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Most Cited Journal of Geriatric Oncology Articles
The most cited articles published since 2011, extracted from Scopus.
Screening older cancer patients for a Comprehensive Geriatric Assessment: A comparison of three instrumentsCynthia Owusu | Siran M. Koroukian | Mark Schluchter | Paul Bakaki | Nathan A. Berger
Volume 2, Issue 2, April 2011, Pages 121-129
Background: The Vulnerable Elders Survey (VES-13) has been validated for screening older cancer patients for a Comprehensive Geriatric Assessment (CGA). To identify a widely acceptable approach that encourages oncologists to screen older cancer patients for a CGA, we examined the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) and Karnofsky Index of Performance Status (KPS) scales' ability to identify abnormalities on a CGA and compared the performance of the two instruments with the VES-13. Methods: We enrolled 117 participants, ≥ 65 years with stage I-IV cancer into this cross-sectional study. Our primary outcome variable was ≥ two abnormalities on the CGA, (Yes or No). We employed receiver operating characteristic curve analysis to compare the discriminatory abilities of the three instruments to identify ≥ two abnormalities on the CGA. Results: Of the 117 participants, 43% had ≥ two abnormalities on the CGA. The VES-13 was predictive of ≥ two abnormalities on the CGA, area under the curve (AUC)=0.85 [(95% CI: 0.78-0.92); sensitivity=88%, specificity=69%, at cut-off ≥ 3]. The ECOG-PS and KPS showed similar discriminatory powers, AUC=0.88 [(95% CI: 0.83-0.94); sensitivity=94%, specificity=55%, at cut-off ≥ 1]; and AUC=0.90 [(95% CI: 0.84-0.96); sensitivity=78%, specificity=91%, at cut-off ≥ 80%], respectively. Conclusion: The ECOG-PS and KPS were equivalent to the VES-13 in identifying older cancer patients with at least two abnormalities on the CGA. Given that oncologists are already conversant with the KPS and ECOG-PS, these two instruments offer medical oncologists a widely acceptable approach for screening older patients for a CGA. © 2010 Elsevier Inc.
Evaluation of the Groningen Frailty Indicator and the G8 questionnaire as screening tools for frailty in older patients with cancerAbdelbari Baitar | Frank Van Fraeyenhove | An Vandebroek | Els De Droogh | Daniella Galdermans | Jeroen Mebis | Dirk Schrijvers
Volume 4, Issue 1, January 2013, Pages 32-38
Objective: In this study, we evaluated the Groningen Frailty Indicator (GFI) and the G8 questionnaire as screening tools for a Comprehensive Geriatric Assessment (CGA) in older patients with cancer. Patients and Methods: Eligible patients with various types and stages of cancer were evaluated for frailty before treatment. Patients were categorized as patients with a normal CGA and abnormal CGA (≥2 impaired tests). The diagnostic performance of the screening tools was evaluated against the CGA with Receiver Operating Characteristic analysis. Results: In total, 170 patients (79 women) with median age 77. years old (range 66-97. years) were included. Sixty-four percent of patients had an abnormal CGA while according to the GFI (GFI. ≥4) and G8 questionnaire (G8≤14) 47% and 76% of patients had an abnormal screening test, respectively. Overall, there was no significant difference (p=0.97) in diagnostic performance between the two screening tools. The Area Under the Curve was 0.87 for both tools. For the GFI and G8 questionnaire the sensitivity was respectively 66% (95% CI: 56-75%), 92% (95% CI: 85-96%); the negative predictive value (NPV): 59% (95 CI%: 49-69%), 78% (95% CI: 63-88%); and the specificity: 87% (95% CI: 76-94%), 52% (95% CI: 39-65%). Conclusion: In this study, we showed that overall both the GFI and the G8 questionnaire were able to separate older patients with cancer with a normal and abnormal CGA. For the G8 questionnaire, an adequate sensitivity and NPV were demonstrated, however at the expense of the specificity. For the GFI, we suggest to lower the threshold with one point to GFI ≥3 to screen patients for a CGA. © 2012 Elsevier Inc.
Frailty and malnutrition predictive of mortality risk in older patients with advanced colorectal cancer receiving chemotherapyAb A. Aaldriks | Lydia G M van der Geest | Erik J. Giltay | Saskia le Cessie | Johanneke E A Portielje | Bea C. Tanis | Johan W R Nortier | Ed Maartense
Volume 4, Issue 3, July 2013, Pages 218-226
Introduction: In general, geriatric assessment (GA) provides the combined information on comorbidity and functional, nutritional and psychosocial status and may be predictive for mortality outcome of cancer patients. The impact of geriatric assessment on the outcome of older patients with colorectal cancer treated with chemotherapy is largely unknown. Methods: In a prospective study, 143 patients with colorectal cancer who were 70. years and older were assessed before chemotherapy by Mini Nutritional Assessment (MNA), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Groningen Frailty Indicator (GFI) and Mini Mental State Examination (MMSE). Results: Fifty-four (38%) patients received adjuvant chemotherapy and 89 (62%) patients received palliative chemotherapy. Malnutrition and frailty were prevalent in 39 (27%, assessed by MNA) and 34 (24%, by GFI) patients, respectively; whereas cognitive impairment was prevalent in 19 (13%, by IQCODE) and 11 (8%, by MMSE) patients, respectively. In patients with palliative chemotherapy, poor MNA scores were associated with receiving less than 4. cycles of chemotherapy (p = 0.008). Poor MNA and GFI scores were associated with increased hazard ratios (HR) for mortality for patients with palliative chemotherapy: HR = 2.76 (95% confidence interval [CI]: 1.60-4.77; p < 0.001) and HR = 2.72 (95% CI: 1.58-4.69; p < 0.001), respectively, after adjustment for several clinical parameters. Conclusions: Malnutrition and frailty were strongly associated with an increased mortality risk in patients who underwent palliative chemotherapy. Furthermore, a poor score on MNA was predictive for less tolerance of chemotherapy. Our findings may help the oncologist in future decision making and advice for elderly patients with colorectal cancer. © 2013 Elsevier Inc.
Improved targeting of cancer care for older patients: A systematic review of the utility of comprehensive geriatric assessmentAliya Ramjaun | Mohammed O. Nassif | Stanimira Krotneva | Allen R. Huang | Ari N. Meguerditchian
Volume 4, Issue 3, July 2013, Pages 271-281
A comprehensive geriatric assessment (CGA) provides clinicians with detailed information on a patient's physiological age and may aid in the treatment decision-making process. Conducting a CGA, however, is time-consuming, requiring extensive data collection and, in some cases, the involvement of multiple healthcare professionals. The CGA is also not specifically targeted towards assessing patients presenting with neoplastic pathologies. These limitations have precluded this tool's inclusion in routine oncologic practice involving seniors. In order to identify CGA domains most predictive of important cancer-specific outcomes, we conducted a systematic review (PROSPERO registration number CRD42012002476) using MEDLINE, CINAHL, EMBASE and CANCERLIT databases. Studies published in English or French between May 1997 and May 2012, in which a CGA was conducted in patients over the age of 65 initiating cancer treatment, were assessed for eligibility, of which 9 studies were selected for this review. As part of the inclusion criteria, all studies must have assessed, at minimum, the following domains: nutritional, cognitive and functional status, polypharmacy, comorbidities and the presence of geriatric syndromes. In predicting mortality, in at least one study or another, all of the aforementioned CGA domains were found to be significant. Most frequently, however, the following domains were reported for predicting mortality: nutritional status (HR = 1.84-2.54), the presence of geriatric syndromes such as depression (HR = 1.51-1.81), and functional status (HR = 1.04-1.33). With regards to chemotherapy-related toxicity, similar findings were obtained where functional status (OR = 1.71-2.47) and the presence of geriatric syndromes, such as impaired hearing (OR = 1.67, 95% CI 1.04-2.69), had the most significant predictive value. Only one study reported on the incidence of post-operative complications for which severe comorbidity was found to be highly associated with experiencing severe complications (OR = 5.62, 95% CI 2.18-14.50), while functional status was found to be significantly associated with experiencing any complication (OR = 4.02, 95% CI 1.24-13.09). © 2013 Elsevier Inc.
Patient characteristics associated with polypharmacy and inappropriate prescribing of medications among older adults with cancerGopi K. Prithviraj | Siran Koroukian | Seunghee Margevicius | Nathan A. Berger | Rakesh Bagai | Cynthia Owusu
Volume 3, Issue 3, July 2012, Pages 228-237
Objectives: To identify patient characteristics associated with polypharmacy and inappropriate medication (PIM) use among older patients with newly diagnosed cancer. Materials and Methods: This is a cross-sectional study conducted in ambulatory oncology clinics at an academic center. Participants included 117 patients aged ?. 65 years with newly diagnosed histologically confirmed stage I-IV cancer and were enrolled between April 2008 and September 2009. Medication review, included patient self-report and medical records. Polypharmacy was defined as the concurrent use of ?. five medications, (Yes/. No). PIM use was defined as use of ?. one medication included in the 2003 update of Beers Criteria, (Yes/. No). Results: The prevalence of polypharmacy and PIM use was 80% and 41%, respectively. Three independent correlates of medication use were identified. An increase in comorbidity count by one, ECOG-PS score by one, and PIM use by one, was associated with an increase in medication use by 0.48 (P= 0.0002), 0.79 (P= 0.01) and 1.22 (P= 0.006), respectively. Two independent correlates of PIM use were identified. The odds of using PIMs decreased by 10% for one unit increase in Body Mass Index [Odds Ratio (OR) 0.90, 95% CI = (0.84, 0.97)], and increased by 18% for each increase in medication count by one [OR 1.18, 95% CI = (1.04, 1.34)]. Conclusion: There was a high prevalence of polypharmacy and PIM use in older patients with newly diagnosed cancer. Given the co-occurrence of polypharmacy with poor performance status and multi-morbidity, multi-dimensional interventions are needed in the geriatric-oncology population to improve health and cancer outcomes. © 2012 Elsevier Inc.
Medical treatment of advanced non-small cell lung cancer in elderly patients: A review of the role of chemotherapy and targeted agentsGiulia Meoni | Fabiana Letizia Cecere | Elisa Lucherini | Francesco Di Costanzo
Volume 4, Issue 3, July 2013, Pages 282-290
Lung cancer is the leading cause of cancer related mortality worldwide. Non-small cell lung cancer (NSCLC) accounts for 85% of all cases. Half of the patients at diagnosis of NSCLC are over seventy years old; therefore, the elderly represent a large subgroup of patients affected by advanced NSCLC in our clinical practice. Nevertheless, the elderly are under-represented in clinical trials. Given the fact that old age is frequently associated with several comorbidities, poor general conditions and physiologic reduction in organ function, clinicians must carefully choose the best treatment option for elderly patients with advanced NSCLC, always taking into account the expected risks and benefits. In this paper we perform a review of literature evidence regarding the medical treatment of elderly patients affected by advanced NSCLC, encompassing single-agent chemotherapy, doublet chemotherapy and targeted agents. We conclude that single-agent chemotherapy with a third generation agent (vinorelbine, taxanes, gemcitabine) represents a valid treatment option for elderly patients who are not eligible for a combination chemotherapy due to clinical features such as comorbidities, poor performance status and inadequate organ function. Platinum-based doublet chemotherapy shows similar efficacy in elderly patients as compared to their younger counterpart, despite greater treatment related toxicity and it is indicated in elderly patients with ECOG PS: 0-2, adequate organ function and no major comorbidities. Elderly patients affected by epidermal growth factor receptor (EGFR) mutated NSCLC benefit mostly from a tyrosine kinase inhibitor of EGFR (erlotinib, gefitinib) which is associated with a good toxicity profile. Currently there are no available data to strongly support the use of bevacizumab in combination with first line chemotherapy in the treatment of older adults. Elderly patients affected by NSCLC harboring the EML4-ALK translocation could benefit mostly from a treatment with an oral inhibitor of such a rearrangement (crizotinib). © 2013 Elsevier Inc.
Geriatric assessment is associated with completion of chemotherapy, toxicity, and survival in older adults with cancerTanya M. Wildes | Alexander P. Ruwe | Chloe Fournier | Feng Gao | Kenneth R. Carson | Jay F. Piccirillo | Benjamin Tan | Graham A. Colditz
Volume 4, Issue 3, July 2013, Pages 227-234
Objectives: Our purpose was to determine whether geriatric assessments are associated with completion of a chemotherapy course, grade III/IV toxicity or survival in older adults with cancer. Materials and Methods: In this prospective cohort study, patients aged 65. years and older with colorectal, lung, or breast cancer or lymphoma completed a brief geriatric assessment prior to chemotherapy. Endpoints included completion of the planned number of chemotherapy cycles, grade III/IV toxicity and survival. Multivariate logistic regression determined which factors were independently associated with completion of therapy, grade III/IV toxicity or death. Results: Sixty-five patients were enrolled in the study. The median age was 73. years (range 65-89). Geriatric syndromes were common, including depression (21.5%), dependence on others to carry out instrumental activities of daily living (38.5%) and activities of daily living (10.8%), and comorbidities (mild 47.7%, moderate 20%, severe 15.4%). Of the 65 participants, 67.6% completed the planned number of chemotherapy cycles. Curative intent therapy [OR 4.97 (95% CI 1.21-18.81)], Eastern Cooperative Oncology Group (ECOG) performance status 2-3 [OR 0.089 (0.015-0.53)] and renal function [OR 1.03 (1.00-1.06) per ml/min] were significantly associated with therapy completion. Furthermore, 31.1% experienced grade III/IV non-hematologic toxicity. Moderate to severe comorbidities significantly increased the risk of grade III/IV non-hematologic toxicity [OR 6.13 (1.65-22.74)]. Patients who received chemotherapy with curative intent had lower mortality [HR 0.15 (0.06-0.42)], while patients who reported a fall in the month prior to chemotherapy had an increased risk of death [HR 3.20 (1.13-9.11)]. Conclusions: Geriatric assessment is associated with completion of a planned number of cycles of chemotherapy, grade III/IV non-hematologic toxicity, and mortality. © 2013 Elsevier Inc.
The influence of clinical assessment (including age) and geriatric assessment on treatment decisions in older patients with cancerLore Decoster | Cindy Kenis | Katrien Van Puyvelde | Johan Flamaing | Godelieve Conings | Jacques De Grève | Tony Mets | Koen Milisen | Jean Pierre Lobelle | Hans Wildiers
Volume 4, Issue 3, July 2013, Pages 235-241
Objectives: The aim of this prospective study in older patients with cancer was to evaluate how clinical assessment (including age) determines the physician's treatment decisions, and how geriatric assessment (GA) further influences these decisions. Patients and Methods: Patients aged ≥ 70. years old with cancer were included if a new therapy was considered. All patients underwent a GA and results were communicated to the treating physician. After the final treatment decision, a predefined questionnaire was completed by the physician. Results: In total, 937 patients with median age of 76. years old were included. A total of 902 (96.3%) questionnaires were completed by the treating physicians. In 381/902 patients (42.2%) clinical assessment led to a different treatment decision compared to younger patients without co-morbidities. This difference was most prominent for chemotherapy/targeted therapy decisions. In 505/902 cases (56%) the treating physician consulted GA results before the final treatment decision. In these patients, the treatment decision was influenced by clinical assessment in 44.2%. In 31/505 patients (6.1%) the GA further influenced treatment, mostly concerning chemotherapy/targeted therapy. In eight patients GA influenced the physician to choose a more aggressive chemotherapy. Conclusions: Physicians use different treatment regimens in older versus younger patients, based on clinical assessment, including age. GA results further influence treatment decisions in a minority of patients and may trigger the use of less aggressive as well as more aggressive treatments. GA information is not always utilized by oncologists, indicating the need for better education and sensitization. © 2013 Elsevier Inc.
A comparison of two pre-operative frailty measures in older surgical cancer patientsSiri R. Kristjansson | Benedicte Rønning | Arti Hurria | Eva Skovlund | Marit S. Jordhøy | Arild Nesbakken | Torgeir B. Wyller
Volume 3, Issue 1, January 2012, Pages 1-7
Background: Measuring frailty in older adults with cancer may identify patients with an increased risk of treatment complications. As it remains controversial how to identify frailty, the aim of this study was to compare a pre-operative multi-domain frailty measure based on a comprehensive geriatric assessment (CGA) to a modified version of the physical phenotype of frailty (PF) in a cohort of older adults with colorectal cancer, and to analyze the ability of the two classifications to predict post-operative complications and survival. Methods: A prospective longitudinal study including 176 patients aged 70-94. years electively operated for colorectal cancer in three Norwegian hospitals. A pre-operative CGA, self-reported quality of life, and measurements of grip strength and gait speed were performed. CGA-frailty was defined as fulfilling one or more of the following criteria: dependency in activities of daily living, severe comorbidity, cognitive dysfunction, depression, malnutrition, or > seven daily medications. PF was defined with three or more of the following criteria: unintentional weight loss, exhaustion, low physical activity, impaired grip strength, or slow gait speed. Outcome measures were post-operative complications and survival. Results: The agreement between the classifications was poor. CGA-frailty was identified in 75 (43%) patients, while PF was identified in 22 (13%) patients. Only CGA-frailty predicted post-operative complications [P. =0.001]. Both measures predicted survival. Conclusions: A multi-domain frailty measure based on a CGA was more useful than frailty identified from a modified version of the PF criteria in predicting post-operative complications. For overall survival, both frailty measures were predictive. © 2011 Elsevier Inc.
Comparison of scoring methods for ACE-27: Simpler is betterDorina Kallogjeri | Jay F. Piccirillo | Edward L. Spitznagel | Ewout W. Steyerberg
Volume 3, Issue 3, July 2012, Pages 238-245
Objective: To examine the prognostic value of different comorbidity coding schemes for predicting survival of newly diagnosed elderly cancer patients. Materials and methods: We analyzed data from 8867 patients aged 65 years of age or older, newly diagnosed with cancer. Comorbidities present at the time of diagnosis were collected using the Adult Comorbidity Evaluation-27 index (ACE-27). We examined multiple scoring schemes based on the individual comorbidity ailments, and their severity rating. Harrell's c index and Akaike Information Criterion (AIC) were used to evaluate the performance of the different comorbidity models. Results: Comorbidity led to an increase in c index from 0.771 for the base model to 0.782 for a model that included indicator variables for every ailment. The prognostic value was however much higher for prostate and breast cancer patients. A simple model which considered linear scores from 0 to 3 per ailment, controlling for cancer type, was optimal according to AIC. Conclusion: The presence of comorbidity impacts on the survival of elderly cancer patients, especially for less lethal cancers, such as prostate and breast cancers. Different ailments have different impacts on survival, necessitating the use of different weights per ailment in a simple summary score of the ACE-27. © 2012 Elsevier Inc.
Diffuse large B-cell and peripheral T-cell non-Hodgkin's lymphoma in the frail elderly. A phase II EORTC trial with a progressive and cautious treatment emphasizing geriatric assessmentPierre Soubeyran | Hussein Khaled | Marius MacKenzie | Muriel Debois | Catherine Fortpied | Robrecht de Bock | Joel Ceccaldi | Daphne de Jong | Houchingue Eghbali | Muriel Rainfray | Alain Monnereau | Gilbert Zulian | Ivana Teodorovic
Volume 2, Issue 1, January 2011, Pages 36-44
Objectives: Many frail elderly patients with diffuse large B-cell lymphoma (DLBCL) cannot tolerate standard chemotherapy treatment. The objective of this phase II trial was to assess the efficacy of a cautious COP-based (cyclophosphamide, vincristine, prednisone) regimen with comprehensive geriatric assessment (CGA). Trial registration number: NCT00039351. Materials and methods: DLBCL patients aged ≥70years with poor physiological functioning received cyclophosphamide (750mg/m2 IV at d1), vincristine (1.4mg/m2 IV at d1, maximum of 2mg) and prednisone (40mg/m2 d1 to d5) for six cycles. Comprehensive Geriatric Assessment (CGA) was performed for all patients before and after treatment. Results: Thirty-two patients were included, of whom 27 were evaluable for efficacy. Low response rates were observed with only 18.5% complete response and 25.9% partial response leading to the early termination of the trial. Despite strict dose reduction rules, high toxicity rates were observed with four severe toxicities and eight early deaths. CGA data showed that over 90% of patients were depressed, over 80% dependent for instrumental activities of daily living (IADL) and almost half of our patients had severe comorbidities showing that we clearly selected a population of "frail" elderly. Conclusion: This adapted COP regimen for vulnerable patients produced an 18.5% complete response rate. Future research will include the addition of rituximab to determine if it can improve treatment efficacy. The geriatric assessment should be part of routine management of frail patients with aggressive lymphomas as it allows us to identify specific issues of vulnerability in this population on which intervention should be focused. © 2010 Elsevier Inc.
A novel approach to improve health status measurement in observational claims-based studies of cancer treatment and outcomesAmy J. Davidoff | Ilene H. Zuckerman | Naimish Pandya | Franklin Hendrick | Xuehua Ke | Arti Hurria | Stuart M. Lichtman | Arif Hussain | Jonathan P.Weiner | Martin J. Edelman
Volume 4, Issue 2, April 2013, Pages 157-165
Objectives: To develop and provide initial validation for a multivariate, claims-based prediction model for disability status (DS), a proxy measure of performance status (PS), among older adults. The model was designed to augment information on health status at the point of cancer diagnosis in studies using insurance claims to examine cancer treatment and outcomes. Materials and Methods: We used data from the 2001-2005 Medicare Current Beneficiary Survey (MCBS), with observations randomly split into estimation and validation subsamples. We developed an algorithm linking self-reported functional status measures to a DS scale, a proxy for the Eastern Cooperative Oncology Group (ECOG) PS scale. The DS measure was dichotomized to focus on good [ECOG 0-2] versus poor [ECOG 3-4] PS. We identified potential claims-based predictors, and estimated multivariate logistic regression models, with poor DS as the dependent measure, using a stepwise approach to select the optimal model. Construct validity was tested by determining whether the predicted DS measure generated by the model was a significant predictor of survival within a validation sample from the MCBS. Results and Conclusion: One-tenth of the beneficiaries met the definition for poor DS. The base model yielded high sensitivity (0.79) and specificity (0.92); positive predictive value. =48.3% and negative predictive value. =97.8%, c-statistic. =0.92 and good model calibration. Adjusted poor claims-based DS was associated with an increased hazard of death (HR. =3.53, 95% CI 3.18, 3.92). The ability to assess DS should improve covariate control and reduce indication bias in observational studies of cancer treatment and outcomes based on insurance claims. © 2013 Elsevier Inc.
Determination of an adequate screening tool for identification of vulnerable elderly head and neck cancer patients treated with radio(chemo)therapyLies Pottel | Tom Boterberg | Hans Pottel | Laurence Goethals | Nele Van Den Noortgate | Fréderic Duprez | Wilfried De Neve | Sylvie Rottey | Kurt Geldhof | Koen Van Eygen | Khalil Kargar-Samani | Véronique Ghekiere | Frank Cornelis | Supriya Mohile | Philip R. Debruyne
Volume 3, Issue 1, January 2012, Pages 24-32
Objectives: We evaluated two proposed screening tools, the Vulnerable Elders Survey-13 (VES-13) and the G8, to identify patients who could benefit from a comprehensive geriatric assessment (CGA). Materials and Methods: All consecutive patients aged ≥ 65. years with primary head and neck cancer were assessed with VES-13, G8 and CGA. Receiver operating characteristics (ROC)-analysis was used to determine diagnostic performance of both screening instruments. Results: Fifty-one patients were recruited, of which 39.2%, 66.7% and 68.6%, were defined vulnerable when evaluated with VES-13, G8 and CGA, respectively. The area under the ROC-curves (AUC ± SE) of VES-13 (0.889 ± 0.045) and G8 (0.909 ± 0.040) did not significantly differ (P=0.7083). A sensitivity and specificity of respectively 57.1% and 100% for VES-13 (cut-off ≥ 3) and 85.7% and 75.0% for G8 (cut-off ≤ 14) was obtained. The combined score "VES-13. +. (maximum-G8)" (AUC. =0.971 ± 0.019) showed a superior AUC to G8 (P=0.0242) and VES-13 (P=0.0237). The most optimal cut-off score of 5 for the combined test resulted in a sensitivity of 91.4% and a specificity of 93.8%. Positive and negative predictive values were 100% and 51.6%, 88.2% and 70.6%, and 97.0% and 83.3% for the VES-13, G8 and combined test respectively. Conclusion: Both tools were found to have good diagnostic performance. However, at the proposed cut-off scores, our data suggest the G8 as the most optimal screening tool. Moreover, the combined tool could represent an interesting alternative. © 2011 Elsevier Inc.
Polypharmacy and drug use in elderly Danish cancer patients during 1996 to 2006T. L. Jorgensen | J. Herrstedt | S. Friis | J. Hallas
Volume 3, Issue 1, January 2012, Pages 33-40
Background: Elderly people are frequently exposed to polypharmacy defined as the simultaneous use of multiple drugs. However, data on drug use among elderly cancer patients are limited. The aims of this study were to describe drug use and polypharmacy in cancer patients aged ≥ 70 years and to describe their drug usage pattern prior to and following the cancer diagnosis. Methods: Population-based case-control study of all incident cancer cases in the Danish province of Funen (population 480,000) from 1996 to 2006. Data were collected from the Danish Cancer Registry and the Odense Pharmacoepidemiologic Database. Conditional logistic regression was used to compare drug use in cases and controls. Results: We identified 24,808 cancer cases and 99,299 controls. Of these, 47% were aged ≥ 70 years. At diagnosis, 35% of elderly cases used ≥ 5 drugs daily compared with 27% of controls, OR 1.76 (95% CI 1.66-1.86), and drug use was significantly higher as early as 18. months prior to the cancer diagnosis. In particular, use of analgesics, acid-suppressing drugs, and antibiotics increased markedly six months preceding cancer diagnosis. Mean daily drug use at diagnosis increased during the study period. Conclusion: Newly diagnosed elderly cancer patients use more drugs than the background population. Drug use increased markedly the last six months prior to the cancer diagnosis. This could suggest an increased symptom burden in patients prior to diagnosis and might serve as a warning signal for general practitioners. © 2011 Elsevier Inc.
Comprehensive geriatric assessment (CGA) in older oncological patients: Why and how?Hans Wildiers | Cindy Kenis
Volume 3, Issue 2, April 2012, Pages 174-176
A Comprehensive Geriatric Assessment (CGA) is the most appropriate method to obtain a view on the general health status of an older individual (including social situation, functionality, falls, cognition, mood changes, nutritional status). There is often limited knowledge among oncologists/healthcare workers on practical aspects of geriatric assessment. Under the auspices of the educational committee of SIOG, a practice guideline was developed with very concrete information on the most frequently used geriatric assessment tools. This guideline is available at the SIOG website, and is meant to become an 'up-to-date' system where healthcare workers can add new evidence or information if required. This editorial also discusses the reasons why oncologists need a geriatric assessment. © 2011 Elsevier Ltd.
Exercise and cancer treatment symptoms in 408 newly diagnosed older cancer patientsLisa K. Sprod | Supriya G. Mohile | Wendy Demark-Wahnefried | Michelle C. Janelsins | Luke J. Peppone | Gary R. Morrow | Raymond Lord | Howard Gross | Karen M. Mustian
Volume 3, Issue 2, April 2012, Pages 90-97
of exercise for managing cancer and treatment-related side effects have been shown among various populations of cancer survivors, a relative dearth of information exists among older cancer patients. Objectives: To determine the prevalence of exercise participation during and after primary cancer treatment in older (≥ 65. years) and the oldest (≥ 80. years) cancer patients and to examine the relationships between exercise, symptoms, and self-rated health (SRH). Materials and methods: 408 newly diagnosed older cancer patients (mean age = 73, range = 65-92) scheduled to receive chemotherapy and/or radiation therapy reported symptoms and SRH prior to, during, and 6. months after treatment, and exercise participation during and following treatment. Results: Forty-six percent of older and 41% of the oldest patients reported exercising during treatment. Sixty percent of older and 68% of the oldest patients reported exercising in the 6. months thereafter. Older patients who exercised during treatment reported less shortness of breath and better SRH during treatment, and better SRH following treatment. The oldest patients who exercised during treatment reported less memory loss and better SRH during treatment and less fatigue and better SRH following treatment. The oldest patients who exercised following treatment reported less fatigue, skin problems, and total symptom burden following treatment. Conclusion: These data suggest a willingness of older cancer patients to attempt exercise during and after treatment. Exercise during these times is associated with less severe symptoms; further clinical research examining the efficacy of formal exercise interventions to reduce symptoms and improve SRH in older cancer patients is needed. © 2012 Elsevier Ltd.
Evaluating the physiological reserves of older patients with cancer: The value of potential biomarkers of aging?Athanasios G. Pallis | Sigrid Hatse | Barbara Brouwers | Graham Pawelec | Claire Falandry | Ulrich Wedding | Lissandra Dal Lago | Lazzaro Repetto | Alistair Ring | Hans Wildiers
Volume 5, Issue 2, January 2014, Pages 204-218
Aging of an individual entails a progressive decline of functional reserves and loss of homeostasis that eventually lead to mortality. This process is highly individualized and is influenced by multiple genetic, epigenetic and environmental factors. This individualization and the diversity of factors influencing aging result in a significant heterogeneity among people with the same chronological age, representing a major challenge in daily oncology practice. Thus, many factors other than mere chronological age will contribute to treatment tolerance and outcome in the older patients with cancer. Clinical/comprehensive geriatric assessment can provide information on the general health status of individuals, but is far from perfect as a prognostic/predictive tool for individual patients. On the other hand, aging can also be assessed in terms of biological changes in certain tissues like the blood compartment which result from adaptive alterations due to past history of exposures, as well as intrinsic aging processes. There are major signs of 'aging' in lymphocytes (e.g. lymphocyte subset distribution, telomere length, p16INK4A expression), and also in (inflammatory) cytokine expression and gene expression patterns. These result from a combination of the above two processes, overlaying genetic predispositions which contribute significantly to the aging phenotype. These potential "aging biomarkers" might provide additional prognostic/predictive information supplementing clinical evaluation. The purpose of the current paper is to describe the most relevant potential "aging biomarkers" (markers that indicate the biological functional age of patients) which focus on the biological background, the (limited) available clinical data, and technical challenges. © 2013 Elsevier Inc.
Understanding the link between cancer and neurodegenerationJane A. Driver
Volume 3, Issue 1, January 2012, Pages 58-67
There is growing evidence that cancer shares a number of biological pathways with common neurodegenerative diseases of aging. In epidemiologic studies, Parkinson's and Alzheimer's disease seem to be associated with a decreased cancer risk. Genes associated with neurodegeneration have important functions in protein folding and processing, but often play a role in the cell cycle. Activation and deregulation of the cell cycle is a core feature of both diseases; in the neuron, the end result is apoptosis, while in the malignant cell, it is uncontrolled proliferation. Successful aging requires a careful balance between the forces that promote tissue renewal and those that suppress the cell cycle. Proteins such as p53 and Pin1 might explain why some individuals are relatively protected from cancer but at increased risk of neurodegeneration. This article reviews the available epidemiologic evidence linking neurodegenerative disease and cancer, discusses the cellular pathways and genes which might account for this unexpected relationship, and explores the potential therapeutic implications of this area of research. © 2011 Elsevier Inc.
Comprehensive Geriatric Assessment (CGA) of elderly lung cancer patients: A single-center experienceRegina Gironés | Dolores Torregrosa | Inma Maestu | José Gómez-Codina | Jose M. Tenias | Rafael Rosell Costa
Volume 3, Issue 2, April 2012, Pages 98-103
Purpose: This study investigated the association of CGA variables with function and survival in elderly lung cancer patients. Patients and methods: We prospectively included 83 consecutive elderly patients with lung cancer who were seen at the outpatient oncology unit at the Hospital Lluis Alcanyis. The patients completed a geriatric assessment tool to measure functional status, comorbidity, cognitive function, psychological state, social support and nutritional status. The correlations of oncological and geriatric variables with survival were determined. Results: The median patient age was 77. years, and the mean number of comorbidities was 3. The measures of dependency were 48.2% for ADL and 69.9% for IADL. PS (p < 0.001), IADL dependency (p < 0.001), dementia (p < 0.001), depression (p < 0.001), weight loss, hypoalbuminemia, delirium and incontinence were independently associated with survival. Frail patients exhibited poorer survival (mean: 18.5. months vs. 9.1. months), but this difference was statistically not significant (p = 0.07). Conclusions: Geriatric assessment detects more information than oncological evaluation alone. Factors related to survival may assist in the classification of elderly lung cancer patients. © 2011 Elsevier Ltd.
Clinical trial design in older adults with cancer-The need for new paradigmsStuart M. Lichtman
Volume 3, Issue 4, October 2012, Pages 368-375
Increasing age is directly associated with an increasing risk of cancer, and persons over 65 constitute the fastest growing group in the United States. Not only do older adults comprise the majority of cancer patients, at the same time, they have also been vastly underrepresented in clinical trials. As a result, little evidence-based data exist to guide their course of treatment. Alternative trial designs and expanded research evaluations are needed to guide cancer therapy in this population, which is estimated to account for 20% of all Americans by the year 2030. In this review, after examining the status quo, we propose ways to correct the widespread underreporting and underrepresentation of older adults in cancer trials, and highlight existing barriers to trial enrollment. We also outline specific issues of treatment and survivorship as they pertain to older adults, including function, clinical benefit, quality of life, polypharmacy, toxicity, and comorbidity. © 2012 Elsevier Ltd.
Exercise for older adult inpatients with acute myelogenous leukemia: A pilot studyHeidi D. Klepin | Suzanne C. Danhauer | Janet A. Tooze | Kylie Stott | Kristin Daley | Tanya Vishnevsky | Bayard L. Powell | Shannon L. Mihalko
Volume 2, Issue 1, January 2011, Pages 11-17
Objectives: Acute myelogenous leukemia (AML) largely affects older adults. Few interventions have sought to improve functional status and health-related quality of life (HRQL) during treatment. The objective of this study is to examine the feasibility of an exercise intervention among older adults with AML undergoing induction chemotherapy. Materials and Methods: Pilot study of adults ≥ 50. years of age hospitalized for AML chemotherapy. The 4-week exercise intervention included stretching, walking, and strength exercises. Feasibility measures included recruitment, retention, number of exercise sessions completed, and barriers to participation. Physical function, HRQL, depression, and distress were assessed at baseline (week 1), upon completion of intervention (week 5), and during follow-up (weeks 9-13). Exploratory analyses used repeated measures ANCOVA to model changes over time. Results: Among 55 eligible inpatients, 24 enrolled (43.6%). Mean age was 65.1. years (SD 7.8). Participants (87.5%) completed baseline measures; 70.8% attended ≥ 1 exercise sessions, and 50.0% completed post-intervention assessment. Among baseline characteristics, only higher physical performance was associated with greater number of exercise sessions attended (p=0.001). Post-intervention, HRQL and depressive symptoms improved (p< 0.05). Conclusion(s): Recruitment to an exercise intervention was feasible. Exercise shows promise to maintain physical function and enhance HRQL. Strategies to enhance adherence to exercise are needed to maximize benefit. © 2010 Elsevier Inc.
Main priorities for the development of geriatric oncology: A worldwide expert perspectiveMartine Extermann | Matti Aapro | Riccardo Audisio | Lodovico Balducci | Jean Pierre Droz | Christopher Steer | Hans Wildiers | Gilbert Zulian
Volume 2, Issue 4, October 2011, Pages 270-273
Objective: The world population is aging rapidly, thanks to improvements in nutrition, sanitation, disease treatment and prevention (notably for infectious diseases), and better economic conditions. As aging is the main risk factor for cancer, its incidence follows suit. This represents a worldwide challenge and addressing it correctly will require a vast international effort and clear priorities.Methods: The International Society of Geriatric Oncology (SIOG), a multidisciplinary society of experts in the field, decided to identify those priorities. The SIOG National Representatives (NRs) were asked first to identify the 10 highest priorities to address on a worldwide scale. Then, the NRs were asked to identify how these priorities were/could be implemented in their country. A writing committee assembled and edited the results.Results: We identified 3 key areas of priority: education, clinical practice, and research. Education should be targeted at both the professional and the population levels. In clinical practice, pilot models of multidisciplinary collaboration should be expanded first to key reference centers, and a 2-step approach to screening and evaluation should be used to optimize resource use. In research, several strategies can render trials more relevant for older patients. These priorities are fully detailed in a monograph. 1 that can be viewed online at www.siog.org or ordered from firstname.lastname@example.com. This article explores the rationale and general academic and public health implications of these priorities.Conclusions: These priorities represent an expert consensus with potential to guide education, clinical practice, and research to improve the care of older cancer patients throughout the world. © 2011 Elsevier Inc.
Comorbidity and geriatric assessment for older patients with hematologic malignancies: A review of the evidenceM. Extermann | U. Wedding
Volume 3, Issue 1, January 2012, Pages 49-57
The majority of hematologic malignancies occur in patients aged more than 65. years. Such patients have very variable health status, comorbidity levels, and geriatric syndrome prevalence. It is important to identify who would be a candidate for standard treatment schemes, and who would be a candidate for modified therapeutic approaches. Accurate assessment of patient fitness and comorbidities is key when planning therapy for this group as such factors will affect prognosis. In this paper, we review the published literature on a comprehensive geriatric assessment and comorbidity measurements in patients with hematologic malignancies and their correlation with outcomes. Our review identified the Charlson score and the Cumulative Illness Rating Scale-Geriatric as the most frequently used comorbidity instruments in the general setting, and the Hematopoietic Cell Transplantation-Comorbidity Index in the transplant setting. For the geriatric assessments, the most commonly used scheme combines age, comorbidity, Activities of Daily Living, and the presence of geriatric syndromes. Correlations with overall survival and treatment tolerance are fairly consistently demonstrated. Some tentative thresholds are apparent but remain to be firmly confirmed. Future trials should integrate these assessments as correlates or stratification tools in order to build on the early results already available. © 2011 Elsevier Inc.
Systematic review of falls in older adults with cancerTanya M. Wildes | Priya Dua | Susan A. Fowler | J. Philip Miller | Christopher R. Carpenter | Michael S. Avidan | Susan Stark
Volume 6, Issue 1, January 2015, Pages 70-83
© 2014 Elsevier Inc.Objectives: Older adults frequently experience falls, at great cost to themselves and society. Older adults with cancer may be at greater risk for falls and have unique risk factors. Materials and methods: We undertook a systematic review of the available medical literature to examine the current evidence regarding factors associated with falls in older adults with cancer. PubMed, Embase, CINAHL, CENTRAL, DARE, Cochrane Database of Systematic Reviews and clinical trials.gov were searched using standardized terms for concepts of oncology/cancer, people 60 and older, screening, falls and diagnosis. Eligible studies included cohort or case-control studies or clinical trials in which all patients, or a subgroup of patients, had a diagnosis of cancer and in which falls were either the primary or secondary outcome. Results: We identified 31 studies that met our inclusion criteria. Several studies suggest that falls are more common in older adults with a diagnosis of cancer than those without. Among the 11 studies that explored factors associated with outpatient falls, some risk factors for falls established in the general population were also associated with falls in older adults with cancer, including dependence in activities of daily living and prior falls. Other factors associated with falls in a general population, such as age, polypharmacy and opioid use, were not predictive of falls among oncology populations. Falls among older adults with cancer in the inpatient setting were associated with established risk factors for falls in people without cancer, but also with factors unique to an oncology population, such as brain metastases. Conclusions: Falls in older adults with cancer are more common than in the general population, and are associated with risk factors unique to people with cancer. Further study is needed to establish methods of screening older adults with cancer for fall risk and ultimately implement interventions to reduce their risk of falls. Identifying which older adults with cancer are at greater risk for falls is a requisite step to ultimately intervene and prevent falls in this vulnerable population.
Frailty indicators and functional status in older patients after colorectal cancer surgeryBenedicte Rønning | Torgeir Bruun Wyller | Marit Slaaen Jordhøy | Arild Nesbakken | Arne Bakka | Ingebjørg Seljeflot | Siri Rostoft Kristjansson
Volume 5, Issue 1, January 2014, Pages 26-32
Objectives: The number of older survivors from colorectal cancer is increasing, but little is known regarding long-term consequences of cancer treatment in this patient group. Physical function is an important outcome for older patients, affecting both autonomy and quality of life. We aimed to investigate physical function in older patients with colorectal cancer before and after surgery, and to examine the role of individual frailty indicators as predictors of functional decline. Material and Methods: We present 16-28. months follow-up data of older patients after elective surgery for colorectal cancer. During a home-visit, physical function was evaluated by activities of daily living (ADL), instrumental activities of daily living (IADL), the timed up-and-go (TUG) test, and grip strength. Measurements were compared with those obtained preoperatively using the Wilcoxon signed rank test. Frailty indicators were dichotomized and implemented in logistic regression models to explore their associations to a decline in the physical function scores. Results: Eighty-four patients were included and the median age was 82. years. There was a significant decrease in ADL (p. = 0.04) and IADL scores (p. ≤. 0.001) at follow-up. We found no associations between frailty indicators and the risk of decline in physical functioning. Conclusion: In our population of older patients with surgically treated colorectal cancer, there was a significant decline in ADL- and IADL-scores at follow-up. No change was found in TUG or grip strength, and frailty indicators did not predict decline in physical function. © 2013 Elsevier Inc.


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Hiram College - Library telephone number is (330) 569-5359.
Telefax: No fax number available
Website: No web address available
Biz owner? Moderate reviews or edit listing.
Search entire category for Universities & Colleges
Universities and Colleges, in Hiram, are institutions for education, learning, research and teaching. They are centers for higher learning and teaching, and confer academic degrees like bachelor's, master's, and doctorates to the students upon successful completion of their courses and research work. They provide instruction in a variety of fields like the liberal arts, medicine, vocational courses, engineering and other technical subjects, music, agriculture, etc.
Biofuel: Food In, Fuel Out, But Is It The Answer We're looking For?
(Long Island, NY) In today's environmentally-conscious worldview that is being shared by more and more people, alternative fuel sources are the Holy Grail of the "green" movement. There are many new ways to eschew hydrocarbon-laden gasoline when it comes to filling up your vehicle's tank at the pump, and one of the most oft-talked about are biofuels- mainly ethanol and..

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text: Brand: Change Style: 19804201 Sizes: 30 - 38 A, B, C, D, DD, E, F Fabric Content: 87% Nylon 13% Elastane 79% Nylon 21% Elastane Change Lingerie Seamless Push Up Bra19804201. The Sofia push up bra features seamless cups for invisibility under clothing. Straps can be converted either criss-cross or halter. Adjustable straps for a more personal fit.


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Thursday, 18 April 2013
Ciate, the brand behind the caviar manicure have just launched their newest nail kit, The Chalkboard Manicure.
The Chalkboard manicure kit includes a matt black chalkboard polish base and a set of four chalk pens that allow to doodle all over your nails to create your ideal design, the best part is that if you make a mistake you can wash it right off with water. Once you have perfected your design all you need to do is give it a matt top coat to seal the final product.
The Chalkboard Kit retails for £25 and at this time it is exclusive to Selfridges but will be available on a wider release a little later.
Labels:Exclusive,Make Up,Nails,Selfridges
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Every once in a while, teammates stand next to each other and combine to make a quirky word or phrase. South Carolina redshirt junior Patrick Fish and freshman Elliott Fry were caught on the field next to each other near the end of the first half against Tennessee on Saturday.
Somebody was particularly impressed:
Oh my goodness South Carolina is my new favorite team pic.twitter.com/l490JsW7CG— Ian Radcliff (@radiancliff) October 19, 2013


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Several residents were evacuated in the Pine Hills area of Harriman on Dec. 1 because of a significant gas leak.
"We had to evacuate," said Bill Young, Harriman Utility Board manager. "We didn't have to, but we did for safety."
Young said the situation was tricky because utility workers had to fix the leak while the line was still "hot" or under pressure.
The utility recently purchased fire suits for employees working in gas for such situations.
Months after the position came open, Roane County still doesn't have the parks and recreation director job filled.
"We're not just going to hire anybody off the street," Roane County Executive Ron Woody said. "We're selective on our side about the candidate we want."
The job opened up over the summer when Tony Brown left to go work for the road department.
Woody said six interviews were conducted. He said the job was offered to one of the candidates, but the person turned it down.
Hammer-wielding Thomas Cook of Harriman works with a crew dismantling a dock at 58 Landing in Kingston. The dock once served a privately owned Watts Bar Belle riverboat the city allowed to operate there, but it was left behind when the enterprise left because of financial problems. After determining that it was built below standards, the city decided to take it apart and salvage usable material to expand the docks at the Ladd Park boat ramp.
by AVIVA YAFFA
The eight-day holiday of Hanukkah, or the "Feast of Lights," which this year is observed from the evening of Saturday, Dec. 8, to Sunday, Dec. 16, commemorates what many historians as well as religious scholars consider to be the first organized revolt by a nation against tyranny.
The story of Hanukkah goes back well over 2,000 years.
Roane County's congressman is noncomittal about the chances for a deal to avoid the what some have termed a looming fiscal cliff in the federal government.
"I won't say I'm optimistic or pessimistic," said Chuck Fleischmann, who represents Tennessee's Third Congressional District that includes Roane County. "I'm going to continue to be very diligent and vigilant, study the process, so I'm prepared to act if that (a deal) happens."
A man accused of sex crimes in Georgia was arrested in Rockwood last Friday.
City police went with the U.S. Marshals Service to a bakery to arrest William Bradley Jones, who was wanted for aggravated sodomy and aggravated child molestation.
Jones, 22, was arrested and taken to the Roane County Jail.
His home address in police and jail records was listed as 630 N. Front St., Rockwood.
The crimes Jones allegedly committed occurred over the summer in Woodstock, Ga.
The alleged victim was 15.
Although a changes in the Roane County News logo was made as planned with the last edition, the paper size did not change as announced due to a glitch in the pressroom
The new, narrower format already adopted by the larger dailies in our area is now being used by the Roane County News.
Newspapers have made the move to save on newsprint.
A lack of competition in the paper market and other factors have sent newsprint paper costs soaring over the years.
By MIKE GIBSON
The operative word in the latest progress update on Kingston's new city hall might be "snug."
That's a good a general word to describe the budget, some of the space allocation, and even progress toward meeting projected timelines for getting the new hall up and running.
Snug, but certainly not uncomfortable.
And no one is complaining, as the project seems to be going as well as can be expected for an endeavor of this magnitude.
The early-morning hour Saturday didn't stop young shoppers at Walmart from enthusiastically making rounds at the store.
Operation REACH once again took selected youth shopping last weekend, with busloads of young people spilling out at the Rockwood store around 6 a.m. to buy gifts for their families. Later they headed to Rockwood High School and Rockwood Middle School to wrap them.
By MIKE GIBSON
There will be no more kickturns, ollies, and certainly no more boardslides at Kingston's Ladd Park.
For the uninitiated, those are all skateboarding tricks.
The city's lone skatepark — at Ladd Park, in the shadow of the Clinch River Bridge on North Kentucky Street — was recently closed down, due to a rash of vandalism incidents.
Copyright © 2016
The Roane County News is your source for local news, sports, events, and information in Roane County and Kingston, Tennessee, and the surrounding area.


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Ban Ki-moon
South Jorean Politicians Current Secretary-general of the United Nations
Born Jun 13, 1944
"MIT GOTT HILFE" Monsieur le Secrtétaire Général des Nations Unies,Madame,Messieurs, n:nombre de jours du semis à la germination telle qu'elle est codifiée CHIMIQUEMENT. Vg=volume d'ue graine de céreale Vp=pourcentage de ce volume occupé par les substrats… Read More
View newly released photos of Ban Ki-moon.
Learn about the memorable moments in the evolution of Ban Ki-moon.
1944 Birth Ban was born on 13 June 1944 in the small farming village of Haengchi, Wonnam Township (-myeon), in Eumseong County, North Chungcheong Province in Korea. … Read More
1962 18 Years Old In secondary school (Chungju High School), Ban became a star student, particularly in his studies of the English language. In 1962, Ban won an essay contest sponsored by the Red Cross and earned a trip to the United States where he lived in San Francisco with a host family for several months. … Read More
1970 26 Years Old 1 More Event
He received a bachelor's degree in international relations from Seoul National University in 1970, and earned a Master of Public Administration from the John F. Kennedy School of Government at Harvard University in 1985. … Read More
1974 30 Years Old In 1974 he received his first posting to the United Nations, as First Secretary of the South Permanent Observer Mission (South Korea became a full UN member-state on 17 September 1991).
1979 35 Years Old After Park Chung-hee's 1979 assassination, Ban assumed the post of Director of the United Nations Division.
1980 36 Years Old In 1980 Ban became director of the United Nations' International Organizations and Treaties Bureau, headquartered in Seoul.
1990 46 Years Old He has been posted twice to the South Korean embassy in Washington, D.C. Between these two assignments he served as Director-General for American Affairs in 1990–92.
1992 48 Years Old In 1992, he became Vice Chairman of the South-North Joint Nuclear Control Commission, following the adoption by South and North Korea of the Joint Declaration of the Denuclearization of the Korean Peninsula.
1993 49 Years Old From 1993 to 1994 Ban was Korea's deputy ambassador to the United States.
1995 51 Years Old He was promoted to the position of Deputy Minister for Policy Planning and International Organizations in 1995 and then appointed National Security Advisor to the President in 1996. … Read More
1998 54 Years Old Ban was appointed Ambassador to Austria and Slovenia in 1998, and a year later he was also elected as Chairman of the Preparatory Commission for the Comprehensive Nuclear-Test-Ban Treaty Organization (CTBTO PrepCom).
2001 57 Years Old 1 More Event
During the negotiations, in what Ban considers the biggest blunder of his career, he included in a public letter a positive statement about the Anti-Ballistic Missile Treaty in 2001, not long after the United States had decided to abandon the treaty. … Read More
2003 59 Years Old In 2003, incoming president Roh Moo-hyun selected Ban as one of his foreign policy advisors.
2006 62 Years Old 3 More Events
2007 63 Years Old 8 More Events
When Ban became Secretary-General, The Economist listed the major challenges facing him in 2007: "rising nuclear demons in Iran and North Korea, a haemorrhaging wound in Darfur, unending violence in the Middle East, looming environmental disaster, escalating international terrorism, the proliferation of weapons of mass destruction, the spread of HIV/AIDS. … Read More
2008 64 Years Old 2 More Events
Ban Ki-moon flew to Myanmar on 25 May 2008 to guide a conference with international agencies aimed at boosting donations for the nation, which was struck by Cyclone Nargis on 2 May 2008.
2011 67 Years Old 2 More Events
On 6 June 2011, Ban Ki-moon formally announced his candidacy for a second consecutive term as Secretary-General of the United Nations. … Read More
2012 68 Years Old 5 More Events
His new five-year term as Secretary-General commenced on 1 January 2012 and will end on 31 December 2016.
2013 69 Years Old 3 More Events
Ban was named the world's 32nd most powerful person by the Forbes list of The World's Most Powerful People in 2013, the highest among South Koreans.
Original Authors of this text are noted on http://en.wikipedia.org/wiki/Ban_Ki-moon.
Text is made available under the Creative Commons Attribution-ShareAlike License.
Text is made available under the Creative Commons Attribution-ShareAlike License.


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Cute storage ideas provide way more than simply a means to corral your kid's clutter. They can make any space look put together and stylish. Storage has come a long way since the inception of boxes and bins. It now includes fun options that might even promote pick up time when play time is through.
A days-of-the-week hanging organizer doesn't just allow for a week's worth of outfits to be selected ahead of time, it stores them neatly and hangs conveniently on a closet or bedroom door. Add a collapsible laundry tote, and kid's clothing storage solutions are solved. Monogram both of these items and your child might even carry his or her dirty clothes to your laundry area!
Clean up a cluttered and well used play area with cute storage ideas for loose toys and endless stacks of books. Add creative solutions for sports gear like a skateboard holder, and sure ensure that no one takes an unnecessary tumble with rolling gear under foot.
Cute storage ideas that keep kids organized can enhance or complement the decor of your entire home. Check out Lillian Vernon for more fun and functional storage options that help create a tidy and happy home.[cf]skyword_tracking_tag[/cf]


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Diverse lineup on tap for Wilson Center's 2013-'14 season
Performances by the trailblazing Kronos Quartet and Pilobolus dance company top the 2013-'14 season announced recently by the Sharon Lynne Wilson Center for the Arts in Brookfield.
True to form for the Wilson Center, it's a diverse lineup that includes a series of Wednesday matinee shows and the return of free Friday evening outdoor concerts in summer. »Read Full Article
Alchemist Theatre's 'King Lear' reigns as family drama
Early in Friday's opening-night performance of Alchemist Theatre's "King Lear," Bo Johnson's aged king called for the map demonstrating his intended division of Britain among his three daughters. Lear's attendants dutifully unfurled it — with the bottom at the top and the top at the bottom. When they tried to hang the map up, it kept falling down.
Director Leda Hoffmann confirmed during intermission that this sequence wasn't planned. But such a topsy-turvy world aptly illustrates the disorder that descends on Britain once the hot-tempered Lear banishes his beloved Cordelia, counting on his remaining two daughters to keep him and Britain safe. »Read Full Article
Check out interactive map of southeast Wisconsin farmers markets
Another beautiful Saturday morning — perfect farmers market weather.
Good thing there are so many of them operating on Saturdays. »Read Full Article


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Funding Unsuccessful
This project's funding goal was not reached on October 2, 2013.
Premium Yu-Gi-Oh! TCG Game Wallet, made by fans, is available worldwide on Kickstarter (not retail)! Back it and get it made!
This project's funding goal was not reached on October 2, 2013.
Our goal is to make the world's finest game wallet specifically for Yu-Gi-Oh! players -- and to make it available to fans around the world! (See update #1 for the full details on international shipping.)
When WizKids/NECA first joined forces with 4K Media (the official U.S. licensing arm of KONAMI) to do that, our initial ideas were plentiful.
But as we got down to the nitty-gritty of increasingly complex designs, we realized that it was going to be a little more complicated.
To do it right, we needed more than our own opinions -- we needed to bring in an expert. And we did! Thousands of them, in fact. We set up a fan vote website at YuGiOhVote.com where Yu-Gi-Oh! players could vote on every aspect of their dream card wallet, from material to format to device compatibility. After all, no one knows better than a player what the best features for a Yu-Gi-Oh! game wallet would be.
The result? What we believe will be the best Yu-Gi-Oh! card wallet ever. And as we promised during voting, it'll be a Kickstarter exclusive. If you're not familiar with Kickstarter, an important thing to know is that we only receive your money if we reach our pledge goal -- you will not be charged if we do not reach the goal.
A card wallet is one of the most useful and frequently used accessories for Yu-Gi-Oh! players. We found it increasingly difficult to track down high-quality wallets with the most practical features at a great price.
As such, we set out to create the most ideal wallet, keeping it both accessible and affordable without skimping out on features.
We asked the Yu-Gi-Oh! community to vote on their favorite card wallet configuration at YuGiOhVote.com – from shape and layout right down to the color, material and extras. Then, we took the winning design to 4K Media and Konami for their official seal of approval. Here's a Facebook post from the official Yu-Gi-Oh! Fan Page supporting our campaign.
Here's the winning game wallet design:
The result combines the most fan-requested features with a style that we believe will make the most convenient, functional and elegant game wallet. Here are the features the fans selected:
First and foremost, if we do not reach our goal, you will not be charged.
Your up-front support enables us to use more specialized manufacturing techniques to create a superior card wallet -- far beyond what a more general market would request.
That translates to an even safer and more convenient way to carry and store your cards and score-tracking device. With a variety of contribution levels available , we want to make supporting this project and getting an amazing card wallet accessible to as many people as possible. Some of the higher levels include multiple card wallets, so you might consider going in together with a friend to take advantage of extra perks.
Once the Kickstarter campaign wraps up, supporters can expect product delivery in 3-4 months.
Scroll down for the rewards available at each level of support! All of the cool merchandise below has been approved by Konami and 4K Media.
Be sure to check back on a regular basis, too, as we're working hard with Konami and 4K Media to make some additional stretch goals a reality!
Manufacturing any product in large quantities is never easy. As with anything, there could be delays in sourcing the materials, producing the product, and shipping it from the manufacturer for distribution to our supporters. That being said, WizKids and its parent-company NECA, has many years of experience working with our manufacturers to plan for these kinds of delays and to resolve them in the unlikely event they still arise. We have separate product development and logistics teams that will make sure that things go as smoothly as possible.
While the Kickstarter campaign is set up to ship to US customers only, we can make separate arrangements to ship to International Customers. Once the campaign has completed, please contact us to arrange for international shipping.
© 1996 Kazuki Takahashi
© 1996 Kazuki Takahashi
We can ship internationally to everywhere except Asia. We are currently working on being able to ship to Asia, so keep checking back for updates.
For international pledgers: Once the campaign has completed, please contact us so that we can arrange for international shipping. Please be aware that international shipping rates may be higher than shipping within the U.S.
Backers' credit cards are charged at the end of a campaign, and ONLY if the project succeeds in reaching its funding goal. If the project falls short, no one is charged. Funding on Kickstarter is all-or-nothing.
Yes they are! We are working directly with 4K Media (the official U.S. licensing arm of KONAMI), and have gotten their approval on the game wallet concept, the Kickstarter project, and the design and quality of every product included on our Kickstarter page.
Our plans are to focus on the Kickstarter campaign, to make that as successful as possible. We have no current plans to release a wallet outside of Kickstarter with or without other designs. The Elite and Standard designs will never be available outside of Kickstarter.
If there is a huge demand for wallets after the Kickstarter campaign ends and we decide to create a separate wallet, it would have a more simplified design and a slightly simpler feature-set to account for the cost of a general retail product.
Based on the success of the Kickstarter campaign, we may decide to make similar products for other games, which would also feature some exterior branding, designs, or logos.
Yes, but Kickstarter is the first place you can get them. Eventually our full line of Yu-Gi-Oh! merchandise will be available at a number of retail outlets.
Only the Elite and Standard editions are available for this Kickstarter campaign.
If this Kickstarter campaign is successful, we are looking at making similar products for other games. So spread the word!
When the Kickstarter campaign ends, if we have reached our goal, you will receive an email survey that will allow you to specify which designs you want, your t-shirt size, and anything else that is applicable to your specific pledge tier.
The interior features for both designs are the same. The differences are the exterior design and the quantities available. Both are Kickstarter exclusives, but the Elite edition is being made in very limited quantities (520 total across the various tiers). The logo on the front of the Elite edition is also sleeker and more upscale. It is meant to cater a bit more to the power player who might prefer that exclusive look and feel.
Our Game Wallet project is all about reaching out to you, the fans, and listening carefully to your feedback. From the beginning, the fan community has essentially owned this project, contributing ideas and voting the final design into existence, and we don't want that to stop now. Using Kickstarter not only allows us to provide you with exactly the product you wanted, it lets us get a feel for how well future products like this would succeed without Kickstarter. You could say that it's another piece of feedback that we're listening to.
Tell your friends! Tweet it from the rooftops, post it to your blog, anything you can do to let people know is a huge help in us reaching our goal.
Let us know! From the beginning, this project has been about reaching out to the community and listening to your feedback. We genuinely want to hear from you.
As designed, it's approximately 8 inches x 4.5 inches. The thickness will depend on what you put in it, with a maximum thickness of about 1.25 inches. Please remember that these are approximate dimensions.
- (42 days)


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Adult Children by Stephen Beals
- September 25, 2016
- From Beginning
- Previous feature
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One day humans will learn to speak dog.
Panel 1: I've been abandoned, I'm all alone, come and resuce me.
Panel 2: If you hurt my owner I'll bit you.
Panel 3: If you hurt me I'll bite you!
Panel 4: Welcome home, how dare you leave me alone at home all day?
The dog is simply commenting on the life he perceives. His only voice is a bark.
You forgot the about the vacuum.
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Nothing beats the sublime beauty of a desert lake, its azure waters shimmering dreamily against the golden hues around it, green grasses waving invitingly in the breeze, beckoning to thirsty animals and weary travelers.
Dawsons Millpond, Michigan
Dawsons Millpond is located in Oakland county, Michigan. Find dining and lodging options near Dawsons Millpond.
Check out local things to do such as local golfing (Pontiac Municipal Golf Course, Liberty Golf Club and Banquet Center and Shepherd's Hollow 1 Course), water sports (Water Sports Marine Inc, Skiers Pier and Skiers Pier at Pine Lake),.
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Contact us if this lake is a drinking water reservoir or if it's located on a private property.
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Water Management Companies serving Suriname
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Category: Water & Wastewater ×
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Serving: Suriname ×
ZZ Resistivity Imaging Pty. Ltd.
based in Adelaide, AUSTRALIA
ZZ is a South Australia based geophysical company, specialising in the development of resistivity instruments and inversion techniques. We manufacture world-leading 61-channel resistivity data acquisition systems and 2.5D inversion software.
CSA Group, Inc.
based in PUERTO RICO
Full Service Project Delivery and Program Management Company. CSA Group has been involved in the design and implementation of water projects for more than 50 years. Our extensive work includes projects in water, wastewater and water resources through all of the project delivery life cycle. Services provided include program management, architecture and engineering, GIS, ...
Advanced Geophysical Operations and Services Inc. (AGCOS)
based in North York, ONTARIO (CANADA)
Advanced Geophysical Operations and Services Inc. is based in Toronto, Canada and specializes in design and manufacturing innovative and reliable multifunction geophysical EM equipment, instruments, sensors, software and accessories for onshore and offshore geophysical surveys and a wide range of exploration, engineering and scientific applications.AGCOS is the first ...
sree aurobindo technologies
based in hyderabad , INDIA
All water treatment plants, components avaliable. Flow meters , pressure gauges, Leo pumps, Frp vessels.ssskids with good prices. We have imports &exports also.We are located in India Hyderabad .Sree aurobindo technologies is started in 200 I August 15th .
AquaSpark Ltd.
based in Katzerin, ISRAEL
AquaSpark is an Israeli start-up company, which develops an innovative technology BLTT for treatment of industrial wastewater with high contents of organic contaminants. AquaSpark operates within Meytag Technology Incubator and is located at the Katzrin industrial park.
European Water Partnership (EWP)
based in Brussels, BELGIUM
The European Water Partnership (EWP) is an independent value based non-profit organization structured as an open and inclusive member association. The EWP harnesses European capacity, helps to coordinate initiatives and activities in international water issues and undertakes worldwide promotion of European expertise related to water. The ultimate goal of the EWP is to ...
The Probst Group
based in Brookfield, WISCONSIN (USA)
At The Probst Group, LLC we strive to serve the water and wastewater management needs of clients worldwide. From our entry into the water and wastewater management service in 2008 to current day, we dedicate our efforts to finding custom fit solutions that meet the need of every client. Using a consultative approach, our proven methods identify and quantify water and ...
based in Champhol, FRANCE
AFITEX is a manufacturer of specialized geo-synthetics for DRAINAGE, LINING SYSTEMS and SLOPE REINFORCEMENT. The company's activities: PUBLIC WORKS: AFITEX designs, manufactures and markets synthetic drainage solutions used in place of traditional granular fill in roads, dams, ponds, tunnels and bridges. ENVIRONMENT, HYDRAULIC WORKS: Drainage products combined with ...
Chemonics International Inc
based in Washington, DISTRICT OF COLUMBIA (USA)
Chemonics International is a global consulting firm promoting economic growth and higher living standards in developing countries. With offices on five continents and close to 1,000 employees, we are one of the world`s largest firms focusing exclusively on international development. Our environmental services practice stresses the use of market-based incentives, enhanced ...
Kryton International Inc.
based in Vancouver, BRITISH COLUMBIA (CANADA)
Kryton International Inc. is the inventor of the crystalline waterproofing admixture and has been waterproofing concrete. The impact of our technology is evident in the world's most challenging construction projects. From immense hydrostatic pressure in the deepest underground pits, to the rooftops of the highest skyscrapers; we've provided solutions for them all. We ...
AWG plc (Anglian Water International)
based in UNITED KINGDOM
Anglian Water International undertakes concessions together with plant operating contracts and BOT contracts for all aspects of water abstraction, treatment and distribution together with sewerage networks and sewage treatment plants.
Association of Water Technologies (AWT)
based in Rockville, MARYLAND (USA)
The Association of Water Technologies is a non-profit trade organization representing over 500 regional water treatment companies throughout the United States and internationally. These full-service companies specialize in the application of water treatments for industrial and commercial cooling and heating systems. AWT serves our member firms by providing business and ...
AVK International A/S
based in Galten, DENMARK
AVK International A/S manufactures a wide range of valves, hydrants and accessories. Our products are part of vital infrastructures such as distribution of potable water, cleaning wastewater, distribution of natural gas for heating and electricity generation, and in automatic water sprinkle systems used for fire protection. Therefore, we strive to deliver high quality, ...
ELP Integrated Services Group, UK & Nigeria
based in Port Harcourt, NIGERIA
ELP Integrated Services are specialists in Safety and Environmental Engineering providing Consultancy as project managers for construction and updgrade of water an wastewater facilities, new developments and regeneration projects, renewable energy and general power projects (new or upgrades). We can provide a total package including cost for building new projects. We ...
Fall Safe
based in Vila do Conde, PORTUGAL
Fall Safe is a leading premium manufacturer of Personal Protective Equipment against falls from height, we create unique product inovations for the most demanding workers in the most dangerous environments around the globe, we stand for we do it. You`re Safe!
Marelli Motori S.p.A
based in Arzignano, ITALY
Marelli Motori S.p.A. has a tradition dating back to 1891 when Ercole Marelli founded the Company. With over 100 years of manufacturing excellence and experience, Marelli Motori is recognised as a leading supplier to the Power Generation, Industrial, Petrochemical and Marine market sectors, offering a complete range of Generators and Electric Motors in low and high ...
based in Zoetermeer, NETHERLANDS
The Netherlands Waste Management Partnership, abbreviated as NWMP, was established in November 2008. The NWMP is a so-called public-private partnership, and comprises the entire chain of companies that work in the waste management sector. The NWMP aims to promote cooperation among companies in the waste management sector and between these companies and the Dutch ...
Pro-Bac Industries Pty Ltd
based in BAYSWATER, AUSTRALIA
Pro-Bac is being used throughout Australia and now in South East Asia and the Middle East in diverse waste water treatment applications and has proven to be very effective. The performance of the product is well established and because most problems are biological in nature, Pro-Bac users have derived benefits that could not have been achieved by plant modification alone. ...
United Nations Convention to Combat Desertification (UNCCD)
based in Bonn, GERMANY
The international community has long recognized that desertification is a major economic, social and environmental problem of concern to many countries in all regions of the world.In December 1992, the General Assembly adopted resolution 47/188 which called for the creation of an Intergovernmental Negotiating Committee (INCD) to prepare, by June 1994, a Convention to ...
based in Bundall, AUSTRALIA
Hydrasyst is an innovative technology company providing sustainable energy and water treatment solutions, delivered using patented software as a service. From its origins in Australia, Hydrasyst® reaches globally with its proprietary technologies and throughout Oceania with its alliance partner, Hyflux technologies which it represents.


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The Masonic Center for Youth and Families
The Masonic Center for Youth and Families is a non-profit organization that offers evaluation and psychotherapeutic treatment for children, adolescents, and their families, all under one roof.
Our goal is to provide a place where young people with emotional, learning, and behavioral difficulties can work to better understand themselves, in order to lead more fulfilling, productive, and integrated lives.
A wonderful, calm, peaceful oasis in the midst of the daily struggles of family life.
- MCYAF Client Parent
©Copyright 2013 Masonic Center For Youth And Families
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Are you interested in Japan? Its people? Its culture? Its language?
If so, come and join us!
Japan Society North West holds regular Japan-related events in the Manchester / Liverpool / Cheshire / Lancashire region.
Membership Update
We are currently experiencing problems processing new member applications and membership renewals. As a result the sending of membership cards is being delayed. Please be patient while we work through these issues. In the meantime, please feel free to attend our events. If you have any concerns or questions please email us. Please accept our apologies for this unfortunate situation.
Upcoming JSNW Events
Japanese in Britain: Oral Histories Film Screening
Friday 16 September 7:00 pm to 8:30 pm
Following the devastation of the Second World War and the privations of the post-war period, the Tokyo 1964 Olympics marked the re-emergence of Japan on the world stage. As Japan flourished, enjoying economic growth and political stability, the liberalisation of passports and the end of restrictions on foreign currency opened the door for Japanese to travel abroad, and the Japanese community in the UK began to grow. Young travellers, businessmen, artists, entrepreneurs and spouses of British nationals have all contributed to this vibrant community.
The Wasurena-gusa (Forget-me-not) Project, run by the Japan Association in the UK records the history of the Japanese community through video interviews with those who settled in the UK from the 1950s and onwards. For this screening we will present a selection of interviews taken from the project, painting a picture of the many reasons for and ways in which Japanese have come to live in the UK and of the valuable contribution each has made to enriching this country.
If you would like to attend this FREE event please contact our Events Co-ordinator.
Venue: Friends Meeting House, 6 Mount St, Manchester M2 5NS
JSNW Social and Japanese Conversation Evening in Manchester
Friday 23 September 2016 7:00 pm to 9:00 pm
Let's have a drink, enjoy food, and meet someone new. Our former Newsletter Editor,Yuko Howes, will host this fun event. You don't need to be able to speak Japanese, so you can just relax.
If you would like to attend this event please email
Remember, it's on Friday!
Venue: Samsi, 36-38 Whitworth Street, Manchester M1 3NR
A Japanese Conversation Evening in Liverpool
TBA October 2016 7:00 pm - 9:00 pm
Angela Davies, a very experienced instructor of Japanese, will host an evening of Japanese conversation, over delicious food at Etsu restaurant.
If you would like to attend this event it is essential that you contact our Events Co-ordinator. Etsu is a small restaurant - places are limited.
Venue: Etsu Japanese Restaurant, 25 The Strand, (off Brunswick Street) Liverpool, L2 0XJ
Tea Gardens
A lecture on Tea gardens by Robert Ketchell and a talk and demonstration on the Tea Ceremony by Kevin O'Duffey. We join the Japanese Garden Society for this event. Details
Venue: Bury Hospice, Rochdale Old Road, Bury, BL9 7RG
What's On
Tanabata Festival
Saturday 27 August 2016 12:00 pm to 5:00 pm
Visit Tatton's gardens, famous for its Japanese garden, on Saturday August 27th and you'll be invited to join representatives from the Japanese Embassy in making a wish!
This year Tatton is inviting its visitors to take part in the vicinity of the beautiful Japanese garden. There will be an opportunity to learn origami and make paper decorations to adorn the bamboo and nearby trees as well as to write wishes on the tanzaku strips of card and hang them on the bamboo branches. Tatton is privileged to be joined by representatives from the Japanese Embassy who will help demonstrate origami and traditional paper decorations. Details
Venue: Tatton Park, Knutsford, Cheshire, WA16 6QN
Japan Matsuri
Sunday 25 September 2016 Venue: Trafalgar Square, London
Doki Doki
Saturday 12 November 2016 Venue: Sugden Sports Centre, 114 Grosvenor Street, Manchester M1 7HL
Hayao Miyazaki Interview
In a rare interview Hayao Miyazaki, the Japanese animator behind Spirited Away, tells Robbie Collin why he 'bet everything' on his final Studio Ghibli film, The Wind Rises.
Read this article in The Telegraph
NHK World
Kabuki is a world-class theater with a history of over 400 years, but is also exciting entertainment. What is the secret of its enduring attraction? Ichikawa Somegoro, brilliant member of the younger generation of actors, guides us through the world of kabuki.
This is a monthly series on NHK World
You can watch NHK WORLD TV Live Streaming and
Japan Society Events
The Japan Society in London organises a wide range of events. Visit their web site for a full list of upcoming events.
Japan's Sakoku Period
Thursday 4 April 2013 9:00 am and 9:30 pm Radio 4
Melvyn Bragg and his guests discuss Japan's Sakoku period, two centuries when the country deliberately isolated itself from the outside world. Sakoku began with a series of edicts in the 1630s which restricted the rights of Japanese to leave their country and expelled Europeans living there. It was not until 1858 and the "gunboat diplomacy" of the American Commodore Matthew Perry that Japan's international isolation finally ended.
Noriko Ogawa in conversation with Melanie Spanswick
An interview with Japanese pianist, Noriko Ogawa which took place in December 2012 at Jaques Samuel Pianos in London.
Find out what kind of child Noriko was, and what kind of sound world she lives in in this biographical interview.
Study Tours to Japan
Visit Akemi's web site for more information.
Japanese Food in Lymm
Japanese Food Specialists TK Trading set up shop in Lymm High School every other Saturday - see their web site for the schedule.
Venue: Lymm High School, Oughtrington Lane, Lymm, Cheshire WA13 0RB
It's Alright - Official song for Japan
This song was composed by JSNW member Adrian Summersell. Adrian asks all who enjoy hearing this song, to please make a small donation directly to Sanaburi Foundation Japan. See the song information under the video on YouTube to learn more.
Japan Photos
Explore JapanPhotos.org.uk for a high resolution tour of Japan.