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Studly Aicantar -- Follower and Marriage Options (Multiple Appearance Choices)
Skyrim » Companions
Skyrim » Companions
Added: 17/07/2014 - 04:29PM
Updated: 07/11/2016 - 12:29PM
Last updated at 12:29, 7 Nov 2016 Uploaded at 16:29, 17 Jul 2014
When my Dovahkiin first met Calcelmo's nephew Aicantar, she thought him a sweet, young Altmer who would be much happier studying conjuration at the College of Winterhold than excavating the Dwemer ruin of Nchuand-Zel. She also found herself charmed by him and was quite distressed that Bethesda had chosen not to include him (or any Altmer males) as a follower or a marriage prospect. Therefore, the Creation Kit and I were sent to the rescue.
As I wanted to make Aicantar as handsome as possible for my Dovahkiin, I started with a few changes to his appearance. I lightened his hair color a bit, gave him a little facial hair, made a few facial tweaks, and changed his hairstyle. I also changed his default outfit from Court Wizard Robes (enchantment: "Magicka regenerates 50% faster") to either Adept Robes of Conjuration (enchantment: "Conjuration spells cost 17% less to cast; Magicka regenerates 100% faster") or Expert Robes of Conjuration (Conjuration spells cost 20% less to cast; Magicka regenerates 125% faster), as the Court Wizard Robes didn't have a "no hood" version and seemed too weak for a follower.
There are several versions of Studly Aicantar to choose from (both follower/marriage and appearance only), as well as a vanilla appearance Aicantar with follower/marriage options. All versions (except vanilla) have the same facial changes, but they will have either a different hairstyle, a different outfit, or both. There are five different appearance choices for Studly Aicantar with follower/marriage options, and four different appearance choices for Studly Aicantar with appearance changes only. Please see the screenshots for details.
Stat Changes:
Level multiplier changed from 0.50 to 1.00. (This means his level will be identical to the player's upon first meeting him, instead of half of the player's level.)
Calculated minimum level changed from 5 to 10.
Calculated maximum level changed from 50 to 81.
He has been given the "Light Foot" perk, so he will not trigger any traps.
AI Data Changes:
Aggression changed from "unaggressive" to "aggressive."
Confidence changed from "cautious" to "brave."
Morality changed from "no crime" to "any crime."
Aicantar's disposition has been set to 80, and he has been given an "Ally" relationship with the Player, which makes it possible to recruit him as a follower or to marry him at any point after encountering him.
He also has the default setting of "Helps Allies," which has not been changed.
Existing Save Info:
If you are starting a new game with Studly Aicantar installed, the changes to his stats will automatically take effect. However, if you are installing Studly Aicantar on an existing save, and you have already been inside Understone Keep, there is a chance the stat changes may not take effect because Aicantar's level has already been calculated by the game. There is an easy way to fix this using the console:
1. Open the console with the ~ key with Aicantar in front of you.
2. Click on his face so his Reference ID (00019909) is selected.
3. Type "getlevel" (without the quotation marks) and hit "enter." If Aicantar's level is half of your character's current level, the stat changes did not take effect.
4. Type "setlevel 1000,0,1,81" (without the quotation marks) and hit "enter."
5. Type "getlevel" again and hit "enter." Aicantar's level should now be the same as your character's.
6. Close the console with the ~ key.
Thieves Guild "Hard Answers" Quest:
Regarding the Thieves' Guild quest "Hard Answers," I would strongly suggest that you dismiss Aicantar as a follower before getting the quest in your journal, as he is involved in the quest and having him as a follower during it will probably break it. If you plan on marrying Aicantar, I would also suggest waiting to do so until after that quest is completed. However, if you don't plan on doing the Thieves' Guild questline (or if you want to throw caution to the wind), then this isn't an issue, and you can marry him whenever you like.
According to the Wiki, the game often leaves Aicantar in Calcelmo's Tower after "Hard Answers" is complete, instead of returning him to the court mage's area in Understone Keep. I use the unofficial patches, and he was returned to the court mage's area once the Thieves' Guild questline was completely finished. However, if he doesn't return after completing the questline, you can "teleport" Aicantar to you by using the console if you want to continue using him as a follower (or if you want to marry him):
1. Open the console with the ~ key.
2. Type "prid 00019909" (without the quotation marks) and hit "enter."
3. Type "moveto player" (without the quotation marks) and hit "enter."
4. Close the console with the ~ key.
Aicantar should now be near your character, and you can ask him to be your follower again. You may have to do this every time you dismiss him, as he may return to Calcelmo's Tower again instead of the court mage's area in Understone Keep. However, if you married him, he should return to whatever home you have chosen (I strongly suggest that you have Aicantar move in with you.).
I hope you enjoy Aicantar, and if you do, endorsements are very much appreciated. I also love seeing screenshots of the characters in game, so please upload them to the "Images" section.
Required Mods
Vanilla Aicantar-Follower and Marriage: None. I used only vanilla resources.
All other versions of Studly Aicantar (both follower/marriage and appearance only): ApachiiSkyHair (the Male Standalone Pack "ApachiiSkyHairMale_v_1_2"): http://www.nexusmods.com/skyrim/mods/10168/?
Recommended Mods
(If you want Aicantar to look exactly like he does in the screenshots)
1) High Quality Eyes by Xenius: http://www.nexusmods.com/skyrim/mods/498/?
2) Better Males – Beautiful Nudes and Faces – New Hairstyles by Chris57 and FavoredSoul: http://www.nexusmods.com/skyrim/mods/2488/?
(I used "Faces – YoungerFacesMergedWithMenByGeonox")
Extract the file to a temporary location.
Copy/place the .esp in your Skryim Data folder.
Merge my "meshes" folder with the "meshes" folder in your Skryim Data folder.
Merge my "textures" folder with the "textures" folder in your Skyrim Data folder.
Make sure the .esp is checked in the "Data Files" section of the Skryim Launcher.
As for where it should go in your load order, it doesn't really matter, although I would recommend putting it ABOVE any multi-follower mod (AFT, EFF, UFO) just in case.
Uncheck the .esp in the Skyrim Launcher.
Delete the .esp from your Skyrim Data folder.
Delete my meshes and textures.
As this changes Aicantar, it will most likely be incompatible with any other mod that changes him.
None that I know of.
Please leave a comment or send me a PM, and I'll respond as soon as possible.
Please ask my permission before using my mod in your work, and please give me credit for my mod.
Bethesda for creating Skyrim.
The Nexus for giving gamers/modders a place to find and showcase mods.
Apachii for creating such wonderful hairs and for giving me permission to use them.
Check out my other mods.
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Raymond Davis Makes Headlines Again
Remember Raymond Davis, the Central Intelligence Agency contractor who caused a diplomatic storm in January when he shot dead two armed men in the streets of Lahore, Pakistan?
Well, on Saturday police in Douglas County, Colorado, reportedly arrested Mr. Davis, 36 years old, on charges of third-degree assault after he allegedly punched a man in a fight over a parking spot. Later in the day, Mr. Davis posted bail and was released, news articles said.
It's not Mr. Davis's first experience in police detention. He was held from late January until mid-March in a Pakistani jail after shooting dead two men he claimed were trying to rob him at gunpoint in Lahore, where he was working undercover as a security contractor for the CIA.
Perhaps readers will also remember that U.S. Sen. John Kerry, sent by the Obama administration in February to secure Mr. Davis's release, promised the U.S. Department of Justice would launch its own "thorough criminal investigation" into the incident.
Pakistan's government pardoned Mr. Davis after the U.S. agreed to pay the dead men's relatives.
What happened to the probe?
A spokesman for the U.S. Embassy in Islamabad declined to comment. A search of the U.S. Department of Justice website didn't come up with anything.
A spokeswoman for Pakistan's Foreign Ministry said she wasn't aware of any probe but promised to check with a colleague on the ministry's Americas desk.
Looking back, Mr. Davis's actions in Lahore marked the beginning of a severe deterioration in U.S.-Pakistan relations, compounded by the U.S. raid in May on Abbottabad where former al Qaeda leader Osama bin Laden was hiding.
Perhaps a probe conducted by the Justice Department would not be able to get to the bottom of exactly what happened months ago in disputed circumstances in a foreign country. Certainly Pakistan's police and legal system is not world-class.
But the U.S., at the very least, doesn't appear to be acting with quite the same alacrity in getting to the bottom of that episode as Mr. Kerry did in promising an investigation.
You can follow Mr. Wright on Twitter @TomWrightAsia. Follow India Real Time on Twitter @indiarealtime.
More In Pakistan
- What Donald Trump Said About Pakistan's Prime Minister Sharif
- Pakistan's Somali Community Shocked After Attack at Ohio State University
- What Indian and Pakistani Newspapers Said About Donald Trump's Victory
- National Geographic's 'Afghan Girl' Arrested in Pakistan
- India, Pakistan Tensions Reach Movie and TV Industries
- India Still Has Work to Do on Rule of Law, Report says

subset: commoncrawl


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Stormont cuts led to road flood that caused crash death of my girl... it is responsible
The parents of a girl killed in an accident have urged a Stormont department to learn from the tragedy and take action.
The parents of a girl killed in an accident have urged a Stormont department to learn from the tragedy and take action.
It's a serious message delivered with humour from the stars of Give My Head Peace.
Women in Antrim and Newtownabbey areas of Northern Ireland can expect just 51.4 years in good health - the lowest in the UK.
More than 900 people are living with HIV in Northern Ireland, the Stormont Assembly has been told.
Children under ten are among a huge hike in the numbers of people being diagnosed with an eating disorder in Northern Ireland in the past five years.
A hormonal link between the liver and brain that regulates alcohol consumption may help scientists develop new treatments for problem drinkers, according to new research.
Stormont has shifted the goalposts of hospital waiting time targets it has emerged - as the health department continues to face pressure as new figures show a marked increase in waiting list times.
Hospital waiting times in Northern Ireland have become unacceptable and symbolise a "workforce in crisis," the UK's largest medical union has warned.
Domestic violence in Northern Ireland has reached its highest level in more than a decade.
An immunotherapy drug hailed as a potential game changer in the treatment of Alzheimer's has missed its targets in a large-scale clinical trial.
The number of people referred for professional help because they are confused about whether they are male or female has rocketed by 1,600% in a decade. More than 200 referrals to gender identity services were made in Northern Ireland last year - up from just 13 in 2006.
A card may be the simplest of things - but that's all it will take to make this little boy smile this Christmas.
A petition with more than 45,000 signatures calling for reform of the abortion law has been delivered to Stormont.
The UK should follow in California's footsteps and legalise cannabis, according to a new report into domestic drugs policy.
The neurosurgeon who intends to attempt the first ever human head transplant says he may do so in the UK.
How healthy is Belfast compared to the rest of the UK?
The Department of Health in Northern Ireland spent almost £100m on medical negligence cases last year, new figures have revealed.
A Northern Ireland baby who developed a cancerous tumour the size of an orange while he was still in the womb is now a happy one-year-old after he healed himself.
The former Maze Prison site - which has been at the centre of a political deadlock - will be the new home to Northern Ireland's first air ambulance base.
Legal action is being taken against a health trust for failing to provide appropriate accommodation for a man charged with rape.
Scientists have discovered a new way to edit DNA that could fix "broken genes" in the brain, cure previously incurable diseases and potentially even extend the human lifespan.
A glass of red wine before lighting up can prevent some of the harm caused by smoking, researchers claim.
A Co Antrim father, whose 11-week-old baby died after contracting the superbug E.coli in a leading children's hospital, has pledged to fight for a "proper apology" after "a catalogue of errors" in the little boy's care.
The number of people self-harming in Northern Ireland is on the rise, with more than 25,000 cases dealt with in hospital in the last three years.
Probiotics may help improve thinking and memory skills among people with Alzheimer's disease, research suggests.
Smoking flavoured e-cigarettes can produce "unacceptably dangerous" levels of formaldehyde and other carcinogenic compounds, according to a new study.
Products like cheese, milk and yoghurt are rich in iodine, a vital nutrient for the development of babies and building up the immune system of young women, says Armagh-born nutritionalist Professor Margaret Rayman. She tells Una Brankin they should be part of our...
A former Ulster Unionist MLA who resigned from the Stormont Assembly last year after saying he'd tried to take his own life amid bouts of depression is back in the public eye...as an actor.
Air Ambulance Northern Ireland unveiled its primary helicopter at Titanic Belfast on Wednesday.
Co Antrim woman Heather Beaumont has recently been nominated for a prestigious UK Carer of the Year Award with charity Headway for her devotion to Gary who suffered a brain haemorrhage.
Ovarian cancer survivor Carol Bareham, from Larne, says she owes her life to a locum doctor who caught the disease in time. Now she tells Una Brankin why women need to be aware of symptoms of this potential killer.
There's a scene in the movie, Annie Hall, in which a couple are making out. The guy suddenly pulls away saying, "I can't concentrate. The Warren Commission said the shots..." The woman interrupts, "Why are you using the Kennedy assassination to avoid making love to me?"
The 37-year-old lives in south Belfast with his wife, Caroline, who works for charity Christian Aid, and recently appeared in The Fall and Mrs Brown's Boys D'Movie. He played nurse Ritchie in The Fall and also had leading roles in Ripper Street, The Missing and The Magdalene...
One in every six emergency admissions to hospitals in Northern Ireland is unnecessary, a shocking report reveals today.
They say that life is the most precious gift of all. But it's death that presents a rare breed of benefactors in Northern Ireland with what might be called a once-in-a-lifetime opportunity to leave the ultimate bequest for the good of future generations by donating their bodies...
For Jon and Rita Orr, a good night's sleep is a rare luxury.
A coroner has ruled that a man who took his own life hours after visiting a third hospital in five days was not failed by the system.
Around 900 new cases of lung cancer are diagnosed in Northern Ireland each year, with smoking responsible for 90%.
A pioneering new drug has been shown to clear away toxic clumps of protein material in the brain thought to be a primary cause of Alzheimer's.
A young mother launched a 300km walk to Dublin to personally plead with Irish health minister Simon Harris to fast-track cannabis-based drug treatment for Irish children facing potentially life-threatening seizures.
An appeal to grant Northern Ireland women NHS-funded abortion care in England will be heard by the Supreme Court today.
In 2003 Sean Watson's parents were told that he might never walk again after suffering a massive brain haemorrhage and stroke.
There are a thousand love stories in which one partner dies young. Think of Love Story itself, which started as Erich Segal's novel and then became a film and a song, a paean to a perfectly intelligent and beautiful young woman who died of cancer.
A major new study into the pain-relieving benefits of cannabis-based medication is to be carried out in Belfast.
The effectiveness of vitamin D supplements during pregnancy depends on the season and on the mother's weight gain, according to a new study.
Northern Ireland's healthcare system must radically transform or it will collapse, an international expert has said in a stark warning to Stormont.
Hundreds of lives could be saved every year if health bosses put in place measures to improve the care of lung cancer patients, it has been claimed.
A drug used to treat the common cold could be used to stop the spread of bladder cancer, a study has found.
With Cancer Focus Northern Ireland's In Pink campaign well under way Marie Foy talks to Julie Scates from Castlereagh and Emily Stanton from Belfast about coping with the BRCA1 gene.
Mid Ulster has been found to be Northern Ireland's land of giants.
EU referendum
Northern Ireland
Northern Ireland
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Sunday Life
Premier League


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In June 2005, Senator Jeff Bingaman (D-NM) drafted a proposal to impose mandatory limits on greenhouse gas emissions, based on the recommendations published by the National Commission on Energy Policy (NCEP). A draft bill of the proposal was named the "Climate and Economy Insurance Act of 2005," although the bill was not formally introduced into Congress.
The Act would require the Secretary of Energy to set emissions intensity targets for years starting in 2010, and to translate these intensity targets into an annual cap on greenhouse gas emissions (GHGs). The cap would apply to "upstream" fuel producers and other entities including manufacturers, importers and emitters of non-fuel GHGs, and would provide for trading of emissions allowances between covered sources. The Act includes a safety valve price that may be paid in lieu of an allowance, limiting the cost of compliance, but also allowing emissions to rise above the established cap. The Energy Information Administration (EIA) projects that, at the safety valve price recommended by NCEP, emissions would exceed the target caps after 2016 and rise through the foreseeable future, though at a somewhat lower rate than projected under a "business as usual" scenario. (See graph of emissions according to the cap, and actual expected emissions due to use of the safety valve.)
Target: Each year's target cap would be calculated on the basis of "emissions intensity," defined as the total amount of covered GHG emissions divided by the forecasted Gross Domestic Product (GDP). In 2006, the Department of Energy (DOE) would calculate the target cap for each calendar year from 2010 through 2019 by (a) projecting the emissions intensity expected for 2009 (based on EIA's projections of GDP and GHG emissions), (b) reducing that amount annually by 2.4% to arrive at the "emissions intensity target" for each year through 2019, and (c) multiplying the year's emissions intensity target by the GDP forecasted for that year to arrive at an absolute emissions cap. In 2016, DOE would issue the target caps for 2020 through 2024 using the same procedure, but with a 2.8% reduction rather than 2.4%. The procedure would be repeated every five years, but could be modified under the Congressional Review procedure.
Allowances: The Act would annually require regulated entities to submit an allowance or pay the safety valve price for each ton of GHG emissions. Regulated entities include regulated fuel distributors (natural gas pipelines, petroleum refineries, coal mines of a certain size, natural gas processing plants, and fuel importers) and non-fuel regulated entities (producers or importers of HFCs, PFCs, SF6, or N2O; cement or lime producers; aluminum smelters; and various other non-fuel-related emitters). Fuel distributors would submit allowances based only on their covered fuels, while non-fuel entities would submit allowances based only on their non-fuel-related GHGs.
Allocation of Allowances: The bill specifies the amount of allowances that would be allocated for free, with 91% of emissions allocated in 2010, gradually dropping to 87% allocated after 2019. The Secretary of Energy would distribute the allowances to regulated entities and other affected sectors in such a way that offsets—but no more than offsets—expected losses of profits attributable to this program. One percent of allowances would be provided to organizations assisting affected workers. A small percentage of allowances would be auctioned rather than allocated, starting with 5% in 2010 and rising to 10% after 2019. Each year, an additional 3% of allowances would be reserved for offsets and 1% for early reductions. Any undistributed allowances would be auctioned.
Cost-Reducing Mechanisms: The most important cost reducing mechanism would be the provision allowing any entity to avoid submitting allowances by paying the "safety valve" price, starting at $7/ton-CO2 in 2010, and annually rising in price by a nominal 5% (i.e., not adjusted for inflation). As mentioned, this would assure an upper bound on costs, but also make it highly likely that emissions each year after 2016 would exceed the target caps. In addition, to minimize the cost of the program, allowances and credits could be sold, exchanged, purchased, or transferred. Credits, which could also be submitted in lieu of an allowance, would be distributed to entities that geologically sequester combustion-related carbon dioxide, export covered fuels or non-fuel GHGs, use covered fuels as feedstocks, or otherwise destroy non-fuel GHGs. A pilot program for international offset projects would be established to distribute the 3% of annual allowances reserved for offsets. Each year, 1% of the allowances would be made available to entities that reduce or sequester emissions before the initial allocation period, as demonstrated through reports to the EIA's Voluntary Reporting of Greenhouse Gases Program (1605(b)).
Congressional Review: By January 2015 and every 5 years afterwards, the President would establish an interagency group to review and make recommendations regarding this program and any similar programs underway in China, India, Brazil, Mexico, Russia, Ukraine, or any OECD country. Recommendations may include modifications to the rate of emissions intensity improvement or the rate of safety valve price increases, along with the feasibility of including other non-regulated entities, or modifications to the percentage of allowances auctioned.
Monitoring and Reporting: DOE would establish procedures for reporting and monitoring emissions, and would determine eligibility for credits, offsets and early-reduction allowances.
Penalties: A regulated entity that failed to submit an allowance would pay an amount equal to three times the safety valve price for each allowance not submitted. Failure to comply would bring civil and criminal penalties.
The Act would also create a trust fund to support climate change adaptation and early technology deployment, with provisions for conservation, zero- or low-carbon energy technologies, advanced coal technologies, cellulosic biomass, and advanced vehicles. A subtitle on International Programs would facilitate the deployment of clean energy technologies in developing countries.


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Lesley Pocock
Curriculum Vitae
personal details
Date of Birth: 15/10/1927
Degrees and Qualifications:
Professional Employment History
academic employment history:
Royal Australian College of General Practitioners (RACGP)
Monash University - professional employment history
Hospital Boards of Management
1975-85 Royal Southern Memorial
Hospital (Monash appointee)
1976-84 President, Fawkner Park Community Health
Secondary Education
Royal Australian College of General Practitioners
Special Achievements
1. Establishing the Blackburn Clinic
This is a teaching practice of Monash University and was founded by me in 1952. I have been associated with its continuing growth and development as senior partner for 23 years and as an active associate since then. The clinic is unique in its concept and has been a leader in the advance of modern primary care. It is a multidisciplinary clinic with other health professionals on site including pharmacy, dentists, podiatry, nurse, physiotherapy including hypnotherapy, rehabilitation and variety of visiting and full-time specialists. Radiology including CT scanning and pathology collection are all on site.
The practice has been innovative in a number of ways such as the first to introduce computerization in 1964, developing recall systems, the first FMP training practice, a major undergraduate teaching resource, in-house CME, involvement in research etc.
2. Early, continuing and active involvement in the RACGP
I joined the RACGP soon after its foundation and became a Fellow at the first examination. I established practice management as a standing committee of the College and was heavily involved in developing the examination for the Family Medicine Programme, The Australian Family Practice. I was instrumental in processing the Trawalla headquarters and the foundation of the Victorian Academy for General Practice. I am still an examiner and board member. I have also been the Chairman of the Academic Programme for the last 3 annual meetings of the College held in Victoria and for the two International Computer Conferences held in Victoria. I was also co-author and editor of the Home Course in Electrocardiology now in its 3rd edition. This was one of the early successful publications produced by the RACGP.
3. Foundation Chair in "General Practice", known as Community Medicine, and its development
Although each medical school received funds in 1975 only two appointees were from full-time general practice, including myself. The main achievements during my leadership are highlighted and include:
(i) Building a unique department facility funded almost exclusively from external funding. This has been gradually developed over the years. The building houses the Department's teaching practice, six full-time doctors, and five full-time support staff. This is unique in Australia although other models are being developed in two other schools.
(ii) Medical Computing, in particular computer assisted learning has been developed over ten years. This is currently of world standard with state of the art learning programmes being developed. The group that has been brought together now have international connections. Over 60 CAL programmes developed by the Department are now in use. Other areas such as PHOCUS, and Medical Records and under development.
(iii) Undergraduate Teaching - This has expanded from 3 to 11 weeks during the past 17 years. It has been noted for its innovative and committed style using enthusiastic teachers, developing self learning methods and the learning laboratory concept, communication and consulting skills teaching, video feedback and role play techniques permitting effective teaching of patient management, small group and case base teaching, and formalizing all these into "on the shelf" teaching packages.
(iv) The department has been the first to develop a Masters Degree in Family Medicine and the Diploma in Distance Education is a world first. Continuing medical education has been introduced into the Faculty ad has legitimized the role for universities.
(v) Clinical Services have been gradually developed and these include -
Rural Health -
Intellectual Disability Unit -
Multiple Locations -
Research -
Funding -
Summary of Publications
M. R. Kidd, G.L. Gan, B. Cesnik, N.E. Carson, M.L. Bearman, "Data and Information Technology". In: Primary Health Care: A South East Asian Perspective. Ed: N. Yuen. Hong Kong, 1992.
C.A. Silagy, N.E. Carson, "Research in Primary Care". In: Primary Health Care: A South East Asian Perspective. Ed: N. Yuen. Hong Kong, 1992.
D.C. Walker, R.M. Crampton, M.R. Kidd, N.E. Carson et al., "Health Information Issues in General Practice in Australia", National Centre for Epidemiology and Population Health, Canberra, 1991.
Conference Proceedings:
N.E. Carson, M.R. Kidd, B. Cesnik, "Computer
Assisted Learning - Looking to the Future", Proceedings of the 6th
Royal Australian College of General Practitioners Computer Conference,
Sydney, 1990.
Computer Programmes:
N.E. Carson, M.R. Kidd and B. Cesnik, "Patient
Management Problem: Janet Jones" (computer programme), Department
of Community Medicine, Monash University, 1988.
Departmental (In-House) Publications:
Co-authorship of the following:
Clinical and Communication Skills 3rd Year Handbook
An Introduction to Consulting Skills 4th
Year Handbook
An Introduction to Emergency Medicine 4th Year Handbook
The Practice of Preventive Medicine 4th Year Handbook
Final Year Handbook
Final Year Workbook
One of the successful training programmes established in the department was the Community Practice Training programme funded from the Academy for General Practice with trainers appointed as lecturers in the department. This was very successful and led to appointments for some of these lecturers on a continuing basis. In one year there were 6 plus trainers appointed. Some of these appointees eventually became professors in the department and in other medical schools, including Vice chancellor and Dean and Deputy Deans, etc.
Supplementary C.V.
Career in the United Arab Emirates, 1993-1995
1. Appointed as Professor of Family Medicine
for 2 years in the UAE University, Faculty of Medicine and Health Sciences.
2. New Appointments
3. Medical journal input
4. Developments
The following are a result of my work in the UAE
a. Establishment of a formal department meeting (agenda and minutes), which occurs every week. I act as chairman of that meeting.
b. Development of a final year teaching programme using the learning laboratory programmes and the consulting skills programme developed at Monash University, Australia. I have negotiated with Monash for the rights to use these programmes without cost.
c. Establishment of the Staff Medical Clinic for the use of the Faculty Staff and their families. In addition to episodic care on a daily basis, "Well-woman" and "Well-baby" Clinics have commenced.
d. Developed documentation for EMFAM proposal.
6. UAE Postgraduate Centre for training
and research in Family Medicine.
7. Examiner Appointments.
8. Other roles in the UAE are:
(b) Department Training and Other Activities
(c) Academic programme staff development
The following sessions have occurred:
(d) Clinical
(e) Administration
9. Publications:
10. Documents, in-house publications and reports
1. Department Policy document - clinical
service policy
11. Research
My main role, because of year by year tenure has been to support the research developments of other staff members. My personal research activities are:
12. Honours
13. Presentation of Papers
(i) "Doctor of the Desert" -
Monash Refresher Course, 1994


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Warriors rookie nets hat trick in Hamonic Cup game
© Times-Herald photo by Matthew Gourlie
Spencer Tremblay, goalie for Team White, stops Justin Kirsch (12) in close in the Hamonic Cup Black-White game Sunday.
After an amazing playoff run, Brayden Point probably didn't need to make a statement at the Moose Jaw Warriors training camp.
Point did anyway.
The sensational Warriors rookie scored three goals and added two assists as his Team Black beat Team White 10-2 in the Hamonic Cup intrasquad game.
"I want to play as hard as I can and not put too much pressure on myself," said Point who had seven goals — including a pair of overtime winners — and 10 points in 14 playoff games in the spring, a season before he even old enough to play in the WHL.
"I'm going to play my hardest in whatever role I'm given and that's my main priority," said Point.
Point had pretty good chemistry with 20-year-old left winger Justin Kirsch who had two goals and two assists. Point found himself playing in the top-six in the playoffs and earning power play time, but he said his sole focus is making the team right now.
Though he is trying to keep that rookie mindset, he did admit that he was feeling at lot more at home at camp the second time around.
"Confidence is everything," said Point. "I feel I have a lot more confidence after playing in the playoffs. To be able to come here and have a little bit of success just gives me more confidence."
There were plenty of other hopefuls that did their aspirations of making the team some good.
Brandon Potomak, Josh Uhrich and Miles Warkentine each had a goal and an assist as each forward looks to stick with the team this season.
"I got the chance to play with some good linemates and hopefully they liked what they saw," said Uhrich, a Warriors' second round Bantam pick in 2011. "I moved here and I'm not considering anything else. That's my main goal."
Black jumped out to an 8-0 lead after two periods and as much as the Black attack looked dynamic at times, the game had some pretty sloppy spells.
"You can't expect a Picasso in a Black and White scrimmage, but I thought we saw some positives," said Warriors head coach Mike Stothers. "I've been impressed with some of the young guys. They've been good.
"From Wednesday to Sunday I've seen some improvement, some strides have been made and I'm encouraged."
Veteran defenceman Joel Edmundson had a goal and two assists, while captain Kendall McFaull and Ethan Lazaro also scored for Black. Defenceman Christos Zinis had White's other goal. Another defenceman, Dallas Valentine, chipped in with two assists for the victors.
Justin Paulic stopped all 10 shots he faced before Zach Sawchenko stopped 12 of the 14 shots he faced. It was a rough night for incumbent Spencer Tremblay who gave up seven goals on 21 shots. Daniel Wapple allowed three goals on 17 shots in relief as the goalies split the game for both teams.
The Warriors released five before the Hamonic Cup game: defenceman Yanni Mamais and forwards Braydon MacDonald, Vincent Paquette, Danny Vlanich and Daniel Wanner.
The Warriors will play the Swift Current Broncos Tuesday in a rookie game at 7 p.m. at Mosaic Place. The price of admission is a donation to the Warriors education fund.
Tribe tidbits . . . all of the Warriors left in camp took part with the exception of Morgan Rielly, Tanner Eberle (shoulder) and Brayden Cuthbert (concussion). The Warriors still have 43 players left in camp.


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More and more people are consuming protein drinks to help with their weight loss goals, supplement their diets, and achieve improved athletic performance… but are they safe?
- According to the ISSN (International Society of Sports Nutrition), protein shakes are a safe way to ensure enough protein, when used as part of a balanced, nutrient-rich diet.
- Protein shakes restore muscle glycogen, a fuel source for exercise, which gets used up during workouts.
- For the strength athlete, protein shakes can also help repair damage to muscles, leading to muscle synthesis
- Protein shakes are also convenient and tolerated better (for some people) after intense workouts when solid foods are not.
What kinds of protein are available?
- Whey protein: A protein found in milk; fast-absorbing; in your body for a shorter time; good supplement after intense workouts; great source of protein for muscle synthesis and help the body store less body fat. yesss please.
- Casein protein: the main protein in milk; slow-absorbing; in your body for a longer time; a good supplement for meal replacements or to take before bed
- Soy protein: a plant-based source of protein; as digestible as other sources of protein; known for its antioxidant capabilities; a good supplement for meal replacements
How Much Protein is Enough?
|0.8-1.0g per kg (0.36-0.45g per lb)
|Recreational exercisers
|0.8-1.0g per kg (0.36-0.45g per lb)
|Serious resistance athletes:early in training
|1.5-1.7g per kg (0.68-0.77g per lb)
|Serious resistance athletes:established training program
|1.0-1.2g per kg (0.45-0.55g per lb)
|Serious Endurance Athlete
|1.4-1.6g per kg (0.64-0.73g per lb)
|Teenage Athletes
|1.5-2.0g per kg (0.68-0.91g per lb)
SO.. are they safe?
An investigation by Consumer Reports found traces of heavy metals in all of the protein drinks tested. Of the fifteen protein drinks tested most had low to moderate levels of heavy metals; but three drink products (EAS Myoplex Original Rich Dark Chocolate Shake, Muscle Milk chocolate powder, and Muscle Milk vanilla crème) had high enough levels to cause concern. Consuming three servings a day of these three drinks could cause unsafe exposure to three substances — arsenic, cadmium and lead. Consuming these kinds of protein drinks on a regular basis can in some cases create the risk of chronic exposure, even at low levels, to heavy metals such as cadmium and lead that can pose health problems, particularly to vulnerable people," says Andrea Rock, the Consumer Reports editor for the investigation. Among vulnerable people are children under age 18, pregnant women, and people with diabetes or chronic kidney conditions, she says.
According to Greg Pickett, founder of CytoSport, which makes Muscle Milk, "The substances tested in the report are naturally occurring in the environment, it would be uncommon, if not impossible, not to detect the trace amounts reportedly found in any agricultural product, such as dairy products, fruits and vegetables."
What's a little scary? Protein drinks are considered dietary supplements, so the makers are not required to test the products before sale to ensure they are safe and effective. eeek.
More is not always better. Over-doing it with protein can be very detrimental to your health. Experts say too much protein can lead to dehydration and digestive problems, increase your risk for osteoporosis, and for some people, cause kidney problems. Please notify your MD of any changes in your diet.
- Get your daily protein intake from food, if possible 🙂 Lean meats and seafood, eggs, low-fat dairy, nuts/nut butters, high protein whole grains, and soy can easily help one get their recommended daily protein intake.
- If you're going to drink protein supplements… have them in moderation (please), and make sure you consume no more than 30 grams of protein at one time. Overloading your body with excess protein is a waste (your body can only use so much, at one time).
- Choose protein supplements without a lot of added "crap", all you need is the protein 🙂


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Reviewed By Oanh N (PENSACOLA, FL) Reviewed for a 2008 Chevy Tahoe —4/19/2013 10:30 AM
This products does not fit the Tahoe Hybrid. Even if it said fit ALL MODELS. I did not order the areowrap due to the addition information it give (Non-hybrid models only). Assuming it did not have that information on the Superguard section, so I decide to order it. I receive it like within 1 week. The non-hybrid holes are 2left 2right (....) while the hybrids are mid left, mid, mid right ( . . . ). Lucky I got a family that have a LTZ. Install 5-10mins, plug plastic in, line it up n screw it in.


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MyBCH Online Services
Leif Redal, MD
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Dr. Redal has dedicated his career to keeping families healthy and has a special rapport with kids. His ongoing interest in preventive medicine and the latest medical advances ensures that his patients get cutting-edge care, with heart attack and stroke prevention an area of special training and expertise.
He is devoted to his family and is an avid lover of nature and the outdoors, where you will often find him cycling, skiing and hiking in Colorado's high country with his wife and two children.
To schedule an appointment with Dr. Redal, please call 303-415-4015.
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Lisa Goudy
Any day is a better day with fruit.
I love eating fruit. Name almost any type of fruit and chances are that I like it. There are only a few types of fruit I don't like. I try to eat fruit every day.
During one of my first trips to Hawaii when I was younger, I'll never forget my Grandpa telling us to eat a fruit plate every day, which we did while we were there.
He said a fruit plate consists of three different types of fruits. With two types of fruit, it's not a fruit plate, but a plate of fruit. Having only one type of fruit is nothing but eating fruit. We were encouraged to always eat a fruit plate.
Recently, he's decided a fruit plate should consist of five different types of fruit.
Every day when I come to work, I take a lunch with me and in those lunches, I always have a piece of fruit, typically a Granny Smith apple or an orange. Often I'll eat half a grapefruit for breakfast.
When I'm not at work, I try to have a fruit plate as often as possible. Types of fruit included depend on what's in season. I think everyone should have fruit plates or some kind of fruit every day.
Apart from how delicious fruit it, it's very nutritious for our bodies as well. Fruits are filled with vitamins, minerals, antioxidants, enzymes and phytochemicals. All of those help create a healthy body.
According to the website Fresh Fruit Nutrition, enzymes help the body easily and quickly digest food and release energy into the body. Antioxidants slow down the aging process.
"Many studies have confirmed that regular consumption of fruits and vegetables reduces the risk of developing degenerative diseases such as cancer and heart diseases," the website said. "What's more, nutrients in fruits have healing properties. Some can lower blood pressure while others are effective for other conditions."
The more colourful a fruit is, the more phytonutrients it contains, the website said. Phytonutrients can help prevent disease and keep our bodies working properly.
Bananas are great sources of potassium, which are great for the heart, and controlling blood pressure. It also is high is B vitamins.
Mangos have high sugar content, good for energy boosts, and are also rich in vitamin A and vitamin C. Vitamin A is good for eyes and vitamin C helps boost our immune systems.
Oranges are another fantastic source of vitamin C and nutrients such as cyaniding-3-glucoside, flavanones and carotenoids, the website said, which helps give better protection than vitamin C on its own.
Apples are also rich in antioxidants and dietary fibre. Cherries contain vitamin C, vitamin A and a lot of potassium. Grapefruit contain potassium, vitamin C, vitamin A and other vitamins as well as potassium calcium, iron, magnesium, phosphorous, zinc and manganese.
The website added kiwis have "more vitamin C than a similar amount of orange. One kiwi fruit supplies more than the daily need of vitamin C." It also has vitamin E and more potassium than a banana. It does a lot to boost the immune system.
The list is endless. Strawberries, pineapples, watermelon, grapes, plums or cantaloupes — you name it. Every fruit is good for you. Making it a daily habit of eating fruit is healthy and delicious.
Yes, I'm a fruit lover. We should all make it a goal to consume fruit very often. Our bodies and our taste buds will thank us.
Follow Lisa Goudy on Twitter @lisagoudy.


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Open Arms Adoption Network Panel on Transracial Adoption
As transracial adoptions have grown significantly over the past decade, JFCS' adoption program, Open Arms, has taken proactive steps to meet the needs of our transracial families. Open Arms is currently the only local agency providing specifically designed transracial adoption support services.
Stefani Moon, Program Director for the Open Arms Adoption Network, explains, "Five years ago, we started a social support group called Families Like Ours (FLO) for families who had adopted transracially. The group has grown by leaps and bounds, and it was clear that we needed to expand these offerings. Parents were asking us how to explain transracial adoption to their children, how to advocate for them, and most recently, with everything that has gone on in the news, how to protect them and help them protect themselves. In response to this feedback, we assembled a panel of experts to discuss 'Black and White: Race and Racism and Implications in Transracial Adoption.'"
The panel was extremely well received; 80 people registered to attend, and guests stayed long after the presentations ended. They continued the discussion in smaller groups, connecting, supporting each other, sharing their experiences, and asking for more events like it.
JFCS is committed to meeting the changing needs of our clients. We commend Open Arms for this innovative program, for harnessing these necessary resources, and for responding thoughtfully and effectively to our clients' needs.
For additional information on Open Arms Adoption, please contact firstname.lastname@example.com.


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Cybersecurity Law Institute
May 24-25, 2017
It is more important than ever that in-house and outside counsel stay abreast of the most current developments and best practices in cybersecurity.
Those lawyers who ignore cyber threats are risking millions of dollars for their companies or their clients. Recent reports by Cisco and the World Economic Forum both highlight the paramount importance of cyber risk management. The Cybersecurity Law Institute will give you insights into the latest information and strategies.
You have an important role to play in cybersecurity leadership, especially in keeping corporate officials and the board of directors informed. Too often, well-meaning officials don't know what they don't know!
At our Institute you will receive insights on the best governance, preparedness, and resilience strategies from experienced government officials, general counsels, and cybersecurity practitioners who face these issues on a daily basis.
We are currently planning the 2017 Institute, please check back soon.
The 2017 Institute will also be available as a Live Webcast.


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... I had such great plans to make a chocolate and hazelnut cake for the 'we should cocoa' challenge this month... and use pureed chestnuts in it too (just to prove BVG wrong) ... but then Tracey bought me an Ice Cream Maker and things kind of changed...
... this is a very very very late entry due to my commitments in London this week, in fact I have missed the deadline completely... but here it is nonetheless...
Ludicrously Chunky Toasted Hazelnut and Chocolate Chunk Ice Cream
1 small packet of hazelnuts
1 large bar of fabulous dark chocolate (I used Green and Blacks 72%)
225ml cream
225ml semi skimmed milk
50g sugar
An ice cream maker is not essential but it does make the whole thing a lot easier so just get your neighbour to buy you one for goodness sake!
- crush the nuts with a rolling pin and then toast them in a dry frying pan till they're toasty (technical term) and they start to give off that stunning aroma that only toasting them can do... be careful not to burn... there's a very fine line between toasty and burnt and it tastes horrid!
- gently warm the milk and melt the sugar in to it (this can be done on the stove or in the microwave) ... you do it so that the finished ice cream doesn't have that granulated texture from the un-melted sugar
- let the milk cool in the fridge till cold
- break the chocolate bar into chunky chunks and then combine all the ingredients
- add to the Ice Cream Maker and let it do it's magic baby!
simple, chunky... and bloody tasty!
eat and of course, enjoy!


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By Marc Schoder: FREEDOM NEWSPAPERS
For some, it's just a good way to clean out the garage. For one Tucumcari woman, it's a labor of love for a good cause.
"I am not doing this garage sale for profit. I am doing it to benefit kids who have cancer in local (Albuquerque area) hospitals," said Elizabeth Knott.
Knott said her first three sales held earlier this summer netted nearly $200 with which she promptly bought toys for kids. She said she is holding another sale Friday and Saturday and hopes to have one more after that before the end of the month.
The former Wisconsinite lost her 9-year-old daughter Rosie to cancer in 1996. Her daughter's memory has motivated her to gather toys for kids with cancer.
"Rosie liked to give her toys to less fortunate kids," Knott said.
Knott's garage sale, held at her home at 1902 S. 3rd, is typical in that she plans to offer old furniture, clothes and knickknacks. The difference is that she plans to use any money she makes to purchase toys and games for children with cancer. She's also accepting donations of toys and games.
Knott said her daughter was like other 9-year-olds who liked to ride bikes and play games. "Rosie was a bubbly kid and always liked to laugh," Knott said.
It's in Rosie's memory that Knott, along with Mental Health Resources in Tucumcari, will fill a van with toys to take to Albuquerque-area hospitals.
"I have tried something like this in Wisconsin, but I am looking forward to trying this in New Mexico for the first time," Knott said.
Knott said her efforts at gathering donations have already paid off.
"I have gotten stuffed animals, puzzles … I bought some crayons, coloring books and radio controlled cars," she said.
Anyone donating toys should sterilize them first, she said.
"Toys given to kids with cancer need to be cleaned really well or be brand new," Knott said.
Knott hasn't gone at this project alone. Susie Moore of Tucumcari is helping.
"I have donated a lot of stuff as well as helped Elizabeth with picking up items from people when she has been unable to do it," Moore said.
Moore said she's spoken with numerous area residents supporting the project.
Knott said people who want to donate money instead of toys can do so, though such donations are not tax deductible.
"Any money I receive will go into a jar, then it will be handed over to a hospital to use for the kids with cancer," Knott said.


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Cars have changed; so have traffic rules, driving conditions and the roads you travel every day. By taking the AARP Safe Driving course, you'll learn about the current rules of the road, defensive driving techniques, how changes in our bodies affect driving, proper use of safety belts, air bags, anti-lock brakesand new technologies used in cars. This brand new edition of the AARP Safe Driver Program is a fast paced four-hour in-classroom course.
Tue., May 6, 12:45 – 5 p.m. at the Pardee Signature Care Center.
Please pre-register in person at the Pardee Signature Care Center. To secure your space, pay in advance by check made payable to AARP.
Cost is: $15- AARP Members, $20 Non-Members


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This first video explains the rules of the competition. You can then scroll through the videos of entries to date.
We're giving away ten copies of Crazy Talk 6 pro, the software used to create this animation.
To enter follow these steps:
1. Download the free trial version of Crazy Talk 6, available at http://www.reallusion.com/crazytalk/crazytalk_trial.asp
2. Use Crazy Talk to animate one of your own photos, or you could add an animation to one of the templates provided if you prefer.
3. Upload your animation to YouTube: http://www.youtube.com
4. Enter the YouTube url of your video into the competition form at www.whatdigitalcamera.com/cometitions
All entries can be seen in this gallery. Take a look now to check out the competition.
Scary video
Scary Video – Sample of a Crazy Talk video by our Deputy Editor, Mat Gallagher.
Use the free trial and send in your video to win a copy of CrazyTalk 6. Further details
Give me some food
Give me some food! by Fen Oswin
Dating Service Robot
Dating Service Robot


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The massive menorah was built by a congregation in Fort Worth, Texas.... READ ON
The beginning of Hanukkah is only a couple days from now -do you know where your chanukiyah, the nine-branch menorah, is? Using the Hanukkah menorah your grandparents used may be a family tradition, but do-it-yourself, arty, or high-tech menorahs have the same symbolism. Here are a few interesting ones found around the internet.
1. LED Hanukkah Menorah... READ ON


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You would have to be living under a rock not to sense the buzz created by Johnson & Johnson (JNJ) at the American Society of Clinical Oncology-ASCO-meetings yesterday when the results of the Phase 3 trial for the company's Zytiga treatment for prostate cancer were presented. Heralded with a major press release from Janssen Pharmaceutical Companies ('Janssen') of JNJ, the company was quick to point out that Zytiga (abiraterone acetate) plus prednisone showed improvements in asymptomatic or mildly symptomatic chemotherapy-naïve patients with metastatic castration-resistant prostate cancer. Readers will recognize this indication as that of Dendreon's (DNDN) Provenge. So, it was not surprising that the anticipation of the release of these data, together with the general weakness of the market last week, caused Dendreon's stock to continue its fall.
The latest round of weakness in the stock arguably could be traced to Janssen's previous announcement the study had been unblinded based on the unanimous recommendation of an independent data monitoring committee. According to the company, "[T]he Independent Data Monitoring Committee-IDMC-unanimously recommended unblinding the study based on a planned interim analysis in which differences in radiographic progression-free survival, or rPFS, overall survival, or OS, and secondary endpoints were observed that constitute evidence of clinical benefit as well as continued evidence of favorable safety in patients receiving abiraterone acetate plus prednisone as compared to those receiving placebo plus prednisone. Based on these results, the IDMC also recommended that patients in the placebo arm be offered treatment with Zytiga." In fact, Zytiga reduced the risk of prostate cancer worsening or death-the definition of progression-free survival-by 57% compared to a placebo. And the chances of the results being a chance occurrence were less than one-hundredth of 1%.
After an initial burst of enthusiasm for the drug by the medical community and the press-accompanied, of course, by taking Dendreon to the woodshed-some members of the media pressed JNJ for more details regarding one of the two primary endpoints: OS. As it turned out, the trial had not achieved statistical significance (stat sig) for overall survival. Here are the data.
rPFS: The data demonstrate a statistically significant improvement in rPFS in the abiraterone acetate plus prednisone arm (Zytiga arm) of the study compared to the placebo plus prednisone (control) arm. The median rPFS in the control arm was 8.3 months but had not yet been reached in the Zytiga arm because progression events were occurring more slowly in the Zytiga arm compared to the control arm (N=150 vs. 251, respectively). The Hazard Ratio (NYSE:HR) equaled 0.43, there was a 95% confidence interval (NYSE:CI): [0.35, 0.52], and the p-value was <0.0001.
OS: Treatment with Zytiga plus prednisone resulted in an estimated 33 percent improvement in survival (median overall survival in the Zytiga arm was not reached and was 27.2 months in the control arm; HR=0.75; 95% CI: [0.61, 0.93], p=0.0097). At the time of these interim analyses, the pre-specified p-value of 0.0008 to achieve statistical significance was not reached. The strict requirement of achieving less than 0.04 at the final look, there is the possibility the trial still could achieve stat sig OS. However, with patients in the placebo arm now crossing over and taking Zytiga, the ability to demonstrate stat sig OS is problematic.
Let's review the study, dubbed COU-AA-302. This was an international, randomized, double-blind, placebo controlled Phase 3 study that included 1,088 men with mCRPC who had not received prior chemotherapy, who were randomized to receive abiraterone acetate (Zytiga) 1,000 milligrams-mg-administered orally once daily plus prednisone 5 mg administered twice daily or placebo plus prednisone 5 mg administered twice daily. The co-primary endpoints of the study are rPFS and OS. One 'cycle' of dosing comprises 4 weeks of Zytiga treatment (co-administered with prednisone), and the full treatment for the patients on the treatment arm of the study was just under 14 months.
The background above is interesting, but it really doesn't get to the point, which is: strange things happen when science meets hype, for it is precisely at this boundary that reality sets in. And that's exactly what happened when the scientific and medical communities got its first look at Zytiga's Phase 3 trial data.
What am I talking about? Here is the presentation given by JNJ at ASCO on Saturday morning, June 1, 2012 (courtesy ASCO Daily News; presentation by Dr. Charles Ryan). Look closely at the second figure, which is shown below:
(The same graphic can be found in the video presentation around the 15-minute mark). This is one of the strangest Kaplan-Meier analyses I have ever seen. The treatment and placebo arms of the study do NOT separate for nearly 18 months!
Compare these data with a more 'normal' K-M analysis for a late-stage disease. Below, for example, are the data for Dendreon's Provenge presented by Gomella, et al. (L. G. Gomella, C. Nabhan, J. B. Whitmore, M. W. Frohlich, D. J. George; The Kimmel Cancer Center at Jefferson, Philadelphia, PA; Advocate Lutheran General Hospital and Oncology Specialists, S. C., Park Ridge, IL; Dendreon Corporation, Seattle, WA; Duke Cancer Institute, Durham, NC) in a 2011 ASCO poster presentation. (You can view the entire poster here. (Reproduced with the permission of Dr. L. G. Gomella, personal communication, November 17, 2011; I discussed these and other results pertaining to Provenge here.)) For the Provenge data, the curves separate almost immediately, with the control arm (that is, the arm without the benefit from either Provenge or Frovenge) shown in red dashes. No matter how you slice and dice the data, there is a clear advantage to administering Provenge that is seen almost immediately (certainly by the 6-month mark).
One might posit the bizarre behavior of the Zytiga K-M analysis can be explained by a very long median PFS and OS for the patients in the control arm. These indicators showed that patients enrolled in the trial must have been very healthy. So, the long period taken for the survival curves to separate may mean Zytiga provided no benefit to them while their health remained good seems plausible. Who knows? Alternatively, maybe prednisone, for all its debilitating side effects, truly is a wonder drug, and it alone was responsible for the longevity of patients in the placebo cohort!
The curves for the Zytiga Phase 3 M-K analysis did separate eventually, but they did so beyond the point when patients completed their treatment (14 months). Specifically, no survival effect was seen until month 18…4 months beyond the point where the patients had been taken off the drug (and prednisone). Of concern, as well, was the fact that 69% of patients in the treatment arm (Zytiga + prednisone) discontinued treatment at the time the trail was stopped (versus 84% of patients in the placebo + prednisone arm). Many ASCO participants found these results 'surprising.'
Now, about 50% of patients were known to take subsequent therapies. Still, the IDMC had good reason for recommending termination, given that the study had achieved stat sig PFS. Whether Taxotere or Provenge was administered by the time the interim analysis was performed, there is a question here as to how these therapies might have been working to improve the survival benefit. Whether or not the trial will achieve stat sig OS with patients crossing over from the placebo arm and taking the drug is another matter entirely, and one upon which the entire debate regarding FDA approval will almost certainly be focused on these issues in the months ahead.
To set the stage for that debate then, here are points that should frame and instruct the discourse.
First, would it be better to treat men with Provenge when they first become candidates, knowing that the hazard ratio-HR-when Dendreon's treatment is used continues to improve with time? (HR is the ratio of the hazard rates corresponding to the conditions described by two sets of explanatory variables. For example, in a drug study, the treated population may die at twice the rate per unit time as the control population. The hazard ratio would be 2, indicating higher hazard of death from the treatment. Or in another study, men receiving the same treatment may suffer a certain complication ten times more frequently per unit time than women, giving a hazard ratio of 10.)
The science supports early treatment in the form of the immune system learning, as we and others have talked about in the past.
Further, how do the Zytiga Phase 3 results just reported impact on the use of Provenge? There is a danger, I believe, if Zytiga is approved for pre-chemo patients, that doctors will, basically, put their patients on 'auto-pilot,' and will not, under most circumstances, interrupt their treatment to administer other treatments, even if such treatments may be indicated. This conclusion is based on an ASCO 2012 paper in which it was asserted that "[T]aking periodic breaks from a commonly used treatment for prostate cancer could shorten men's lives.
Still, is maintaining treatment continuity Good Medical Practice under all circumstances? Treating a patient with Zytiga pre-chemo without interruption for the full term (14 months) carries the risk that he will transit Provenge's 'space' and finish his treatment with no option to avail himself of Dendreon's immunotherapy. More to the point, if Zytiga treatment is begun pre-chemo, Good Medical Practice, the core ethical guidance imposed on physicians, should require patients be provided with some level of monitoring. This should be done to determine when the may be a candidate for Provenge, Taxotere, or other treatments so these can be 'layered on,' in serial or parallel fashion, before the patient's immune system is compromised or the disease metastasizes to the point that there are no available options.
The Journal of Clinical Oncology already has weighed in on this topic vis-à-vis the sequencing of Provenge and Zytiga. Here's what it had to say: "The practical dilemma of the appropriate sequence of use of the two new noncytotoxic agents (sipuleucel-T and abiraterone) is being addressed by trials that are under development. For now, given the broader window of applicability of abiraterone and the longer time required to develop an immune response with sipuleucel-T, if both agents are to be used, it seems reasonable to administer sipuleucel-T first with Abiraterone after additional disease progression. Biomarkers to help define the optimal use of immunotherapy are needed."
The subject of Zytiga use pre-chemo leads naturally to this question regarding insurance payments. Should Medicare and the insurance industry pay for a treatment based a long (18-month) delay for OS curve separation? That is, is it worth it to treat patients for 18 months with an expensive treatment when they really don't need that anyway? Fifteen (15) cycles of Zytiga costs more than $82,425. Cost per cycle according to JNJ presentation is $5,495/cycle, not including blood tests and other treatments that may be required for adverse events…a cost that is poking its head close to Provenge $93,000 cost. And again, there is no indication of a survival benefit for at least 18 months following the initiation of treatment. In the case of the Zytiga Phase 3 trial, 20% of the patients on Zytiga died before the curves separated. They acquired no life-extension benefit whatsoever! And if the patient is on Medicare, for example, and transits the 'donut' hole twice during his Zytiga dosage, his out-of-pocket expenses will exceed by a wide margin the co-payment charges incurred by Provenge patients. (The latest data indicate 70% of Provenge patients have no out-of-pocket expenses.)
Other questions loom large, as well. If you read the protocols for Dendreon's IMPACT trial here, you will see there was an entry restriction of 6 months for patients entering the study. Should CMS and other insurers impose an 18-month life expectancy entry restriction on patients before they will reimburse for Zytiga pre-chemo?
What's the bottom line? Just this (and this is a message David Miller of Biotech Stock Research has been trumpeting to one and all for well over a year): Dendreon management must get the message across primarily to urologists-who are the ones who see early stage prostate cancer patients-that if they are going to help the early stage sufferer, then (1) if that patient has a 6-month or longer survival expectation, and (2) if he is eligible for Provenge, administer Provenge first! Then, layer on Zytiga or other treatments, as indicated.
If Provenge is effective, the patient should start to see a survival advantage within 6 months. Instead of simply talking about Provenge's 4.1-month median survival advantage, talk about a 38% improvement in 3-year survival and/or a 22.5% improvement in risk of dying. Put another way, these data say the odds of a patient treated with Provenge (Sipuleucel-T) surviving at 3 years is about one in three comparing to the odds of about one in five for an untreated patient. This level of efficacy, coupled with a mild side effect profile (mild flu-like symptoms), paints a compelling picture for Provenge's use as early in the disease cycle as possible that is difficult for both the patient and his physician to ignore.
This is what the Zytiga Phase 3 trial data tell me.
Technical Analysis
The Daily chart, courtesy StockChart.com, shows the stock continued to fall into Oversold territory last week. The MACD is negative, with just the hint of turning up.
The Weekly chart shows much the same story as above. The price is testing the low from last October while the Relative Strength is approaching Oversold levels. The MACD is neutral,
Disclosure: I am long DNDN.
Additional disclosure: I own DNDN and do not intend to change my position within 72 hours of the time of publication of this article. I am not a registered investment advisor and do not provide specific investment advice. The information contained herein is for informational purposes only. Nothing in this article should be taken as a solicitation to purchase or sell securities. Before buying or selling any stock you should do your own research and reach your own conclusion. It is up to investors to make the correct decision after necessary research. Investing includes risks, including loss of principal.


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Aug 10, 2010
Sirius Business: Cardinal Rules
This weekend on Sirius XM Fantasy Football, fellow senior writer Matt Camp and I were inundated with calls (which we love), so we really did not have much time for the guests that have populated the show in recent weeks. Still, we had space for our pal Kent Somers, who joined us to talk some Cardinals, and how the 2008 NFC Champs are moving on without future HOF QB Kurt Warner.
Kent covers the Cards for the Arizona Republic (@kentsomers on Twitter):
Of course, we knew that the Cardinals would be suffering a downgrade at QB without Warner, no matter who took the job. Right now, it's apparent that Matt Leinart has done nothing to lose the job that was assumed his in the first place. Leinart has had some shaky practices according to Somers, but Somers admits Leinart may just look "bad" because Warner has been the model of consistency over the last few years. While up and down, Leinart has had some good days recently, and that's more than can be said for veteran Derek Anderson, who was brought in to back up (and maybe push) Leinart. Anderson has more pure physical ability than Leinart, but his inaccuracy has to be maddening to a team that has watched Warner for a few seasons.
Though Leinart and Anderson are entrenched as the #1 and #2 RBs on this squad, their relatively unimpressive resumes mean that the QB job could be open in the near future. We loved the addition of Fordham QB John Skelton in the NFL Draft, but while Skelton's pure physical attributes have shone through, he's definitely looked like a rookie and needs a lot of work. In fact, Somers contended that undrafted free agent Max Hall of BYU has actually looked better than Skelton; Hall is more polished, but he's not as talented, so it's certainly possible the Cards keep all four QBs on their roster this year. Given Skelton's awesome potential and Hall's impressive camp showing, there's good reason to doubt either player would last a while on the practice squad, so the Cardinals may have no choice but to keep both.
That brings us to the running game, where Somers believes Tim Hightower will be the starter once again, though he expects Beanie Wells to get the majority of the touches (Somers contended 18 of 25 touches would go to Wells, or 72%). Though Wells has elite ability, it's obvious Hightower is going nowhere. The team loves his versatility and his "dirty work" (blocking, catching), and he should remain a strong presence. But Wells gives them a powerful home run threat they've lacked since Ottis Anderson was in town decades ago. Additionally, Somers assured us that the Cards believe Wells can be a completely adequate pass catcher. Somers believes the division will be much like coach Ken Whisenhunt employed with Willie Parker (Wells) and Jerome Bettis (Hightower) in Pittsburgh in 2006, which was effective enough to carry the Steelers to a championship.
The wildcard here could be second-year back LaRod Stephens-Howling, whom the team envisions filling the "3rd-and-long" role, much like JJ Arrington played in the Cards' Super Bowl season. Hightower figures to see the 3rd-and-short touches, on which the Cards can run or pass, but in obvious passing downs, don't be shocked to see them go with the shifty and elusive Stephens-Howling, who also figures to contribute in the return game.
In the passing game, the Cards have to replace veteran Anquan Boldin, who has been Larry Fitzgerald's right-hand man for the entirely of Fitz's career. Still, Somers implores us to remember that Steve Breaston filled in more than adequately when the injury-prone Boldin has missed games in the past, and the Cards truly believe in Breaston. In single coverage, which Breaston saw a lot with Fitzgerald on the other side of the field, he had a lot of success, and Warner trusted him. The Cards are also thrilled in the development of slot receiver Early Doucet, who had a big postseason and has continued his momentum throughout the off-season. Where Somers contends the loss of Boldin is felt the most is in the overall depth of the receiving corps, which has rookie Andre Roberts and a handful of no-names and camp bodies behind the top three guys. An injury could really limit the explosiveness of this offense, which may lack burst anyway.
Still, despite the loss of Boldin, don't expect the Cards to involve the TE any more in their pass game. Even this off-season, with Leinart checking down more than Warner ever did, no TE has separated himself according to Somers. Ben Patrick is definitely the best all-around TE on the team, but he's been inconsistent, and he's dealing with a kneecap injury in camp. He figures to have most of his value near the goal line. Stephen Spach has never asserted himself, and while Anthony Becht will play, he's almost exclusively a blocker. Whisenhunt has used TEs like Heath Miller effectively in the past, so the lack of involvement is probably more a function of the players than the scheme.


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Chapter Home
Kidney tumor - adult malignancies
Adult renal cell carcinoma
Classification of renal cell carcinoma
Reviewers: Sean Williamson, M.D. (see Reviewers page)
Revised: 3 June 2012, last major update June 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.
● Based on cytology, tissue characteristics (Thoenes, Storkel & Rumpelt,
Path Res Pract 1986;181:125) and cytogenetics (Heidelberg classification: J Pathol 1997;183:131)
● New entities continue to be described based on immunohistochemical and molecular features – some not yet recognized in WHO Classification
● Use of "granular cell variant" not recommended – may falsely combine a spectrum of tumors with varying clinical significance / treatment: clear cell, chromophobe, unclassified renal cell carcinoma, or oncocytoma (Urology 2007;69:452)
● Diagnosis of "sarcomatoid carcinoma" not recommended; classify as high-grade carcinoma of type from which it originated (or unclassified) with sarcomatoid features and percentage of sarcomatoid features (Cancer 1997;80:987)
WHO (2004) Classification
Renal Tumors and Tumor-Like Conditions of Adults
Renal Cell Carcinoma:
● Clear cell renal cell carcinoma
● Multilocular cystic renal cell carcinoma
● Papillary renal cell carcinoma
● Chromophobe renal cell carcinoma
● Carcinoma of the collecting ducts of Bellini
● Renal medullary carcinoma
● Xp11 translocation carcinoma
● Renal cell carcinoma associated with neuroblastoma
● Mucinous tubular and spindle cell carcinoma
● Renal cell carcinoma, unclassified
Familial Renal Cell Carcinoma Syndromes:
● Von Hippel-Lindau Disease (VHL)
● Hereditary Papillary Renal Carcinoma (HPRC)
● Hereditary Leiomyomatosis and Renal Cell Cancer (HLRCC)
● Birt-Hogg-Dubé Syndrome (BHD)
Papillary (Renal Cortical) Adenoma
Metanephric Tumors:
● Metanephric adenoma
● Metanephric adenofibroma
● Metanephric stromal tumor
● Metanephric adenosarcoma
Rare Tumors with Epithelial and/or Parenchymal Differentiation:
● Carcinoid Tumor
● Neuroendocrine carcinoma of the kidney (small cell carcinoma)
● Primitive neuroectodermal tumor
● Juxtaglomerular cell tumor
● Teratoma
● Nephroblastoma and other "pediatric" renal tumors
● Cystic nephroma (multilocular cyst)
● Mixed epithelial and stromal tumor
● Spiradenocylindroma
Mesenchymal Tumors:
● Angiomyolipoma
● Epithelioid angiomyolipoma
● Medullary fibroma
● Leiomyoma
● Lipoma
● Hemangioma
● Lymphangioma
● Other benign mesenchymal tumors
● Leiomyosarcoma
● Liposarcoma
● Intrarenal schwannoma
● Solitary fibrous tumor
● Hemangiopericytoma
● Fibrosarcoma
● Pleomorphic sarcoma (malignant fibrous histiocytoma)
● Rhabdomyosarcoma
● Angiosarcoma
● Osteosarcoma
● Synovial sarcoma
● Other malignant mesenchymal tumors
Lymphoid Tumors:
● Lymphoma
● Plasmacytoma
Metastatic Tumors
Tumor-Like Lesions:
● Xanthogranulomatous pyelonephritis
● Inflammatory myofibroblastic tumor (pseudosarcomatous myofibroblastic proliferation)
● Perirenal and sinus cysts
Additional references
Suggested new features to incorporate:
● VEGF expression (Lab Invest 2008;88:962)
● Gene expression (ScientificWorldJournal 2006;6;2505)
End of Kidney tumor - adult malignancies > Adult renal cell carcinoma > Classification of renal cell carcinoma
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