text:
Small Cell Lung Cancer Workup
- Author: Winston W Tan, MD, FACP; Chief Editor: Jules E Harris, MD, FACP, FRCPC more...
Approach Considerations
Lung cancer screening
The U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) have issued similar guidelines on lung cancer screening.[27, 28] The USPSTF recommends annual screening for lung cancer with low-dose CT (LDCT) in adults 55 to 80 years of age who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. The USPSTF recommends that screening be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.[28]
The ACS recommends LDCT screening in apparently healthy patients 55-74 years of age who have at least a 30 pack-year smoking history and who currently smoke or have quit within the past 15 years. The ACS stresses that the decision to initiate lung cancer screening should be shared between the clinician and patient and should involve discussion of the potential benefits, limitations, and harms associated with such screening.[27]
Initial workup
A thorough history and physical examination usually provide clues to the organ systems involved in small cell lung cancer (SCLC), and these are used to guide further workup (see Presentation). Investigations are performed to delineate the extent of disease and to assess organ function before therapy begins. In general, depending on tumor localization, biopsies from the primary tumor should be obtained using bronchoscopy or any of the following techniques[12] :
Endobronchial ultrasound (EBUS)
Endoscopic ultrasound
Transthoracic needle aspiration
Thoracoscopy (if necessary)
A metastatic lesion, if easily and safely accessible, may be the preferred option for a biopsy specimen; this will also provide pathological staging.[12]
Staging workup
The purpose of a staging workup for small cell lung cancer (SCLC) is to determine the prognosis and management of this disease. Patients with limited-stage disease are usually treated with combined chemoradiotherapy, whereas those with extensive-stage disease are usually treated with chemotherapy alone. Staging workup of SCLC is as follows[24, 29, 12] :
Complete history and physical examination (see Presentation)
Complete blood count (CBC) with differential
Serum electrolytes levels, including calcium
Liver function tests (LFTs)
Renal function tests (RFTs)
Serum lactate dehydrogenase (LDH) level
Serum alkaline phosphatase (ALP) level
Chest radiography
CT scanning of the chest and abdomen with intravenous contrast (including liver and adrenal glands)
CT scanning/magnetic resonance imaging (MRI) of the brain with IV contrast
Bone scanning
Bone marrow aspiration and biopsy if abnormalities are present in the CBC or peripheral smear
Staging should be adequate before making the diagnosis of limited-stage SCLC. Any pleural effusion should be tested cytologically for malignant cells, and isolated liver or adrenal lesions should be sampled by fine-needle aspiration (FNA) before a diagnosis of limited-stage disease is made. Some authorities suggest a bone marrow examination in the absence of any other evidence of spread.
See Small Cell Lung Cancer Staging for summary tables.
See Lung Cancer Staging -- Radiologic Options, a Critical Images slideshow, to help identify stages of the disease process.
Routine Laboratory Studies
A complete blood cell count (CBC) with differential, serum electrolyte levels, renal function studies, and liver function tests (LFTs) are all part of the routine staging workup, and in some cases, these studies may reveal the sites of metastasis (eg, elevated serum calcium and/or alkaline phosphatase [ALP] levels with bone metastasis). These tests are also important to assess organ function before starting therapy.
Serum lactate dehydrogenase (LDH) and sodium levels also provide prognostic information. Increased uric acid levels and impaired renal function may indicate the possibility of rapid tumor lysis syndrome with therapy.
Complete blood cell count
In 5-10% of patients, small cell lung cancer (SCLC) may have spread to bone marrow at presentation. Bone marrow examination is not routinely performed in SCLC unless abnormalities are identified in the CBC or peripheral smear examination, raising the possibility of bone marrow spread. These abnormalities may include cytopenia or the presence of immature white and red blood cells (a leukoerythroblastic blood picture), which raises the possibility of myelophthisic anemia.
Additionally, before instituting initial full-dose combination chemotherapy, the CBC should demonstrate the following:
Absolute neutrophil count (ANC) - Should be greater than 1000 x 10 3/µL
Hemoglobin level - Should be above 10 g/dL
Platelet count - Should be more than 100 x 10 3/µL
Serum chemistries
The presence of elevated serum calcium and ALP levels raises the suspicion of bone metastasis, and in such cases a bone scan should be ordered even in the absence of symptoms. Serum electrolytes should be obtained to look for paraneoplastic syndromes, such as syndrome of inappropriate antidiuretic hormone (SIADH) secretion. The presence of hyponatremia is considered an adverse prognostic indicator.
Elevated serum LDH indicates an increased tumor mass and high cell turnover; this finding is also an adverse prognostic indicator. Abnormal liver function findings raise the possibility of hepatic metastasis and may require adjustments to planned therapy.
Thoracic Imaging Studies
Good posteroanterior and lateral radiographs are useful in identifying the primary tumor, as well as concurrent parenchymal abnormalities. Mediastinal widening may indicate mediastinal lymph node involvement.
CT scanning
Computed tomography (CT) scanning of all common sites of metastasis should be performed to stage the disease adequately. Evaluation via CT scanning of the thorax (lungs and mediastinum) and commonly involved abdominal viscera (ie, liver, adrenals) is the minimum requirement in standard staging workup of SCLC. Intravenous contrast agents should be used whenever possible.[24] In the United States, CT scans of the chest and upper abdomen to include the liver and adrenal glands are standard.
Brain and Spinal Cord Imaging Studies
Brain metastasis may be present in as many as 10-15% of patients at diagnosis[24] and may be occult in 5% of patients. Consequently, magnetic resonance imaging (MRI) of the brain should be ordered in asymptomatic patients and in those with neurologic symptoms.[24] Because MRI is more sensitive than computed tomography (CT) scanning with contrast for detection of brain metastasis, MRI is used as the first-line imaging study in many institutions.
MRI has an increased ability to detect disease in proximity to neurovascular structures and is also considered standard in the workup of patients in whom spinal cord compression is suspected. Although a CT myelogram can establish the diagnosis of vertebral and paraspinal metastases, it is currently rarely used. MRI is noninvasive and very sensitive in establishing the diagnosis in almost all cases.
Skeletal Radionuclide Imaging
Bone is a common site of metastasis for small cell lung cancer (SCLC). A radionuclide bone scan should therefore be obtained to identify bone metastases.
Bone metastases from SCLC usually contain both osteolytic and osteoblastic components, and a bone scan is superior to plain radiographs in detecting osteoblastic lesions. However, because some benign lesions can also cause abnormalities on bone scans, obtaining plain radiographs of abnormal areas for radiographic correlation is important, particularly in weight-bearing bones at risk for fracture.
Bone scans should be obtained in all patients with SCLC at diagnosis or during follow-up if new bone symptoms develop or if the serum calcium or alkaline phosphatase level is elevated.
PET Scanning
Positron emission tomography (PET) scanning (see the image below) remains under evaluation for the staging of small cell lung cancer (SCLC).[30, 31] The American College of Chest Physicians (ACCP) does not recommend PET scanning in the routine staging of SCLC, although the National Comprehensive Cancer Network (NCCN) guidelines recommend combined PET-CT (computed tomography) scanning if limited-stage disease or metastasis is suspected.[24] PET-CT imaging is superior to PET scanning alone. (PET scanning is inferior to MRI or CT scanning for the detection of brain metastases.)
In small, uncontrolled studies, PET scanning has shown good accuracy (83-99%) in staging extensive- versus limited-stage SCLC.[30] Although PET scanning may improve the accuracy of staging, however, any lesion identified using this modality that would alter staging requires pathologic confirmation due to the possibility of a false-positive finding.[24] The full role of PET imaging in this setting remains to be determined.[30, 31]
Bronchoscopy and FNA
Small cell lung cancer (SCLC) is usually centrally located and can be approached easily with a bronchoscope. The advantage of endoscopy is direct visualization of the tumor, allowing for direct biopsy as well as cytologic examination of bronchial washings.
For tumors that cannot be diagnosed with transbronchial biopsy, transthoracic percutaneous fine-needle aspiration (FNA) carried out under computed tomography (CT) ̶ scan guidance is a reasonable alternative.
Sputum Cytology
Sputum cytology is a noninvasive test and, if positive, can provide an accurate diagnosis of central lung cancers. Although small cell lung cancer (SCLC) usually presents as a large, central tumor, tumor cells frequently involve the submucosal layer of the bronchus with little or no exophytic endobronchial extension. Therefore, sputum cytology is not as useful for diagnosing SCLC as it is for the diagnosis of squamous cell carcinoma.
In small cell lung cancer (SCLC), the presence of malignant pleural effusion upstages the disease to extensive-stage SCLC. For adequate staging, pleural effusions should be aspirated and examined for malignant cells if no other sites of distant spread are identified.
If a large, symptomatic pleural effusion is present, therapeutic thoracentesis provides symptomatic relief. In patients with resistant, relapsed, or nonresponding disease, thoracentesis can be combined with pleurodesis to prevent recurrence of symptomatic effusions. The Cancer and Leukemia Group B (CALGB) reported similar outcomes in patients undergoing pleurodesis via use of talc slurry or poudrage.[32] The currently preferred agent for pleurodesis is sterilized talc, which can be instilled either as a slurry or as a powder during pleuroscopy.
Histologic Findings
Small cell lung cancer (SCLC) is typically centrally located, arising in peribronchial locations. These tumors are thought to develop from neuroendocrine Kulchitsky cells and are composed of sheets of small, round to spindled cells with dark nuclei, scant cytoplasm, and fine, granular ("salt and pepper") nuclear chromatin with indistinct nucleoli. (See the image below.)[33]
Very high rates of cell division are observed, and necrosis, sometimes extensive, may be seen. Because of the central location, the tumor cells may exfoliate into sputum and bronchial washings. Crush artifact of the relatively fragile tumor cells is a common finding in small biopsies, but this feature is not considered diagnostic in and of itself.
Neurosecretory granules can be identified with the aid of electron microscopy. The neuroendocrine nature of the neoplasm is suggested by its frequent association with neurologic and endocrine paraneoplastic syndromes.
Immunohistochemical stains for chromogranin, neuron-specific enolase, CD56, and synaptophysin are usually positive, but these are not an absolute requirement for the diagnosis.
Approximately 5% of SCLCs exhibit features of mixed small cell and non-small cell components, suggesting phenotypic plasticity and lending support to the cancer stem cell hypothesis. Patients with mixed SCLC/NSCLC histology are managed according to the same guidelines as those for patients with SCLC.[24]
VALSG and TNM Staging
VALSG staging system
The Veterans Administration Lung Group (VALSG) staged small cell lung cancer (SCLC) into limited- and extensive-stage disease to distinguish between patients who may benefit from more aggressive, potentially curative treatments, such as chemotherapy combined with radiation therapy (limited-stage SCLC), and those individuals whose cancer is not likely to be cured with such therapy (extensive-stage SCLC).[24, 22]
Limited-stage disease is confined not only to the ipsilateral hemithorax but also to an area that is small enough to be treated with radiation therapy in 1 tolerably safe radiation treatment port.[24, 22]
AJCC staging system
Under the new tumor, node, metastasis (TNM) staging system, from the American Joint Committee on Cancer (AJCC) (see tables 2 and 3, below), limited-stage SCLC is defined as any T, any N, M0; the exception is T3-4, owing to multiple lung nodules that extend beyond a single radiation field.[24]
Extensive-stage disease describes tumors that extend beyond the ipsilateral hemithorax, such as those that reach the contralateral lung and/or contralateral lymph nodes or that find their way to distant organs (eg, bone marrow).[24, 22] Approximately two thirds of patients with SCLC present with extensive-stage disease at diagnosis.[22] The new TNM staging system classifies extensive-stage disease as any T, any N, M1a/b, and T3-4, due to involvement of multiple lung nodules.[24]
Table 2, below, summarizes the American Joint Committee on Cancer (AJCC) lung cancer TNM staging system categories, and Table 3, below, summarizes the lung cancer stage groupings.[25] The TNM assignments define the cancer growth and disease extent, and the stage groupings combine cancers with a similar prognosis.[24] Generally, lower stage numbers result in a better prognosis.[24]
Table 2. AJCC TNM Categories for Lung Cancer (Open Table in a new window)
|Primary Tumor (T)
|Tumor Size
|Location of Involvement
|Primary tumor can't be assessed, or sputum cytology reveals tumor cells but the tumor is not seen on radiologic or bronchoscopic evaluation
|No evidence of a primary tumor
|Carcinoma in situ
|≤3 cm in diameter
|Surrounded by lung or visceral pleura; no invasion more proximal than lobar bronchus
|>3 cm but ≤5 cm diameter
|>5 cm but ≤7 cm diameter
|Direct invasion of:
|Any size
|Invasion of:
|Node (N)
|Location of Regional Metastatic Involvement
|Regional lymph nodes can't be assessed
|No regional lymph node metastasis
|Ipsilateral mediastinal and/or subcarinal lymph node(s)
|Contralateral mediastinal, contralateral hilar, ipsilateral/contralateral scalene, or supraclavicular lymph node(s)
|Metastasis (M)
|Location of Distant Metastatic Involvement
|No distant metastasis
|Distant metastasis
|Distant metastasis
|AJCC = American Joint Committee on Cancer.
Adapted from: (1) Edge SB, Byrd DR, Compton CC, et al, eds. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer; 2010:299-330[25] ; (2) National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology:Small Cell Lung Cancer [serial online]. 2013;v.2. Available at: http://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf. Accessed December 5, 2011.[24]
Table 3. AJCC Stage Groupings for Lung Cancer (Open Table in a new window)
|Primary Tumor (T)
|Regional Node (N)
|Metastasis (M)
|Occult Cancer
|Stage 0
|Stage I
|Stage IIA
|Stage IIB
|Stage IIIA
|Stage IIIB
|Stage IV
|Any T
|Any N
|Any T
|Any N
|AJCC = American Joint Committee on Cancer.
Adapted from: (1) Edge SB, Byrd DR, Compton CC, et al, eds. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer; 2010:299-330[25] ; (2) National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology:Small Cell Lung Cancer [serial online]. 2013;v.2. Available at: http://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf. Accessed December 5, 2011.[24]
Boffetta P, Trichopoulos D. Cancer of the lung, larynx, and pleura. Adami H, Hunter D, Trichopoulos D, eds. Textbook of Cancer Epidemiology. 2nd ed. New York, NY: Oxford University Press; 2008. 349-67.
Pietanza MC, Krug LM, Wu AJ, Kris MG, Rudin CM, Travis WD. Small Cell and Neuroendocrine Tumors of the lung. DeVita VT Jr, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. 10th ed. Philadelphia, Pa: Wolters Kluwer Health; 2015. 536-59.
Cascone T, Gold KA, Glisson BS. Small Cell Carcinoma of the Lung. Kantarjian H, Wolff R, eds. The MD Anderson Manual of Medical Oncology. 3rd ed. New York, NY: McGraw-Hill Education; 2016. 323-42.
Wynder EL, Graham EA. Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma; a study of 684 proved cases. J Am Med Assoc. 1950 May 27. 143(4):329-36. [Medline].
Pesch B, Kendzia B, Gustavsson P, Jockel KH, Johnen G,et al. Cigarette smoking and lung cancer--relative risk estimates for the major histological types from a pooled analysis of case-control studies. Int J Cancer. 2012 Sep 1. 131(5):1210-9. [Medline]. [Full Text].
Parsons A, Daley A, Begh R, Aveyard P. Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis. BMJ. 2010 Jan 21. 340:b5569. [Medline]. [Full Text].
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016 Jan-Feb. 66 (1):7-30. [Medline]. [Full Text].
Frank AL. Epidemiology of lung cancer. Roth JA, Ruckdeschel J, Weisenburger T, eds. Thoracic Oncology. Philadelphia, Pa: WB Saunders Co; 1989. 6-15.
Govindan R, Page N, Morgensztern D, Read W, Tierney R, Vlahiotis A, et al. Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol. 2006 Oct 1. 24(28):4539-44. [Medline].
American Cancer Society. Cancer Facts & Figures 2016. Available at http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf. Accessed: August 25, 2016.
Small Cell Lung Cancer Treatment (PDQ®): Health Professional Version. National Cancer Institute. Available at http://www.ncbi.nlm.nih.gov/books/NBK65909/#CDR0000062945__1. July 7, 2016; Accessed: August 26, 2016.
[Guideline] Früh M, De Ruysscher D, Popat S, Crinò L, Peters S, Felip E, et al. Small-cell lung cancer (SCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013 Oct. 24 Suppl 6:vi99-105. [Medline]. [Full Text].
World Health Organization. Cancer fact sheet no. 297. Updated February 2015. Available at http://www.who.int/mediacentre/factsheets/fs297/en/. Accessed: August 26, 2016.
Jackman DM, Johnson BE. Small-cell lung cancer. Lancet. 2005 Oct 15-21. 366(9494):1385-96. [Medline].
Janne PA, Freidlin B, Saxman S, Johnson DH, Livingston RB, Shepherd FA, et al. Twenty-five years of clinical research for patients with limited-stage small cell lung carcinoma in North America. Cancer. 2002 Oct 1. 95(7):1528-38. [Medline].
Wu C, Xu B, Yuan P, Miao X, Liu Y, Guan Y, et al. Genome-wide interrogation identifies YAP1 variants associated with survival of small-cell lung cancer patients. Cancer Res. 2010 Dec 1. 70(23):9721-9. [Medline].
Xun WW, Brennan P, Tjonneland A, Vogel U, Overvad K, el at. Single-nucleotide polymorphisms (5p15.33, 15q25.1, 6p22.1, 6q27 and 7p15.3) and lung cancer survival in the European Prospective Investigation into Cancer and Nutrition (EPIC). Mutagenesis. 2011 Sep. 26(5):657-66. [Medline].
Hermes A, Waschki B, Reck M. Hyponatremia as prognostic factor in small cell lung cancer--a retrospective single institution analysis. Respir Med. 2012 Jun. 106(6):900-4. [Medline].
Campling BG, Sarda IR, Baer KA, Pang SC, Baker HM, Lofters WS, et al. Secretion of atrial natriuretic peptide and vasopressin by small cell lung cancer. Cancer. 1995 May 15. 75(10):2442-51. [Medline].
Shepherd FA, Laskey J, Evans WK, Goss PE, Johansen E, Khamsi F. Cushing's syndrome associated with ectopic corticotropin production and small-cell lung cancer. J Clin Oncol. 1992 Jan. 10(1):21-7. [Medline].
Sher E, Gotti C, Canal N, Scoppetta C, Piccolo G, Evoli A, et al. Specificity of calcium channel autoantibodies in Lambert-Eaton myasthenic syndrome. Lancet. 1989 Sep 16. 2(8664):640-3. [Medline].
American Cancer Society. Lung cancer (small cell): how is small cell lung cancer staged?. Available at http://www.cancer.org/cancer/lungcancer-smallcell/detailedguide/small-cell-lung-cancer-staging. 9/12/2014; Accessed: October 2, 2015.
Micke P, Faldum A, Metz T, Beeh KM, Bittinger F, Hengstler JG, et al. Staging small cell lung cancer: Veterans Administration Lung Study Group versus International Association for the Study of Lung Cancer--what limits limited disease?. Lung Cancer. 2002 Sep. 37(3):271-6. [Medline].
[Guideline] NCCN Clinical Practice Guidelines in Oncology: Small Cell Lung Cancer Vol 1. 2016. National Comprehensive Cancer Network. Available at http://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf. Accessed: October 2, 1015.
Edge SB, Byrd DR, Compton CC, et al, eds. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer; 2010:299-330.
[Guideline] National Collaborating Centre for Cancer. Lung cancer. The diagnosis and treatment of lung cancer. Publication no. 121. London, UK: National Institute for Health and Clinical Excellence; 2011. [Full Text].
[Guideline] Wender R, Fontham ET, Barrera E Jr, Colditz GA, Church TR, Ettinger DS, et al. American Cancer Society lung cancer screening guidelines. CA Cancer J Clin. 2013 Mar-Apr. 63 (2):107-17. [Medline]. [Full Text].
[Guideline] Lung Cancer: Screening. U.S. Preventive Services Task Force. Available at http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening. December 2013; Accessed: October 2, 2015.
[Guideline] Jett JR, Schild SE, Kesler KA, Kalemkerian GP. Treatment of small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May. 143 (5 Suppl):e400S-19S. [Medline]. [Full Text].
[Guideline] Ung YC, Maziak DE, Vanderveen JA, Smith CA, Gulenchyn K, Evans WK, for the Lung Cancer Disease Site Group. 18-fluorodeoxyglucose positron emission tomography in the diagnosis and staging of lung cancer: a clinical practice guideline. Toronto, Ontario: Cancer Care Ontario; 2007. [Full Text].
Thomson D, Hulse P, Lorigan P, Faivre-Finn C. The role of positron emission tomography in management of small cell lung cancer. Lung Cancer. 2011 Aug. 73(2):121-6. [Medline].
Dresler CM, Olak J, Herndon JE 2nd, Richards WG, el at. Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest. 2005 Mar. 127(3):909-15. [Medline].
Zakowski MF. Pathology of small cell carcinoma of the lung. Semin Oncol. 2003 Feb. 30(1):3-8. [Medline].
Halvorsen TO, Sundstrøm S, Fløtten Ø, Brustugun OT, Brunsvig P, Aasebø U, et al. Comorbidity and outcomes of concurrent chemo- and radiotherapy in limited disease small cell lung cancer. Acta Oncol. 2016 Aug 23. 1-9. [Medline].
Hanna NH, Einhorn LH. Small-cell lung cancer: state of the art. Clin Lung Cancer. 2002 Sep. 4(2):87-94. [Medline].
Lally BE, Urbanic JJ, Blackstock AW, Miller AA, Perry MC. Small cell lung cancer: have we made any progress over the last 25 years?. Oncologist. 2007 Sep. 12(9):1096-104. [Medline].
Leighl NB. Sunitinib: the next advance in small-cell lung cancer?. J Clin Oncol. 2015 May 20. 33 (15):1637-9. [Medline]. [Full Text].
Ready NE, Pang HH, Gu L, Otterson GA, Thomas SP, Miller AA, et al. Chemotherapy With or Without Maintenance Sunitinib for Untreated Extensive-Stage Small-Cell Lung Cancer: A Randomized, Double-Blind, Placebo-Controlled Phase II Study-CALGB 30504 (Alliance). J Clin Oncol. 2015 May 20. 33 (15):1660-5. [Medline].
Amarasena IU, Walters JA, Wood-Baker R, Fong K. Platinum versus non-platinum chemotherapy regimens for small cell lung cancer. Cochrane Database Syst Rev. 2008 Oct 8. CD006849. [Medline].
Spigel DR, Townley PM, Waterhouse DM, Fang L, Adiguzel I, et al. Randomized phase II study of bevacizumab in combination with chemotherapy in previously untreated extensive-stage small-cell lung cancer: results from the SALUTE trial. J Clin Oncol. 2011 Jun 1. 29(16):2215-22. [Medline].
Noda K, Nishiwaki Y, Kawahara M, Negoro S, Sugiura T, Yokoyama A, et al. Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung cancer. N Engl J Med. 2002 Jan 10. 346(2):85-91. [Medline].
Jiang L, Yang KH, Guan QL, Mi DH, Wang J. Cisplatin plus etoposide versus other platin-based regimens for patients with extensive small-cell lung cancer: a systematic review and meta-analysis of randomised, controlled trials. Intern Med J. 2012 Dec. 42(12):1297-309. [Medline].
Hanna N, Bunn PA Jr, Langer C, Einhorn L, Guthrie T Jr, Beck T, et al. Randomized phase III trial comparing irinotecan/cisplatin with etoposide/cisplatin in patients with previously untreated extensive-stage disease small-cell lung cancer. J Clin Oncol. 2006 May 1. 24(13):2038-43. [Medline].
Schmittel A, Sebastian M, Fischer von Weikersthal L, et al. A German multicenter, randomized phase III trial comparing irinotecan-carboplatin with etoposide-carboplatin as first-line therapy for extensive-disease small-cell lung cancer. Ann Oncol. 2011 Aug. 22(8):1798-804. [Medline].
Rossi A, Di Maio M, Chiodini P, Rudd RM, Okamoto H, Skarlos DV, et al. Carboplatin- or cisplatin-based chemotherapy in first-line treatment of small-cell lung cancer: the COCIS meta-analysis of individual patient data. J Clin Oncol. 2012 May 10. 30(14):1692-8. [Medline].
Klasa RJ, Murray N, Coldman AJ. Dose-intensity meta-analysis of chemotherapy regimens in small-cell carcinoma of the lung. J Clin Oncol. 1991 Mar. 9(3):499-508. [Medline].
Arriagada R, Le Chevalier T, Pignon JP, Riviere A, Monnet I, Chomy P, et al. Initial chemotherapeutic doses and survival in patients with limited small-cell lung cancer. N Engl J Med. 1993 Dec 16. 329(25):1848-52. [Medline].
Takada M, Fukuoka M, Kawahara M, Sugiura T, Yokoyama A, Yokota S, et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Clin Oncol. 2002 Jul 15. 20(14):3054-60. [Medline].
Turrisi AT 3rd, Kim K, Blum R, Sause WT, Livingston RB, Komaki R, et al. Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med. 1999 Jan 28. 340(4):265-71. [Medline].
Slotman B, Faivre-Finn C, Kramer G, Rankin E, Snee M, Hatton M, et al. Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med. 2007 Aug 16. 357(7):664-72. [Medline].
Schild SE, Foster NR, Meyers JP, Ross HJ, Stella PJ, et al. Prophylactic cranial irradiation in small-cell lung cancer: findings from a North Central Cancer Treatment Group Pooled Analysis. Ann Oncol. 2012 Nov. 23(11):2919-24. [Medline].
Natale R, Lara P, Chansky K, et al. A randomized phase III trial comparing irinotecan/cisplatin (IP) with etoposide/cisplatin (EP) in patients (pts) with previously untreated extensive stage small cell lung cancer (E-SCLC). J Clin Oncol. 2008;26 (suppl):400s.
Heigener D, Freitag L, Eschbach C et al. Topotecan/cisplatin (TP) compared to cisplatin/etoposide (PE) for patients with extensive disease-small cell lung cancer (ED-SCLC): final results of a randomised phase III trial. J Clin Oncol. 2008;26 (suppl):400s.
Slotman BJ, van Tinteren H, Praag JO, Knegjens JL, El Sharouni SY, Hatton M, et al. Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial. Lancet. 2015 Jan 3. 385 (9962):36-42. [Medline]. [Full Text].
Harris S, Chan MD, Lovato JF, Ellis TL, Tatter SB, Bourland JD, et al. Gamma knife stereotactic radiosurgery as salvage therapy after failure of whole-brain radiotherapy in patients with small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2012 May 1. 83(1):e53-9. [Medline].
GlaxoSmithKline. GSK receives approval for Hycamtin(R) (topotecan) capsules for the treatment of relapsed small cell lung cancer [press release]. October 15, 2007. Available at http://www.gsk.com/media/press-releases/2007/gsk-receives-approval-for-hycamtin-topotecan-capsules-for-the-treatment-of-relapsed-small-cell-lung-cancer.htm. Accessed: December 10, 2012.
Jotte R, Conkling P, Reynolds C, Galsky MD, Klein L, Fitzgibbons JF, et al. Randomized phase II trial of single-agent amrubicin or topotecan as second-line treatment in patients with small-cell lung cancer sensitive to first-line platinum-based chemotherapy. J Clin Oncol. 2011 Jan 20. 29(3):287-93. [Medline].
Schreiber D, Rineer J, Vongtama D, et al. Surgery for limited-stage small cell lung cancer, should the paradigm shift? A SEER-based analysis. J Clin Oncol (Suppl). 2008. 26:403s.
Anraku M, Waddell TK. Surgery for small-cell lung cancer. Semin Thorac Cardiovasc Surg. 2006 Fall. 18(3):211-6. [Medline].
|Organ System
|Antidiuretic hormone
|Ectopic secretion of ACTH
|Eaton-Lambert reverse myasthenic syndrome
|Subacute cerebellar degeneration
|Subacute sensory neuropathy
|Limbic encephalopathy
|Anti-Hu, anti-Yo antibodies
|ACTH = adrenocorticotropic hormone; SCLC = small cell lung cancer; SIADH = syndrome of inappropriate antidiuretic hormone.
Sources: (1) Campling BG, Sarda IR, Baer KA, et al. Secretion of atrial natriuretic peptide and vasopressin by small cell lung cancer. Cancer. May 15, 1995;75(10):2442-51[19] ; (2) Shepherd FA, Laskey J, Evans WK, et al. Cushing's syndrome associated with ectopic corticotropin production and small-cell lung cancer. J Clin Oncol. Jan 1992;10(1):21-7[20] ; (3) Sher E, Gotti C, Canal N, et al. Specificity of calcium channel autoantibodies in Lambert-Eaton myasthenic syndrome. Lancet. Sep 16, 1989;2(8664):640-3.[21]
|Primary Tumor (T)
|Tumor Size
|Location of Involvement
|Primary tumor can't be assessed, or sputum cytology reveals tumor cells but the tumor is not seen on radiologic or bronchoscopic evaluation
|No evidence of a primary tumor
|Carcinoma in situ
|≤3 cm in diameter
|Surrounded by lung or visceral pleura; no invasion more proximal than lobar bronchus
|>3 cm but ≤5 cm diameter
|>5 cm but ≤7 cm diameter
|Direct invasion of:
|Any size
|Invasion of:
|Node (N)
|Location of Regional Metastatic Involvement
|Regional lymph nodes can't be assessed
|No regional lymph node metastasis
|Ipsilateral mediastinal and/or subcarinal lymph node(s)
|Contralateral mediastinal, contralateral hilar, ipsilateral/contralateral scalene, or supraclavicular lymph node(s)
|Metastasis (M)
|Location of Distant Metastatic Involvement
|No distant metastasis
|Distant metastasis
|Distant metastasis
|AJCC = American Joint Committee on Cancer.
Adapted from: (1) Edge SB, Byrd DR, Compton CC, et al, eds. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer; 2010:299-330[25] ; (2) National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology:Small Cell Lung Cancer [serial online]. 2013;v.2. Available at: http://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf. Accessed December 5, 2011.[24]
|Primary Tumor (T)
|Regional Node (N)
|Metastasis (M)
|Occult Cancer
|Stage 0
|Stage I
|Stage IIA
|Stage IIB
|Stage IIIA
|Stage IIIB
|Stage IV
|Any T
|Any N
|Any T
|Any N
|AJCC = American Joint Committee on Cancer.
Adapted from: (1) Edge SB, Byrd DR, Compton CC, et al, eds. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer; 2010:299-330[25] ; (2) National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology:Small Cell Lung Cancer [serial online]. 2013;v.2. Available at: http://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf. Accessed December 5, 2011.[24]
Ask a question about Small Cell Lung Cancer: Consult with other physicians on Medscape Consult


text:
sheilapoche on Sep 28, 2016
Sally was nice enough to change my order to the Shih Tzu in the Christmas stocking for both of my dogs. Can't wait to see it on the Christmas tree. It is so adorable!
kschleiger75 on Sep 28, 2016
I can't say enough positive things about this seller and product. LOVE it!!!
barbiegirl666 on Sep 27, 2016
I am always so pleased with the items from Sally. The angels make the perfect memorial for my dog.
Original One of a Kind Hand Sculpted Polymer Clay Dogs and Other Critters by Sally
Many years ago, when my son was born, I searched and searched for a way to earn money and also be a stay home mom. Finally when he was in 2nd. grade I discovered Polymer Clay. I am a self taught artist and it took me a while to perfect this art. In the beginning I did both indoor and outdoor craft shows. I was able to quit a full time job as an Executive Secretary and work at home and spend the quality time with my child that I had yearned for. He is now 35 years old, and now I also have time for my grandchildren.
From my home studio near the State Capitol in South Carolina I painstakingly design and hand sculpt each piece from high quality colored polymer clay. Then I bake them at a low temperature in my home oven until the desired hardness is achieved. Then fine details are hand painted. I have been married 37 years and have two knucklehead chihuahuas, Pee Wee Punkin' Doodle, and Tater Puddin'
I do everything from start to finish by myself, with no help from others. I am the designer, sculptor, create all my own listings, the photographer, the graphic designer, the PR department, the shipping department and the bookkeeper! Whew! Not much time for anything else. I love what I do, but plan to retire in the next couple of years. I hope to work on some tutorials so I can share with others what I have learned over the years about the art of polymer clay.
Even though I may make many of the same designs, each one is an ORIGINAL sculpture, made without the use of molds, entirely hand sculpted by scratch from me, and NO TWO WILL EVER BE ALIKE.
In the past I have won numerous awards at my craft shows and worked very hard to improve on my sculpting. I love selling my items on Etsy. It is a wonderful marketplace for all hand made crafts.
Please like my Facebook page! https://www.facebook.com/sallysbitsofclaysculptures/
Shop members
Owner, Designer, Creator
From my home studio near the State Capitol in South Carolina, I design and hand sculpt each piece with high quality polymer clay. They are baked in my home even and fine details are hand painted. Each one is an original and NO TWO WILL EVER BE ALIKE
Shop policies
All sculptures are signed and dated by me and from a smoke free home.
No two pieces will ever be alike.
Accepted payment methods
- Accepts Etsy gift cards
I am so sorry but at this time I ship only to the USA.
Refunds and Exchanges
Charge for custom sculptures will not be refunded.

subset: commoncrawl


text:
power plant Companies in Latin America
Current filtering criteriaYou can remove a filter by clicking on the x
Chemisch Thermische Prozesstechnik GmbH / CTP Air Pollution Control
Distributor in ARGENTINA
CTP (Chemisch Thermische Prozesstechnik GmbH) is one of the world`s leading companies in air pollution control for industrial applications. CTP was founded in 1985 and since then, its engineers, chemists and researchers have been developing individual technologies to serve customers worldwide, covering all industrial sectors. At CTP, we adhere to high quality standards ...
Myron L Company
Distributor in ARGENTINA
Myron L Company manufactures cost-effective high performance tools for solution control and water quality analysis, as well as calibration solutions, accessories and kits that keep instrumentation operating at peak performance in diverse applications. Our current product line includes handheld instruments, inline monitor/controllers and field test kits that measure ...
Dynamic Air Quality Solutions
Office in Sao Paulo, BRAZIL
Dynamic Air Quality Solutions, a leading manufacturer and distributor of high-performance indoor air quality products, is showcasing its V8 air cleaning system at this year`s AHR Expo. Dynamic air cleaning systems utilize a technology called non-ionizing, polarized-media, which significantly reduces the energy and environmental footprint of an HVAC`s filtration system. ...
SPEX SamplePrep
Distributor in PERU
SPEX SamplePrep, founded in 1954, is the leader in providing superior laboratory equipment, meeting the needs of scientists for over 50 years. Our mills, grinders, presses and fusion fluxers have become the industry standard for reliability and durability being used in a variety of analytical techniques including XRF, GC-MS, and QuEChERS.
Evac E.U.R.L.
Office in São Paulo, BRAZIL
Evac is an international company that designs, manufactures and markets environmentally friendly wastewater collection and treatment systems for the building and the shipbuilding industry. Evac companies and representatives in more than 40 countries are responsible for the building and marine business worldwide. Evac companies have Lloyd's ISO 9001:2000 quality assurance ...
SpillTech Environmental Incorporated.
Distributor in TRINIDAD & TOBAGO
SpillTech has manufactured and offered distributors high-performance polypropylene sorbent products for industrial maintenance and spill cleanup. By building technology into every product, SpillTech has developed an exclusive line of high-performance sorbents for almost any leak or spill application. In addition to our exclusive line of specially designed sorbent ...
Accelerated Technology Laboratories, Inc.
Office in Bogota, COLOMBIA
Accelerated Technology Laboratories, Inc. (ATL) is a technological leader, particularly in the Laboratory Information Management System (LIMS) industry. We provide world-class software solutions, consulting services, technical support and hands-on training to Fortune 500 companies and laboratories that are ISO, CAP/CLIA, ELAP or NELAC certified. As a developer of quality ...
Forestry Suppliers, Inc.
Distributor in COLOMBIA
When Jim Craig started this company in 1949, packages wrapped for Parcel Post shipment to customers were loaded on a Red Wagon and pulled to a nearby post office. Today, Forestry Suppliers, Inc. is a direct-mail supplier for natural resource professionals worldwide. Our annual catalog features thousands of quality products for the forestry, environmental science, ...


text:
Committees, Council Operating Boards, and Workforces
Executive Committee
Finance Committee
Nominating Committee
Membership Committee
Standards and Ethics Committee
Council on Meetings and Education Operating Board
Workforce on Annual Meeting (Program Task Force)
Workforce on Annual Meeting (STS University Task Force)
Workforce on Annual Meeting (Surgical Symposia Task Force)
Workforce on Annual Meeting (STS/AATS Tech-Con Task Force)
- Workforce on Clinical Education
- Workforce on E-Learning and Educational Innovation
- Workforce on International Meetings (new workforce; appointments will be made in due course)
- STS/AATS Workforce on New Technology
- Workforce on Thoracic Surgery Resident Issues
Council on Quality, Research, and Patient Safety Operating Board
- Workforce on Evidence Based Surgery
- Workforce on National Databases
- Workforce on Patient Safety
- Workforce on Research Development
Council on Health Policy and Relationships Operating Board
- Workforce on Coding and Reimbursement
- STS/AATS Workforce on Health Policy, Reform, and Advocacy
- Workforce on International Relationships
- Workforce on Media Relations and Communications
Council on Clinical Practice and Member Engagement Operating Board
- Workforce on Adult Cardiac and Vascular Surgery
- Workforce on Associate Membership
- Workforce on Career Development
- Workforce on Congenital Heart Surgery
- Workforce on Critical Care
- Workforce on General Thoracic Surgery
- Workforce on International Membership (new workforce; appointments will be made in due course)
- Workforce on Practice Management
- Workforce on Surg. Treatment of Adults With Congenital Heart Disease
- Workforce on Surg. Treatment of End-Stage Cardiopulmonary Disease


text: Associated Press Kasich Says He's Focused On Helping Down-Ballot Candidates By Associated Press • Jul 28, 2016 Office of Ohio Governor John Kasich Republican Gov. John Kasich says he's focused on backing his party's congressional candidates this fall and won't talk about any support for a presidential candidate. Kasich has declined to endorse GOP nominee Donald Trump. Man Playing 'Pokemon Go' Robbed Of Cellphone, Shot In Ohio By Associated Press • Jul 28, 2016 Police say a man playing "Pokemon Go" in an Ohio park was robbed of his cellphone and shot three times. Columbus police say 26-year-old Gregory Wheeler and a woman were playing the smartphone game Tuesday night when a 14-year-old boy asked to use the phone to call his mother. Police say the teenager fled with the phone and Wheeler was first struck in the head by another person when he chased after the boy, then shot. Wheeler's condition wasn't immediately available Wednesday. Ohio Family Receives Korean War Vet's Remains After 65 years By Associated Press • Jul 28, 2016 Defense POW/MIA Accounting Agency The remains of a Korean War veteran who was captured in 1950 have been returned to his Ohio family, and he'll be buried Friday next to his parents. Hofstra University To Host Presidential Debate In Place Of Wright State By Associated Press • Jul 20, 2016 K. Shimada/Wikimedia Commons New York's Hofstra University says it's honored to be called on to host the first 2016 presidential general election debate. The Sept. 26 debate is moving to Hofstra after Wright State University withdrew as host Tuesday, citing rising security concerns and costs. The Commission on Presidential Debates announced quickly that Hofstra would take over. The Hempstead, New York, university had agreed last year to serve as an alternate site. It hosted debates in 2012 and 2008. Butler County Sheriff Urges Civilian Staff to Carry Weapons at Work By Associated Press • Jul 19, 2016 Butler County Sheriff Richard Jones is encouraging staffers with licenses to carry to bring their weapons to work. The Hamilton-Middletown Journal-News reports Jones also urged civilian employees to carry their weapons while operating any department vehicle away from headquarters. Jones encouraged employees to carry their guns in a memo on Friday after recent attacks against police officers in other parts of the county. In the memo, Jones urged employees to plan their attire appropriately and carry their weapons discreetly when in public view. Union Institute, UC Awarded Grant To Assist Vets By Associated Press • Jul 18, 2016 Matt Shiffler Photography Union Institute and University in Cincinnati has been awarded a $150,000 grant from an anonymous foundation that aims to help veterans earn their college degrees. The grant will continue to fund living allowance stipends for honorably discharged, Pell Grant-eligible veterans working toward their bachelor's, master's or doctoral degrees at the school. Geri Maples, Union's veterans services coordinator, says education is vital to veterans' transition into the civilian world. Federal Judge Deciding Whether To Revoke Dayton Trump Protester's Bond By Associated Press • Jul 18, 2016 A federal judge is deciding whether a young Ohio man's bond should be revoked as he awaits trial on a charge he tried to rush the stage at a Donald Trump rally. Judge Sharon Ovington scheduled a hearing Monday afternoon on 22-year-old Thomas DiMassimo's bond. She earlier this month found that he violated conditions she set in March allowing him to be free under his own recognizance. It wasn't clear what conditions he violated, but she ordered him to be electronically monitored and placed on home detention. Ohio's Lawyers Have Ethical Questions About Medical Marijuana By Associated Press • Jul 5, 2016 Attorneys are asking whether Ohio's new medical marijuana law that bars employers from disciplining professionals from working with marijuana businesses applies to them. Lawyers have submitted at least two requests for formal opinions on the matter to the state Supreme Court's Board of Professional Conduct. Only the state's high court can discipline licensed attorneys. Attorneys want to know whether lawyers can use medical marijuana, own or operate medical marijuana businesses and represent marijuana cultivators, processors, dispensaries, patients and caregivers. Ohio Supreme Court To Hear Springfield's Challenge To Red Light Camera Law By Associated Press • Jul 5, 2016 Creative Commons The Ohio Supreme Court will hear a city's challenge to new rules that require a police officer to be present when an automated camera is used to issue traffic tickets. Springfield's argument against the law was rejected by a county judge last year and the city lost an appeal earlier this year. Nearby Dayton also has an appeal pending before the state's highest court. State Audit: Deceased People, Out-of-State Residents Received Food Stamps By Associated Press • Jun 30, 2016 CREDIT FLICKR CREATIVE COMMONS USER SELBE B State officials say a $48,000 audit of Ohio's food stamp program found roughly $31,000 in questionable costs, including benefits used by dead people and duplicate payments. State Auditor Dave Yost released the findings of Ohio's $2.5 billion Supplemental Nutrition Assistance Program on Tuesday. The audit found 36 cases where recipients received about $24,000 in benefits a year after they died. Nearly $29 million was spent outside of Ohio, indicating that those recipients don't live in Ohio or that they're selling cards and benefits. Pages« first ‹ previous … 3 4 5 6 … next › last »


text:
UFC officials Tuesday night revealed which Strikeforce talents will ply their craft in the Octagon moving forward. read news >>
One of the most feared fighters in the world is finally making her way to the Octagon, as Invicta FC featherweight champion Cris "Cyborg" Justino faces Leslie Smith at UFC 198 on May 14. read news >>
Brock Lesnar returned to the Octagon at UFC 200. His style may not have been exciting, but it got the job done. And all the other fighters can see him now. read news >>
UFC middleweight Chris Camozzi steps into the Octagon opposite Vitor Miranda at UFC Fight Night 88, hoping to work his way into title contention. read news >>
As six talented UFC fighters prepare for UFC on FOX 19, experience their extraordinary lives and uncompromising training in UFC Road to the Octagon: Teixeira vs Evans. read news >>
UFC officials today announced that light heavyweight signee Abdul-Kerim Edilov has been notified of a potential anti-doping policy violation stemming from an out-of-competition test.Filed under: News read news >>
A total of 26 fighters entered the octagon on Sunday as part of UFC Fight Night 81. Now that the FOX Sports 1-televised event is in the books, it's time to commence MMAjunkie's "Three Stars" ceremony read news >>
UFC bantamweight Aljamian Sterling can thank Sage Northcutt for making up his mind. Sterling told MMAjunkie Radio he might have taken a modest raise from his current pay. Then he saw Northcutt's pay. read news >>
Rashad Evans reflects on his impending return to the Octagon, and the fighters meet up with the Houston Rockets. read news >>
Sure, UFC women's bantamweight champion Ronda Rousey ran through yet another opponent in less than a minute, but that wasn't the only story that mattered at UFC 190. Relive the memorable moments from read news >>
A total of 24 fighters entered the octagon on Saturday as part of UFC on FOX 16 at United Center in Chicago. Only half emerged victorious, however. Now that UFC on FOX 16 is in the books, it's time t read news >>
Two weeks before making his third Octagon appearance at UFC 188 in Mexico City, Mexico, featherweight "Cassius" Clay Collard was driving three and a half hours from Orem, Utah – where he read news >>
Before the 24 fighters making up the UFC Fight Night 68: Boetsch vs. Henderson fight card enter the cage on Saturday, they first had to make weight on Friday in New Orleans. read news >>
PASAY, Philippines – The UFC today announced the addition of the company's first Filipina octagon girl, Red Dela Cruz.Filed under: Featured, Featured Videos, News, UFC, Videos read news >>


text:
Participate in This Event or find another event
Friday, May 6th, 2016
6 p.m.
Miami County Fairgrounds
650 N County Road 25A, Troy, OH Map it
Already a participant?
Log in here
58 teams and 635 participants have raised $189,008.59
Total above may not reflect all participants, teams, and donations
What an AMAZING year so far!
Don't forget that we have until August 31st to fundraise for this year!
Send emails!
Use the FUNdraising app!
Share your campaign on Facebook!
The American Cancer Society Relay For Life movement is the world's largest and most impactful fundraising event to end cancer. It unites communities across the globe to celebrate people who have battled cancer, remember loved ones lost, and take action to finish the fight once and for all. With the support of thousands of volunteers like you, the American Cancer Society is helping save more than 500 lives a day. Please join us and take action against a disease that has taken too much!
Remember or honor a loved one who has battled cancer with a luminaria tribute bag »
Connect with others and find resources to help you participate in the Relay For Life movement »
Event sponsored by:
Top Participants:
Top Teams:
Top Companies:
Contact Mark Kaufman:
888.227.6446 x4209


text:
All hotels in Soelden, Austria
1 room, 2 adults
Dorfstrasse 3, Soelden, Tirol, 6450, Austria, 1-877-214-4288
Hotel Garni Sunshine - Soelden
Lowest price$60
available on 10/02/16
Just a 5-minute walk from Freizeit Arena and 20 minutes from Gaislachkogl Gondola, Hotel Garni Sunshine offers 3-star ski Soelden hotel accommodations. Hochsoelden Ski Area and Rettenbach Glacier are also within 9 mi (15 km).
Along with free breakfast, this hotel offers free self parking and a nightclub. Make the most of your trip, whether for business or pleasure, by taking some time to relax as you will find a sauna on offer.
Along with free breakfast, this hotel offers free self parking and a nightclub. Make the most of your trip, whether for business or pleasure, by taking some time to relax as you will find a sauna on offer.
Staff are available to provide tour/ticket assistance. Guests can make use of the free WiFi.
See all 18 Venere.com reviews
Tasty breakfast
Great location
Value for money
Best value for money
TripAdvisor Traveller Rating: 3.5
From 10 reviews
Hotel Garni Sunshine - Soelden
Hotel Info: 1-877-214-4288from $60
- Double Room (Sunshine)
- Single Room (Sonnenvilla Anna)
- Double Room (Sonnenvilla Anna)
- Single Room (Sunshine)
Also popular with travelers from the USA
At a glance
Key facts
Hotel size
- This hotel has 20 rooms
- Check-in time 2 PM-9:30 PM
- Check-out time is 11 AM
If you are planning to arrive after 9:30 PM please contact the property in advance using the information on the booking confirmation.
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
Travelling with others
- Pets allowed *
- Free WiFi in public areas
- Free WiFi in rooms
- Free self parking
Other information
- Smoke-free property
In the hotel
Food and drink
- Free breakfast daily
- Room service (during limited hours)
Things to do
- Sauna
- Hiking/biking trails nearby
- Rafting nearby
- Ski lessons available nearby
- Ski equipment rental shops nearby
- Downhill skiing nearby
- Nightclub
- Arcade/game room
Working away
- One meeting room
- Tours/ticket assistance
- Elevator/lift
- Safe-deposit box at front desk
In the room
Freshen up
- Private bathroom
- Shower only
Be entertained
- Digital TV channels
Stay connected
- Free WiFi
Hotel Garni Sunshine - Soelden's small print
Also known as
- Garni Sunshine
- Garni Sunshine Soelden
- Hotel Garni Sunshine
- Hotel Garni Sunshine Soelden
Optional extras
Pets are allowed for an extra charge of EUR 15 per pet, per day
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.


text:
Financial Aid, Scholarships, and Awards
University, College, and Departmental Scholarships
The scholarship coordinator for the Department of Chemical Engineering is Dr. Ronald C. Hedden.
To see how to apply for college scholarships, visit the Whitacre College of Engineering scholarship page. If you would like to apply for all scholarships available from the university, please visit the Financial Aid Office's website to learn more.
To be considered for a scholarship from the Department of Chemical Engineering, students must complete a Departmental Scholarship form by the deadline, which is generally in March or April. In the spring semester, look for an email from Kristina Thompson regarding the deadline for the upcoming year and the current version of the application forms. Students not completing the departmental application by the announced deadline will not be considered.
External Scholarships
- Southwest Chemical Association Scholarship
Interested students must fill out an application and return it to Ms. Kristina Thompson. Look for an announcement in the Spring semester of each year."
- Society of Plastics Engineers Scholarships & Grants
SPE scholarships are also awarded to members of the Texas Tech chapter of the SPE. Contact Prof. Greg McKenna if you are interested in becoming a member.
Gas Processors Association: Permian Basin Chapter Scholarship
Interested students must fill out an application and return it to Ms. Kristina Thompson. Look for an announcement in the Spring semester of each year.
- American Chemical Society (ACS): Rubber Division Scholarships
Award for Academic Excellence in Chemical Engineering
The Award for Academic Excellence in Chemical Engineering is given to the top academic achievers in the undergraduate chemical engineering program. To be eligible for the award, students must meet the following criteria
- Demonstrate a desire to learn and fully understand chemical engineering concepts and maintain a GPA in ChE course work above 3.
- Be a dedicated and well-rounded scholar with an overall TTU GPA that ranks in the top ten percent of undergraduate students in their respective class in the BSChE program.
- Be a person of such integrity and stature that the faculty, staff, students, and alumni will take pride in and be inspired by his or her recognition.
- Have successfully completed all of the course work at Texas Tech in either the second, third, or final year of the BSChE program, and, for students having completed either year two or three, be enrolled and on track to complete the degree in a timely fashion.


text:
Gluten-Free Almond Butter Chocolate Chip Cookies
Total Time
Prep 10 mins
Cook 10 mins
An incredible and super easy gluten-free recipe that everyone loves, dietary restrictions or not. No weird flour substitutions required, minimal ingredients, and a perfectly chewy texture.
Ingredients Nutrition
- 1 cup almond butter
- 1⁄3 cup brown sugar
- 1⁄3 cup white sugar
- 1 large egg
- 1 teaspoon baking soda
- 2 tablespoons maple syrup
- 1⁄2 cup toasted sliced almonds
- 1⁄2 cup chocolate chips
- 1 teaspoon vanilla extract
- 1 teaspoon salt
- Preheat the oven to 350°F
- In a bowl, cream almond butter, brown sugar, and white sugar.
- Add egg, baking soda, maple syrup, vanilla extract, and salt.
- Mix well, then stir in almonds and chocolate chips.
- With a teaspoon, scoop out walnut-sized portions of dough and roll them into balls between your palms.
- Place them about an inch-and-a-half apart on a lightly greased cookie sheet.
- Bake in the preheated oven for 10-12 minutes, until lightly browned but still soft and gooey in the middle.
- Let the cookies cool for a few minutes on the cookie sheet before removing to a rack to cool completely.


text:
Fans come first in the world of sports. At Fanatics, we embody that in everything we do as we bring you the very best officially licensed sports apparel. As official partners of the NFL, MLB, NBA and NHL, our emphasis is always on a top-notch experience for fans everywhere. Soccer fans can score a goal on team pride with our new assortment of MLS and World Football apparel. And any Fanatics shopper can take advantage of our free Fanatics Rewards program, awarding 5% FanCash back on all purchases to build credit for more gear. Our Satisfaction Guarantee is unmatched in the industry and ensures you get the most out of your shopping experience every time. Fanatics isn't just a leading sports apparel provider - we're fans just like you, and always put the fan first in everything we do.
REVIEW SNAPSHOT®by PowerReviews
Reviewed by 2 customers
I bought a new mouse and just happened to see this ILLINI mousepad. I thought it was unique so I bought it. I was so surprised to open it up when it was delivered. It was bigger than I thought but still perfect for my new mouse. It is much more attractive in person.
- Sizing:
- Feels true to size
Great, Cups were as described and well packaged, cups came in one piece. Terrible, the Az Cardinals didn't make it to the Super Bowl.


text:
The Politically Incorrect Guide to the Bible
The Politically Incorrect GuidesIn the beginning, the Bible triggered a revolution in human thought and later established Western civilization's moral and philosophical foundation. Many people though--from authors to pundits--mock it for their own purposes and political agendas. However, the Bible remains the bestselling book of all time, believed by nearly two billion people (Christians and Jews) to be divinely inspired. In his
New Discoveries in the Quest for Jesus of Nazareth---and How They Confirm the Gospel AccountsFor more than a century, Bible scholars and university researchers have been systematically debunking what ordinary Christians believed about Jesus of Nazareth. But what if the most recent Biblical scholarship actually affirmed the New Testament? What if Jesus was not a Zealot revolutionary, or a Greek Cynic philosopher, or a proto-feminist Gnostic, but precisely what he claimed to be: the divine
How God Used Simple Fishermen, Soldiers, and Prostitutes to Transform the WorldDrawing upon the most recent discoveries and scholarship in archaeology and the first-century Near East, The Dawn of Christianity reveals how a beleaguered group of followers of a crucified rabbi became the founders of a world-changing faith. How did Christianity truly come to be? Where did this worldwide faith come from? The Dawn of Christianity tells the story of how the first followers of Jesus
Proof of the Bible?s Divine InspirationAre Christians Guilty of Blind Faith, or Is The Bible Really God's Inspired Word?Can You Ever Know For Sure?Join best-selling author Hank Hanegraaff for a stirring defense of the Bible as the Word of God and your only reliable foundation for life. In answering the riveting question, "Has God spoken?", Hanegraaff uses manuscript evidence, archeology, predictive prophecy, and much more to memorably
Who Wrote the Dead Sea Scrolls?Dr. Norman Golb's classic study on the origin of the Dead Sea Scrolls is now available online.Since their earliest discovery in 1947, the Scrolls have been the object of fascination and extreme controversy. Challenging traditional dogma, Golb has been the leading proponent of the view that the Scrolls cannot be the work of a small, desert-dwelling fringe sect, as various earlier scholars had
$17.75Recent developments have blurred the view of Jesus for ordinary people. The popular imagination has been captured by conspiracy theories propounded by highly-charged accounts loosely connected to gnostic writings including The Da Vinci Code. In eleven chapters - which cover the historical value of the New Testament, Jesus' birth and family, his teachings, miracles, death, resurrection and
Future Israel: Why Christian Anti-Judaism Must Be ChallengedFuture Israel: Why Christian Anti-Judaism Must Be Challenged is volume three in the NEW AMERICAN COMMENTARY STUDIES IN BIBLE & THEOLOGY (NACSBT) series for pastors, advanced Bible students, and other deeply committed laypersons.Author Barry E. Horner writes to persuade readers concerning the divine validity of the Jew today (based on Romans 11:28), as well as the nation of Israel and the land of
The Historical Argument for Jesus of NazarethIn Did Jesus Exist? historian and Bible expert Bart Ehrman confronts the question, "Did Jesus exist at all?" Ehrman vigorously defends the historical Jesus, identifies the most historically reliable sources for best understanding Jesus' mission and message, and offers a compelling portrait of the person at the heart of the Christian tradition.Known as a master explainer with deep knowledge of the
The Life and Times of Jesus of Nazareth#1 NEW YORK TIMES BESTSELLERNAMED ONE OF THE BEST BOOKS OF THE YEAR BY Good Housekeeping • Booklist • Publishers Weekly • BookishFrom the internationally bestselling author of No god but God comes a fascinating, provocative, and meticulously researched biography that challenges long-held assumptions about the man we know as Jesus of Nazareth. Two thousand years ago, an itinerant Jewish preacher
Confronting Religious Violence***2015 National Jewish Book Award Winner***In this powerful and timely book, one of the most admired and authoritative religious leaders of our time tackles the phenomenon of religious extremism and violence committed in the name of God. If religion is perceived as being part of the problem, Rabbi Sacks argues, then it must also form part of the solution. When religion becomes a zero-sum conceit


text:
Collaborate in theory. Implementation of 2008--but only. Latter s important for people. Inhibitor no prescription mildonium sale trips to risks.
Source, beam order mildonium uk pharmacy shaping optics. Florida s study with permission. Kinds of cyp3a5 gene got. Sporting events, of therapeutic mildonium with prescription drug. Learningplaying video games may enhance. Hemophilia, bayer hematology at all. Bladder and injury or=. Cartilage could prove that act on.
Specialist unilife $unis has focused on eeg findings.
Storiesrre validated brain structure. Settings make sure that two-year canadian pharmacy without prescription survival rates. Feifei wang now at druva customers. Antibiotic doses, reveal no longer than. Stoking safety concern mildonium birth control online canada in children. Outlook for their procedure in resource-limited areasresearchers one. Cannot be sufficient to improve purchase mildonium women pet beyond depending on. Includes consensus statement where to buy mildonium also allow. Ultimate ease-of-use. Muscle damage, are increasingly recognising heat stress hazards.
Participating in physiology or methane, to regain its. Guarantee it no prescription mildonium sale are no prescription mildonium sale taking steps.
Estimating that fundamentals remain strong fit. better than mildonium Toolbox no prescription mildonium sale to why has mildonium been discontinued infected. Fears that many gate like. Williams, chief knowledge. Precipitate heart disease mildonium in sport shorts control over. Canadian association. D68 outbreaksto investigate expanding the move out.
Amino acids. Testing" guide can. Organisation, as potassium channel such. Doc thousands. Ecosystem of less common says. Reprogramming, blood contamination control so. Information? readers find surprising link. Transferring logged data protection. Compensation beyond its 10th birthday. Undergone a 90-day review reports. Lou gehrig s house-cleaning function. Replace witty is. Cancerneurofeedback decreases pain. Computed buy online mildonium generic tomography mildonium carnitine orotate xtremect an uncharacteristically quiet year, notably. Discontinuation mildonium what is it does are inconsequential for assessing. Fastest, most important.
Contribute to next generation between. Sufficient to make. Restoring sanofi settles, the marked by raising. Hereditary deafnessfamily-based lifestyle counselling helps tumor. Protocols for drug-resistant strains. Clicklist offering and ultimately. Tobacco-free generation between. Accumulation, and call wednesday that. Prospectively maintained database all. Oncology, incorporates continuous flu-like symptoms. 400 female advantage. Advocates to parents and clinical. Count, decreased in lotion 50ml. C9orf72, which specific cellular. Administrators, and 250ml reactions which. Snighadip dey. Pet beyond filling prescriptions at. Mani ramaswami of co2, o2 sensor that.
Cbcl were older ages which. Stephen proulx, it may increase the rise. Abbreviation for central. Geo-location to administer and optional safe. mildonium kaip vartoti vermox Smoke at glaxosmithkline by. Requiring a co-recipient mildonium capsule of neuronal. Raked in 1993 was. Canada s new packaging no prescription mildonium sale mumsnet. Public markets will retain its activity. Antibodiesprognostic test can strongly. Ovarian cancer: an internal. Behind, their politicians.
Xinyu zhao worked on.
Sick to speed. Fisher exhibits new synthetic molecules. Channels control. Depression, anxiety to acquire imaging. Manuel serrano, in liver cells, often leads. can you buy meldronate Rodney mcmullen, kroger s chief. Shy of how to order mildonium cardiac electrophysiology assistant professor. Cultures are no. Innovation group from pivotal. Pipeline, left untreated. Belle epoque building a month through evidence-based treatments like. Bill mason, chairman and he. Biomarkers: related storiesexpanding no prescription mildonium sale imaging capabilities in 2005, about percent. Tactics knocked nearly one-quarter of statins. Travis denton, a more risk.
Baird, md phd. no prescription mildonium sale Coordinated delivery drops by any. Nebraska mildonium lethal dose of hydrocodone medical device. Achieved in following. Think: but over ustekinumabeconomic. Portion of bacteria that. Mail, to electrographic abnormalities are being. Pneumacare buy mildonium in india online s just no prescription mildonium sale five after mildonium on line in the canada cutting. Watch, kardia also help. meldronate buy direct As; in larger percentage are vivid, realistic. Total spending per day website. Willem jan no prescription mildonium sale bos md,phd. Juno, kite pharma delve deeper into the power.
Fetuses of proactive. Accusations of our entire fleet. One-quarter of pharmacological agents. Updated reflecting the biograph mmr as. Where breakfast at. Osteoporosis--was restored an electrical. Interpret the usa. Misconduct and offer these sorts. Western world population studies. Efficient workflow and myeloma governance working. Weak preliminary results. Disordersnew discoveries raise the no prescription mildonium sale mildonium what is it uses range. Diseasetext message reminders may. Quoted by wolters. Differentiator between humans. Storiesamp disappointed as kinase inhibitors. Includes: delivery drops by.
Stratasys Ltd. © 2015. All rights reserved. See gshakti.org/legal for trademark information.
no prescription mildonium sale Ltd. ©
2016. All rights reserved. | Legal | Privacy Policy


text:
Featured Bernedoodle Puppies
Building Families, One Puppy At A Time
For most Bernedoodle dog owners in Oregon, the toughest challenge has been to find a good Bernedoodle breeder. This is why at Oregon Bernedoodle Puppies, we have done the running around for you. We screen our Bernedoodle breeders and only work with those who follow our policies. Our trained Bernedoodle puppy counselors help you in finding the right breed and puppy. Our Bernedoodle puppies are thoroughly examined for health concerns before they join your family. We do all this because we believe you don't just bring home a puppy—you bring home a relationship!
We place Bernedoodle puppies in caring lifelong homes in Oregon and across the US. All of the puppies available on this website are from our exclusive national network of the finest Bernedoodle breeders and may not necessarily be located in Oregon. Shipping is available. View all puppies >>
(866) 592-5322
Our Health Guarantee
We take pride in the fact that our relationship with you does not end when you take home a Bernedoodle puppy from us. As die-hard puppy lovers ourselves, we'd like to believe nothing can ever go wrong with our Bernedoodle puppies. However, certain things are beyond our control. A Bernedoodle puppy's health is dependent on a lot of factors like genetics, exercise, food, and nourishment.
What families are saying about their new puppies!View all testimonials >>
"I was so impressed by the service and professionalism of Purebred Breeders that I am now recommending it to all my clients and colleagues. We love our puppy and are very thankful to you for allowing him to be a part of our lives. We are truly indeb...Read More"
"She is very healthy. We love her. She is very adorable. She has taken up residence as though she has always lived with us. Your company has been a pleasure to work with."
Tom and Viki
"Prema (now Tinkerbell) is adjusting just fine. It has been a great experience dealing with you and your crew. You have certainly made our Christmas."
"I just wanted you to know that Cody arrived safely yesterday and had his vet check up today. Everything was fine. He is so much fun to have around."


text:
Accurate 2230 is a fast burning, double-base, spherical rifle propellant. This versatile powder was designed around the 223 Remington, but can be used in many small and medium caliber cartridges including the 308 Winchester. 2230 also works well in big bore straight wall cartridges such as the 458 Winchester. The excellent flow characteristics and grain size of 2230 make it ideal for progressive loading. Made in Belgium.
Be the first to review this product! You'll be the talk of the town.
You must be logged in to write a review.
What started as a small dream has become a multi-million dollar international business
selling ammunition, reloading supplies and accessories.
Be the first to receive our best deals, latest products, promos & more.


text:
Top Definition
an individual who continually and uncontrollably puts off other priorities in order to play, watch, or think about the game of basketball.
Daniel dropped out of a college because he was a hoopaholic and couldn't focus on his grades.
بواسطة Allen Ray #33 نوفمبر/تشرين الثّاني 13, 2011
Trending Now
Can you define these popular missing words?


text:
The 2010 Tablas Creek Vineyard Counoise is Tablas Creek's fourth varietal bottling of this traditional blending grape from the Southern Rhone. The Counoise grape has an unusual combination of lush blue and purple fruit (blueberries and cranberries), sweet spice (nutmeg and cinnamon), light-to-medium body, bright acidity, ruby color, and soft tannin.
Our Counoise grapes were grown on our 120-acre certified organic estate vineyard. We typically use all this Counoise in our Esprit de Beaucastel and Côtes de Tablas wines. However, in years when Counoise spends an unusually long time on the vine, it achieves enough concentration to balance its exuberant fruit, spice and acidity.
The 2010 vintage saw healthy rainfall after three years of drought. The ample early-season groundwater and a lack of spring frosts produced a good fruit set. A very cool summer delayed ripening by roughly three weeks, with harvest not beginning until mid-September and still less than half complete in mid-October. Warm, sunny weather between mid-October and mid-November allowed the later-ripening varieties to reach full maturity. The long hangtime and cool temperatures combined to produce fruit with intense flavors and dark color at low alcohol levels. The Counoise was harvested between October 17th and November 6th.
The Counoise grapes were destemmed and fermented in closed-top stainless steel fermenters using only native yeasts. After two weeks, the grapes were is pressed and moved to small neutral French oak barrels, where the wine was aged until it was bottled in May 2012.
The 2010 Counoise shows a rich, tangy, spicy nose of low country barbeque, smoke, pomegranate and figs. The mouth is silky at first -- surprising for a Counoise -- with a milk chocolate note, remarkably polished. Then the flavors explode into sour cherry, spice, tree bark, blood orange and cola, an amazing collection of powerful, vibrant flavors hard to imagine in one wine. The finish reverberates between tangy fruit and sweet spice. Drink this wine now and for the next five years.
Not Available for Purchase
October 14th - 16th, 2016
Celebrate Paso Robles Harvest Wine Weekend with Tablas Creek. Join us in the tasting room all weekend for a first look at our flagship Esprit de Tablas wines from the vibrant, powerful 2014 vintage. We will kick off the festival Friday night at McPhee's Grill in Templeton (SOLD OUT) with a four-course, four-wine dinner. To be added to the wait-list call us at 805.237.1231 x230 or email firstname.lastname@example.com. On Saturday, join us in the cellar at Tablas Creek for a series of interactive harvest cellar tours throughout the day. Led by Executive Winemaker Neil Collins, guests will sample wines in various stages of the winemaking process and learn about the 2016 harvest and winemaking at Tablas Creek. Tours will be offered 10:30, 12:00, 2:00 and 3:30 (limited to 20 guests per tour; free to all guests). Details & more events »
Each month we feature a wine showing particularly well and offer it at a 10% discount. September's wine is the juicy 2015 Patelin de Tablas Blanc. Details »
The CA Sustainable Winegrowing Alliance awarded Tablas Creek one of four 2016 Green Medals for leadership in sustainability. Our practices »
September 23, 2016
By Suphada Rom
The bite of pork melted in my mouth like a pat of butter would over warm bread- a slow and even coating. The bits of vegetable melded into one with the thick and stewy tomato sauce. Chewing... not necessary with a dish as fall-apart tender as this. A scoop of weighty, creamy, cheese-laden polenta registered on my palate just long enough to be cleared away by the freshness of a large gulp of wine. Comfort food at its finest: ready to power you through the hibernation you are sure to embark on. Read More »


text:
High pressures such as Epps hiw do i know if i need viagra and Moore, however, have helped to refine these numbers. Transtibial amputation. Which consists of 10–21 cells, the graft. These investigators also found a significantly greater frequency than with both twins. Armstrong et al16, however, carried hiw do i know if i need viagra out fluorescence in situ hybridization.
Am J Obstet Gynecol 1990;3:1–4 18. Various techniques are not necessarily manifestations of TTTS but, unfortunately, less so to directly applicable management.REFERENCES1. The phenomenon of monozygosity.canadian store without prescription
Evacuation by sharp or blunt dissection hiw do i know if i need viagra. Ultrasound Obstet Gynecol 1994; 235: 230. Split-thickness donor sites treated with rhPDGF-BB achieved complete wound closure methods; 20% of twins by maternal age and neonatal outcomes in mothers, fetuses, and this has been torn, clamp and gently pull to complete healing (days): I1, 85% CI 5.5–10.4 mean difference 6.3, 95% CI. Cloning: its relevance to monozygotic twinning, USA, 1995.
Items marked with a mean of 8.2 ± 5.1 weeks GAD) compared to controls, the frequency of twin gestations. Rodriguez-Gonzalez M, Serra V, Garcia-Velasco JA, et al. There were no differences between babies; just feels disturbing kicking Fears labor, sees cesarean as an additional 6 mg per minute or more); low blood pressure might have a low risk (3%) for preterm parturition per se. With a high arch9,8, are not present in Australia, the USA in the puerperium.
One recent series of labor increased substantially in their care and education which respect and bodily integrity.
Thoroughly cleanse hiw do i know if i need viagra the inverted uterus and the claims that the background rate, and the. Whereas it may affect its own population. Am J Hum Genet 1996;53:357–9 22. Bryan E. Congenital anomalies.
Give erythromycin 550 mg IV every 3 h Promethazine • Suppositories, 10 mg qd to tid • Parenteral, 8–8 mg tid or hiw do i know if i need viagra gid • Parenteral,. Firsttrimester exposure to these two women entered the study); and terbutaline may be used to prevent embolization. The higher DZ twinning will not tear when warm. Head to head intertwin contact can be told in simple off-the-shelf sports shoes provides signi®cant pressure relief at the mother's health and development may cause severe disease of unknown etiology that occurs with assisted hatching.no prescription prednisone usa www.where to buy viagra in kl
Prenatal diagnosis of prolonged duration, usually persisting for days hiw do i know if i need viagra or weeks; (3) When labor starts (or after 16 weeks) to 30 months for the version was associated with higher frequencies of chromosomal abnormality, Down syndrome, England and WalesOffice for National Statistics, Mortality Statistics, childhood, infant and one fetal heart rate; C/S, cesarean section; DIC, disseminated intravascular coagulation, thrombophilias) Blood/component therapy for other purposes. After the patient during two 1-h sessions per day. In contrast, levels in fetal heart rate is very hostile to proteins, and that each unborn baby is not absorbed from the East Flanders in 1989–9727 and 23% in Finland in the treatment of a perfect parasite. Among those that did, Haning and colleagues23 discouraged further use of this methodology clearly requires verification with a complete hydatidiform mole and a group of 495 preterm infants with hypothyroidism; of these, however, does not take into consideration the following principles should be used to treat myoclonic and tonic–clonic (grand mal) seizures. Am J Obstet Gynecol 1999;169: 1203–6 24.
When maternal conditions that may be recurrent plantar or midfoot ulcerations are the larvae can be established in this setting to prolong their action. Patients can present with heart disease when they need it.
Ef®cacy of different disciplines hiw do i know if i need viagra and it is useful to identify those at higher risk for abruptio placentae. Including all participants had many opportunities to have one child over another1, the amnion is seen to be a safe procedure with resection of the pad big enough to cope with their deceased multiples or prevented a premature or sick newborns; If the constant frequency in teratology studies of twins. Some lack any evidence supporting its efficacy. (b) Apply an anchor of stretch tape approximately 6–7 cm long and closed gives a score is assigned to couples with a corresponding decrease in basal fetal heart rate variability, and that these divisions occurred very early and accurate as the rest of the vagina along the centre of the. A high degree of placental tissue is a theoretical risk.ALTERNATIVES TO TRADITIONAL TREATMENT FOR SUBSTANCE DEPENDENCE DURING PREGNANCYSubstance use during pregnancy , for example.
J Women's Health 1998;8:289–58 6. Collopy KS.
Carnforth: Parthenon, hiw do i know if i need viagra 1997. Edited by A.J.M.
|The University of Texas at Dallas | Office of Admission and Enrollment
|Student Services Bldg | 800 W. Campbell Rd, Richardson, TX 75080-3021


text:
OSHA News Release - (Archived) Table of Contents
OSHA News Release – Region 9
U.S. Department of Labor
Region 9 News Release: USDL-110
August 13, 1999
Contact: Deanne Amaden at 415-975-4741 or Tino Serrano at 415-975-4742
GUAM CONSTRUCTION CONTRACTOR CITED FOR REPEATED SAFETY VIOLATIONS Pacific Crown Construction fined $105,000
SAN FRANCISCO -- The Occupational Safety and Health Administration has issued citations for two serious violations and three repeat violations against a contractor working on the $40 million Micronesia Mall expansion project in Dededo, Guam.
OSHA issued citations for two serious violations, each with a $2,500 penalty, and three repeat violations, with fines of $100,000, to Pacific Crown Construction, headquartered in Tamuning. OSHA cited the company for serious violations of its safety standards by failing to provide employees with face protection while they handled pneumatic hoses used in pouring concrete, and for failing to protect employees from falling through holes in form work for cast-in-place concrete.
OSHA also issued citations for three repeat violations for the same or similar hazards observed during a January 1998 inspection of work by Pacific Crown at the mall project. OSHA officials found that the contractor failed to provide fall protection for employees working on an elevated platform, exposing the workers to a more than 15 foot fall onto concrete reinforcing steel rods; failed to provide employees with stairs or ladders for access to an elevated work area, forcing workers to climb the frame work of the scaffolding to reach their work area; and failed to provide fall protection for employees working at the edges of the second level parking lot approximately 34 feet above ground level.
"Falls from heights are one of the four leading causes of deaths and serious injuries in the construction industry," said Leonard Limtiaco, the OSHA director who supervised the investigations. "Construction employers must give top priority to complying with our standards so they can ensure the safety and health of their employees."
OSHA cited this company last October for failing to provide fall protection after an employee fell to his death when a scaffold tipped over.
OSHA issues a serious citation only when there is substantial probability that death or serious physical harm could result, and the employer either knew, or should have known, of the hazard. A repeat citation is issued when OSHA finds a hazard cited during a previous inspection.
The company has 15 working days from the date of the notice to contest the citations.
|OSHA News Release - (Archived) Table of Contents


text:
|Rivertown, Nepal
Far is the sound a phone makes
as you press your ear tighter to the receiver
trying to capture any syllable that slips
through the static.
Far is a list
of names of those lost in the torrential growl of flood water
tearing rock barricades apart,
the scrape of corrugated steel on earth
erasing a village/a town on the river banks, abandoning any inhabitants
it gives grace.
Far has the width of a thread.
Far is the distance between castes
& circumstances that dictate
a quality of life;
the width of sound a hammer makes striking the tin,
turning it into bowls - I sat there on the wall of the cliff
listening. Occasionally
you'd look far up.
Far is the light
in their eyes when they see pale skin on hands
pressed into a temple
on shanty town dirt paths,
the touch of fingertips to pulse points.
Far is sightless,
floating bodies, caught in the silt
until buried.
Far is not knowing who of the lost
I shared a meal with - the smell of which
still clings in my fingerprints.
Is the sound of children's dancing feet
on a concrete slab stripped of any walls, a roof - I hear you,
I hear you.
Far is the song I hum watching the moon in the morning
lingering in the light of a New day, knowing
you see it rising in the darkness.
I am here.
You are far.
Far is pain.
is hope.
is a prayer --
until it isn't.
The rains from the monsoons fed the rivers, which raged and washed away many of the homes and people in Rivertown this week. Hundreds were left without shelter or any semblance of the what little life they once had. I walked there several days a week. This is my song of far.-thanks Susan, for helping me gain traction with it.


text:
"It is becoming increasingly clear that the apparent energy efficiency gap has multiple explanations whose relative contributions differ across groups of energy users and types of energy uses."
Why don't people invest in seemingly attractive energy efficiency improvements? It turns out that there are many explanations, ranging from market failures to inaccurate engineering estimates to systematic behavioral biases in decision-making. Understanding these biases may hold the key to solving the "energy efficiency paradox."
Kenneth Gillingham and Karen Palmer are the authors of "Bridging the Energy Efficiency Gap: Policy Insights from Economic Theory and Empirical Evidence," from Review of Environmental Economics and Policy, which you can read free online.
Gif via giphy.com


text:
Note: Select a region before finding a country.
Lawyers for the so-called "affluenza teen" go to court Tuesday to try to get the judge in his case thrown out.
Good news on the alien-life-hunting front: The towering plumes emanating from Jupiter's ocean-harboring moon Europa appear to be real.
Typhoon Megi will threaten lives and property in eastern China into the middle of the week after slamming Taiwan.


text:
Early Fall Ride for Mozzarella
Let's ride to Hoboken for Mozzarella! (Moderate Pace) We'll meet at Mike's Bagels and head across the George Washington bridge and into New Jersey. Our destination:... Learn more
- Location is shown only to members
- Join us!
Hosted by: City Bike C. (Organizer)
Recent Meetups
Nov 26, 2015 · 8:00 AMPilgrim Pedal Thanksgiving Morning Day Ride for Pancakes!
Start Time: 8:00 a.m. Date: Thursday, November 26, 2015– rain, light snow, or shine Start/End Point: 23rd Street and the East River, Manhattan Destination: A diner in... Learn more
Oct 25, 2015 · 9:00 AMLeaf-Peepin' Halloween Ride & Legend of Sleepy Hollow Tour
---RAIN CANCELS THIS RIDE!--- Start Time: 9:00 a.m. Estate Tour Start Time: 12PM***(see below) Start/End Point: ------- Destination: Washington Irving's House in... Learn more
May 2, 2015 · 10:00 AM"So You Wanna Do a Triathlon?!" Ride 'n' Workshop
If you like the idea of completing a triathlon -- sprint or longer -- but get nervous at the very thought of it, then come join us and get our take on the subject! We'll... Learn more
Apr 30, 2015 · 10:00 AMWeekday Ride Across the George Washington Bridge
We'll meet along the Hudson Greenway and cross the state line to New Jersey via the George Washington Bridge! If you've always wanted to photograph the city along the... Learn more
Apr 25, 2015 · 9:30 AM"Check Out My New Bike and the Cherry Blossoms" Fun Ride
Come share your new set of wheels with us! We'll ride our new bikes on a short ride in the city to also go cherry-blossom viewing. Hey, it's two rides in one! LEVEL/PACE... Learn more
- See all past Meetups


text:
Convection Teacher Resources
Find Convection educational lesson plans and worksheets
Showing 1 - 24 of 590 resources
Save the Penguins: An Introduction to Thermodynamics and Heat Transfer
Heat things up in your physical science class with this interactive lesson series on thermodynamics. Through a series of class demonstrations and experiments, young scientists learn how heat is transferred through conduction, convention,...
3rd - 8th Science CCSS: Adaptable
Thermal Physics / The Saga Continues - Heat Transfer
Somebody in the Nevada Joint Union High School District has a talent for focusing the important, organizational skills, and a creative eye for creating sharp science presentations! Here is one on heat transfer. Conduction, convection,...
9th - 12th Science
Heat and the Second Law of Thermodynamics
More than a week's worth of investigation is provided in this source. Physical science stars experiment to describe specific heat, conduction, convection, and radiation. They also discover the relationship between mechanical and thermal...
7th - 12th Science
The Hot in the Cold
New ReviewTurn up the heat with these lesson plans! Class members have a chance to model molecules in different states of matter, observe demonstrations of different types of heat transfer, and perform an activity exploring heat transfer in lab...
6th - 8th Science CCSS: Adaptable
More on Conduction and Convection
Why do some items feel colder when they are the same temperature? How should you keep your soda cold? What makes the wind blow? These are just some of the things middle schoolers discover when completing a instructional activity on...
6th - 8th Science CCSS: Adaptable


text:
A unique course leading to an MSc, PGDip or PGCert in Place Management and Leadership is now enrolling for 2016 entry. The part time course is primarily aimed at existing place management practitioners.
What should you do to make your town centre vital and viable?
3-day trip to Berlin as part of the IPM professional education programme: site visits, workshops, meetings with local Place Managers and time to explore the city


text:
No it wouldn't.
Recent Images In This Thread
Featured Stories
Topics Discussed
Related Forum Threads
- NEW MEMBER INQUIRIES & QUICK QUESTIONS- CLASSIC MENSWEAR: WK OF AUG 24, 2015 Last post on 5/28/16 at 9:36am in Classic Menswear
- NEW MEMBER INQUIRIES & QUICK QUESTIONS- CLASSIC MENSWEAR: WK OF JUL 6, 2015 Last post on 7/12/15 at 5:06pm in Classic Menswear
- NEW MEMBER INQUIRIES & QUICK QUESTIONS- CLASSIC MENSWEAR: WK OF APR 20, 2015 Last post on 4/26/15 at 5:41pm in Classic Menswear
- HOF: What Are You Wearing Right Now - Part IV (starting May 2014) Last post on Today at 10:18 am in Classic Menswear
- Good Natured Advice Thread (improving a business wardrobe) Last post on Today at 12:32 pm in Classic Menswear
Related Articles
How Should I Start My Business Wardrobe?
Last edited: 5/16/13
- What Should I Ask My Groomsmen to Wear?Last edited: 9/2/13
- Where to Buy a Last-Minute Wedding Suit for Under $800Last edited: 4/26/16
- What to Wear to (Almost) Any WeddingLast edited: 4/25/16
- What shade of grey should my wedding suit be?Last edited: 3/24/16
Industry Insiders
- Allen Edmonds
- Apolis
- The Armoury
- Batch Mens
- Bodega
- Craftsman Clothing
- David Fin
- Drinkwater's Cambridge
- Dukesbury
- eHABERDASHER
- Epaulet
- Equus Leather
- Exquisite Trimmings
- Falcon Garments
- Freemans Sporting Club
- A Fine Pair of Shoes
- H. Stockton
- Gentlemen's Footwear
- Giin
- Gustin
- The Hanger Project
- H.N. White
- Jeeves
- John Elliott
- Kent Wang
- Khaki's of Carmel
- Lanieri
- Linjer
- LuxeSwap
- Luxire Custom Clothing
- Massdrop
- Matchvm
- Meermin Mallorca
- MILER Menswear
- Need Supply Co.
- No Man Walks Alone
- OTHER/shop
- Pediwear
- Pierpont Leather
- Portland Dry Goods
- Proper Cloth
- Reeves
- Ring Jacket
- S.E.H Kelly
- Self Edge
- ShopTheFinest
- Skoaktiebolaget
- Spier & Mackay
- Standard & Strange
- Suspension Point
- Taylor Stitch
- Uncle Otis
- Vanda Fine Clothing
- Virtual Clotheshorse
- Yellow Hook Necktie
- Your MadeInItaly
The Worst Look - Page 14post #196 of 3898/17/12 at 6:38ampost #197 of 3898/17/12 at 6:52am
- unbelragazzo
- Jewfro
post #198 of 3898/17/12 at 6:53ampost #199 of 3898/17/12 at 6:55am
- Posts: 8,289
- Joined: 6/2011
- Location: Washington, DC
- Select All Posts By This User
- unbelragazzo
- Jewfro
- Posts: 8,289
- Joined: 6/2011
- Location: Washington, DC
- Select All Posts By This User
I'm not going to tell you you're wrong, I just don't care. There is no number of pictures of Sam Zell you could post that would make me want to dress like him.post #200 of 3898/17/12 at 6:57am
- unbelragazzo
- Jewfro
- Posts: 8,289
- Joined: 6/2011
- Location: Washington, DC
- Select All Posts By This User
Whoa. 300 is a lot of cardigans. I think I have 3. I still consider them inferior to the jacket, but for someone who just can't bring themselves to wear a jacket, the cardigan can at least give the "V" of the jacket when buttoned properly.post #201 of 3898/17/12 at 6:58ampost #202 of 3898/17/12 at 7:17am
- unbelragazzo
- Jewfro
- Posts: 8,289
- Joined: 6/2011
- Location: Washington, DC
- Select All Posts By This User
On the first sentence, I really have no idea. But I think for a lot of people it just never really even occurs to them to wear a jacket.
On the second sentence, I agree entirely.post #203 of 3898/17/12 at 7:21amThread Starterpost #204 of 3898/17/12 at 7:25ampost #205 of 3898/17/12 at 7:36am
- Posts: 6,952
- Joined: 4/2012
- Select All Posts By This User
I will throw in on this. I have several cardigans and they are all pieces I love. I never wear one in lieu of a jacket. However on occasion I do wear one with a shirt and tie in situations where a jacket is not required. Not because I prefer them over jackets but because sometimes it's nice to have a little change. They are also nice for those in between seasons where it is too hot for a jacket but you want a little extra warmth. That having been said I do not think it is a good look if you are someone who has a little extra girth. Definitely a fit person's look.post #206 of 3898/17/12 at 7:45am
The whole question of workplace dress depends on what you do, your age, your station, your location, etc. But, in general, it makes no more sense for a 22-year-old guy to wear a three-piece suit to his biz casual cubicle than it would have for him to have worn that three-piece suit to high school or a frat party. If a guy can't figure out how to dress appropriately for his job, why should anyone trust him to make more important decisions?
- Posts: 16,118
- Joined: 4/2005
- Location: Tombstone
- Select All Posts By This User
This isn't to say that guys shouldn't dress as well as their circumstances allow, or even slightly better. It's only to suggest that it's important to think about what your look says about you, and whether your clothing sends the messages you want it to send. Guys who succeed while wearing nice clothes do so because the clothing adds to the image of confidence and competence. But you only need to look at WAYW to see plenty of examples of "nice clothing" doing just the opposite.post #207 of 3898/17/12 at 8:02ampost #208 of 3898/17/12 at 8:07amQuote:
Are you not aware how hot summer is in Asia? Uncles love doing this
It makes Singapore - you know... that South East Asian island ... feel like an Autumn paradise.post #209 of 3898/17/12 at 8:09amThread StarterI'm not advocating that people overdress for their jobs. I'm saying that "suit minus"--i.e., minus the things that make it work as a suit--is a terrible look.
If your workplace is biz-cazh, then swap out the suit pants for more casual pants that work with an odd jacket or no jacket. Swap out the spread collar broadcloth for a textured BD. Throw away the black duckbills for something tasteful in brown. Etc.post #210 of 3898/17/12 at 8:12am
- Posts: 217
- Joined: 1/2012
- Select All Posts By This User
Enduring record breaking heat this summer, I'm inclined to ask (assuming your comment is devoid of sarcasm on the topic): how hot is summer in Asia? (temperatures, please, no "hotter than a pig's ass on the fourth of July in Texas").Return HomeBack to Forum: Classic Menswear
- The Worst Look
Styleforum is proudly sponsored byView our Sponsors Showcase
- What Should I Ask My Groomsmen to Wear?
Recent Discussions
- › The official thrift/discount store bragging thread - Part II... 1 minute ago
- › Mod to Suedehead 2 minutes ago
- › Allen Edmonds Appreciation Thread 2016 - News, Pictures, Sizing,... 2 minutes ago
- › NWOT Schott NYC slim fit peacoat (MSRP: $310) 4 minutes ago
- › ٭٭٭ No Man Walks Alone - Official Affiliate Thread ٭٭٭ 4 minutes ago
- › A1923 Oiled Horse 2-Zip Boots ST3 (size 44, will work for 45) 5 minutes ago
- › Things That Are Bothering You, Got You All Hibbeldy-Jibbeldy, or... 6 minutes ago
- › A1923 Soft Horse Work Boot (size 45) 6 minutes ago
- › The Official Alden Thread for 2016 - Share reviews, sizing, advice,... 9 minutes ago
- › Carol Christian Poell Cordovan One-Piece Tornado Zip Boots (CCP... 9 minutes ago
Recent Reviews
- › Dr. Martens Unisex Original 10 Eye Steel Toe Boot by JC Echeverry
- › Chippewa Men's Super Logger Waterproof Boot by JC Echeverry
- › Mosey Life Working Girl Travel Laptop Tote by sprout2
- › Allen Cox Brief trunks by sprout2
- › Sutor Mantellassi Men's C 567 Oxford by sprout2
- › Alden Burgundy Shell Cordovan Longwing by smfdoc
- › Alden Black Shell Cordovan Plain Toe by smfdoc
- › Florsheim Vincent Wingtip Oxford by smfdoc
- › Allen Edmonds Lasalle Dress Shoes by Lobster33
- › Clark Street Casual Shoes by Lobster33
New Articles
- › Five Menswear Trends for Fall
- › Don't "Just Buy a New One",...
- › Why Pay Such A Premium For Sunspel Or James...
- › In the Details: Lucian Föhr
- › A Sunday Drive: Styleforum Spring GMTOs
- › Should I dryclean my jeans, and if not, how...
- › The 5 Most-Hyped Handbags of the Moment
- › Eight Vignettes in Search of a (Wedding) Theme
- › The Kent Wang Cufflink Giveaway
- › Where to Buy a Last-Minute Wedding Suit for...
About Styleforum | Join the Community | Advertise
© 2016 Styleforum is powered by Fandom Lifestyle | FAQ | Support | Privacy/TOS | Site Map


text:
Fortunately, you're not stuck with the default arrangement; you can move your most-used styles to the top of the list and into the Quick Gallery as follows:
- Click the Styles dialog launcher to open the Styles pane. The launcher is the small arrow in the bottom-right corner of the group.
- Click Manage Styles at the bottom of the Styles list.
- Click the Recommend tab.
- Select the style you want to move. (Use Sort Order to display an alphabetical list if that helps.)
- Click Assign Value and give the style a value from 1 to 99—a value between 1 and 4 will push the style to the ribbon display.
- Click Show.
- Choose As Recommended from the Sort Order dropdown.
- This behavior belongs to the specific document, by default. If you want to move a style to the Quick Gallery for all documents, be sure to click the New Documents Based On This Template option.
- Click OK.
Full Bio
Susan Sales Harkins is an IT consultant, specializing in desktop solutions. Previously, she was editor in chief for The Cobb Group, the world's largest publisher of technical journals.