cancer. The operation includes removal of the kidney, adrenal gland, perirenal fat, and Gerota fascia, with or without a regional lymph node dissection.[2] Lymphadenectomy is commonly employed, but its effectiveness has not been definitively proven. External-beam radiation therapy (EBRT) has been given before or after nephrectomy without conclusive evidence that this improves survival when compared with the results of surgery alone; however, it may be of benefit in selected patients with more extensive tumors. In patients who are not candidates for surgery, arterial embolization can provide palliation.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage II renal cell cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Stage III renal cell cancer is defined by the American Joint Committee on Cancer's TNM classification system:[1]
Treatment information for patients whose disease has the following classification:
Radical resection is the accepted, often curative, therapy for stage III renal cell cancer. The operation includes removal of the kidney, adrenal gland, perirenal fat, and Gerota fascia, with or without a regional lymph node dissection.[2] Lymphadenectomy is commonly employed, but its effectiveness has not been definitively proven. External-beam radiation therapy (EBRT) has been given before or after nephrectomy without conclusive evidence that this improves survival when compared with the results of surgery alone; however, it may be of benefit in selected patients with more extensive tumors. In patients who are not candidates for surgery, arterial embolization can provide palliation. In patients with bilateral stage T3a neoplasms (concurrent or subsequent), bilateral partial nephrectomy or unilateral partial nephrectomy with contralateral radical nephrectomy, when technically feasible, may be a preferred alternative to bilateral nephrectomy with dialysis or transplantation.[3]
Treatment information for patients whose disease has the following classification:
Radical resection is the accepted, often curative, therapy for this stage of renal cell cancer. The operation includes removal of the kidney, adrenal gland, perirenal fat, and Gerota fascia, with or without a regional lymph node dissection. Lymphadenectomy is commonly employed, but its effectiveness has not been definitively proven. Surgery is extended to remove the entire renal vein and caval thrombus and a portion of the vena cava as necessary.[4] EBRT has been given before or after nephrectomy without conclusive evidence that this improves survival when compared with the results of surgery alone; however, it may be of benefit in selected patients with more extensive tumors. In patients who are not candidates for surgery, arterial embolization can provide palliation. In patients with stage T3b neoplasms who manifest concurrent or subsequent renal cell carcinoma in the contralateral kidney, a partial nephrectomy, when technically feasible, may be a preferred alternative to bilateral nephrectomy with dialysis or transplantation.[3,5,6]
Treatment information for patients whose disease has the following classifications:
This stage of renal cell cancer is curable with surgery in a small minority of cases. A radical nephrectomy and lymph node dissection is necessary. The value of preoperative and postoperative EBRT has not been demonstrated, but EBRT may be used for palliation in patients who are not candidates for surgery. Arterial embolization of the tumor with gelfoam or other materials may be employed preoperatively to reduce blood loss at nephrectomy or for palliation in patients with inoperable disease.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III renal cell cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Stage IV renal cell cancer is defined by the American Joint Committee on Cancer's TNM classification system:[1]
The prognosis for any treated renal cell cancer patient with progressing, recurring, or relapsing disease is poor, regardless of cell type or stage. Almost all patients with stage IV renal cell cancer are incurable. The question and selection of further treatment depends on many factors, including previous treatment and site of recurrence, as well as individual patient considerations. Carefully selected patients may benefit from surgical resection of localized metastatic disease, particularly if they have had a prolonged, disease-free interval since their primary therapy.
Local Therapy
Tumor embolization, external-beam radiation therapy (EBRT), and nephrectomy can aid in the palliation of symptoms caused by the primary tumor or related ectopic hormone or cytokine production. For patients with metastatic disease, two randomized studies have demonstrated an overall survival (OS) benefit in selected patients who have undergone initial cytoreductive nephrectomy prior to the administration of interferon-alpha.[2,3]
In the larger study, 246 patients were randomly assigned to either undergo a nephrectomy followed by interferon-alpha or receive interferon-alpha alone.[2] The median OS was 11.1 months when the primary tumor was removed first (95% confidence interval [CI], 9.2–16.5) compared with 8.1 months in the control arm (95% CI, 5.4–9.5; P = .05). In the smaller study, 85 patients with identical eligibility criteria were randomly assigned to treatment as in the larger study.[3] Patients who underwent nephrectomy before receiving interferon-alpha had a median OS of 17 months compared with an OS of 7 months in patients who received interferon-alpha alone (hazard ratio [HR], 0.54; 95% CI, 0.31–0.94; P = .03).
These studies were restricted to patients who were asymptomatic or minimally symptomatic, with a performance status (PS) of zero or one, according to the Eastern Cooperative Oncology Group (ECOG) rating scale; these patients were also considered to be candidates for postoperative immunotherapy.[2,3][Level of evidence: 1iiA] Whether the benefit of cytoreductive nephrectomy extends to patients who are not subsequently treated with interferon-alpha has not been tested.
Selected patients with solitary or a limited number of distant metastases can achieve prolonged survival with nephrectomy and surgical resection of the metastases.[4,5,6,7,8,9] Even patients with brain metastases had similar results.[10] The likelihood of achieving therapeutic benefit with this approach appears enhanced in patients with a long disease-free interval between the initial nephrectomy and the development of metastatic disease.
Cytokine Therapy
Cytokine therapy with interferon-alpha or interleukin-2 (IL-2) has been shown to induce objective responses, and interferon-alpha appears to have a modest impact on survival in selected patients. Interferon-alpha has approximately a 15% objective response rate in appropriately selected individuals.[11] In general, these patients have nonbulky pulmonary and/or soft tissue metastases with excellent PS ratings of zero or one, according to the ECOG rating scale, and the patients show no weight loss. The interferon-alpha doses used in studies reporting good response rates have been in an intermediate range (6–20 million units 3 times weekly). A Cochrane analysis of six randomized trials, with a total of 963 patients, indicated an HR for survival of 0.78 (CI, 0.67–0.90) or a weighted average improvement in survival of 2.6 months.[11][Level of evidence: 1iiA]
High-dose IL-2 produces a similar overall response rate to interferon-alpha, but approximately 5% of patients had durable complete remissions.[12,13,14,15,16,17] IL-2 has never been shown in a randomized, controlled trial to result in longer survival. High-dose IL-2 is used because it is the only systemic therapy that has been associated with inducing durable complete remissions, albeit in a small fraction (about 5%) of patients who are eligible for this treatment. The optimum dose of IL-2 is unknown. High-dose therapy appears to be associated with higher response rates but with more toxic effects. Low-dose inpatient regimens have activity against renal cell carcinoma with fewer toxic effects, especially hypotension, but have not been shown to be superior to placebo or any alternative regimen with regard to survival or quality of life.[18] Outpatient subcutaneous administration has also demonstrated responses with acceptable toxic effects but, again, with unclear survival or quality of life benefit.[19] Combinations of IL-2 and interferon-alpha have been studied, but outcomes have not been better with high-dose or low-dose IL-2 alone.[20,21]
Antiangiogenic and Other Targeted Therapy
A growing understanding of the biology of cancer in general, and renal cell carcinoma in particular, has led to the development and U.S. Food and Drug Administration (FDA) approval of six new agents that target specific growth pathways. Two of the approved targeted therapies block the mammalian target of rapamycin (mTOR), a serine/threonine protein kinase that regulates cell growth, division, and survival.
Temsirolimus, an intravenously administered mTOR inhibitor, was shown to result in prolonged OS compared with interferon-alpha in a phase III randomized controlled trial that enrolled intermediate- and poor-risk patients. The trial enrolled patients with a variety of subtypes of renal cell carcinoma and was not restricted to clear-cell kidney cancer. The HR for death was 0.73 (95% CI, 0.58–0.92, P = .008), making temsirolimus the only therapy for renal cell carcinoma to have clearly been shown to result in longer OS than interferon-alpha using conventional statistical analysis.[22]
Everolimus is an orally administered mTOR inhibitor that was evaluated in a double-blind, randomized, placebo-controlled phase III trial. The trial enrolled patients with metastatic renal cell carcinoma with a clear-cell component that had progressed during or within 6 months of stopping treatment with sunitinib or sorafenib, or both drugs. Median progression-free survival (PFS) was 4.0 months with everolimus compared with 1.9 months with placebo.[23] No difference in OS was reported.
Based on research showing that most clear-cell renal cell carcinomas carried a mutation resulting in constitutive production of cytokines stimulating angiogenesis, several agents that targeted vascular endothelial growth factor (VEGF)-mediated pathways were developed. Several of these agents have been shown in randomized, controlled trials to significantly delay progression of clear-cell renal cell carcinoma, but none has resulted in a statistically significant increase in OS as conventionally assessed. Many of these trials allowed crossover upon progression and, in some instances, other agents with similar biological activity were available to patients after they withdrew from the clinical trial. These facts may have made it more difficult to detect an OS benefit. For the clinician, this makes it challenging to determine the real benefit of these drugs to the patient. The four FDA-approved anti-VEGF agents include three oral tyrosine kinase inhibitors: pazopanib, sorafenib, and sunitinib; and an anti-VEGF monoclonal antibody, bevacizumab. Axitinib is a newer, highly selective, and more potent inhibitor of VEGF receptors 1, 2, and 3 and has been approved by the FDA for the treatment of advanced renal cell carcinoma after the failure of one previously received systemic therapy.[24]
Sunitinib and the combination of bevacizumab plus interferon-alpha have each been associated with longer PFS than interferon-alpha alone in randomized, controlled trials. Sunitinib is an orally available multikinase inhibitor (VEGFR-1, VEGFR-2, PDGFR, c-Kit). In 750 previously untreated patients, all of whom had clear-cell kidney cancer, a phase III trial compared sunitinib with interferon-alpha.[25] Sunitinib as first-line systemic therapy was associated with a median PFS of 11 months compared with 5 months for interferon-alpha. The HR for progression was 0.42 (95% CI, 0.32–0.54; P < .001).[25][Level of evidence: 1iiDiii] However, the analysis for OS showed a strong but statistically nonsignificant trend to improved survival (26.4 months vs. 21.8 months, HR, 0.82; 95% CI, 0.669–1.001; P = .051).[26][Level of evidence: 1iiDiii] Bevacizumab, a monoclonal antibody that binds to and neutralizes circulating VEGF protein, delayed progression of clear-cell renal cell carcinoma when compared with placebo in patients with disease refractory to biological therapy.[27] Similarly, bevacizumab plus interferon-alpha as first-line therapy resulted in longer PFS but not OS compared with interferon alpha alone in two similarly designed, randomized, controlled trials.[28,29]
Axitinib was shown to prolong progression of disease when used as second-line systemic therapy. A randomized, controlled trial of 723 patients conducted at 175 sites in 22 countries evaluated axitinib versus sorafenib as treatment for renal cell carcinoma with a clear-cell component that had progressed during or after first-line treatment with sunitinib (54%), cytokines (35%), bevacizumab plus interferon (8%), or temsirolimus (3%).[24,30] The primary endpoint was PFS, and the data were analyzed when disease in 88% of the axitinib patients and 90% of the sorafenib patients had progressed, while 58% and 59%, respectively, had died.
Median PFS was 8.3 months for axitinib and 5.7 months for sorafenib (HR, 0.656; 95% CI, 0.552–0.779, P < .0001 for progressiondeath using a one-sided log-rank test and a threshold of P < .025 for significance). Median OS was 20.1 months with axitinib compared with 19.2 months with sorafenib (HR, 0.969; 95% CI, 0.80–1.17, P = .374). However, the largest benefit was seen in patients who received cytokines as first-line therapy and whose median PFS was 12.2 months with axitinib compared with 8.2 months with sorafenib (P < .0001), while median OS was 29.4 months with axitinib compared with 27.8 months with sorafenib (HR, 0.81; 95% CI, 0.5501.19; P = .144). In contrast, in patients who had previously received sunitinib, axitinib was associated with a 2.1-month increase in PFS compared with sorafenib (6.5 months vs. 4.4 months, one-sided P = .002), but median OS was nearly identical: 15.2 months with axitinib compared with 16.5 months with sorafenib (HR, 1.0; 95% CI, 0.782–1.270; P = .49).[30]
Comparing the toxicity of the axitinib and sorafenib regimens is complicated because the axitinib arm included a dose-escalation component, and only those patients who tolerated the lower dose were subsequently given the higher doses. Hypertension, nausea, dysphonia, and hypothyroidism were more common with axitinib, whereas palmar-plantar erythrodysesthesia, alopecia, and rash were more common with sorafenib.[24,30]
Pazopanib is an orally available multikinase inhibitor (VEGFR-1, VEGFR-2, VEGFR-3, PDGFR, and c-KIT) and has also been approved for the treatment of patients with advanced renal cell carcinoma.[31]
Pazopanib was evaluated in a randomized, placebo-controlled, international trial (VEG015192 [NCT00334282]) that enrolled 435 patients with clear-cell or predominantly clear-cell renal cell carcinoma.[32] Nearly 50% of the patients had previously received cytokine therapy, although the remainder of them were treatment naïve. PFS was significantly prolonged in the pazopanib arm at 9.2 months compared with 4.2 months in the placebo arm. The HR for progression was 0.46 (95% CI, 0.34–0.62; P < .0001), and the median duration of response was longer than 1 year.
Pazopanib was also compared with sunitinib in a randomized, controlled trial (NCT00720941) that enrolled 1,110 patients who had metastatic renal cell carcinoma with a clear-cell component in a 1:1 ratio.[33] The primary endpoint was PFS. The study was powered to assess the noninferiority of pazopanib. Results were reported when there was disease progression in 336 of 557patients (60%) who received pazopanib and 323 of 553 patients (58%) who received sunitinib. The median PFS time was 8.4 months for those in the pazopanib arm and 9.5 months for those in the sunitinib arm (HR, 1.05; CI, .9–1.22). There was no difference in OS (HR, 0.91; 95% CI, .76–1.08). Although quality of life was compared in the study, differences in the scheduled administration of the medications made this comparison difficult to interpret.
A subsequent double-blind, randomized, controlled, cross-over trial compared sunitinib followed by pazopanib with pazopanib followed by sunitinib, and the primary endpoint was patient preference for one drug over the other.[34] Patients were treated for 10 weeks with either sunitinib or pazopanib, followed by a 2-week washout period, followed by 10 more weeks of treatment with the other drug. Preference was assessed at the end of the second 10-week–treatment period. This study design created possible bias in favor of pazopanib.
Although the typical regimen for administering sunitinib is a 6-week cycle of 4 weeks on the drug and 2 weeks off the drug, the Patient Preference Study of Pazopanib Versus Sunitinib in Advanced or Metastatic Kidney Cancer (PISCES [NCT01064310]) chose a treatment period of 10 weeks rather than 12 weeks. Because of this treatment-period change, the 10 weeks of sunitinib treatment included 4 weeks on the drug, followed by 2 weeks off the drug, followed by 4 more weeks on the drug. Patients assigned to pazopanib followed by sunitinib had their preference for treatment assessed at the end of the second 4-weeks-on-the-drug period during which the patients took sunitinib daily for 28 days. At that point, the sunitinib side effects became the most severe. The expected result from an assessment conducted at the end of a 6-week treatment cycle versus the 4-week treatment cycle would be greatly abated side effects.
In addition, the 2-week washout period that occurred between the two 10-week treatment periods was a true break from treatment for patients assigned to take pazopanib first; however, for the patients taking sunitinib, the 2-week washout period was actually just the completion of their second 6-week treatment cycle. In other words, patients assigned to pazopanib first had a true 2-week break from treatment, and their drug preference was assessed at the peak period of toxic effects from sunitinib; however, the patients assigned to sunitinib first had no true treatment break before starting pazopanib and may have had less opportunity to recover from the side effects of sunitinib.
Despite these limitations, 70% of the patients preferred pazopanib, and 22% of the patients preferred sunitinib (P < .001). More patients preferred pazopanib regardless of the treatment they received first; however, that difference was greater for the patients who received pazopanib first (80% vs. 11%) compared with the patients who received sunitinib first (62% vs. 32%). The main side effects cited by the patients that contributed to patient preference were diarrhea, health-related quality of life, fatigue, loss of appetite, taste changes, nausea and vomiting, hand and foot soreness, stomach pain, and mouth and throat soreness. The patients preferring pazopanib cited less fatigue and better overall quality of life as the most common reasons for their preference. The patients preferring sunitinib cited less diarrhea and better quality of life as the most common reasons for their preference. Physician preference was a secondary endpoint of the study, and 61% of physicians preferred to continue patient treatment with pazopanib, compared with 22% of physicians who preferred to continue patient treatment with sunitinib.
Sorafenib is an orally available multikinase inhibitor (cRAF, bRAF, KIT, FLT-3, VEGFR-2, VEGFR-3, and PDGFR-β) and has also been approved for the treatment of patients with advanced renal cell carcinoma.[31]
In an international, multicenter, randomized trial with the primary endpoints of PFS and OS, 769 patients were stratified by the Memorial Sloan-Kettering Cancer Center prognostic risk category and by country and were randomly assigned to receive either sorafenib (400 mg bid) or a placebo. Approximately 82% of the patients had received IL-2 previously and/or interferon-alpha in both arms of the study. The median PFS for patients randomly assigned to sorafenib was 167 days compared with 84 days for patients randomly assigned to placebo (P < .001). The estimated HR for the risk of progression with sorafenib compared with a placebo was 0.44 (95% CI, 0.35–0.55). There was no significant difference in OS.[31][Level of evidence: 1iDiii] A subsequent phase II study of 189 patients randomly assigned to either sorafenib or interferon-alpha reported no difference (5.7 months vs. 5.6 months) in PFS, but sorafenib was associated with better quality of life than interferon-alpha.[35]
Responses to cytotoxic chemotherapy generally have not exceeded 10% for any regimen that has been studied in adequate numbers of patients.
Treatment Options
Because of the lack of curative therapy for metastatic disease and the promise of targeted therapies, patients should be considered for the many ongoing clinical trials testing single or combination therapies, including the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV renal cell cancer and recurrent renal cell cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
General Information About Renal Cell Cancer
Editorial changes were made to this section.
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of renal cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Renal Cell Cancer Treatment are:
Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."
The preferred citation for this PDQ summary is:
National Cancer Institute: PDQ® Renal Cell Cancer Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://www.cancer.gov/types/kidney/hp/kidney-treatment-pdq. Accessed <MM/DD/YYYY>.
Images in this summary 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 this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.
Based on the strength of the available evidence, treatment options may be described as either "standard" or "under clinical evaluation." These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Coping with Cancer: Financial, Insurance, and Legal Information page.
Contact Us
More information about contacting us or receiving help with the Cancer.gov Web site can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the Web site's Contact Form.
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
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The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
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Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.
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Last Revised: 2015-04-28
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Food For Fines
The Neenah Public Library and the Menasha Public Library will be having a combined Food for Fines drive. Saturday, November 8 through Sunday, November 16, return all your late library materials and have your fines cleared if you bring in non-perishable food items to the Circulation Desk at either library. Food items will be given to area food pantries.
Questions? Call Nancy at 886-6320.
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Democratic nominee for U.S. Senate Baron Hill released the following statement to his supporters after withdrawing from the U.S. Senate race and removing his name from the November ballot:
Washington County-Yesterday afternoon (Tuesday, July 5), troopers from the Indiana State Police Post at Sellersburg and deputies from the Washington County Sheriff's Department executed a search warrant at 90 Eastern Park Blvd., Lot 22, in Pekin, IN. The search warrant was executed after a lengthy investigation conducted by troopers from the Indiana State Police and deputies from the Washington County Sheriff's Department.
The 27th annual Firecracker 200 presented by the Scott County Visitors Commission, that was halted by rain on Sunday night, has been rescheduled for Sunday afternoon, July 31st reports track officials.
The following is the arrest list from Floyd County through the early morning hours of July 1.


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- Report: #1036515
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Complaint Review: Reefs2go.com
Reefs2go.com4552 B 107th Circle Clearwater, Florida United States of America
Reefs2go.com Heartbroken, How can a company send Corals out to die. Clearwater Florida
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With all that said... Here is what happened, we made 2 orders in one night because after we paid for the first we talked it out and decided to place a second. We called reefs2go the very next morning asking if they can ship the 2 orders together and were told there is nothing they can do and one order has been processed already and ready to ship. So we waited for the first order and this is what happen yesterday.. the order arrived from reefs2go. Foam cooler heat pack on top of brown paper.. not a problem as we live in MT in a cold aria and that is how Reeftopia sent our items... I ran to the tank set up the breeder on the side of the glass turned the night time lights on and shut off the main day time lights. Was very excited then I removed the brown paper and started to life one of the 5 bags.. the Green Bubble tip was flat on bottom the bag, that was tied off no air in the bag and water dripping all over.. you could fit a silver dollar inside the center of the anemone and the bag was full of small flakes of anemone pieces... Horrified of what I was seeing I called my other half to come home... I lifted the "green candy cane from the cooler.. no air again with water dripping all over.. and the side of it was white like it was bleaching. I floated in our baby breeder and went for the 3rd coral we ordered. the Hydnophora.. there was air in the bag yay... omg no .. WHITE again with slime hanging off the tip... omg.. this is bad.. float in breeder and go for the 4th...Frogspawn.. wth is it.. looks like a pieces of live rock with a green tint on the white " stick" and slime hanging off the stick.... float go for the last.. the one we ordered for me and I was so excited to have, and so i saved him for last. Praying he doesn't look like the other four that maybe he made it here safe.. My poor orange sun coral.. every tip except 1 was white from bleaching.. looked terrible.. and now I was crying. By now Rick come home.. he looked in the bags and just gasped. We began dripping water in the bags in hope they would "come to life" We dripped them for 3 hours and decided now we have to add them to the tank and pray they live. $150. later.. and nothing to show for it. As I said we placed a second order a few hours after the first so I am waiting for that to come in on Friday before I contact these so called people about what they have done to corals. I KNOW I DID EVERYTHING RIGHT.. we have several corals fish and sponges already and to see what was inside those bags was a major disgrace to coral reef keepers. To send living creatures in those conditions and have people pay for them, receive them and expect people to be happy with it? I have enclosed a link to pictures I have took sadly the anemone is now in a bucket as after dripping it for hours and putting him in our ( sick fishy aria )we woke to him dead and smelling pretty bad by morning. the others were put on frags and sat in the main tank with hope they will recover.. so far there is no sign of that happening. http://imageshack.us/g/1/10070011/
I will update on Friday when the second order comes in... this time I will attempt to take picture of them still in the bags so the WHOLE world knows for sure how they DO NOT care for corals !!!!!
This report was posted on Ripoff Report on 03/20/2013 04:39 PM and is a permanent record located here: http://www.ripoffreport.com/r/Reefs2gocom/Clearwater-Florida-33762/Reefs2gocom-Heartbroken-How-can-a-company-send-Corals-out-to-die-Clearwater-Florida-1036515. 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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