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Provocative and timely: A pioneering neurocriminologist introduces the latest biological research into the causes of - and potential cures for - criminal behavior.
A leading criminologist who specializes in the neuroscience behind criminal behavior, Adrian Raine introduces a wide range of new scientific research into the origins and nature of violence and criminal behavior. He explains how impairments to areas of the brain that control our ability to experience fear, make decisions, and feel empathy can make us more likely to engage in criminal behavior. He applies this new understanding of the criminal mind to some of the most well-known criminals in history. And he clearly delineates the pressing considerations this research demands: What are its implications for our criminal justice system? Should we condemn and punish individuals who have little no control over their behavior? Should we act preemptively with people who exhibit strong biological predispositions to becoming dangerous criminals? These are among the thorny issues we can no longer ignore as our understanding of criminal behavior grows.
©2013 Adrian Raine (P)2013 Random House Audio
"Violence comes in many varieties. Poverty and political persecution are good examples of violence, but so are mass killings and rape. Adrian Raine has spent decades investigating the latter variety. His book is an exhaustive, unvarnished survey of what is known about the neurobiological correlates of physical violence. It is deeply informative and it makes for disquieting reading. It wisely refrains from claiming a single cause for the problem or advocating a single solution. It is an indispensable reference." (Antonio Damasio, David Dornsife Professor of Neuroscience, and Director, Brain and Creativity Institute, University of Southern California, Author of Descartes' Error and Self Comes to Mind)
I like mysteries (particularly British ones, historical fiction and nonfiction, science fiction and fantasy.
"Interesting Book the Roots of Abnormal Behavior"
Please bear with me as I first talk about what drew me to this book, that requires a lot of explanation about James Fallon, who is a neuroscientist but who did not write this book.
I recently heard a TED Radio Hour segment by James Fallon, a neuroscientist at the University of California-Irvine, who has been working with psychopaths, trying to physically differentiate the brain of a killer from that of a nonkiller. He was clued in by his mother that his father's family might have some members who were worth studying. He discovered that there was "a whole lineage of violent people-killers" including a connection of Lizzie Borden, who let it be said was acquitted of killing her parents in a court of law, but who has certainly been convicted in the court of public opinion. In a study he had done on Alzheimer's, he had talked family members into taking a PET scan and contributing a DNA sample, now he began to analyze these for signs of abnormality.
In reviewing the PET scan and genotypes of his close family members including his mother, wife and children, they were perfectly normal. But his own PET scan showed a lack of activity in his orbital cortex, a sign that many neuroscientists would regard as significant in that the orbital cortex is supposed to help to control another part of the brain called the amygdala that is associated with aggression. He also looked at the MAO-A gene in his DNA. This is a gene associated with the regulation of serotonin in the brain. If the person has a particular variant of the gene then the brain may not respond to the calming effects of serotonin.
Fallon's conclusion was he was separated from psychopaths who act out on their impulses by a loving and supportive upbringing. According to his TED talk, an insult to the brain or severe trauma at the right (very young) age is the link that might trigger the negative aspects of these variants.
I found this intriguing, so when I saw that this book was about the anatomical aspects of the roots of violence I couldn't pass it up.
First, it's readable. It's written at a level that is accessible to the average reader with some knowledge of the anatomy of the brain and an interest in crime. I don't buy his theories whole hog, but added to what I've read elsewhere and some experience that I have with multi-generational bad actors in families, I find this intriguing.
Adrian Raine talks about his own studies into psychopathy utilizing temp workers-- that's why they have been so unreliable!, longitudinal studies of twins and children and "The Selfish Gene"-- he was taught at University by Dawkins. He also gives examples from his own work in facilities for the criminally insane with violent rapists and murderers, and from his own exposure to criminal violence.
I would recommend this book to anyone who has an interest in crime and criminals and also likes to muse as to why it is that certain tropes are so popular within certain genres.
And then, shades of Bones, it looks like they are going to make Adrian Raine into a semi-fictional character in a TV crime drama-- I swear, the US just make make me want to pound my head against my monitor at times.
The narrator is quite good and easy to listen to.
"Excellent book on the Neuroscience of Violence!"
Yes - only because reading a book like this may bring on napping whereas listening to this book on the road made it easy to follow.
Probably "The Wisdom of Psychopaths" by Kevin Dutton. Raine's "Anatomy of Violence" was clearly more exhaustive; however "Wisdom of Psychopaths" was an easier read. Both books do an excellent job reviewing psychopathy and disorders in the brain.
He was the narrator and did not perform any characters.
Yes - Raine provided a case where a large African American man broke into a young Caucasian woman's apartment and brutally raped her repeatedly, beat her to a pulp, and then slit her throat. It was extremely graphic and made me feel dirty; however the questions posed by the case and the points Raine was trying to make really stuck with me.
Excellent and exhaustive look at the neuroscience of violence! Raine did an incredible job compiling his research, along with others in the field, and presenting it in a reasonable and topical format.
"The Anatomy of Violence" spends a majority of the time examining aspects and structures of the brain that are correlated with violence; however Raine takes it a step further to examine the heart, sweat glands, and other minor organs of offenders to look for correlations and patterns.
Raine also spends time looking at socio-economic factors and family influences to finally bridge the gap of the "nature vs. nurture" debate. Most of his examples and case studies were well picked and referenced to illustrate many of his points.
The only low point of the book was when he offers a hypothetical world and society in 2034. I'm not a fan of hypothetical's, but Raine did a great job using the hypothetical "future" to address philosophical and ethical questions to the reader. I've rarely read other non-fiction works that pose questions back to the reader, so I found this very engaging and impressive.
Pros: Comprehensive and organized look at the external and internal forces that produce violence in humans.
Cons: More case studies and criminal interviews would've been nice, but there were no major cons.
Bottom line: Excellent for anyone interested in crime and how alterations in the brain can affect behavior.
"Dry but exceptionally well thought and delivered."
Almost a textbook, very dry, but if this is a subject matter that you enjoy knowing something about it ends up being a great book, that you can learn plenty from. And it's not just talk and theories, there are a LOT of studies quoted to back up opinions.
The author will also gladly tell you about the shortcomings of cited studies and possible holes in his theories, he's not a know it all, he's an intellectual.
"Not sure if this kind of nonfiction has a "story""
But I found the content highly thought-provoking. I never realised how many factors came together to create crime, and it certainly persuaded me that a compassionate medical model to dealing with violence may be the ideal to strive for. Then again, I went into this book already disliking the revenge-oriented mindset of the US criminal justice system.
"Violence is not just choice"
Adrian Raine is a leading researcher in how the brain's development effects the way people think, respond to life's stressors, and process information. Research shows that people's ability to make good and right choices is not merely genetic, not is it all moral choice, but there are many factors that effect the development of a child's brain. Thought the narrator is not my favorite, the book is very well written and very engaging. I recommend this book for anyone in the fields of criminology, childhood development, medicine, and social welfare.
"Wow! Incredibly Interesting!"
This is non-fiction, and in my many non-fiction purchases, it ranks in the top 10.
I hadn't heard much of these brain studies, and I was surprised and amazed at the depth of the program. Much insight into the how/why of violence, what might be causing it, how to predict it, who is responsible.
"Eye opening and astonishing"
Adrian does a great job in waking the interest for neurobiology. Perhaps too many speculations based on correlations, but that is what makes the book an interesting read. The chapter on the future is the most fascinating.
out of the 60 books that I have read this year this is by far the most fascinating informational book that I've ever read
"My perception of this book"
I loved it but also struggled to finish. this book was interesting but I also feel that it was overly extend. it didn't have to be 17 hrs to get its story across. but overall it was average.
I like to read but listening is better.
"Fascinating; Will challenge your thinking"
This book was everything I expected and more. It was very interesting and educational. I really appreciated that the author did not shy away from providing the controversial conclusions that he came to through his years of studying violence and the brain. The fact that Raine actually conducted many of the studies he cited made it easier to put faith in what he said. I was engaged for nearly the entirety of the book. Towards the end, Raine spends quite a bit of time ruminating over a hypothetical future in which society is able to accurately predict how likely it is that an individual will become a violent offender. I found this to be a pointless exercise and it was the only portion of the work that I found to be uninteresting. The narrator doesn't add much but his accent is actually perfect for this book.
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Compare Proton Garages and Specialists in Headington with Who Can Fix My Car.
Enter your registration to check prices and reviews, and get your Proton booked in today!
Compare Proton Garages and Specialists in Headington with Who Can Fix My Car.
The work was easy to schedule, the final price was as quoted, and staff were helpful and friendly
Established in 1974, Formula One Autocentres set out with a mission to deliver a completely new fast-fit experience to its customers. This would feature clean, modern premises, high-tech equipment and highly trained technicians; far removed from the kind of service normally associated with the industry.
Forty years down the line, we have grown to become one of the UK's largest independent autocentre chains. The business remains family owned and continues to uphold its original commitment to delivering the highest quality service at the most competitive prices.
That commitment has proved incredibly popular with motorists, creating many thousands of loyal customers who continue to put their trust in Formula One Autocentres.
As a result, the company has gone from strength to strength, currently boasting over 85 state-of-the-art branches across England, with over 500 highly trained staff working seven days a week to provide a full range of services including tyres, exhausts, batteries, brakes, clutches, MOT's and servicing.
We remain resolutely independent, and as a family owned business, avoid being tied down to any single manufacturer or supplier. This gives us the freedom and flexibility to offer the biggest deals on the widest possible range of top branded products, making the company a viable, attractive and cost-effective alternative to both the big national chains and smaller local independent outlets. Quite simply, Formula One Autocentres provides cost-conscious motorists with the most reliable and affordable means of maintaining their vehicles.
We defend our position at the forefront of the fast-fit industry by constantly evolving and developing innovative new products and services to meet the ever-changing demands of our customers. With an ongoing expansion programme and by regular investment in technology, we continue to provide unbeatable fast-fit service along with the very best value prices. In fact, we can confidently claim that no other company is better equipped to face the motoring challenges of the future.
Good value but the mechanic didn't turn up on the date of the first booking so I had to phone up and ask where he was. The job was then rescheduled a further two times. Then the mechanic had to go and get some additional parts. Luckily as a mobile mechanic they came to me so it didn't really make much difference, however if I had needed the work doing urgently I would have needed to get another garage to do the work.
Everything about my experience was positive from the info I got from the website to the quotes I received and the quality of the work and the final bill. Couldn't praise it highly enough
The mobile mechanic that comes to you with over 15 years' experience, Paul Turner Mobile Servicing & Repairs offers customers a range of mechanic services from vehicle repairs to MOT tests.
People's lives can be extremely busy. The time taken to bring your car to a garage, waiting around for a mechanic to look at it, and collecting it can be easily avoided, by letting me come to you.
As a mobile mechanic, I'm able to provide mechanic services at an affordable rate for cars and vans.
We offer a personal service where you can actually speak to the technician who has worked on your car.
As a member of the Retail Motor Industry Federation (RMI), you can be sure to receive a high standard of service should you bring your car into our fully equipped workshops for servicing or mechanical repair work. We use the latest tools and engine diagnostics equipment. Any replacement parts required can be after-market or genuine, it's up to you.

subset: commoncrawl


text: Lira was established in 2007 with the express goal of creating fashionable apparel for the action sports enthusiast. Located in southern California, Lira's staff is deeply rooted in the surf, skate, and snow communities and strives to create products that embody the fierce originality of each scene. Lira's founders believe that the action sports community is lacking for places to turn for fashionable gear, and are positioning Lira to be the type of brand that fans of board culture can trust. With diverse collections that are growing with each year, Lira is destined to expand its footprint in the streetwear game.


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Lipscomb community mourns the loss of freshman Isaac Phillips
The Lipscomb University and Academy communities are mourning the loss of university freshman Isaac Phillips who died early Saturday morning, Sept. 28.
A resident of High Rise Residence Hall, Phillips was a 2013 graduate of Lipscomb Academy, where he played football and baseball. This past summer, Phillips travelled to Europe as part of a special study abroad program for Lipscomb Academy graduates who attend the university.
Phillips is the son of John and Melisa Phillips of Nashville. He is survived by sisters, Cassidy, a senior at Lipscomb Academy, and Grace; brother, Sawyer; and son, Cohen.
Visitation with the Phillips' family will take place 5-8 p.m. Monday, Sept. 30, in the Doris Swang Chapel in the Ezell Center. A memorial service is set for Tuesday, Oct. 1, at 2 p.m. in Collins Alumni Auditorium.
"At tragic moments like this, we come together as a community to mourn the loss and to gather strength from each other. While many face these situations without God or a sense of purpose, we face this together with a faith that is affirmed and with a hope and a realization that God is greater than all of these circumstances," said President L. Randolph Lowry.
The university's counseling staff is available for those who would like assistance in dealing with their loss and can be accessed by calling Cathy Lincoln, at 615.966.6294, during business hours. After business hours and on weekends, call 615.966.1990 for counseling assistance. Campus ministers and residence hall staff members are also available to meet with those who seek their comfort.


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Queens Library's staff has picked out the best websites in several languages to aid in the use of the internet by our multicultural and multilingual customers. Whether you're an immigrant who wants to keep up with the news at home or you're a student learning a new language, we hope that the links to these reviewed websites are helpful to you.
The recommended websites are organized by language and then by subjects within each language.


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Google has combined Google Wallet and Gmail so that users can send money to friends, family or others through email. Read »
Reports say that Google Wallet is creating a credit card and not a virtual one. Read »
In its current state, Google Wallet is a handy mobile payment system that lets you buy things with your NFC-enabled smartphone. In the future, Google would like Wallet to replace more than just your cash... Read »
The cell phone provider is expected to start carrying the Google Android-powered Samsung Nexus smartphone later this month but before that happens, Verizon wants Google to ditch its wallet. Read »
Google wants you to switch your wallet for its own. Read »
Several reports say that Google Wallet will debut today at stores near you. Read »
An international study shows that consumers don't trust tech companies with mobile payments and actually trust credit-card companies more. Read »
PayPal alleges that Google hired a key PayPal executive who stole confidential information. Read »


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I think it's no secret around here that Mexican inspired flavors are by far my favorite ones to whip up in the kitchen and place onto my dinner table.
Easiest Ever Cheese Enchiladas
There's something about the cuisine that just captivates me…
Mexican Chicken Soup for a Crowd
Perhaps a love of all things spicy coupled with an affinity towards fresh, bold yet simple, comforting flavors.
Yucatán-Spiced Chicken w/ South of the Border Orecchiette Salad
And ever since this little read I just can't seem to get enough!
Mexican Chicken and Potato Stew topped w/ Spicy Slaw
There's so many fabulous ideas for south-of-the-border eats aside from the usual taco and enchilada too…
Although who doesn't love a good twist on that ol' classic?! 😉
Mexican cuisine is truly so much more. And I just.can't.seem.to.stop!
Huaraches w/ Chicken & Refried Beans
So here are a few of my favorite Mexican-inspired eats, right outta my kitchen to yours…
Mexican-Spiced Chicken Tacos w/ Corn & Summer Squash Saute
Just in time for Cinco de Mayo.
Exploding Chicken Taquitos & Chili Slaw
Which I'll be celebrating tomorrow with some fabulous eats, friends and well, you know…
Priorities, people 😉
Spicy Swiss n' Mixed Greens Enchiladas
Hope you enjoy some spicy flavors and good times this weekend too!!
Black Bean Soft Taco w/ Fresh Mango Salsa
Happy eating 😀


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Editor's note: Every NFL team is preparing to attack its offseason to-do list, with free agency set to open March 12 and the draft April 25-27. This is the seventh of 32 reports in 32 days by Sporting News NFL correspondents, who will analyze the offseason game plan for each team.
Another Patriots season with an AFC East title and another 12 wins ended in postseason disappointment as a team looking like the best in the conference for stretches of the regular season was thoroughly handled in the game that mattered most.
New England isn't typically a major player in free agency. Its own players aren't usually signed for the money they want, but rather what the team believes he's worth, a source of frustration for many Patriots over the years.
After a three-year stretch (2006-08) of terrible drafting, the Patriots have done better in recent years, which has helped infuse the team with young talent and many significant contributors in 2012. A big problem now is that several key veterans—Wes Welker, Aqib Talib, Sebastian Vollmer, Danny Woodhead—are scheduled to be free agents and there isn't a lot of depth, particularly on defense.
The secondary looked far better in the final games of the season (there was nowhere to go but up given the unit's performance the previous few years). But when Talib left the AFC championship game early, the group struggled again. First-round pick Chandler Jones made an immediate impact as a pass-rusher and surprise three-down player, but when he went out with a sprained ankle, there wasn't a sufficient replacement to step in. The linebacking trio of Jerod Mayo, Brandon Spikes and Dont'a Hightower has a bright future together, but again, there isn't much behind them.
Offensively, New England needs at least one other outside-the-numbers receiving threat since nearly all of their top pass-catchers work in the middle of the field.
MORE AFC EAST PLANS: Bills | Dolphins
Talib could be gone. Acquired at the trade deadline, Talib was arguably the best cornerback the Patriots have had since Asante Samuel—when he was healthy. Will another team offer Talib big money despite a history of on- and off-field issues?
Vollmer, a starter at right tackle but capable of playing at a high level on the left side, is likely appealing to many teams despite a history of back problems. If the Patriots were to use their franchise tag, Vollmer is a likely candidate. The franchise number for offensive linemen is around $9.6 million, but offensive line coach Dante Scarnecchia has shown he can turn players into starters, so maybe New England allows Vollmer to walk.
There is also the possibility of Welker leaving if he and the Patriots can't reach a contract agreement. Team owner Robert Kraft said during Super Bowl week he wants Welker to stay. Welker signed his franchise tender very early last year, a sign of how much he wants to be with his team, though it also hurts his leverage to show that urgency.
1. Cornerbacks (again). Talib was a good citizen in his first three months in New England, but will that last if he's given a big deal with a healthy amount of guaranteed money? The smartest move would be to structure a contract for Talib that pays him in increments, perhaps as a sizable roster bonus each year. The Patriots used a similar structure in Aaron Hernandez's rookie deal. That way if Talib reverts to his previous troubled ways, the team is protected. There's no way of knowing if he would agree to that, especially if another team wouldn't put stipulations into a deal.
There is still Ras-I Dowling, a promising corner drafted 33rd overall in 2011, but has played in only nine games over his first two seasons due to long IR stints each year. Kyle Arrington is better suited as a nickel, which is where he played when Talib was on the field. Arrington can be retained for short money.
2. Wide receiver. At the moment, the Patriots have exactly two receivers under contract for the coming season: Brandon Lloyd and Matthew Slater, who didn't catch a pass last year but is a Pro Bowl special teams player.
Tight end Rob Gronkowski is certainly a big part of the passing game—when he's healthy. Gronkowski has missed postseason time in each of the last two years and broke his arm (the first time) in November last year, essentially sidelining him for the rest of the season.
The problem for the Patriots is someone who can spread the field. Gronkowski, Hernandez and Welker (if he re-signs) all work primarily in the middle of the field, so defenses can clog things up there. Lloyd helped stretch things out in 2012, but a bigger threat is needed.
Acclimating to the Patriots' offense isn't easy for every player: receivers have to be able to read defenses and react to what they see. There is also the matter of developing chemistry with Tom Brady. New England hasn't drafted and developed a receiver successfully in over a decade, 2002 picks Deion Branch and David Givens were the last ones, and free agents haven't always worked out (Chad Ochocinco/Johnson).
3. Find pass rushers (again). The Patriots have already taken a step toward addressing this, signing former USC defensive end Armond Armstead, who spent 2012 in the CFL. Armstrong suffered a heart attack at USC that may have been caused by Toradol pain injections. Dwight Freeney is slated to hit free agency. He's older but could help if used as a situational pass rusher.
New England has the players to be strong against the run, but these days teams have to pressure quarterbacks so that players on the back end aren't asked to cover too long. Even a talented secondary will be exposed if a quarterback has all day to throw.
Jake Locker, Joe Flacco, Sam Bradford and Mark Sanchez all completed over 70 percent of their passes against the Patriots last year, and none has a career completion percentage over 60 percent.
4. Cover linebacker/linebacker depth. Mayo can cover adequately, but Spikes can't and is essentially a two-down player. Hightower could grow into that role, but didn't cover much as a rookie. Buffalo tight end Scott Chandler had nine receptions for 127 yards and three touchdowns in two games against the Patriots. In his other 14 games, he totaled 34 catches, 444 yards and three touchdowns. New England needs at least a fourth option at linebacker.
5. Safety. The Patriots like Devin McCourty but he's more of a free safety, meaning New England needs a strong safety to pair with him. Patrick Chung hasn't lived up to expectations and is a free agent. The Patriots wanted Dashon Goldson in 2011 and he's slated to hit the market again. Coming off an All-Pro season, he will be looking for big money.
The Patriots have no problem scoring points in the regular season, but defense wins championships. The Ravens held them to just 13 points in the AFC title game after the Giants held them to 17 points in Super Bowl XLVI.
Since their 2009 divisional-round game against Baltimore, the Patriots have been held to 20 points or less eight times and lost every one.
While New England's defense improved in 2012, it still wasn't able to deliver in key situations and that has to change. Several of the defensive players drafted in recent years show promise, but they have to take that next step, relying on instincts and smarts to make plays, not just sticking to a play as it was drawn up.
Bill Belichick has never been afraid to make trades on draft weekend, and if he feels there's value in the middle rounds this year, he'll have to do just that. Thanks to the (failed) trades for Albert Haynesworth and Ochocinco, as well as the trade for Talib, New England only has five picks—one each in the first, second and third rounds and two in the seventh.
And as every Patriots fan knows, Brady will turn 36 during training camp. The mythical "window closing" talk is cliché, but if they are going to win another title with Brady, the time to do so is slipping away.
Thursday: New York Jets
Friday: Chicago Bears
Saturday: Detroit Lions
Sunday: Green Bay Packers
Monday: Minnesota Vikings
Shalise Manza Young covers the Patriots for Sporting News and the Boston Globe.


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Presenting our iRace4life.org special presentation. seminars. The event took place in Dallas, Texas and was filled with sim racers, sim racing rigs, and endless amount of sim racing wisdom. We cover some of the classes that went on, some of the people that attended and do our best to let you know what it was like being there.
We also have an interview with up and coming driver Ryan Luza. He has been a dominant Legends driver in real life and is also a person to keep an eye for the future in iRacing. We also feature on of the best simrigs ever seen on our show and it was also at the event.
To wrap things up, we have an interview with Sion Alford, the person behind the seminar. We talk to him about this years event and also what is in store for next year.


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Only ten minutes away from the centre of Amsterdam, the Golden Tulip Amsterdam West has 245 rooms and three conference rooms for business parties, so it's a great base for all sorts of travellers. There are great facilities for guests to use during their stay, and private parking for those arriving by car. The proximity to the Dutch capital and all its trappings however is perhaps the highlight of the hotel. If you're looking for a great 4 star hotel in Amsterdam with a difference, look no further.
The 245 rooms are all comfortable and decorated in a warm palette of colours, with soundproofed walls for a good night of sleep after a busy day in the city. With mini-bars, Nespresso coffee machines, flat-screen TVs and free Wi-Fi, the rooms are all well-equipped and suited for an entertaining stay. All rooms come with spacious bathrooms and underfloor heating, which is perfect for those chilly mornings. Guests can choose from Double/Twin Rooms, Family Rooms, or Comfort Double/Twin Rooms.
The international buffet restaurant, D.R.E.A.M, serves breakfast and dinner, and guests can watch their food being cooked right in front of them. If you're looking for meeting rooms in Amsterdam, businessmen and women are welcome to use the three meeting rooms for their corporate affairs and guests who want to keep up their exercise routine can head to the Fitness4me studio - which is a ten-minute walk from the main building - or hop on one of the hotel's bikes, which are available for hire. There's also private parking underneath the hotel, accessible 24-hours-a-day.
The Golden Tulip Amsterdam West is only eight minutes from Sloterdijk train station, from where guests are quickly whisked into the centre of Amsterdam or to and from Schiphol Airport. After a ten-minute train ride, guests can explore tourist sights like the Anne Frank House, Volendam, Dam Square, the canals and the famous Red Light District, as well as a beach for guests seeking to escape the city for a day.


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Fur Sleeping Bag - Zebra
No longer available
- Overview
Catch plenty of zzz's in our furry sleeping bag covered in chic zebra stripes. Supersoft both inside and out, it's sewn with a hood to keep your head warm.
- 32" wide x 75" long
- Made of a modacrylic/polyester/acrylic blend.
- Brushed 100% cotton percale interior.
- Features a hood for style and warmth.
- Filled with plush 320-gram-weight polyester.
- Zipper closure.
- Personalization is available for an additional $7.00.
- Click here to Preview Font Colors.
- Machine wash.
- Imported.
- Dimensions + Care
- Closed: 32" wide x 75" long
- Open: 64" wide x 75" long
- Tie (2): 1.5" wide x 21.5" long
- Machine wash in warm water; gentle cycle.
- Use only nonchlorine bleach, if needed.
- Tumble dry on low heat; remove promptly.
- Warm iron as needed.
- Shipping Info
This item will arrive in 3-5 business days. Please proceed to the Payment & Review page of Checkout for a precise delivery estimate.


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EACH OF MARIN'S seasons offers its own special highlights along the trails. Autumn features views that grow grander as falling leaves reveal hidden vistas. Winter's spectacle is waterfalls. Spring dazzles with wildflowers and summer is the season of sunshine and beach walks. I love them all.
To revel in some of Marin's most scenic views, walk along the Old Railroad Grade. Made famous by the Mount Tamalpais & Muir Woods Railroad that wound up to the summit of Mount Tamalpais, the scenic views awed travelers back then and are still impressive today.
For a moderately strenuous five-mile loop, link the Old Railroad Grade, Corte Madera Trail, Hoo-Koo-E-Koo Road, Temelpa Trail and the Old Railroad Grade together.
Begin at the Open Space gate near the end of West Blithedale Avenue in Mill Valley. Yellow big leaf maple leaves are still adding color to the forest. Turn right and walk briefly on the Horseshoe Fire Road before turning onto the Corte Madera Trail for a steep climb up on a narrow path through a thick grove of redwoods to the intersection with the Hoo-Koo-E-Koo Road.
Turn left on Hoo-Koo-E-Koo Road and follow it along the mountainside alternately crossing open areas and curving around the heads of steep ravines. Redwoods, bay trees and sword ferns crowd into the drainages that are fed by springs. As the road rounds bends, views include Corte Madera, San Quentin and the San Rafael-Richmond Bridge. Continue around a few more curves and San Francisco, Mill Valley, Tiburon, Belvedere, Angel Island and much of San Francisco Bay become visible.
Watch for the Temelpa Trail signpost on the left and head down the steps that cut a path through manzanita bushes.
Fern Canyon Road is part of the Old Railroad Grade that has been paved and used as a city street. Walk downhill on the street and turn left onto the dirt section of Summit Drive. Step around the Marin Municipal Water District gate and continue down the Old Railroad Grade's gradual slope.
This section of Old Railroad Grade descends steadily through some of the 281 curves that earned the train its nickname the Crookedest Railroad in the World. Large wooden trestles once spanned several of the deep ravines. Today, the route hugs the hillside accentuating the curves. Continue downhill on the Old Railroad Grade as it rounds its last sharp turn and heads back to West Blithedale Avenue.
To reach the Old Railroad Grade, leave Highway 101 at the Mill Valley/Tiburon exit. Follow East Blithedale Avenue and West Blithedale almost to the end. Watch for the gate with the Open Space sign. Parking is very limited.
Tacy Dunham is the author of several trail guide books. For more information about her books, email firstname.lastname@example.com. For past columns and
maps, go to www.marinij.com/outdoors.


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A Surprising Twist
The Federal Reserve's Zero Interest Rate Policy (ZIRP) had most investors focusing on or scrambling for dividend yield. To the naked eye, it seemed that a large payout was the key to market success in 2012.
In the end, though, the highest decile dividend yielders turned in the worst performance by far....224 more words left in this article. To read them, just click below and try Real Money FREE for 14 days.
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Photographing Latin America Through a Fair Trade Lens
Photographer James Rodríguez shares insights and experiences from his Fair Trade journey
Today, we are honored to share a Q&A with one of our very talented friends, photojournalist James Rodríguez. James is an independent U.S.-Mexican documentary photographer based in Guatemala since 2004. Fair Trade USA has been working with James to capture the incredible stories and photos from Fair Trade communities in Latin America. To contact James or view his work, please visit his personal website at mimundo.org
Q: You photographed quite a few Fair Trade communities since 2012. Tell us where you went.
Thanks to my collaboration with Fair Trade USA, I was able to witness firsthand the benefits that locals receive from Fair Trade in Northern Mexico, Guatemala, Ecuador and Peru. Previously, I have photographed Fair Trade communities in Belize, Costa Rica, Panama, Honduras and Nicaragua.
Q: What was it like getting to these remote farming communities? Did you have any trouble along the way?
Well, when you are on the road all the time, and you live and work in the Global Economic South, one must be patient, as mishaps become the norm… so does sleeping on wooden planks or getting bit by just about every insect you run into. But fortunately I have been very lucky with no major issues. The places I have visited are very often off the tourist routes, so it is always a great joy and privilege to share time with such amazing people and visit these amazing communities in unbelievable settings.
Q: What was the most surprising thing you learned about the impact of Fair Trade?
The thing that amazed me the most is how truly empowering the collective decision-making process of Fair Trade is for communities in general.
When you have entire communities get together, decide on, and eventually work for a common goal, the atmosphere is really special. The positive effects clearly spill over into the different social structures and institutions.
Q: When you photograph people, you also record their stories. What was the most touching story you heard?
Most people I meet are really inspiring. But the one that keeps coming back to me is the story of Carmen Pucuji, an employee at Agrogana, a Fair Trade flower provider in Ecuador. She is a tiny, tiny woman, and single mother of a 14-year old boy named Kevin. She has been working at Agrogana for over a decade and is such a hard worker and amazing mother. Her son is an outstanding student that excels in English and Computer Science. He has been rewarded with numerous scholarships and prizes, including a computer that proudly sits in a very humble home.
They are both such inspiring people—living examples of hard work and perseverance despite major obstacles. I can still remember how Carmen proudly said to me "I work for him, he is everything to me." The sparkle in her eye was really special. To me, this is what it's all about.
Q: Based on what you've seen and heard from farmers, what do you want people in North America to know about Fair Trade?
I have always believed in the concept of "think globally, act locally," hence I often tried to buy Fair Trade products.
Obviously, as a college student or young professional, I often could not afford to spend that little extra in order to support my ideals. Nevertheless, now that I have seen the benefits with my own eyes and heard it from those on the receiving end, I cannot imagine not spending that extra bit. It makes a huge difference and it is really an investment in our world rather than an extra expense.
Q: You've photographed many other communities in Latin America. How do the Fair Trade communities differ? Do you notice anything different about them?
I have been to many communities not involved in Fair Trade, and I can honestly tell you that even if the economic impact may not be obvious at once in communities where Fair Trade products are certified, at least the spirit of those involved is always positive. There's a sense of hope and the awareness of global solidarity, the search for equality. I have had many locals tell me how happy they are that at least people far away care about them since they are willing to pay bit more for their product.
Q: What would it take to make Fair Trade work even better?
Well, I am not an expert in economics and I barely know the surface of how Fair Trade works, so this is hard. But I think it's important for us to be aware that participating in the Fair Trade system – whether purchasing products or producing products for the Fair Trade market – must be complemented with other progressive ways of thinking and acting in order to improve the way things work. We all know poverty is not a natural problem, but a social one.
Hopefully the success of the Fair Trade system can help inspire governments, activists, entrepreneurs, and everyday folks to realize that we can do things differently, in a more humane manner, where solidarity and fairness are above individual, immediate profit.
Q: What countries or products would you like to photograph next for Fair Trade?
Well, the truth is I want to go everywhere! But if I had to choose, I would say Brazil. I lived there for six months in the early 2000s and speak enough Portuguese to get by, so it would be amazing to go back and see how Fair Trade works in such a budding economy and incredibly unique country. Haiti would also be interesting, since it is the poorest country in the hemisphere. I love Latin America and am continually amazed by its diversity, history, and people. I feel it is my home, and my skills work best here.
Nevertheless, I would also be thrilled to document a few communities in Sub-Saharan Africa. I spent a few months living and working in Kenya and Ethiopia in 2011, and I feel like I have just barely taken a peek into an astounding region full of life and both heart wrenching and inspiring contradictions.
Q: What are your favorite Fair Trade photos that you took last year?
This is quite hard. Instead of selecting some, I invite you all to view the images from my visits on Fair Trade Certified's Facebook feed, Twitter, or to view work on my personal website mimundo.org.
About James Rodríguez
James Rodríguez is an independent U.S.-Mexican documentary photographer based in Guatemala since 2004. He grew up in Mexico City, but attended high school in the Los Angeles area and graduated from UCLA in 1996 with a degree in Cultural Geography. After working abroad as a language teacher and human rights activist, James decided to focus on a long-term documentary photography project that would expose issues involving land tenure disputes, human rights violations, post-war processes, and extractive industries' conflicts with local populations in Latin America. He also provides short-term photography work for progressive organizations—such as Fair Trade USA—that contribute to the development of a fairer global economic system based on solidarity, equality and integrity.
To contact James or view his work, please visit his personal website at mimundo.org


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kirtu wrote:Malcolm wrote:Uttarakuru, as Mipham surely conceived it, is not this planet.
So in your view, Mipham is telling Khenpo Kunpel that they will reunite in a celestial or pure realm? Or perhaps an impure realm just not on the planet? I thought that traditionally all four continents were on this planet surrounding Mt. Meru?
Well, you just tell me where Mt. Meru is on this planet.
The fact is, Uttarakuru is not something accessible for us, according Kosha cosmology, unless you are a siddha.


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Diamond continues mastery against Tigers
Left-hander allows two runs on four hits over six innings in finale
DETROIT -- The Tigers have won the AL Central two years in a row, reached the World Series last year and are in first place in the division again this year.
There may not be many pitchers who have the Tigers' number, but the Twins' Scott Diamond appears to be one.
Diamond allowed two runs through six innings in Wednesday's 6-2 win at Comerica Park. It was his fifth straight start against the Tigers in which he allowed two runs or fewer while going at least six innings, dating back to Sept. 11, 2011.
"Because they've won [so much], they're the team to beat right now," Diamond said. "Whether I get amped up a little more facing them, I enjoy facing them and I enjoy coming to Detroit and pitching here."
Diamond took a no-hit bid into the fifth inning on Wednesday, before a one-out single by Jhonny Peralta.
But he found trouble in the sixth. With Minnesota holding a 3-0 lead, Diamond allowed a one-out double to Austin Jackson, which was followed by an RBI single by Torii Hunter and an RBI double by Miguel Cabrera to cut the lead to 3-2 with the tying run in scoring position.
"Cabrera, our goal is not to give him anything to hit," manager Ron Gardenhire said. "Every time it seems we try not to give him anything to hit, we throw one right down the middle, and he whacks the living fire out of it. I think we have to have a new theory: Try to throw it down the middle. We'll never be able to do that. He's just a great hitter. They put some pressure on us there."
Prince Fielder followed with a groundout as Cabrera moved to third. Instead of pitching around Victor Martinez, Diamond pitched to him, inducing a groundout to end the threat. Gardenhire said he didn't want to put more runners on base, no matter who was up.
"The more guys you put on in this ballpark, the more guys seem to score," he said. "I don't like to take too many chances like that. I put my stock in Scotty going and making some pitches, and that's what he did."
Now four starts into the season after offseason elbow surgery, Diamond called Wednesday a big step. It was his third straight quality start and evened his record at 2-2.
After getting out of the jam, Aaron Hicks led off the seventh with a triple off Tigers reliever Bruce Rondon. Hicks scored on a single by Pedro Florimon with the infield drawn in. A one-out single by Justin Morneau pushed the lead to 5-2. Hicks went 1-for-4, while Morneau was 2-for-5.
"I was trying to take away his fastball, be very aggressive toward his fastball," Hicks said of Rondon. "He's a fastball pitcher. The guy throws 100 mph, so you have to really get the head out. For me, I was just trying to hit the ball solid."
Chris Parmelee led off the eighth with a solo home run to extend the lead to 6-2, and Jared Burton and Glen Perkins held things down the rest of the way.
The win moved the Twins back to .500 for the fourth time in a week. Last season, the Twins had six losing streaks of at least five games. They had one in early April this season, but responded with a five-game winning streak.
After losing two straight to Texas in the previous series, they won the next two, and after losing the first two in Detroit, they took the third game. Players admitted there's more of a positive vibe around the clubhouse that prevents a few losses turning into a lot of losses.
"I think we're learning a lot every game," Diamond said. "I still consider myself a young guy still learning start to start. I think the atmosphere in this clubhouse is a lot different than it was last year. Because of it, we're playing better and able to prevent the streaks of losing or continue streaks of winning. It just feels a lot more positive, even when we lose a couple games.
"In that Texas series, everything remained positive in the locker room and we were still pulling for each other. We don't suddenly start swinging for home runs or trying to strike everybody out. We're relying on what's going to make us win. That's our defense and moving runners. It's a good thing we're focusing on the right things."
Chris Vannini is a contributor to MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.


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While some military and medical equipment is exempt from RoHS compliance, the electronics governed by the standard are among the most common you'll find in your home, from radios to MP3 players to cell phones and (increasingly) computers. In practical terms, the standard protects factory workers at the production level, sharply reducing their exposure to hazardous substances. The standard also has a profound impact on the disposal and recycling of electronics, in that disposed substances will no longer have at least six of the most hazardous chemicals formerly found in electronics, and recycled electronics will not expose workers to toxics as they harvest components.
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We started distributing pillow speakers over 20 years ago and realized they break more often than one would think. So, we took up the quest to design a better, longer lasting Pillow Speaker. In developing this speaker, we also focused on the common wire break point where the cord enters the pillow speaker. Over time the oils and dirt from one's hands and face can cause the wire (where it enters the pillow speaker) to harden and eventually break. Our design uses a high quality wire and a very flexible rubber protective outer cover to help improve the longevity. To stand behind this design, we offer a one year warranty. This is unheard of in an industry where 30 to 90 days is generally the normal warranty period for a pillow speaker.
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'Wei-Chung Wang Wednesdays' a big hit
ST. LOUIS -- Brewers relievers started "Wei-Chung Wang Wednesdays" on a lark last week, but now it's getting big.
Bullpen catcher Marcus Hanel unveiled via Twitter the group's latest dance video on Wednesday morning, set once again to the beat of Wang Chung's 1986 hit "Everybody Have Fun Tonight." This one has legitimate production value, with Wang and his bullpen mates dancing in the shadow of St. Louis' Gateway Arch.
A Milwaukee Magazine reporter reached out to a representative of Wang Chung and yes, the band is aware of and enthusiastic about the Brewers' movement.
"It keeps us loose out there," said lefty reliever Will Smith. "But when the phone rings, all the horseplay gets cut out and it's time to work."
Can they keep it up all season?
"We already have some planned," said right-hander Jim Henderson. "I think the key is keep it simple, goofy and creative."
And keep winning.
"Of course, these things are always great when we win," Henderson said. "We have to keep winning. We're aware of that, too."
Adam McCalvy is a reporter for MLB.com. Read his blog, Brew Beat, and follow him on Twitter at @AdamMcCalvy. This story was not subject to the approval of Major League Baseball or its clubs.


text: by Yukito Kishiro Color poster in this issue! The high seas, chivalrous knights, and a mythical Age of Exploration are all parts of the new world from the creator of Battle Angel Alita! Ashika, the son of a lighthouse keeper, has become a slave to the richest and most pampered person in the world: the imperialist Alcontra, who destroyed the lighthouse of Faro. As Alcontra's seashell-shaped ship rolls across the ocean in fully automated comfort, aqua knight Ruliya is in pursuit ? but how will Ashika adjust to his new life in this mechanized and formalized vessel? And what priceless jewel is stashed in the ship's bowels? b&w, 32pg (1 of 5) Cover price $3.50.


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Thread: Heroe's Handbook: Tieflings
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Friday, 18th September, 2009, 02:54 PM #1
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Heroe's Handbook: Tieflings
This book is the third in a series by Goodman Games expanding on the background and powers of specific races introduced in Dungeons and Dragons, 4th edition. Each book provides a look at the history and culture of the race in the context of Goodman Games' Áereth setting with additional chapters providing new feats, powers, paragon paths and magic items. While the setting material is for the Áereth, it is generic enough so that GMs may import the material into another setting with only slight alterations.
The physical appearance of the book is of a high standard. The full color cover depicts a tiefling engaged in battle against undead rising from tombs. This follows a theme of all of the covers in this series depicting the race fighting undead and apparently all three covers were originally painted as a triptych. The interior is black and white with most of the art executed in a similar style, with one exception that I find a bit jarring. The text is laid out in double columns with a good density. The tables are kept clear with a simple layout and counter shaded entries. The feats and magic items follow the layout from the core 4th edition products, but suffer just a bit from not being in color, as powers in the core books are color coded: green for at-wills, red for encounter, black for daily, and yellow for magic items. The lack of color is not a deal breaker by any means; it just requires the reader to pay a bit more attention to the descriptions. Other minor editing problems crop up, typically missing bold formatting, but they do not detract too much from the overall layout of the book.
Chapter 1: History and Culture
This chapter details the evolution of the tieflings from hellish eugenics experiment to the insular society they are today. After the devils lost the War of Divine Right, they realized direct conquest was not an option for victory. They adopted a new, covert strategy in a effort to tempt humans away from good and to set the stage for the return on the archdevils. During this time the devils used their mortal agents to establish communities of other mortals recruited into their service. These communities were earthly reflections of the Nine Hells, in their strict adherence to law and servitude. One cambion decided to try and fuse human and devil together into a species that retained the free will of humanity but were mystically tied to the archdevils they served. These were the first tieflings, and they were deployed in sleeper cells across Áereth to wait for the signal of the infernal invasion. The signal never came and the tieflings were left without their masters and over the years many of the communities have dissolved and now tieflings typically wander the lands. The history section is an interesting take on the implied background from the 4th edition core books, rather than have a fallen empire; here is an empire that never rose to power. Though it is not spelled out in the book, the failed infernal uprising must have been in the recent past as further in the book references are made to the fact the many tieflings still believe they are superior to the other races as they were created to rule.
The next sections discuss the psyche of tieflings and how the theme of unwilling servitude pervades their mindset. The central belief of all tieflings is that each of them is claimed by a lord of the Nine Hells, whether it is an archdevil, or some other noble. This idea of eternal servitude is contrasted with the need for tieflings to prove themselves and their free will.
Each tiefling, according to their beliefs, is claimed by a specific hellish lord, typically at birth. It is rumored that the soul is actually auctioned off in Hell before being born. These souls serve as a kind of currency and are traded between archdevils for favors. This claim is reflected by a mystical brand on the tiefling's body, which is typically revealed during a coming of age ceremony. These brands are physical indications of which archdevil has a claim on the tiefling and the society has changed to reflect these ties. Each archdevil is naturally distrustful of all others and this is reflected in tiefling culture. Many settlements, or diableries, are inhabited by members of one legacy or group claimed by a particular archdevil. The brand is so important that members of the community that exhibit different brands are typically exiled and this has lead to a weakening of familial bonds and more emphasis placed on the communal raising of children. The bond between parent and child is not completely gone as many parents try and influence the infernal bidding wars by performing specific rituals to ensure membership in a specific legacy. The efficacy of these rituals has never been proven. Most communities will then exile tieflings who manifest different brands, and here again family ties do surface as many send their children into the world well equipped.
Also discussed are tiefling demographics, including a brief look at what makes a legacy different from other social organizations and how they influence the larger tiefling society. Throughout most of the chapter the reader is given the impression that legacy based communities dominate tiefling society, but only one third of tieflings live in such settlements, another third live in family centered communities of mixed legacies, a quarter live in racially mixed societies, e.g. large cities. This leaves the remainder as adventurers and other wanderers.
In addition to the introduction of the brands this book has guidelines on altering the appearance of tieflings based on their legacy. Many of the changes are cosmetic, but each legacy receives mechanical options as well that are detailed in later chapters. Included at the end of this chapter are some tables that can be used to modify the appearance of a tiefling. Here a player can randomly determine (or pick) which legacy he belongs to (there are 15 listed), changes in physical appearance, specific curses (which open access to specific feats) and personality traits. These tables are a welcome addition to adding visual variety to a race that has a greatly varied number of progenitors.
Chapter 2: Archdevils and their legacies
This chapter details eight different legacies and the influence the archdevils have over them. In the previous chapter one of the tables for determining the character's legacy has twenty different options. While only eight legacies are detailed in this book, readers should have a good grasp of how each legacy is described and should be able to fill in the details of the missing legacies. Each description begins with a short fiction vignette describing a scene involving a legatee (member of a legacy) in action. Most of the fiction pieces describe tieflings of dubious moral nature, but there are three stories that have conflicted or good characters. After the fiction, a description of the archdevil associated with the legacy is covered, including how the devil views its tieflings, its position in the Nine Hells, and its relationship with the other archdevils.
The laws of each archdevil are covered next. These laws are four commandments that are enforced to various degrees depending on the archdevil's personality. The mark (brand) of the devil is discussed next including a description of the mark, changes in the tiefling's personality as they approach the time when their mark manifests, and a ceremony specific to that legacy used to reveal the brand.
Additionally, stigmas are discussed, which are physical changes that occur in the tiefling after the revelation of the brand, for example tieflings of Bael grow in height and weight, while those claimed by Lilith become less infernal in appearance. These changes become more pronounced at each adventuring tier and suggestions for each tier are offered. The stigmas are another excellent way to distinguish one tiefling from another and another wise decision on the designer's part is that none of these stigmas have mechanical effects. This allows them to remain relevant for role playing without penalizing the players by requiring them to spend feats, or unbalancing the game by granting characters undue advantages.
The organization of the legacy is next including a discussion of a typical diablerie, or safe house. The organization of each legacy reflects the personality of the archdevil progenitor; Bael's is very structured and epitomizes the Evil alignment, while Belphagor's legacy is much more individually focused. The last section will provide the most use for characters as it describes typical adventurers of the legacy and those rare tieflings who attempt to "break the chains" of their legacy. Ironically most of the groups do not produce many adventurers as they find little use for their powers and opportunities to corrupt others, which is the main goal of the archdevils. In addition to the eight archdevils is a mysterious ninth legacy, that of the unknown benefactor. This legacy is made up of tieflings who have brands that do not fit into any other legacy, and several possible origins are discussed for this legacy.
Each legacy is also provided with a paragon path focusing on the specialty of the legacy. For example, the Somnolent Adept focuses on impairing their foes with sleep effects mirroring the sloth of Belphigor [you spelled the devils name differently in the previous paragraph]. Each paragon path follows the same format as all others with three features and three powers. The legacy description is rounded off with three feats specific to the legacy. The notable exception to this is the legacy of the unknown benefactor, with its description ending with the organization, so no paragon path or feats. All of the feats are well thought out both mechanically and thematically, and a particularly well done example are the feats of Lilith's legacy in translating seduction into effective combat actions. I do wish these feats were placed in the feat chapter, or had been indexed. The other problem I had with this chapter was the organization of the legacies. They are alphabetized by sin, which is not a problem in itself (at least it is alphabetized somehow), but it does lead to some confusion if one is trying to find a specific archdevil. Once again an addition to the table of contents or inclusion of a short index would have been helpful.
Chapter 3: Feats and Malisons
This chapter contains a wide array of feats for tieflings. A new type of feat is introduced, infernal inheritance, which allows a tiefling to draw upon the powers of a plane of Hell rather than a specific archdevil. A character can have only one of these feats at a time. The majority of the feats are in the heroic and paragon tiers of play. The heroic tier ones are evenly divided between general feats (mostly infernal inheritance) and class specific feats which enhance a specific class ability. A special type of feat, the malison, is introduced here as well. The malison is a curse placed upon a tiefling by one of the archdevils, typically for an offence committed by another archdevil. These curses proved a benefit and a penalty to the character, and can be granted outside of the normal feat progression. An example of the benefit/penalty is the malison Alluring Gaze, where the character can pull and daze a target until the end of the next turn, but after that the character grants combat advantage until the end of the encounter. The feature that makes malisons noteworthy is that they scale in power. Each malison has three tiers and as the character advances the power is replaced by the next tier's power. I think this is a very clever idea and look forward to further uses of the idea of scaling feats.
Chapter 4: Equipment and Magic Items
The last chapter is a short one devoted to tiefling specific magic items. There is a very good balance of items with most of the magic item slots getting at least one item each. All but one of the items are linked to a specific legacy for it origin, and the one item that is not is used by foes of a specific legacy, the snow mantle, is created by a celestial hound who is the eternal foe of Bei'thor. The majority of the items are high heroic and paragon tier items and are well designed to fit those levels of power. Once again like the paragon paths many of the items while not seeming to have combat application have had powers designed in such a way that allows their users to be effective, while not necessarily directly damaging.
Overall this is a well written book expanding the coverage of one of the new races introduced in Dungeons and Dragons, 4th edition. Rather than being something like an "Ecology of" article in Dragon, which would expand the generic goodness, this book places a different spin on the tiefling race. This book caters much more to either the conflicted/tormented character type or the tiefling who embraces his hellish heritage. Another clever idea is that of many of the archdevils masquerade as lesser gods in the setting as diabolism (worship of the archdevils) is severely frowned upon. The mechanics presented demonstrate Goodman Games' command of the mechanics of this edition, and as a DM, I would have no hesitation in allowing this product to be used in the games I run. In the interest of full disclosure I did receive a review copy of this book from the publisher.
Friday, 18th September, 2009, 09:59 PM #2
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Hi Grimjaws,
Thanks for the review. Jeff and I are both huge fans of the tieflings, and we had a blast writing this one.
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Prognosis in malignant mesothelioma is difficult to assess consistently because there is great variability in the time before diagnosis and the rate of disease progression. In large retrospective series of pleural mesothelioma patients, the following were found to be important prognostic factors:[1,2][Level of evidence: 3iiiA]
Prognostic scoring systems
Two prognostic scoring systems have been developed for advanced unresectable mesothelioma and are used to stratify patients enrolling in clinical trials: the Cancer and Leukemia Group B (CALGB) index and the European Organization for the Research and Treatment of Cancer (EORTC) index.
CALGB index
The CALGB index was developed retrospectively using the clinical characteristics of 337 patients treated on clinical trials of chemotherapy for advanced mesothelioma during a 10-year period.[3][Level of evidence: 3iiiA] These characteristics were used collectively to define six prognostic groups with median survivals ranging from 13.9 months (Eastern Cooperative Oncology Group [ECOG] performance status [PS] = 0, age <49 years; or PS = 0, age ≥49 years and hemoglobin ≥14.6g/dL) to 1.4 months (PS = 1 or 2 and white blood cell [WBC] count ≥15.6 × 109/L).
The prognostic value of the CALGB index was evaluated retrospectively in a phase II clinical trial of 105 patients.[4][Level of evidence: 3iii] Median survival in this study for patients in the best CALBG prognostic group was 29.9 months compared with 1.8 months for patients in the worst prognostic group. However, the intermediate groups 2 to 4 overlapped in their survival times.
EORTC index
The EORTC index was also developed retrospectively using the characteristics of 181 patients from five phase II clinical trials of chemotherapy during a 9-year period.[5][Level of evidence: 3iiiA] In a multivariate analysis, the following characteristics were associated with poorer survival:
Patients were allocated a numerical prognostic score based on each of these variables (+0.55 if WBC >8.3 × 109/L, +0.60 if ECOG PS ≥1, +0.52 if unconfirmed histology, and +0.60 if male gender). Subsequently, patients were classified into two prognostic groups that included low-risk patients with a prognostic score of ≤1.27 (0–2 risk factors) and high-risk patients with a prognostic score of >1.27 (3–5 risk factors). High-risk patients had a relative risk of death of 2.9 compared with low-risk patients, P < .001; the 1-year survival rate was 40% for the low-risk group compared with 12% for the high-risk group.
Follow-up and Survivorship
Multimodality therapy incorporating radical surgery (extrapulmonary pneumonectomy or radical pleurectomy with decortication) with or without chemotherapy, administered with or without radiation, may be considered for patients with limited disease and has been associated with a relatively long survival in observational series.[6][Level of evidence: 3iiiA] For patients treated with aggressive surgical approaches, factors associated with improved long-term survival include the following:[7,8][Level of evidence: 3iiiD]
For those patients treated with aggressive surgical approaches, nodal status is an important prognostic factor.[7] Median survival has been reported as 16 months for patients with malignant pleural disease and 5 months for patients with extensive disease. In some instances, the tumor grows through the diaphragm making the site of origin difficult to assess. Cautious interpretation of treatment results with this disease is imperative because of the selection differences among series. Effusions, both pleural and peritoneal, represent major symptomatic problems for at least 66% of the patients. (Refer to the PDQ summary on Cardiopulmonary Syndromes for more information.)
A history of asbestos exposure is reported in about 70% to 80% of all cases of mesothelioma.[1,9,10]
Histologically, these tumors are composed of spindle cells (sarcomatoid) or epithelial elements or both (biphasic). Desmoplastic mesothelioma, consisting of bland tumor cells between dense bands of stroma, is a subtype of sarcomatoid mesothelioma. The epithelioid form is occasionally confused with lung adenocarcinoma or metastatic carcinomas. Epithelioid tumors account for approximately 60% of mesothelioma diagnoses.[1] Attempts to diagnose by cytology or needle biopsy of the pleura are often unsuccessful. It can be especially difficult to differentiate mesothelioma from adenocarcinoma on small tissue specimens. Thoracoscopy can be valuable in obtaining adequate tissue specimens for diagnostic purposes.[2]
Examination of the gross tumor at surgery and use of special stains or electron microscopy can often help to determine diagnosis. Pancytokeratin stains are positive in nearly all mesotheliomas.[1] Particularly useful immunohistochemical stains for the differential diagnosis of epithelioid mesothelioma include cytokeratin 5 and 6, calretinin, WT-1, and D2-40. Calretinin and D2-40 positivity in combination with pancytokeratin positivity is most useful to distinguish sarcomatoid mesothelioma from sarcoma and other histologies.[1] Histologic appearance seems to be of prognostic value, and most clinical studies show that patients with epithelial mesotheliomas have a better prognosis than those with sarcomatoid or biphasic mesotheliomas.[3,4,5]
Patients with stage I disease have a significantly better prognosis than those with more advanced stages. Because of the relative rarity of this disease, exact survival information based upon stage is limited.[1]
Definitions of TNM
The American Joint Committee on Cancer (AJCC) and International Union Against Cancer (UICC) have designated staging by TNM classification to define malignant mesothelioma.[2]
AJCC and UICC TNM Staging for Diffuse Malignant Pleural Mesothelioma
Standard treatment for all but localized mesothelioma is generally not curative. Although some patients will experience long-term survival with aggressive treatment approaches, it remains unclear if overall survival (OS) has been significantly altered by the different treatment modalities or by combinations of modalities.
Extrapleural pneumonectomy in selected patients with early-stage disease may improve recurrence-free survival, but its impact on OS is unknown.[1] Pleurectomy and decortication can provide palliative relief from symptomatic effusions, discomfort caused by tumor burden, and pain caused by invasive tumor. (Refer to the PDQ summary on Pain for more information.) Trimodality therapy refers to a combination of chemotherapy, definitive surgery, and radiation therapy. Because of the rarity of mesothelioma and the complexities of patient selection, surgical technique, and optimal sequencing of therapy, delivery of such therapy in centers with medical personnel who have established experience and expertise in the management of mesothelioma has shown better results. Operative mortality from pleurectomy with decortication is less than 2%,[2] while mortality from extrapleural pneumonectomy has ranged from 6% to 30%.[1,3]
Several single-arm, phase II studies have demonstrated prolonged survival times (compared with historic controls) for selected patients who received adjuvant radiation therapy after definitive surgery.[2,4,5] The use of radiation therapy in pleural mesothelioma has also been shown to alleviate pain in the majority of patients treated; however, the duration of symptom control is short-lived.[6,7] Other single-arm, phase II studies investigated neoadjuvant chemotherapy (mainly with platinum and pemetrexed or gemcitabine) followed by definitive surgery followed by adjuvant radiation.[8,9,10] These studies have also shown prolonged survival compared with historical controls; however, this advantage has yet to be confirmed in a randomized study.
Standard treatment options:[1]
Treatment options under clinical evaluation:
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with localized malignant mesothelioma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Standard treatment options:
Information about ongoing clinical trials is available from the NCI website.
Many phase II trials of chemotherapy for the treatment of advanced malignant mesothelioma have been reported.[6,14,15] The safety and efficacy of pemetrexed, an antifolate, and cisplatin in chemotherapy-naive patients with malignant mesothelioma who were not eligible for curative surgery was demonstrated in a randomized, phase III trial.[16][Level of evidence: 1iiA] This trial compared pemetrexed (500 mg/m2) and cisplatin (75 mg/m2 on day 1) with cisplatin alone (75 mg/m2 on day 1 intravenously every 21 days). With a total of 456 enrolled patients in the trial, 226 patients received pemetrexed plus cisplatin; 222 patients received cisplatin alone, and 8 patients did not receive therapy. After 117 patients had enrolled, folic acid and vitamin B12 were added to reduce toxic effects. Folic acid (350–1,000 µg orally) was given daily, beginning 1 to 3 weeks before the first chemotherapy dose and continuing daily until 1 to 3 weeks after treatment ended. A vitamin B12 injection (1,000 µg intramuscularly) was administered 1 to 3 weeks before the first chemotherapy dose and was repeated approximately every 9 weeks until treatment ended. Dexamethasone (4 mg) or an equivalent corticosteroid was administered orally twice daily for skin rash prophylaxis to all patients 1 day before, on the day of, and 1 day after each pemetrexed dose.
In an analysis of all patients who were randomly assigned and treated, the combination of pemetrexed and cisplatin was associated with a statistically significant improvement in survival compared with cisplatin alone; the median survival was 12.1 in the pemetrexed plus cisplatin arm versus 9.3 months in the cisplatin alone arm (P = .020). The hazard ratio for death of patients in the pemetrexed plus cisplatin arm versus those in the control arm was 0.77. Median time-to-progression was significantly longer in the pemetrexed plus cisplatin arm (5.7 months vs. 3.9 months, P = .001). This superiority in the combination arm was also demonstrated in the vitamin-supplemented subgroup. The median survival was 13.3 in the combination arm and 10.0 months in the cisplatin alone arm (P = .051). The principal adverse effects of the pemetrexed plus cisplatin regimen were myelosuppression, fatigue, nausea, vomiting, and dyspnea. Most grade 3 to 4 adverse effects were significantly reduced by vitamin supplementation without any decrease in efficacy.
A randomized, phase III trial of 250 patients was performed by the European Organisation for Research and Treatment of Cancer (EORTC-08983) to compare cisplatin alone with the combination of raltitrexed, a thymidine synthase inhibitor, and cisplatin in first-line treatment of patients with malignant pleural mesothelioma.[17] Cisplatin (80 mg/m2 IV) was given on day 1, alone or combined with raltitrexed (3 mg/m2). No toxic deaths resulted, and the main grade 3 or 4 toxicities observed were neutropenia and emesis, which were reported twice as often in the combination arm. Among 213 patients with measurable disease, the response rate was 13.6% versus 23.6%, respectively (P = .056). No difference in quality of life was observed. The combination arm was associated with increased survival. Median overall survival was 8.8 months versus 11.4 months, and the 1-year survival rate was 40% versus 46% (P = .048).[17][Level of evidence: 1iiA]
Malignant Peritoneal Mesothelioma
A multi-institutional registry study evaluated cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for diffuse, malignant, peritoneal mesothelioma.[18] Among 401 patients, 187 (46%) had complete or near-complete cytoreduction, and 372 (92%) received HIPEC. Of the HIPEC patients, 311 (83%) received cisplatin and doxorubicin. The median follow-up period was 33 months (range, 1–235 months). Grade 3 to 4 complications were seen in 127 (31%) of the 401 patients, and 9 patients (2%) died perioperatively.
The mean length of hospital stay was 22 days (standard deviation, 15 days). The overall median survival was 53 months (1–235 months), and 3- and 5-year survival rates were 60% and 47%, respectively. Four prognostic factors were independently associated with improved survival in the multivariate analysis:
This kind of analysis is subject to the biases of strong patient selection.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with advanced malignant mesothelioma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Treatment of patients with recurrent malignant mesothelioma usually utilizes procedures and agents not previously employed in the initial treatment attempt. No standard treatment approaches have been proven to improve survival or control symptoms for a prolonged period of time. Selected patients with localized disease recurrence may be candidates for additional chest wall resection. One trial of 47 carefully selected patients at a single institution indicated that chest wall resection could be safely performed; time-to-recurrence from initial resection appeared to be predictive of expected survival benefit and should be factored into decision-making.[1][Level of evidence: 3iiiA]
Patients with recurrence are candidates for phase I and II clinical trials evaluating new targeted therapies, biologicals, chemotherapeutic agents, or physical approaches.[2,3,4,5,6,7,8,9] Patients with recurrent malignant mesothelioma who have not received chemotherapy previously are candidates for first-line chemotherapy with cisplatin pemetrexed or cisplatin raltitrexed. (Refer to the Advanced Malignant Mesothelioma (Stages II, III, and IV) section of this summary for more information.) However, patients with recurrent malignant mesothelioma who undergo surgery, or at least do not receive chemotherapy as part of the primary treatment and recur subsequently, are candidates for chemotherapy.
A large, randomized study compared pemetrexed with best supportive care in 243 patients who received one previous regimen of chemotherapy that did not include pemetrexed.[10][Level of evidence: 1iiA] No survival benefit was shown in patients who received pemetrexed, although the progression-free survival rate, time-to-progression, and the response rates favored the pemetrexed arm.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent malignant mesothelioma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Recurrent Malignant Mesothelioma
Added text to state that patients with localized disease recurrence may be candidates for additional chest wall resection and cited a trial of 47 patients from a single institution that indicated that chest wall resection could be safely performed, but that time-to-recurrence from initial resection appeared to be predictive of expected survival benefit, which should be factored into decision-making (cited Burt et al. as reference 1 and level of evidence 3iiiA); also revised text to state that patients with recurrence are candidates for phase I and II clinical trials evaluating new targeted therapies, biologicals, chemotherapeutic agents, or physical approaches (cited Papa et al. and Calabrò et al. as references 8 and 9, respectively).
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of malignant mesothelioma. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Malignant Mesothelioma Treatment are:
Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."
The preferred citation for this PDQ summary is:
National Cancer Institute: PDQ® Malignant Mesothelioma Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://www.cancer.gov/types/mesothelioma/hp/mesothelioma-treatment-pdq. Accessed <MM/DD/YYYY>.
Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.
Based on the strength of the available evidence, treatment options may be described as either "standard" or "under clinical evaluation." These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Coping with Cancer: Financial, Insurance, and Legal Information page.
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More information about contacting us or receiving help with the Cancer.gov Web site can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the Web site's Contact Form.
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For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
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Last Revised: 2015-08-07
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Topic: First steps in the battle against the disease. We need directions pls
My sister and I found out 3 weeks ago that our dad ,71 years old, and best friend has cancer of the gall bladder and bile ducts. This has been devastating for us. He had an operation 1 week ago but unfortunately it was unresectable (I understand that means that they couldn't take it all out). I understand that they have cleaned a bit around the area but have left everything including the gall bladder. It appears for the moment that the liver is only affected in the area adjacent to the bile ducts and that the nodes around are not affected. We are wondering what to do next. We have heard of the Mayo and MD Anderson clinics as well as through your website of the Wake Radiology onchology centre in the US. Which one should we go to first? What treatment should he be put on? Oxaliplatin, Xeloda, Sorafenib, Herceptin (I hear there is a clinical trial about this one at Anderson for this type of cancer), Davanat? We are a bit lost and don't know what to do next? Please advise! We are also really happy to have found your website.


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BLACKBURN Rovers boss Gary Bowyer is ready to watch more matches from the stands after admitting his self-imposed stint away from the dugout has given him a fresh perspective.
For the first time in his senior managerial career Bowyer – whose side continue their play-off push at Middlesbrough tomorrow – did not venture toward the touchline in last weekend's home win over Blackpool.
The 42-year-old took the decision after he felt he let himself down with his conduct toward the officials following the frustrating draw at Barnsley four days earlier.
A furious Bowyer questioned referee Sebastian Stockbridge's decision to award the penalty from which the struggling Tykes scored their equaliser to earn a point.
Replays proved Stockbridge got it wrong but Bowyer, on reflection, concedes emotion got the better of him.
"I wasn't happy with myself," said Bowyer.
"I got myself in a little bit of trouble with the referee after the Barnsley game so I decided to go and watch the Blackpool match from the stands.
"It happens a lot in rugby – both in league and in union – and I thought it was a good opportunity to try it.
"It definitely does give you a different viewpoint and it's something I potentially might continue with.
"When you are on the line you can easily get caught up in the emotion of the game and there are times when you have to remove yourself from that situation to make the correct calls.
"That was proved right on Saturday against Blackpool as from where I was sat I was able to do that."
So given Rovers won, will Bowyer be able to return to the sidelines at Middlesbrough tomorrow?
He joked: "No, my OCD won't let me!"
What is certain is that Bowyer is expecting a closely fought match. Rovers' shut-out against the Seasiders made it 10 league clean sheets for the campaign, equalling the same amount they achieved last season.
While since Aitor Karanka – Jose Mourinho's former assistant manager at Real Madrid – arrived at the Riverside in November, Middlesbrough have kept eight clean sheets in 14 league games.
Bowyer said: "I don't want to put the mockers on it but both teams have done well in maintaining clean sheets.
"Their manager is going to come with a lot of experience, having worked with Mr Mourinho, and we knew it was going to be a tough place to go anyway."
Rovers are, however, in good goalscoring form.
Since top scorer Jordan Rhodes broke the deadlock in the New Year's Day win at Leeds United, six different players – Rudy Gestede, now departed skipper Scott Dann, Ben Marshall, Tom Cairney, David Dunn and new captain Grant Hanley – have found the net.
Bowyer is delighted that the goals are beginning to be shared around.
However he is tipping 16-goal Rhodes to end his six-match drought.
Bowyer said: "Jordan is due a goal that's for sure and we hope that it arrives on Saturday.
"But while he may not have scored his work rate off the ball and his link-up play has got better."
Middlesbrough – who are four points and four places below Rovers in 12th – have not scored in more than five-and-a-half-hours of football.
But head coach Karanka has strengthened his forward line with the loan capture of Danny Graham from Sunderland as well as bolstering his backline with the loan signings of young Chelsea duo Kenneth Omeruo and Nathaniel Chalobah.
Bowyer said: "They've brought some top Premiership players in so it's going to be a difficult game for us."


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SoLoMo: The Collision of Social, Local, and Mobile Media
July 25, 2011
Mike Kelly, CEO and president, The Weather Channel, discussed how his organization has used the inherent social, local, and mobile nature of weather to become a major cross-platform media company.
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