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Non-Hodgkin's Lymphoma
The non-Hodgkin's lymphomas (NHL) are a group of cancers that develop in the body's lymphatic system. There are many different types of non-Hodgkin's lymphoma. Most types of NHL involve B cells, while a small percentage involve T cells. Common types of B-cell non-Hodgkin's lymphomas include diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma.
Non-Hodgkin's lymphomas are classified as indolent (slow-growing) or aggressive (fast-growing). Aggressive lymphomas, such as DLBCL, are often curable. Indolent lymphomas, such as follicular lymphoma, are more difficult to treat and tend to recur after periods of remission. With the advancement of new treatments and drugs, survival rates for patients with NHL have significantly improved.
Risk Factors
The risk of NHL increases with age. Most patients are diagnosed when they are in their 60s and 70s. However, NHL can develop in people of any age, including children. People who have immune system impairment because of infections, disease, or exposure to certain types of chemicals appear to have increased risk. Still, people without any known risk factors can develop NHL.
The most common first sign of lymphomas is painless enlargement of one or more lymph nodes, usually in the neck, armpits, or groin.
More generalized symptoms can include:
NHL is diagnosed based on the results of physical examination, blood tests, imaging tests, and biopsy. A lymph node biopsy is the definitive test for diagnosing NHL, determining the type of NHL, and distinguishing NHL from Hodgkin's disease.
Radiation and chemotherapy are the main treatments for NHL. Rituximab, a biologic drug, is increasingly being used and may be added to a chemotherapy regimen. For some patients, stem cell transplantation may be an option.
New Drug Approvals
Until recently, bortezomib (Velcade) was the only drug approved for the treatment of mantle cell lymphoma. In 2013, the FDA approved two new biologic drugs:
Lymphomas are malignancies of the lymph system that are generally subdivided into two groups: Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). Hodgkin's disease accounts for about 10% of all lymphomas, and NHL for the remaining 90% of lymphomas.
Non-Hodgkin's lymphoma is a term for malignancies that range from a very slow disease to an extremely aggressive but curable condition. They have certain features in common.
Lymphomas, such as non-Hodgkin's lymphomas and Hodgkin's disease, represent tumors of the lymphatic system. This system is a network of organs, ducts, and nodes. The lymphatic system interacts with the blood's circulatory system to transport a watery clear fluid called lymph throughout the body. The lymphatic system contains lymphocytes, important cells involved in defending the body against infectious organisms.
Lymphocytes. The lymphatic system is involved in the production and transportation of lymphocytes, white blood cells that are an essential part of the immune system:
Lymph Nodes. In lymph nodes, lymphocytes receive their initial exposure to foreign substances (antigens), such as bacteria or other microorganisms. This exposure activates the lymphocytes to produce antibodies, which are immune system factors that target and attack specific foreign proteins (antigens). The size of a lymph node varies from that of a pinhead to a bean. Most nodes are in clusters located throughout the body. Important node clusters are found in the neck, lower arm, armpit, and groin.
Other Structures in the Lymphatic System. The tonsils and adenoids are secondary organs composed of masses of lymph tissue that also play a role in the lymphatic system. The spleen is another important organ that processes lymphocytes from incoming blood.
Non-Hodgkin's lymphomas occur most often in lymph nodes in the chest, neck, abdomen, tonsils, and the skin. NHL may also develop in sites other than lymph nodes such as the digestive tract, central nervous system, and around the tonsils.
There are more than 30 distinct types of non-Hodgkin's lymphomas. Lymphomas are categorized in a several ways:
The following are common types of B-cell lymphoma.
Diffuse Large B-Cell Lymphoma (DLBLC). DLBCL is the most common type of non-Hodgkin's lymphoma, accounting for about 30% of all NHL cases. It is an aggressive, fast-growing lymphoma that usually affects adults but can also occur in children. DLBCL can occur in lymph nodes or in organs outside of the lymphatic system. DLBCL includes several subtypes such as mediastinal large B-cell lymphoma, intravascular large B-cell lymphoma, and primary effusion lymphoma.
Follicular Lymphoma (FLs). Follicular lymphoma is the second most common type lymphoma, accounting for about 20% of all NHL cases. It is usually indolent (slow growing), but about 20 to 50% of follicular lymphomas transform over time into the aggressive diffuse large B-cell lymphoma.
Mantle Cell Lymphoma. Mantle cell lymphoma is an aggressive type of lymphoma that represents about 7% of NHL cases. It can be a difficult type of lymphoma to treat and often does not respond to chemotherapy. It is found in lymph nodes, the spleen, bone marrow, and gastrointestinal system. Mantle cell lymphoma usually develops in men over age 60.
Small Lymphocytic Lymphoma (SLL). SLL is an indolent type of lymphoma that is closely related to B-cell chronic lymphocytic leukemia (CLL). It accounts for about 5% of NHL cases.
Marginal Zone Lymphomas (MZL). MZLs are categorized depending on where the lymphoma is located. Mucosa-associated lymphoid tissue lymphomas (MALT) usually involve the gastrointestinal tract, thyroid, lungs, saliva glands, or skin. MALT is often associated with a history of an autoimmune disorder (such as Sjögren syndrome in the salivary glands or Hashimoto's thyroiditis in the thyroid gland). MALT is also associated with bacterial infection in the stomach (H. pylori) and can be potentially cured by antibiotics when treated in its early stages. Splenic marginal zone lymphoma affects the spleen, blood, and bone marrow. Nodal marginal zone B-cell lymphoma is a rare type of indolent lymphoma that involves the lymph nodes.
Lymphoplasmacytic Lymphoma. Lymphoplasmacytic lymphoma, also called Waldenstrom's macroglobulinemia or immunocytoma, is a rare type of lymphoma accounting for about 1% of NHL cases. It usually affects older adults and most often involves bone marrow, lymph nodes, and spleen.
Primary Central Nervous System Lymphoma. This lymphoma affects the brain and spinal cord. Although it is generally rare, it is common in people who have AIDS.
Burkitt's Lymphoma. Burkitt's lymphoma is one of the most common types of childhood NHL, accounting for about 40% of NHL pediatric cases in the United States. It usually starts in the abdomen and spreads to other organs, including the brain. A specific type of Burkitt's lymphoma that typically occurs in African children often involves facial bones and is associated with Epstein-Barr virus infection.
Lymphoblastic Lymphoma. This lymphoma is also common in children, accounting for about 25% of NHL pediatric cases, most often boys. It is associated with a large mediastinal mass (occurring in chest cavity between the lungs) and carries a high risk for spreading to bone marrow, the brain, and other lymph nodes.
Non-Hodgkin's lymphoma is one of the most common cancers in the United States. Each year, about 70,000 Americans are diagnosed with non-Hodgkin's lymphomas, and about 19,000 people die of the disease. Since the 1970s, NHL incidence rates have doubled. Part of the reason for this dramatic rise may be due to AIDS, which increases the risk for high-grade lymphomas.
The cause of non-Hodgkin's lymphoma is unknown, but certain factors may increase a person's risk of developing this cancer.
Non-Hodgkin's lymphoma can develop in people of all ages, including children, but it is most common in adults. The most common types of NHL usually appear in people in their 60s and 70s.
NHL is more common in men than women. In the United States, NHL is the sixth most common cancer in men, and the seventh most common cancer in women.
Overall, the risk for NHL is slightly higher in Caucasians than in African-Americans and Asian Americans.
People who have close family relatives who have developed NHL may be at increased risk for this cancer. However, no definitive hereditary or genetic link has been established.
Viral or bacterial infections may play a role in some lymphomas. These include:
Patients with diseases or conditions that affect the immune system may be at higher risk for lymphomas:
Patients with a history of autoimmune diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus, Hashimoto's thyroiditis, Crohn's disease, and Sjögren's syndrome, are at an increased risk for certain NHLs, such as marginal zone lymphomas.
Overexposure to a number of industrial and agricultural chemicals (such as pesticides, herbicides, and petrochemicals) has been linked to an increased risk for lymphomas. The data, however, are not consistent.
Researchers are investigating whether some chemotherapy drugs may increase the risk for later developing non-Hodgkin's lymphoma. At this point, it is not clear whether it is these drugs or the other cancers themselves that increase risk. Other types of drugs, such as tumor necrosis factor (TNF) inhibitors that are used to treat autoimmune disorders, are also being studied as possible risk factors for lymphomas.
People who have had radiation treatment for cancers such as Hodgkin's disease appear to have an increased risk for later developing non-Hodgkin's disease. The risk may be higher for patients treated with both chemotherapy and radiation.
Survivors of nuclear reactor disasters have an increased risk of developing NHL, as well as other types of cancers.
Lifestyle does not seem to be a major risk factor for NHL. Some studies have suggested that obesity may increase risk, but this association is not definite. Other studies have investigated the role of diet. Although some research has indicated an increased risk for diets high in consumption of red meat and lower risk for diets high in vegetables, the association remains speculative. There is no evidence that smoking increases the risk for NHL itself, although it has been linked with high-grade and follicular NHLs in people with lymphoma.
The most common first sign of lymphoma is painless enlargement of one or more lymph node, usually in the neck, armpits, or groin. These enlarged lymph nodes may cause discomfort depending on where they are located. For example, abdominal tumors may cause stomach distention or pain, while lymph nodes in the chest may cause coughing or difficulty breathing. Patients should see their doctors if these symptoms do not go away within 2 to 3 weeks.
Sometimes patients with NHL do not experience any symptoms, or symptoms may not appear until the cancer is very advanced. Enlarged lymph nodes can also be caused by many noncancerous conditions, such as infections.
The most common lumps or swellings in the neck are enlarged lymph nodes. They can be caused by bacterial or viral infections, cancer, and other rare causes.
Lymphomas sometimes cause systemic symptoms -- symptoms that affect the whole body, rather than a specific location. Some systemic generalized symptoms are referred to as B symptoms. Patients who have B symptoms have a more severe condition than asymptomatic patients with the same cancer stage or tumor location or size.
B systemic symptoms include:
The doctor will first ask questions about the patient's medical history and perform a physical examination to detect any node enlargements. If these procedures indicate lymphoma, additional tests will be done to rule out other diseases or to confirm the diagnosis and extent of the lymphoma.
The doctor will examine not only the affected lymph nodes but also the surrounding tissues and other lymph node areas for signs of infection, skin injuries, or tumors. The consistency of the node sometimes indicates certain conditions. For example, a stony, hard node is often a sign of cancer, usually one that has metastasized (spread to another part of the body). A firm, rubbery node may indicate lymphoma. Soft tender nodes suggest infection or inflammatory conditions.
A biopsy is the most important test for diagnosing non-Hodgkin's lymphoma and determining the subtype. Tissue samples retrieved from biopsy are examined under a microscope to find out if the cell type involved indicates Hodgkin's disease or non-Hodgkin's. (Hodgkin's disease is marked by the presence of Reed-Sternberg cells, which are not found in non-Hodgkin's lymphomas.) Sometimes a doctor may choose to wait and observe the involved lymph nodes, which will usually go away on their own if a temporary infection is causing the swelling. (However, some lymphomas may go away and appear to be benign, only to reappear at a later time.)
The Procedure. The type of biopsy performed depends in part on the location and accessibility of the lymph node. The doctor may surgically remove the entire lymph node (excisional biopsy) or a small part of it (incisional biopsy). In some cases, the doctor may use fine needle aspiration to withdraw a small amount of tissue from the lymph node.
Results. Even if the biopsy appears normal, in some cases the disease may still be present. The doctor should continue to observe the patient until swelling or other signs of disease are gone. Biopsied tissue samples should be frozen in case special tests are later required. These tests are used to detect specific antibodies, genetic and immune factors, and certain markers (substances that may indicate disease) located on the surface of the cells. If lymphoma has been diagnosed, the tissue will be examined for its histology, the cellular structures that determine the lymphoma type.
Bone marrow aspirate and biopsy are routinely performed to determine whether the disease has spread. With bone marrow aspirate, bone marrow cells are sucked out through a special needle. A biopsy may be performed before or after the aspiration. In this procedure, a special needle removes a core of the marrow that is structurally intact.
Chest X-Ray. A chest x-ray may show lymph nodes in the chest and neck area. It is particularly useful in detecting Hodgkin's disease and enlarged lymph nodes.
Computed Tomography. Computed tomography (CT) scans are much more accurate than x-rays. They can detect abnormalities in the chest and neck area, as well as revealing the extent of the cancer and whether it has spread. CT scans are used to evaluate symptoms and help diagnose lymphomas, help with staging of the disease, monitor response to treatment, and evaluate symptoms. A CT scan is also often used to detect lymphomas in the abdominal and pelvic areas, the brain, and the chest.
Magnetic Resonance Imaging (MRI). MRIs may be used to detect the spread of the disease to the brain, spine, chest, pelvis, and abdomen.
Positron Emission Tomography (PET). PET scans can help predict whether an enlarged lymph node is benign or cancerous. PET scans are more accurate than CT scans or other imaging tests for staging lymphomas. PET scans may also help doctors determine how well a patient has responded to treatment, if any residual cancer exists, and if a patient has achieved remission.
Blood tests help rule out infection and other diseases. Such tests include a complete blood count to measure the number of white blood cells. In a patient already diagnosed with lymphoma, blood tests that measure the enzyme lactate dehydrogenase are important in determining the prognosis of patients with fast-growing lymphomas. High levels indicate bulkier tumors.
Tests of lymphoma's DNA are in use or are being developed to detect particular gene defects that help determine prognosis and response to treatment. Examples of such abnormal genetic arrangements are those that affect normal cell death, resist chemotherapy, or trigger aggressive cancer growth.
Survival rates for NHL vary widely, depending on the lymphoma type, stage, age of the patient, and other variables. According to the American Cancer Society, the overall 5-year relative survival rate for patients with non-Hodgkin's lymphoma is 68% and the 10-year relative survival rate is 57%. (The relative survival rate estimates the likelihood that a patient will survive a certain number years after diagnosis. It is calculated to exclude the likelihood of death from diseases other than the cancer.)
Because so many different factors affect survival, it is difficult to make general statements about prognosis. For example, patients with very slow growing (indolent) lymphomas can live many years. However, they are usually diagnosed at a late stage, after the cancer has spread, which gives a poorer outlook. Without treatment, aggressive lymphomas are more likely to cause early death, but they are also often curable. In fact, aggressive lymphomas usually have better chances for cure than indolent lymphomas.
Survival rates for patients with all types of NHL have greatly improved since the early 1990s, especially for patients under age 45. Advances in treatment have contributed to this improvement.
Follicular lymphomas, the most common indolent (slow-growing) NHLs, are potentially curable in early stages I and II. Unfortunately, these slow-growing malignancies produce no symptoms until they are in advanced stages. In most cases, these lymphomas are not diagnosed until they have spread to other sites, including the spleen and bone marrow. In such cases, they are difficult to cure. Predicting outcome for indolent follicular lymphomas is more difficult than for aggressive lymphomas. Even if treatment achieves a response, these tumors almost always recur. Even after relapse, however, the tumors can be treated again if they are still very slow-growing.
In general, the average survival rate for follicular lymphoma is 7 to 10 years after diagnosis, depending on other risk factors. New drug treatments, particularly monoclonal antibodies, have significantly improved survival rates.
High-grade aggressive lymphomas are often symptomatic early on and are potentially curable with aggressive treatments. Diffuse large B-cell lymphoma (DLBLC), the most common aggressive non-Hodgkin's lymphomas, while fatal if not treated, is often curable with intensive chemotherapy combinations. If relapse occurs after chemotherapy, it usually does so within 2 years.
Most other aggressive lymphomas respond to aggressive chemotherapy. Some aggressive lymphomas, such as mantle cell lymphoma, are sometimes less responsive to standard chemotherapy.
Doctors often use a scoring system called the International Prognostic Index for predicting outcome in patients with more aggressive B-cell lymphomas such as DLBCL. It uses five risk factors to help predict survival odds:
Having one or none of these risk factors indicates the best outlook. Two factors indicate a low-to-intermediate likelihood of a poor outlook. Three factors predict an intermediate-to-high likelihood of poor outlooks. Finally, four or five factors pose the highest likelihood of poor survival. However, the International Prognostic Index was developed before the introduction of newer drug therapies like rituximab, which has dramatically improved the outcome of patients with DLBCL.
A similar prognostic index is used for follicular lymphoma.
The radiation and chemotherapy treatments used for treating NHL can potentially have long-term effects on many organs in the body and can increase the risk for serious illnesses, including heart disease and certain cancers. Other long-term effects of cancer treatments include somatic symptoms such as fatigue and generalized aches and pains.
Some cancer treatments can cause infertility. Patients who may wish to have children in the future should ask their doctors about fertility-preserving treatments. It is very important to have these discussions before cancer treatment starts. The American Society for Clinical Oncology (ASCO) has guidelines for the best fertility preservation methods for male and female cancer patients. They include sperm freezing and banking (sperm cryopreservation) for men, and egg (oocyte) and embryo cryopreservation for women.
Treatment for non-Hodgkin's lymphoma is highly specific for each patient and is determined by the tumor classification. It includes the following factors:
Grading refers to how fast the tumor cells grow and divide, and for how fast the tumor itself spreads. In NHL, indolent lymphomas are slow growing and referred to as low grade. Aggressive lymphomas are fast growing and referred to as high grade. Aggressive lymphomas are considered more curable than indolent lymphomas. Indolent lymphomas may respond to treatment but tend to recur. (Recurrence is also called relapse.)
Staging refers to where the tumor is contained and where it has spread. The stages of non-Hodgkin's lymphoma are:
Stage I. In Stage I (early disease), lymphoma is found in only one lymph node area or in only one area or organ outside the lymph nodes.
Stage II. In Stage II (locally advanced disease), lymphoma is found in two or more lymph nodes on the same side of the diaphragm or the lymphoma extends from a single lymph node or single group of lymph nodes into a nearby organ.
Stage III. In Stage III (advanced disease), lymphoma is found in lymph node areas on above and below the diaphragm. Lymphoma may have also spread into areas or organs adjacent to lymph nodes, such as the spleen.
Stage IV. In Stage IV (widespread disease), the lymphoma has spread (metastasized) via the bloodstream to organs outside the lymph system, such as the bone marrow, brain, skin, or liver.
The main treatments for non-Hodgkin's lymphoma are:
In early stages of lymphoma, doctors may recommend watchful waiting where treatment is delayed until symptoms appear or worsen. Treatment for lymphomas generally uses chemotherapy (particularly intensive regimens using several drugs) or a combination of chemotherapy and radiation. Monoclonal antibody biologic drugs, (a treatment approach also called immunotherapy), are now being used more frequently in combination with chemotherapy drugs. Transplantation is mainly used to treat patients who relapse. Surgery is not a usual treatment option.
Patients may also wish to consider enrolling in a clinical trial that tests new and experimental drugs or treatments.
In assessing the success of a clinical trial, doctors often refer to the tumor response. A complete response, for example, means that there is no longer any evidence of the disease by examination, blood tests, or x-ray studies. It does not necessarily mean that the disease is cured. It may still recur later on.
In judging the success of a treatment for NHL, the most important criteria are overall survival and the duration of time until the disease progresses or the patient dies.
Chemotherapy plays a role in the treatment of nearly all patients with lymphoma and has achieved remarkable results, even in late stages. It uses drugs to kill cancer cells. Such drugs are called cytotoxic drugs. Chemotherapy is referred to as systemic therapy because the drugs travel throughout the bloodstream to the entire body.
Chemotherapy may also be used along with radiation.
A chemotherapy cycle is usually 21 to 28 days. Patients take the drugs for a few days, then have a period of rest. The drugs may be taken as pills at home or given by injection or infusion in a medical center or doctor's office. Chemotherapy is injected into the spinal fluid if the cancer has spread to the brain. This approach is called intrathecal chemotherapy. Intrathecal chemotherapy is also used as a preventive measure in patients at high risk for central nervous system involvement. Some patients receiving chemotherapy need to remain in the hospital for several days so the effects of the drug can be monitored.
CHOP. A current standard chemotherapy regimen for NHL is CHOP. CHOP is a combination of cyclophosphamide, doxorubicin hydrochloride (Adriamycin), vincristine (Oncovin), and prednisone. It is particularly effective for many stages of lymphoma when used in combination with rituximab (Rituxan), a biologic drug. (See Biologic Therapy section of this report.) Some studies of this combination in low-grade lymphomas have reported response rates of 70 to 100%.
CVP. This stands for cyclophosphamide, vincristine, and prednisone. It is another common chemotherapy regimen for non-Hodgkin's lymphoma. It is also used in combination with rituximab.
Bendamustine. Bendamustine (Treanda) has been replacing CHOP and CVP in the management of low grade lymphomas. It is often used in combination with rituximab.
Fludarabine. Fludarabine (Fludara) is a type of drug called a nucleoside analogue. It is one of the most used drugs for treating low-grade lymphomas. Fludarabine is often used in a chemotherapy regimen called FND (fludarabine, mitoxantrone, and dexamethasone). Other fludarabine regimens for follicular and low-grade lymphomas are FAD (fludarabine, doxorubicin, and dexamethasone) and FMD (fludarabine, mitoxantrone, and dexamethasone). Fludarabine is also being studied in combination with rituximab.
Etoposide. Etoposide is another cancer drug that is sometimes used in a regimen called EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin.) EPOCH may be used in combination with rituximab.
Side effects and complications of any chemotherapeutic regimen are common. They are more severe with higher doses. Side effects may increase over the course of treatment. Radiation treatment may worsen chemotherapy side effects.
Common Side Effects. Common side effects include:
These side effects are nearly always temporary. Most patients are able to continue with normal activities for all but perhaps a few days a month.
Serious Side Effects. Serious chemotherapy side effects can also occur and may vary depending on the specific drugs used. They include:
Long-Term Complications.
In general, these serious late side effects depend on the type of drug used and cumulative drug dose.
Biological response modifier therapy, also called immunotherapy, uses the body's own immune system to fight cancer. These biologic drugs are often combined with other treatments.
Monoclonal antibodies (MAbs) are the main drugs used in biologic therapy. MAbs are designed in the laboratory to mimic the body's natural antibodies and attack specific antigens (foreign substances) produced by the cancer. Lymphomas carry antigens that provoke strong immune responses and so are particularly good candidates for MAb therapy.
Rituximab (Rituxan) was the first monoclonal antibody approved for cancer. This drug targets the CD-20 antigen, which is found on most B-cell lymphomas. It is the most commonly used biologic drug, particularly in combination with standard chemotherapy regimens.
Rituximab is used to treat many types of CD20-positive tumors. Rituximab is used as a single drug for low-grade or follicular lymphoma that has either returned after being treated (relapsed) or has not been helped by other treatments (refractory). It is also used in combination with other drugs for other types and stages of lymphomas including diffuse large B-cell (DLBC). Rituximab in combination with CHOP (a regimen called R-CHOP, or CHOP-R) is used for first-line treatment of aggressive lymphomas.
Rituximab is given by infusion. The treatment has mild-to-moderate short-term side effects, including nausea, fever, chills, hives, dizziness, and headache. Uncommon and more serious side effects are severe allergic reactions, very low blood pressure, blood abnormalities, wheezing, infections, and sudden heart events.
Rituximab has also been associated with cases of progressive multifocal leukoencephalopathy (PML), a rare and potentially deadly brain disorder. Patients who experience any of the following symptoms should immediately contact their doctors:
Patients who have previously had hepatitis B, or who are at high-risk for this viral infection, should be tested before taking rituximab because the drug has been linked to reactivation of the hepatitis B virus. Patients who are HIV-positive may experience more adverse effects from rituximab than with CHOP alone.
Some newer MAbs are used to treat NHL by attaching radioactive molecules to them. When the drug is injected, the monoclonal antibody targets an antigen (protein) on the surface of the tumor. The radioisotope is then delivered directly into the tumor where it kills the cancer. Ibritumomab and tositumomab both target the CD-20 antigen. Treatment with these drugs takes about 7 to 9 days to complete, compared to several months for traditional chemotherapy treatments.
In general, these drugs cause fewer side effects than traditional chemotherapy. However, serious complications may include skin infections, severe allergic reactions, and temporary lowering of blood counts. Due to the radioisotope component, these drugs are also more difficult to administer than rituximab. They tend to be used if patients do not respond to rituximab.
Three biologic drugs are FDA-approved for treatment of mantle cell lymphoma:
Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. It may also be used as palliative therapy to relieve symptoms in advanced cancer. Radiation may be used as the sole therapy for some early-stage (I or II) lymphomas, or may be used along with chemotherapy for later-stage (III or IV) lymphomas.
Radiation is tailored to the individual and usually limited to the diseased areas and possibly nearby regions:
Fatigue, nausea, diarrhea, dry mouth, skin irritation, and increased risk for infections are common short-term side effects of radiation therapy. These side effects generally clear up after treatment is completed.
Radiation therapy can cause more serious long-term complications. These side effects generally depend on the radiation target site in the body. They include:
Stem cell transplantation involves removing and replacing stem cells, which are produced in the bone marrow. Stem cells are the early forms for all blood cells in the body. Transplantation is usually reserved for patients with relapsed aggressive NHL or patients whose lymphoma is in remission but is likely to return.
Stem cell transplantation usually follows an intensive regimen of high-dose chemotherapy, which is sometimes given along with radiation. The goal of the high-dose chemotherapy is to destroy as many cancer cells as possible, including cancer cells that have been resistant to standard-dose treatment. However, high-dose chemotherapy also destroys bone marrow and the stem cells it contains. Transplantation allows for the re-introduction of healthy blood-forming stem cells.
Sources of Cells. Stem cells must first be collected in one of the following ways:
Peripheral blood stem cell transplantation is the most commonly performed type of stem cell transplantation. .
Donor or Patient Cells. The marrow or blood stem cells can be taken from the patient (autologous) or from a matched donor (allogeneic):
The Blood Stem Cell Collection Procedure. With peripheral blood stem cell transplantation:
Stem-cell transplantation is a serious and complex procedure that can cause many short- and long-term side effects and complications.
Early side effects of transplantation are similar to chemotherapy and include nausea, vomiting, fatigue, mouth sores, and loss of appetite. Bleeding due to reduced platelets is a high risk during the first four weeks.
Later side effects include fertility problems (if the ovaries are affected), thyroid gland problems (which can affect metabolism), lung damage (which can cause breathing problems) and bone damage. In younger people, there is a small long-term risk for development of secondary cancers such as leukemia.
Two of the most serious complications of transplantation are infection and graft-versus-host disease.
Infection resulting from a weakened immune system is the most common danger. The risk for infection is most critical during the first 6 weeks following the transplant, but it takes 6 to 12 months post-transplant for a patient's immune system to fully recover.
Many patients develop severe herpes zoster virus infections (shingles) or have a recurrence of herpes simplex virus infections (cold sores and genital herpes). Pneumonia, and infection with germs that normally do not cause serious infections such as cytomegalovirus, aspergillus (a type of fungus), and Pneumocystis jiroveci (a fungus) are among the most important life-threatening infections.
Graft-versus-host disease (GVHD) is a serious attack by the patient's immune system triggered by the donated new marrow in allogeneic transplants. Mild cases of GVHD can actually be helpful as they can cause graft-versus-lymphoma where the immune system kills remaining lymphoma cells. Still, severe GVHD can pose serious complications.
Acute GVHD occurs in 30 to 50% of allogeneic transplants, usually within 25 days. Its severity ranges from very mild symptoms to a life-threatening condition (more often in older patients). The first sign of acute GVHD is a rash, which typically develops on the palms of hands and soles of feet and can then spread to the rest of the body. Other symptoms may include nausea, vomiting, stomach cramps, diarrhea, loss of appetite and jaundice (yellowing of skin and eyes). To prevent acute GVHD, doctors give patients immune-suppressing drugs such as steroids, methotrexate, cyclosporine, tacrolimus, and monoclonal antibodies.
Chronic GVHD can develop 70 to 400 days after the allogeneic transplant. Initial symptoms include those of acute GVHD. Skin, eyes, and mouth can become dry and irritated, and mouth sores may develop. Chronic GVHD can also sometimes affect the esophagus, gastrointestinal tract, and liver. Bacterial infections and chronic low-grade fever are common. Chronic GVHD is treated with similar medicines as acute GVHD.
Too much sun exposure can trigger GVHD. Be sure to always wear sunscreen (SPF 15 or higher) on areas of the skin that are exposed to the sun. Stay in the shade when you go outside.
It is very important to take precautions to avoid infections. Guidelines for post-transplant infection prevention include:
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Shankland KR, Armitage JO, Hancock BW. Non-Hodgkin lymphoma. Lancet. 2012;380(9844):848-857.
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Click here for the Orientation Evaluation - Summer 2017
Welcome to Indiana University South Bend
We are genuinely pleased to welcome you to IU South Bend. As a new student—whether a recent high school graduate, a transfer student from another university, or an adult entering college for the first time—you join a unique campus community. With its diverse and talented student body, excellent faculty, and beautiful campus, IU South Bend offers you an exciting learning environment.
Becoming a college student brings many challenges. In the months ahead you will discover new classroom styles, hear new terminology, and manage your life in new ways. We hope this Web site will give you information and insights to help you make a smooth transition to college life.
Probably the most important thing you can do to ease your transition to college is to create vital connections with faculty, staff, and other students. Research has shown that becoming involved in campus life increases academic success. The more people you get to know, the more resources you will have when problems arise. We especially encourage you to take the time to get to know your advising unit and to make it your "academic home."
As your days fill up with studying, working, and other commitments, do not forget to take the opportunity to enjoy this special time in your life. Take advantage of IU South Bend's concerts and art exhibits. Try out the equipment in our new Student Activities Center. Go to a basketball game or join intramurals. Talk with a friend in Northside Hall's courtyard or take a picnic down to the river. The buildings, people, and resources at IU South Bend are here for you.
All of us—staff, administrators, and faculty—are eager to provide the information, advice, and support you need to reach your academic and career goals, so do not hesitate to contact us for assistance. We look forward to working with you and getting to know you.
Best wishes for an enjoyable and successful college experience.
Terry L. Allison
Indiana University South Bend
Karen L. White
Associate Vice Chancellor
Office of Student Services

subset: commoncrawl


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Brown Bag Lunch with the Mayor
Saturday, July 16, 2011 12:00 pm - 1:00 pm
Please join the Mayor! Bring your Brown Bag Lunch! He wants to hear from you!
12pm to 1pm at the following locations:
July 20th Sunset Park Cynthia Soliday
July 27th North Lake Park Zumba
August 3rd John Todd Park Darcie' Twirlers
August 10th Liberty Park "Let's Move Campaign"
Presented By: Friends of Culliver
« Back to Calendar


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Mila Kunis is wearing a ring. Which, obviously, means she's going to marry Ashton Kutcher any second.
The Huffington Post pointed out that Kunis, 30, was spotted by photographers buying flowers Wednesday in West Hollywood with a thin gold band on her ring finger.
She's probably pregnant, too … with twins.
As you know, Kunis has been dating her former "That '70s Show" co-star Kutcher, 35, since around April 2012. The marriage rumors started flying earlier this year, but have since evaporated. Ashton is still technically married to Demi Moore, at least until their lawyers can hammer out of a financial settlement.
A rep for Kunis hasn't responded to the site's request for comment about the ring. Stay tuned for any emergency updates we can provide.
Contact Tony Hicks at Facebook.com/BayAreaNewsGroup.TonyHicks or Twitter.com/insertfoot.


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I missed Soundbeam when it came out a few months ago. It's a visual spectrum and waveform analyzer for iOS. I'm not sure about the license attached to recording it's video output but I think this would be cool to use in a promo music video (update: in a Tweet the developer said it's ok to use Soundbeam's visuals in your own videos as long as you send them a link to what you created).
"Soundbeam is an audio analyzer that processes the input of your microphone in real time displaying it like a classic oscilloscope." – evilwindowdog.com
For more info: evilwindowdog.com
via matrixsynth


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Photos of Malgosia Bela in Vogue Paris April 2011 Issue
Dreaming of a White Summer
We're antsy for warmer weather, and so is Black by Sara. She's dreaming of a white Summer via Vogue Paris's all-white editorial featuring the gorgeous Malgosia Bela.
Some of you had a white Winter, and some of you are dreaming of a white Summer, like myself. White is undeniably refreshing and minimalistic color to wear. And what better way to cool off the intense heat than with an easy to decorate hue. As you already might know, I'm not that friendly with colors, but I'm willingly making my toes wet this Summer. I love to accessorize with colors, but bold statement outfits are not in my collection, yet. I loved these white editorial shots for Vogue Paris and will take some notes from it. Maybe I'll start off with a two toned striped gypsy dress. What is your favorite color for the Summer?
Want to see more? Start following OnSugar blog Black by Sara or start your own blog now. We may just feature you on Fab!


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Joined: 27 Mar 2003
Posts: 15038
Posted: Wed Nov 16, 2011 6:05 am
Post subject:
World Diabetes Day' observed
Balanced diet most effective tool to prevent diabetes
* Healthy diet and physical activities essential for managing diabetes
By Shahid Farooq
KARACHI: Adopting a healthy diet, exercising regularly and maintaining normal body weight can prevent type II diabetes, the most common kind that can develop at any age.
This was stated by health experts at a seminar on World Diabetes Day held here at the Aga Khan University Hospital (AKUH) auditorium on Monday.
Defining the disease and its effect on the body, AKUH consultant endocrinologist Prof Dr Najm-ul-Islam said that diabetes was a chronic disease that affected how the body utilised blood glucose.
He elaborated that two most common types of diabetes were type I and type II. "In type I diabetes, the body's own immune system attacks and destroys the insulin-producing cells in the pancreas", he explained.
Dr Islam said that it was unclear why diabetes occurs, though a person's family history and environmental factors might play a role. "Its symptoms include excessive urination, thirst, constant hunger, weight loss, blurred vision and fatigue", he added.
Consultant endocrinologist further said that type II diabetes occurs when the body could not effectively use insulin or the pancreas fail to produce sufficient insulin to cover the inability.
Dr Islam said that approximately 90 percent of the people with diabetes around the world suffered from type II. Its symptoms might be similar to those of type I, but were often less marked which showed that the disease might be diagnosed several years after its onset.
"The number of people suffering from diabetes in Pakistan is increasing at an alarming rate and it is imperative that we adopt preventive measures if we are to stop the rapid spread of this disease," warned Dr Islam.
AKUH clinical nutritionist Sumaira Naseem said that the most effective preventive tool from diabetes was balanced diet. "We are beginning to see unhealthy lifestyles develop in Pakistan, as we are consuming more fatty foods and becoming less mobile," she said adding that the whole family needed to take a more balanced diet not only to prevent future cases of diabetes but also to help diabetics feel less isolated.
AKUH diabetes education nurse Farzana Rafiq stressed the need for diabetics to be vigilant about their feet. She said that foot problems were common and could become serious, adding that it was essential for diabetics to get their feet checked by their healthcare provider at least once a year and learn whether they had any nerve damage. Patients with known nerve or blood vessel damage should check and care for their feet every single day, she added.
She said that it could be done by examining the feet thoroughly and washing them in lukewarm water with a mild soap. She stressed that it was vitally important for diabetics to dry their feet thoroughly as wet areas were more prone to infection.
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Joined: 27 Mar 2003
Posts: 15038
Posted: Thu Nov 17, 2011 9:51 am
Post subject:
AKU hosts seminar on indoor pollution
Pakistan has one of the highest childhood death burdens in the world, and pneumonia is the main single cause of death. As a contributor to the pneumonia burden, the country has a significant indoor air pollution (IAP) problem. Biomass fuel (wood, crop residues, animal dung) which is being used in four fifths of all households in Pakistan is the major source of IAP when it is burned for cooking, space heating and lighting homes. Biomass is mostly burned in inefficient three-stone stoves leading to incomplete combustion and high levels of indoor air concentration of smoke. There is a dearth of scientific studies in Pakistan to relate IAP to health effects; consequently IAP is not a recognized environmental hazard at policy level.
Building on the Situation analysis of household energy use and indoor air pollution in Pakistan, WHO organized a one day seminar at The Aga Khan University (AKU), Karachi, in September 2005 to raise awareness of household energy issues, indoor air pollution and its effect on child health.
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Joined: 27 Mar 2003
Posts: 15038
Posted: Tue Nov 22, 2011 5:44 am
Post subject:
Al-Karim Haji of AKU speaks to Africa Investor TV about human capacity and resources
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Joined: 27 Mar 2003
Posts: 15038
Posted: Sat Dec 10, 2011 10:57 am
Post subject:
The Centre for the Comparative Study of Muslim Societies and Cultures Simon Fraser University (SFU-CCSMSC) And The Institute for the Study of Muslim Civilizations Aga Khan University (AKU-ISMC) present:
International Summer Programme 2012 – Expressions of Diversity: An Introduction to Muslim Cultures
Monday, July 9 – Friday July 20, 2012 – Simon Fraser University, Vancouver Campus
Who should attend? Teachers, journalists, lawyers, NGO professionals, administrators, business persons, doctors, politicians, students, and those who work in multicultural settings or have an interest in exploring the full range of Muslim cultures.
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Joined: 27 Mar 2003
Posts: 15038
Posted: Wed Dec 14, 2011 6:00 am
Post subject:
A new milestone at Aga Khan university Hospital
Published on 12/12/2011
A new milestone has been achieved at the Aga Khan University Hospital, Nairobi with the successful introduction of mini invasive surgery.
The cardiac surgical team of the Hospital, under Prof Dr Paul Simon, launched this type of cardiac operation in Kenya for the first time.
Explaining the procedure Dr Simon said, "Cardiac surgery generally poses a major trauma and usually requires complete opening of the chest by splitting the chest bone for access to the heart.
Routinely, a patient's blood circulation needs to be supported by the heart-lung-machine while the diseased structures of the heart are repaired or replaced.
Recovery of the patient usually takes more than a week in the hospital and several weeks at home until full daily functioning can be resumed."
"Minimally invasive cardiac surgery has been shown to reduce length of hospital stay and morbidity after cardiac surgery and may speed up recovery. It is not suitable for all, but the approach needs to be tailored to the individual patient. Some procedures can also be done on the beating heart completely avoiding the use of the heart-lung-machine, but using stabilising devices, which may also increase safety of cardiac surgery in some patients."
Dr Simon stressed the importance of these techniques being performed only after extensive training.
He said, "The technical demands on the surgeon and the whole team increase substantially and safety cannot be jeopardised in mini-invasive cardiac surgical procedures".
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Joined: 27 Mar 2003
Posts: 15038
Posted: Fri Dec 16, 2011 11:22 am
Post subject:
AKU involved in a study: Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health
3-year study identifies key interventions to reduce maternal, newborn and child deaths
Some 56 evidence-based interventions will sharply reduce the 358,000 women who still die each year during pregnancy and childbirth and the 7.6 million children who die before the age of 5, according to a massive three-year global study.
The study, Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health, is designed to facilitate decision-making in low- and middle-income countries about how to allocate limited resources for maximum impact on the health of women and children.
The study reviewed 50,000 medical papers to determine the proven effectiveness of interventions and impact on survival, identifying 56 essential inventions. The study is released today by the World Health Organization (WHO), the Aga Khan University and The Partnership for Maternal, Newborn & Child Health (PMNCH).
Some of the interventions include:
Manage maternal anemia with iron;
Prevent and manage post-partum hemorrhage;
Immediate thermal care for newborns;
Extra support for feeding small and preterm babies;
Antibiotics for the treatment of pneumonia in children.
PMNCH which has 440 partners, including countries, UN and multilateral agencies, non-governmental organizations, health groups, foundations, academic and research institutions, and the private sector, will distribute this essential list through its global network and actively advocate for its use. A condensed version on a simple, hand-held slide ruler for instant reference is currently under development.
"A lot is not brand new," says Elizabeth Mason, M.D., Director of the World Health Organization's department of Maternal, Newborn, Child and Adolescent Health, and an author of the study. "It has been more a question of putting together information in a different way and building consensus among physicians, scientists and professional organizations to lay out an evidenced-based path to help women before, during and after birth and their children. Everyone now agrees on the 56 essential interventions."
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Joined: 06 Jan 2003
Posts: 4557
Posted: Sun Jan 08, 2012 7:39 pm
Post subject: Arusha to have new city plan / AKU assisting.
Arusha to have new city plan
Monday, 09 January 2012 08:18
By Zephania Ubwani, The Citizen Bureau Chief
Arusha. Arusha City will have a new master plan whose implementation will involve public and private sectors.
The Arusha Chapter chairman of the Tanzania Chamber of Commerce, Industry and Agriculture (TCCIA), Mr Adolf Olomi said a committee had been formed to make the plan a success.
"We want to make Arusha a modern city," he told stakeholders in business and industry at the Nelson Mandela African Institute of Science and Technology (NM-AIST) on Friday here.
Mr Olomi, who is the managing director of the Arusha-based Banana Investment winery, said the first meeting of the task force on the development of the city took place recently to lay ground for the way forward.
The committee is made up of officials from the city council and representatives from the private sector.
However, he said much work remained to be done to set in motion preparation of the plan.
Arusha is the headquarters of regional institutions such as the East African Community and should be well developed in the next 30 to 50 years, he said. "We can't afford to have the present structures in Arusha in the next 30 years if the town is to become competitive in East Africa."
According to him, the last development master plan for Arusha was prepared in 1978 and, according to Mr Olomi and other stakeholders it had largely not been implemented.
"I can't say why it had not been implemented. May be some people did not like it," he said of the plan prepared by Canadian experts when the population of the town was below 100,000.
According to him, the Arusha "of tomorrow" will need industrial parks, well demarcated areas for low and high density as well as specially designated areas for businesses and social services. Municipal Council officials could not be reached to comment on the new plan.
The government, nevertheless, in 2010 tripled the size of the city to 270 square kilometres from 93 square kilometres after hiving off some wards in Arumeru District.
The population of the city is currently estimated at well above 500,000 with some projections hinting that it could reach one million by the time the National Population Census is held next August.
Key infrastructure development projects that have started being undertaken, including expanding the road network as well as opening new roads around the city to cope with huge traffic.
The NM-AIST vice chancellor, Prof Burton Mwamila, said the institute was working with the Aga Khan University to make Arusha an East African hub of higher education.
The Aga Khan Foundation is setting up a university on the outskirts of Arusha after acquiring hundreds of acres in the former coffee Estate, some 10 kilometres outside the town off Dodoma road.
A number of universities based here include the Mt Meru University, Arusha University, Makumira University and campuses or field training centres for other local universities, including the University of Dar es Salaam.
The city also hosts the Eastern and Southern Africa Management Institute and scientific and technological organisations. They include the Tanzania Wildlife Research Institute, the Tanzania Atomic Energy Commission and the Tropical Pesticides Research Institute
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Joined: 27 Mar 2003
Posts: 15038
Posted: Sat Jan 14, 2012 11:25 am
Post subject:
Aga Khan University Newsletter – Winter 2011
Balochistan, AKU-IED working jointly to restructure educational system
our correspondent
Tuesday, January 10, 2012
The Balochistan education department and the Aga Khan University Institute for Educational Development (AKU-IED) are collaborating to restructure the education system across Balochistan.
Secretary Education Munir Ahmed Badini headed a delegation visiting the AKU-IED to discuss steps to be taken for capacity development on Monday. The steps would include an innovative teacher training programme and establishing a centre for excellence in education at Gwadar, an AKU-IED spokesperson said.
During the meeting, Director AKU-IED Dr Muhammad Memon highlighted the initiatives taken by the institute in Balochistan, particularly the Strengthening Teacher Education Programme (STEP) being implemented across Quetta, Killa Saifullah and Chaghai. It was funded by the Canadian International Development Agency and the Aga Khan Foundation.
"Under STEP, a "Cluster-based" mentoring programme has been introduced in 110 primary schools by dividing these institutes at district level. This would ensure constant professional development of teachers, especially in rural areas," Memon told the delegation.
STEP also offered scholarships to teachers and educational managers in Balochistan for a two-year MEd programme, he added.
Also, a Whole School Improvement Programme had been implemented in 27 schools which aimed at improving the general school environment, making it conducive to learning as well as teaching, the director added.
Meanwhile, Badini lauded the contribution of the Aga Khan Development Network towards social sector development throughout Pakistan. He pointed out that joint ventures between public and private institutions must be encouraged to improve the quality of education in the country.
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Joined: 27 Mar 2003
Posts: 15038
Posted: Wed Jan 18, 2012 4:16 pm
Post subject:
AKUH launches first automated laboratory system
January 19, 2012 RECORDER REPORT 0 Comments A state-of-the-art automated laboratory system that ensures more accurate test results as well as allows a quicker reporting time is being launched at Aga Khan University Hospital, Karachi (AKUH).
Firoz Rasul, President, Aga Khan University, will be the chief guest at the inaugural ceremony to be held on January 19.
Aimed to advance patient care, this new system will automate the diagnostic tests resulting in a faster turnaround time of tests performed at the main clinical laboratory in Karachi.
Lab Cell Automation Solution by Siemens Healthcare Diagnostics will streamline workflow and increase clinical efficiency by minimising errors, increasing test consistency and achieving a shorter, more predictable turnaround.
With over 700 test menus offered, AKUH Clinical Laboratories perform over seven million tests annually, and also receive samples from Afghanistan, UAE, East Africa and Central Asia.-PR
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Joined: 27 Mar 2003
Posts: 15038
Posted: Tue Jan 31, 2012 8:59 am
Post subject:
To learn and serve: Bioethics Assembly comes to order
By Our Correspondent
Published: January 29, 2012
The first bioethicists group of Pakistan, named the Bioethics Assembly, held their initial seminar at the Aga Khan Hospital on Saturday.
The Bioethics Assembly, an academic group from the Aga Khan University (AKU), aims to spread education and information regarding bioethics in medical colleges, universities, hospitals and health care units.
The participants at the seminar underscored on the need for lectures and discussions on bioethics at different institutions and health care centres to create awareness.
The AKU Bioethics Unit Coordinator, Dr Arshi Farooqui, encouraged participants to write articles in medical journals to spread information.
Farooqi said that there is a deficiency of bioethics education in the country and the university will soon offer short courses to assist more people.
The Bioethics Assembly, comprising three batches of the AKU graduates and masters in Bioethics, will meet every alternate month to discuss and spread information on new topics emerging in the field.
Published in The Express Tribune, January 29th, 2012.
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Joined: 27 Mar 2003
Posts: 15038
Posted: Wed Feb 08, 2012 9:00 am
Post subject:
The Aga Khan University and the Harvard Committee on African Studies present Resilience and Transformation in East Africa ......
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Joined: 27 Mar 2003
Posts: 15038
Posted: Wed Feb 15, 2012 8:30 am
Post subject:
Facebook Twitter 16 graduate in nursing at Aga Khan News
Sunday, 12 February 2012 23:03 Written by Joseph Kimbowa 2 Comments
A graduand receives her graduation certificate
For two and a half years, Sylvia Nalubega had to travel from Tororo to Kampala every Sunday evening and repeat the three-hour journey each Tuesday, back to Tororo where she works and lives with her family.
Commuting from Tororo to attend classes at the Aga Khan University (AKU) in Kampala has been a tough run, but Nalubega's efforts paid off when she graduated with a Bachelor of Science in Nursing on Saturday.
"It was not easy. My employers gave me two days off: Monday and Tuesday. I, therefore, had to come every Sunday evening and go back on Tuesday evening", she said.
In addition to the degree, she received the award of Academic Excellence after she emerged top among the students graduating from the BSC Nursing programme.
"She was not only the best performer in Uganda, but also the best of all graduating students in East Africa this year", said Firoz Rasul, president Aga Khan University, while presenting her with the award.
Sixteen graduands received the degree of BSC Nursing at AKU's ninth convocation ceremony held at the university premises in Old Kampala, Saturday. State minister for health, Richard Nduhura, who officiated at the event, noted the increasing brain drain from the region and said it could only be arrested "if we can meet the demand for intellectual and economic fulfillment". He stressed the need to limit the financial burden on students through bursaries and loan programmes.
Founded in 1983, Aga Khan University specialises in the health and education fields. The university currently has programmes in eight countries spread over three continents. In East Africa, it offers advanced nursing studies programmes in Kenya, Uganda and Tanzania, supported by the 250-bed Aga Khan University teaching hospital in Nairobi. Rasul said the university has established 30 medical outreach centres across East Africa, where students practise.
Nalubega dedicated her award to her family, particularly her husband, David Ogwang. "He is such an understanding man. I work the entire week and my children have had little time with me, but he has always been there for me", she said.
Ogwang called her a "heroine" for her commitment and endurance, saying few people would accomplish such a feat under her circumstances.
"I believe that wives are managers of the home. They should be given more time to study to make a positive influence on our children", Ogwang said. "To me, she is a heroine; a blessing to the family".
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Joined: 27 Mar 2003
Posts: 15038
Posted: Mon Feb 20, 2012 5:46 am
Post subject:
AKU in partnership with Room to Read
Programs & Results
Room to Read's operations in Tanzania began in 2011, with the search for a local staff, initial baseline assessments and site selection. Those activities, along with program implementation began in early 2012 through a partnership with Aga Khan University's Institute for Educational Development—East Africa (AKU).
AKU will work with our Reading & Writing Instruction program to provide teacher training and capacity building in the schools where we work, with Room to Read providing ongoing support after the initial training period.
Consistent with our model of holistic intervention, Room to Read will also launch our School Library, School Construction and Girls' Education programs in partnership with the local government and individual communities served.
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Joined: 06 Jan 2003
Posts: 4557
Posted: Mon Mar 19, 2012 5:00 am
Post subject: AKU's humanities school - first phase $500 million campus
The Express Tribune
Campus is calling for AKU's humanities school but the bigger the project the longer the wait
Key figures deny rumours that Education City project has been shelved.
By Saba Imtiaz
Published: March 19, 2012
The first phase of AKU's new campus will cost $500 million and will include an academic building spread over 200 acres. PHOTO: AFP
KARACHI: In the early 2000s, students would often wonder when the much-rumoured humanities school by the Aga Khan University (AKU) would materialise.
They can dream on for a bit. Even though the AKU's Faculty of Arts and Sciences is slated to open at the ambitious Education City project in Karachi, it is still several years away from completion.
The AKU's new school is one of several high-profile campuses planned for the 9,000-acre Education City. Other schools that have signed on to build campuses at the site include the Sindh Institute of Urology and Transplantation, the Shaheed Zulfikar Ali Bhutto Institute of Science and Technology and the Sir Syed University of Engineering and Technology.
Rumours that AKU had backed out of the project have surfaced, but the project director for the Faculty of Arts and Sciences, Karim Nurmohamed, and Zubair Motiwala, who serves as an adviser to the Sindh chief minister, have denied this. "His Excellency the Aga Khan has assured that it will go ahead," Motiwala told The Express Tribune. "The AKU is at a very advanced stage, in terms of its model and master plan."
It appears that it is simply a case of all the pieces taking time to come together to fit. Initially, the universities had two years to build up their campuses at Education City. But in 2010, the government realised it wasn't a workable deadline. "We have changed this (deadline) according to the size of the universities," said Motiwala. "AKU suggested this (given the size of their project) and we have acceded to their suggestions."
In order to gauge the magnitude of the task consider the numbers. The first phase of AKU's new campus will cost $500 million and will include an academic building spread over 200 acres. The entire campus will take up about 1,200 acres, with 560 of them for the academic campus and about the same space for the university residential village. While AKU will be approaching funding agencies and will raise funds in Pakistan and abroad, it has already elicited interest and donations.
While Motiwala suggested that AKU would take about six years, Nurmohamed said there was no set timeline because they plan to start work on infrastructure and development as soon as the master plan is approved and they have a board in place.
As the universities work on their blueprints, a crucial part of the picture is the government's input, which will come in the form of its master plan for Education City. Nurmohamed told The Express Tribune that AKU and other campuses are waiting on the government to complete its master plan for Education City, and they have given the government feedback on its preliminary plan.
"We wanted to make sure it would be a fit with what we've planned," he said, stressing the importance of the campus for AKU. "We are basically a university that offers professional education to doctors, nurses and teachers and we want to move forward to being a complete university."
Nurmohamed says there has been "very good recent progress" and he feels that the current political administration has been very helpful.
AKU's new project envisages schools for architecture and human settlement, education, law and management, according to a document available on the Sindh Board of Investment's website. Nurmohamed said that while they have a basic academic framework, it is dependent on the recruitment of senior faculty to help set up the actual curriculum and programmes, and that they will recruit once there is progress on the master plan.
It also aims to draw students who may have not considered a liberal arts education owing to a lack of universities offering a good programme. "The Lahore University of Management Sciences and the Forman Christian College in Lahore offer some courses in humanities, but they are still on a limited scale. We'll be offering much more."
The AKU is also opening a faculty of arts and sciences in Tanzania, and imagines that the two campuses will have similar faculties. Additionally, AKU says it is planning for a greener campus, which will position the sports facilities closer to the classrooms. Its design for the Karachi project has already received two awards – for land use and design.
An act governing Education City is also supposed to be presented in the Sindh Assembly. Motiwala, who also chairs the Sindh Board of Investment, aims that in five years, the board for Education City will include new entrepreneurs and that the chancellors or owners of the educational institutions will be eligible to become board members. He isn't worried about instability in the city or political developments, since he believes mega projects like the Education City are long-term. "There are 9,000 acres of land and only 20% has been allocated," he said by way of explaining not only how large the project is but also that it will take time to execute in its entirety.
While projects like this tend to be ignored when governments change, Motiwala says he has elicited all the help needed from the government and the draft legislation is ready. Once it is passed, it will be all systems go for Education City.
Published in The Express Tribune, March 19th, 2012.
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Joined: 27 Mar 2003
Posts: 15038
Posted: Fri Mar 30, 2012 11:07 am
Post subject:
Group photo of Chief Minister Gilgit - Baltistan with GB cabinet members and officials of Aga Khan University's Professional Development Centre North (PDCN)
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Big 12 story lines to watch in 2013:
Bedlam reversal
Oddly enough, it's Oklahoma State, not Oklahoma, that is the favorite to win the Big 12. A lot has changed in the conference, and the Cowboys' emergence is one of the biggest. We say this knowing Oklahoma State lost five games last year. That same five-loss team had the most productive offense in school history. That means something is wrong with the defense, so much so that coordinator Bill Young was not asked back. Oklahoma State also has a new offensive coordinator. It won't be more of the same—but it might be the best in the Big 12.
Win or else
Texas finished 9-4 last year, and that's a good thing, really. The Longhorns had posted records of 5-7, 8-5 and 9-4 in the previous three seasons. So, they saw improvement. But you have to think UT has to get into that regular 10- and 11-win category—at the very least—to appease a growing bunch of fans who aren't accustomed to mediocrity. A short while ago, coach Mack Brown was saying he wanted to play smash-mouth, physical football. Now, he's talking uptempo, spread-'em-out play. It's a search for what will work, a desperation to get back to the glory days. Only this time, it absolutely has to work.
Welcome back
Texas Tech and Tommy Tuberville was a match made somewhere, but it wasn't heaven. He's gone and now things are back to normal in Lubbock. So much so, in fact, that former gunslinger Kliff Kingsbury is back home. Kingsbury coached up Heisman winner Johnny Manziel last year at Texas A&M, but when the knock from the Red Raiders came, he swung the door wide open. Kingsbury is the right guy at the right time and takes over a program that was 8-5—a better situation than most new coaches inherit.
Can't wait to see
Baylor running back Lache Seastrunk was talking big stuff this offseason. His "I'm going to win the Heisman" proclamation was widely dismissed as bravado, but here's the thing: He was serious. He wants it and thinks it's within reach. Remember, it wasn't long ago that another Bear, Robert Griffin III, pulled it off. Seastrunk went over 1,000 yards in this pass-happy offense (1,012) and averaged 7.7 yards a carry. That should get your attention.
We'll have to wait a week to see TCU's Devonte Fields again. Last year's Freshman All-American has been suspended from the first game of the year, and that is against LSU. It's unfortunate, because he could be the best defensive end in the Big 12. He won't get to show that off against one of the SEC's best. It will also be interesting to see how Horned Frogs quarterback Casey Pachall bounces back after spending last season in a drug and alcohol rehabilitation center.


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Ready Pac Foods Inc. has begun nationwide retail distribution of organic versions of its Bistro Bowl salads line.
The four Bistro Organic salads are Orange Ginger Tofu, Caesar Cranberry, Zesty Harvest Grains and Honey Mustard Spinach, according to a news release. The single-serve bowls were introduced to the trade in May at United Fresh 2012.
"Single serve and organics are the two fresh-cut salad segments driving packaged salad category growth, with 17% and 11% growth over last year, respectively," Tristan Simpson, director of marketing at Irwindale, Calif.-based Ready Pac, said in the release. "We're aiming … at the sweet spot where these two segments, as well as consumer demand for organics and convenient meal solutions, all come together."
Ready Pac produces the organic salads at California, Georgia and New Jersey plants. The produce and condiments are certified organic by Quality Assurance International.
The recipes were developed by chefs to offer a twist on traditional salad flavors such as Caesar, Simpson said.


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The NBA has identified its first flopping perpetrators of the 2012-13 season, extending warnings to J.J. Barea and Donald Sloan for exaggerating upon contact in games they played on Friday.
Barea earned his warning when he lunged backward on a phantom forearm from Sacramento guard Jimmer Fredette in the fourth quarter of the Minnesota Wolves' 92-80 win over the Kings. In Barea's case, an official incorrectly called a foul on Fredette, a decision that was later rectified by the league.
Sloan's flop also came on the defensive side of the ball, when he spun and fell to the floor after a minor bump from Nazr Mohammed near halfcourt.
No foul was called and play continued as Sloan lay on the ground. Sloan had very little to gain from his flop, with the Cleveland Cavaliers trailing the Bulls, 97-77, as 5:59 remained on the clock in the fourth quarter. Chicago went on to win 115-86.
VIDEO: Barea flops from forearm extension | Sloan flops from midcourt screen
Neither player will be fined because this is their first offense against the NBA's new policy on flop attempts. However, if either player is found to be in violation of the flop rule a second time, they will be fined $5,000.
The NBA flopping rule mandates that players are fined $5,000 for the second offense and $5,000 for every flop thereafter until the sixth offense, which could result in an increased fine or a suspension, whichever the circumstances dictate.
The NBA instituted the rule before the 2012-13 season to quell flopping around the league, an action that became more pervasive in recent years. Throughout the season, an NBA flopping update will be kept on NBA.com.


text: Huge amount? Really? I only regret the Gerald Green contract. The Augustin contract, which at the time many of us (myself included) thought was too short), looks like great one-year contract. I'm happy with the Mahinmi contract. You can't really compare big man value to other guys--there's an inflated value there.This quote is hidden because you are ignoring this member. Show Quote