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|December 26, 2012, 09:03 PM
Join Date: December 29, 2002
Location: AZ, IA, WA
Posts: 1,682
I agree completely that putting armed security in each and every school in the country is simply cost prohibitive. It may be a good approach in some of the larger districts that can afford it.
I think the majority of can agree on one thing: The ONLY effective way to stop an active shooter bent on killing is IMMEDIATE armed response. Some propose allowing teachers and school staff to carry concealed weapons in schools, if they have concealed weapons permits. This might well stop an active shooter, or, if made known, dissuade a potential shooter from even attempting a mass murder. But allowing teachers to carry their concealed weapons would open the possibility that unauthorized persons could gain access to the weapons if left in a purse, briefcase, or desk drawer. Moreover, the responding teacher would be at a severe disadvantage in using a pocket pistol to confront a gunman with a high-powered semi-automatic rifle or shotgun, possibly wearing body armor. Finally, there would be a severe risk that a teacher attempting to intervene in an active shooting incident would be shot on sight by responding law enforcement officers.
Based on my training and experience training law enforcement agencies all over the country, I believe there is a better solution to effective immediate armed response while minimizing the risk to the armed responder. A fellow law enforcement trainer has accurately called active school shooters monsters. Every school building in the country has fire extinguishers to enable teachers and staff to fight fires, should they occur. I believe that schools should also have monster extinguishers strategically located throughout the campus a securely locked container holding an easy-to-use rifle, such as an M-1 Carbine or AR-15, plus an armored and distinctively marked raid jacket that would instantly identify the responder to law enforcement responders and provide some modicum of protection from the shooter. Specially trained volunteer teachers and staff members would have keys to these containers, and would be able to respond instantly with effective lethal force to terminate the threat. The rifle is much easier to shoot accurately in an emergency than a handgun, and would penetrate all but the most cumbersome body armor.
Violence is an ugly thing, but not the ugliest of things. The decayed and degraded state of moral and valorous feeling which believes that nothing is worth violence is much worse. Those who have nothing for which they are willing to fight; nothing they care about more than their own personal safety; are miserable creatures who have no chance of being free, unless made and kept so by the exertions of those better than themselves. Gary L. Griffiths, Chief Instructor, Advanced Force Tactics, Inc. (Paraphrasing John Stuart Mill)
|December 26, 2012, 09:12 PM
Join Date: December 24, 2002
Location: Alma Illinois
Posts: 13,601
In the article I linked in the opening post, the parents of the boy in Missouri talk about their struggles to keep their son in residential treatment. The long term beds aren't there anymore. And the system is set up to keep putting these people back into society.
Every peace officer who ever put the man hours into doing an involuntary committal can relate stories of how they went off to the mental institution, were put on meds and released and within days were back doing whatever it was got them committed in the first place because without someone to see they stayed on their meds, they didn't.
Millwright said;
1911 guy said;
Here in Illinois the governor is closing the state facilities for the developmentally disabled. His solution is to put them in neighborhood group homes. Many of them are functionally incapable of caring for themselves at all. The families of these unfortunate people have been fighting this for two years. It won't be long until we see some of them in the criminal justice system.
Texan Scott said;
How many teachers with CCW permits would accept the job knowing they had no civil immunity?
And I never said anything about stripping people who voluntarily seek help of anything. Have you every talked with any of these disturbed people? I have to as part of my job. Many of them would rather be in the hospital but our system is not set up for that any longer.
tpaw said;
|December 26, 2012, 09:12 PM
Join Date: August 24, 2009
Location: Outside Seattle, WA
Posts: 1,084
Please dont forget, parents are FREE to spend any amount of $$ they wish protecting their kids, including homeschooling, private schools, or paying for armed security in public schools (if that's allowed. Laws against that are likely to change, at least for security if not staff).
Fortune favors the bold
Freedom doesn't mean safe, it means free.
|December 26, 2012, 09:19 PM
Join Date: August 24, 2009
Location: Outside Seattle, WA
Posts: 1,084
So they get his/her gun and shoot up some fellow gangbangers or other students?
Just another witchhunt against guns.
Again, I'm really trying to avoid big changes that can come back and bite us in the butt WHEN they get over come...as any will. Armed guards dont always work now...if pro-gun people shove that down the public's throat and it stilll happens? We keep getting backed further and further into corners where the guns end up being the last straw for them to grasp.
There is no complete solution. It's a mistake to mislead the public that there is. On BOTH sides.
Fortune favors the bold
Freedom doesn't mean safe, it means free.
|December 26, 2012, 10:06 PM
Join Date: May 2, 2012
Location: The Texas Hill Country
Posts: 3,184
Mr White,
Please permit me to clarify two points :
First, when I suggest that that school teachers and administration be allowed to CC, I do NOT mean that they should require permission of the local school board. We can do that already in Texas, and most schools won't, because of anti- 2A sentiment or simply fear of, as you suggest, legal liability.
I suggest the State (and here, for my part, I mean Texas) needs to make it plain that it is the teacher's individual right; that the ISD has no authority to deny, or need to know, and therefore a legal indemnity from liability. Each person will exercise their own rights at their own risk, AS DO WE ALL who CC.
Further, to suggest they shouldn't be allowed to carry because simply having a CHL doesn't make them qualified to respond is a dangerous charge levelled at CHL holders in general ... are the rest of us dangerously unqualified CHL holders also?
Second, I do not recall you (Mr White) saying that anyone should be stripped of civil rights because of what they MIGHT do... but others have gone as far as to suggest a tracking database of citizens who took medication as teenagers! Will we now have on someone's legal record the fact that they were given ritalin or prozac as a 13 year old? And would that contraindicate allowing gun ownership? If not, why even do it? And how comfortable are we with allowing private medical history become public record? Such things are violations of privacy that discourage people from seeking treatment for themselves or their families.
Of course, people who have made threats, displayed disturbing or dangerous behavior, become substance abusers or otherwise demonstrated that they are not capable of managing their lives because of mental issues HAVE done something demonstrable... and it should be shown in court (a hearing, due process) that they are mentally incompetent. The legal basis for this already exists. No draconian new laws are needed; we need to be willing to FOLLOW THROUGH with the system we have. Yes, that costs money. No, it won't prevent every tragedy. But if we're going to "do something" we need to try what we're supposed to have already been doing.
We're not supposed to trust them. We're supposed to hold them accountable.
Still, they must be good for something, or we wouldn't need them, right? right?
Last edited by Texan Scott; December 26, 2012 at 10:15 PM.
|December 26, 2012, 10:16 PM
Join Date: June 11, 2005
Location: TN
Posts: 10,499
Even with an armed guard at a school, after months or years of boring inactivity.... a determined shooter could easily get past them and take them out without extra-ordinary measures taken.
The mental health approach may be the approach to take. But I would first insist (and fund) the transfer of appropriate documents to the FBI/ATF to be included in the NICs data base and see what develops. There are already laws about someone being declared mentally ill and not qualified by their mental condition to own a firearm. Expanding those laws would have to be very thoughtfully done and would be subject to court challenge.
|December 26, 2012, 11:06 PM
Join Date: August 24, 2009
Location: Outside Seattle, WA
Posts: 1,084
And also because it can put the teachers at risk to be found with a drawn gun in a situation where the police respond. (Just like the rest of us).
Fortune favors the bold
Freedom doesn't mean safe, it means free.
|December 26, 2012, 11:40 PM
Join Date: October 2, 2010
Posts: 1,136
|December 27, 2012, 12:28 AM
Join Date: September 26, 2007
Posts: 788
22-RIM Fire States:
Think about how much tax payer dollars pay for Obama's family vacations to Hawaii. Starting with Air Force One, it's flight crew, fuel and all other expenditures. Now, wouldn't you rather see YOUR tax dollars go to a more meaningful cause? One being your childs safety. Is his vacation more important than your children. I'm sure he has dozens of agents protecting HIS children everywhere they go. Are they any better than yours?????
Last edited by tpaw; December 27, 2012 at 12:40 AM.
|December 27, 2012, 12:49 AM
Join Date: October 2, 2010
Posts: 1,136
I don't believe that is an answer at all myself. I believe the Utah solution is all we need to do coupled with profiling of potential shooters. They have many things in common. Assuring that they cannot have access to any weapons is not an impossible task. Once again, they stopped a creep that was going to do a "Columbine" in a school about 5 miles from my house.
We do have a lot of tools available.
Another issue is that gun owners do have to take the responsibility of gun ownership seriously and protect others by securing their weapons. I hope we get some updates on how the kid got his mother's weapons especially when she wanted to have him placed in a secure facility.
|December 27, 2012, 01:28 AM
Join Date: September 26, 2007
Posts: 788
Alaska 444 States:
Allocation of officers to secure schools would not be a burden here, in fact, it's being done now in many areas, and will continue.
Many municapalities do not have that advantage and I understand that.
Inteligent planning by qualified personel is essential where resources are limited. Parental In-put is essential. Go to school board meetings. Take an active interest! Show up, ask questions! Apathy is our worst enemy. Parents need to get involved in their childrens education and extra curricular activities.
Perhaps cutting back on tax dollars for perks in certain school districts is a start. What perks? It's up to the parents to decide. After all, it's your tax dollars that pay for it all.
Just my opinion guys. There is no ONE answer to the problem.
|December 27, 2012, 01:53 AM
Join Date: October 2, 2010
Posts: 1,136
|December 27, 2012, 02:27 AM
Join Date: August 24, 2009
Location: Outside Seattle, WA
Posts: 1,084
I would teach my child in the best way I could how to react in such a situation. I would get the school board to allow teachers to cc if they chose to.
*I* have nieces and nephews in NJ...a very un-gun-friendly state. The oldest are now shooting skeet and practicing and know how to use guns safely. My eldest nephew likes shooting ARs and I'm saving to buy him one (but he's only 16) I reinforce this along with their parents. We do these things together. *I* teach my eldest niece about self-defense (the other is 6). *I* am not unduely worried about them in public schools. I do worry about lots of other things.
However *since these school shootings are no more common than being struck by lightning or being mauled to death by a dog,* I would not subject my fellow Americans to footing the bill for it because that goes against my beliefs in the Constitution.
I would accept that the ultimate protection of myself and my family was OUR responsibility, not the local or state or federal govts'.
And you did NOT answer my question. I respected you enough to do so.
Fortune favors the bold
Freedom doesn't mean safe, it means free.
|December 27, 2012, 03:16 AM
Join Date: June 11, 2005
Location: TN
Posts: 10,499
Last edited by 22-rimfire; December 27, 2012 at 04:05 AM. Reason: Cut some useless banter out.
|December 27, 2012, 08:55 AM
Join Date: September 26, 2007
Posts: 788
Please re-state your question, I'll be more than happy to answer it to the best of my ability. Thank you.
|December 27, 2012, 09:02 AM
Join Date: December 26, 2002
Location: Richmond, Virginia
Posts: 13,092
I'd like a show of hands please. Who believes the reason that school buses don't have seatbelts is due to anything other than money? And don't dare mention air bags.
Speaking of mental health and community living, I had a client referred to me earlier this year for a vocational evaluation. Nice guy with pretty good skills, but because of his history the private/treatment high school was required to send 2 adults with him and at least one of them had to be watching him at all times.
But I'm retired now. 37 years was at least 7 years too long. They kept cutting every agency's budget year after year and I see they're still cutting.
|December 27, 2012, 11:35 AM
Join Date: January 3, 2003
Location: 0 hrs east of TN
Posts: 39,609
We closed mental health institutions because of abuses and expense in the 80s. What many pointed out was that there was no way to care for many of the people being abandoned in the closings. What rational person thinks that someone that has to be supervised to take their medication will continue to take their medication without supervision. Group homes with supervision helped many, but others simply weren't suitable for them and were also abandoned because of economics and "principle". Homeless rates skyrocketed after patients were put out on the street.
Add that the stigma against mental health care is still strong in this country and we have a poor system for helping those most in need and protecting the public from those we most need to protect ourselves from.
Finally, even if you have private insurance that will cover a teen and permit you to get them in an institution for care, that insurance will not cover an adult family member. The blogger anarchistsoccermom posted "Thinking The Unthinkable" about how things had to go before her son was institutionalized. I have a colleague who's 15 year old son began "acting out" a year ago. We talked about his behavior from time to time since I have a daughter of similar age and a son who's older. When he told me several weeks ago that his son had made threats about killing kids in his HS by taking a knife or gun or even gasoline they'd finally picked up the phone and had him taken to a local private in-patient facility. He also pointed out that when they realized this was their last resort they also realized it was probably 9 months later than when they should have done it. "How do you cook a lobster without all the fuels? Turn the heat up a little bit at a time.", he said. We talked about a parents love for a child "blinding" them to the serious nature of the child's problems. We talked about denial also. We talked about how even after you see there's something more than teen challenges to authority going on how the process of getting counseling for a kid can be challenging (I walked that path with my son after he ran away from his mother's) and how that can even cloud you to seeing the greater problem.
It isn't easy to get help for your kid if they have personality or mental disorders that are dangerous. It isn't easy because you don't want them to be sick, because you don't want the neighbors or family to see them as sick, because you don't have the money or the community doesn't have the resources or they tell you that the police will handle it when they can't.
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TheHighRoad exists to provide a higher grade of discussion than is found on some other gun forums so antis and undecideds can see that gun owners and RKBA advocates are not the reckless misanthropes they tell everyone we are. Personal attacks, group stereotyping, macho chest-thumping, and partisan hackery are low road and hurt all of us.
|December 27, 2012, 03:44 PM
Join Date: October 2, 2010
Posts: 1,136
There are indeed people that benefit from in patient hospitalization. There are also many who truly are a danger to themselves or others. The homeless problem in America is mainly a combination between those that have drug abuse issues and the mentally ill. There is no law against being crazy. The only time that anyone can intervene is when there is objective evidence of a danger of harm to themselves or others.
With these school shooters, often times they hit the radar for being strange or different, but they don't commit any acts that puts them in the other categories where intervention is indicated.
I believe that there is an even deeper failure of parents who don't have any clue what their kids are doing. Thinking again of the huge number of guns that the Columbine kids had in their homes. I can't imagine that happening in my home since there were not any off limit places in my home. My kids did not have the presumption of privacy outside of hygiene of course. I looked and searched my kids rooms to know what they were doing when they were teenagers. I did intervene on my own on a couple of occasions. Parents are still part of this loop. If the cops can find much evidence after the fact, where were the parents before the fact?
|December 27, 2012, 03:58 PM
Join Date: October 29, 2010
Location: Lakewood, Washington
Posts: 5,521
I disagree with armed guards, but I have to say giving a few teachers training and letting them carry would be a far cheaper way to provide a quicker end for an active shooter in our schools.
"For a victim of violent crime to call for gun control is like a victim of shipwreck calling for the elimination of life boats." - Vern Humphrey
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|December 27, 2012, 04:20 PM
Join Date: October 10, 2010
Posts: 392
The idea of a guard in every school may not be practical, but the idea of guards should not be dismissed. At the very least it should be an option in every school district in the nation and left for the parents to decide. Perhaps some would want to contribute toward hiring a guard. Perhaps some parents with gun training (like local vets or retired cops) would want to volunteer for guard duty. Perhaps providing some teachers training and providing a gun in a lock box or principal's desk drawer would be better than nothing. Perhaps consideration that a school gun free zone guarantees the safety of the shooter, not the children. After all, the protection of children is a priority of the parents. Entrusting politicians for this is not a good idea... might even be called crazy.
I believe that the immediate dismissal of the concept of security guards was more an ideological response than practical. It's at least worth discussing.
NRA Life Endowment Member
Supporter of the Constitution and our troops
|December 27, 2012, 04:24 PM
Join Date: July 13, 2006
Location: Anchorage, AK
Posts: 5,076
There's the Dave Grossman et al argument that spree shootings by younger shooters are heavily influenced by violent video games, violent television, and violent movies.
If the 2nd Amendment can be subjected to restrictions like NFA related tax stamps and such, what about the idea of similarly infringing the 1st Amendment and impose a tax penalty on Hollywood and video game manufacturers for any product that promotes violent behavior above a certain threshold. Establish certain thresholds for glorifying violence and sadistic behavior and if they are exceeded by a game, TV show, or movie, slap a major tax penalty on it. (Ideally then use the funds for things like mental health resources for at risk teens and school security programs, but of course Congress doesn't ever do the right thing with a money supply.)
|December 27, 2012, 04:26 PM
Join Date: December 29, 2002
Location: Los Anchorage
Posts: 23,649
Getting kids used to that sort of thing in school trains them to accept it as adults. And bit by bit we become a liberty-free nation. In such a world, the mere fact of owning a few firearms becomes moot.
The NRA is mostly on our side, but it is also in favor of brutal federal criminal laws and is not "small government" by any stretch.
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|December 27, 2012, 04:27 PM
Join Date: October 2, 2010
Posts: 1,136
|December 27, 2012, 04:55 PM
Join Date: December 24, 2002
Location: Alma Illinois
Posts: 13,601
awgrizzly said;
We are not going to have properly trained and equipped security forces in our schools for minimum wage. It costs a heck of a lot of money to train and equip an effective officer. Remember, the training is continual. We don't want to trust someone who's only training was what the state requires to be an armed security guard to interact with our children and expect him or her to risk their life taking out an active shooter. If you want quality, effective people in that job you are going to have to pay a decent wage. I don't know how the schools are funded where you live, but here we pay for them with our real estate taxes. It's not unreasonable to expect the kind of security you are talking about to cost $80 to $100K per officer per year by the time you figure salary, training, equipment, the employer's share of social security, unemployment insurance premiums, health insurance etc.
How many school buildings do we have in this country? I am sure some of them, like the high school I went to are large campuses with several buildings which would require a security force to properly secure, not a single officer. School districts would have to have more then one officer per building so that there was a reserve available to fill in when the regularly assigned officer was sick or taking a personal day.
It's easy to say "Put an armed officer in every school building in America!" it sounds good and really upsets the antis. But the logistics of such a program boggles the mind.
cosmoline said;
|December 27, 2012, 08:22 PM
Join Date: August 24, 2009
Location: Outside Seattle, WA
Posts: 1,084
Fortune favors the bold
Freedom doesn't mean safe, it means free.
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(Sketches By: Jerry Lemenu)
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Yay! Congrats!!!
Yay! Congrats!!!
Unfortunately I just had a m/c so I will be coming back here eventually.
GL to the rest of the ladies this month!
I am so sorry for your loss.
No Liz, No... I am so sorry honey, This is not fair! I am so so sorry! If you need to talk PM me and add me on facebook so we can talk. It shouldn't have happened to you. Lots of hugs!
Cait[24] & Gene-Paul[28] Dx with PCOS & Left Tube Blocked Dec. '12
Sean Patrick born 3/11/14, 7lbs 13oz
Thanks ladies. Fortunately the mc seems to be progressing on its own. Hopefully I can start ttc again in a month or two, depending on what my dr says.
GL to everyone else this month!!!!
I am new here but I will likly be testing on the jan 26. Me and my husband are actually waiting to try in april - may but due to a condom break and my first cycle off birth control a little worried since I have no idea where I am at in my cycle or what it is doing. All I know is I should get a period around the 26 27. I was a 35 -38 day cycle before bc so who knows after comming off of it.
Added you Simbi!
Hey ladies, well I'm drinking hot cocoa this morning to celebrate my BFP! I'm hopefull that this one will stick around, holding off until Friday before calling the Dr. Thank you ladies again for all of your support, determination and love!
Negative For me today but no af either. So still waiting. Will test in 1 week if no af.
AF is here. On to next month....
Sam(Me)-25 Mitch(DH)-34 4 Furbabies TTC since May 2009. My Blog: Infertility Bites
...bah! (((Big hugs)))!!
Praying, praying, praying for a Feb bfp for you


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On Thursday, the CME sent a letter to its customers warning of potential impact the federal spending cuts may have on some livestock and dairy contracts:
"As a valued customer, we wanted you to be aware this is an issue we are closely monitoring, as it's possible mandatory spending cuts – should they begin on March 1 – could have an impact on the physical delivery and cash settlement mechanisms of certain CME livestock and dairy products. In addition, the budget cuts could result in the disruption of USDA reports that are used in the daily calculation of the CME Feeder Cattle Index and CME Lean Hog Index and the monthly calculations used to determine settlement prices for CME Dairy futures products.
"As the CME Live Cattle contract utilizes USDA grading/inspection in the delivery process, a furlough of USDA staff may require the Exchange to modify in accordance with Exchange rules the current operational process around delivery/settlement of these products. In addition, CME Group's cashsettled livestock and dairy products could also be impacted in the event the data used to compile these indexes is unavailable. Finally, CME Group's spot call dairy markets could be impacted in the event USDA grading/inspection staff is unavailable effective on March 1, 2013."
The CME livestock and dairy contracts that may be impacted, include:
Access the full letter here.
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FLASHBACK: 35 Years Ago - 'Elvis In Concert' Airs On CBS
Wednesday, October 3, 2012
It was 35 years ago tonight (October 3rd, 1977) that CBS aired Elvis Presley's final concert special, Elvis In Concert. The show, which was broadcast six weeks after Elvis' death of a heart attack at the age of 42, featured a heavily made up and obviously ill Elvis, looking bloated and sweating profusely. Sadly, in pop culture circles, the show is best known as the "Fat Elvis" concert.
Although he was physically in bad shape, his voice was able to carry the special, which featured footage taped on June 19th, 1977 in Omaha, Nebraska and on June 21st in Rapid City, South Dakota. Although many have referred to the performance as Presley's final one, his last concert actually took place on June 26th, 1977 in Indianapolis.
Among the high points of the show were a near operatic version of his cover of Timmy Yuro's "Hurt," 1970s concert staples such as "You Gave Me A Mountain," and such '50s and '60s hits as "It's Now Or Never," "Jailhouse Rock," "Teddy Bear," "Don't Be Cruel," "Can't Help Falling In Love," and his version of the Frank Sinatra standard "My Way."
After its initial airing and several repeats, which were allowed as part of the original contract with CBS, the Presley estate has never permitted any further showings of the full special, which showed Elvis at his worst.
James Burton, Presley's lead guitarist and bandleader from 1969 to 1977 says that Presley was unpredictable as he was charismatic on stage: "With Elvis, y'know it was a lot of surprises, and you didn't have any idea. You could never take your eyes off of him. You had no idea where he was going to go next."
Former Memphis Mafia member Jerry Schilling, who is now the Creative Affairs director of Elvis Presley Enterprises, was asked whether fans can ever expect to see an official release of the 1977 special: "I wouldn't be one on a bandwagon saying, 'Let's do 14 DVDs on the concert on which Elvis looked the worst of his life and shouldn't have been on the stage, and was dying. . .' No, I'm not that guy. Should it ever come out again? Probably. I wouldn't say that it's never going to come out. I think there needed to be a moratorium after his death."
According to Schilling's recent memoir, Me And A Guy Named Elvis, he took Presley's manager Colonel Tom Parker to task for allowing Presley to appear in such bad shape before the cameras. Parker reportedly told Schilling that he tried to stop the deal due to Presley's poor health, but that Presley demanded that the special go ahead as scheduled.
The soundtrack album to the Elvis In Concert special peaked at Number Five on the Billboard 200 album charts and went all the way to Number One on the Country charts.
In the years since the special aired, the Presley estate has only allowed three performances from the concerts to be used in official projects. Backstage footage and Presley's performances of "Are You Lonesome Tonight" "Love Me," and "My Way" were featured in the 1981 documentary This Is Elvis.
Presley's solo piano performance of "Unchained Melody" was included in the newly reissued Elvis: Great Performances DVD.
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Gene Model Predicts Recurrence Risk in Early-Stage NSCLC
Researchers have developed a lung "metagene" model that accurately predicts the risk of recurrence for patients diagnosed with early-stage (IA) non-small-cell lung cancer (NSCLC), according to results published in the August 9 New England Journal of Medicine.
Previous studies have shown the benefit of adjuvant chemotherapy after surgery for patients with later stages of NSCLC, but not for stage IA disease. However, about 25 percent of patients in that stage subsequently have a recurrence, suggesting a need to identify a subgroup that might benefit from adjuvant drug treatment, noted the researchers, led by Dr. Anil Potti of the Duke Institute for Genome Sciences & Policy at Duke University. Read more
Getting New Interventions to Patients More Quickly
There is much excitement in the cancer research community about the rapid discovery of biomarkers. These discoveries range from protein signatures that may predict recurrence or response to therapy, to new imaging technologies that measure the extent of drug-target interactions. The combination of these types of biomarker discoveries with studies that are demonstrating the predictive prowess of gene-expression profiles, like the one highlighted in this week's lead story, is generating tremendous optimism about the future of personalized oncology care.
Of course, advanced technologies have significantly improved our ability to discover potential biomarkers. But biomarker discovery is only the beginning. The harder part is to qualify or validate the biomarker - that is, conduct the clinical studies and develop the correlative data that definitively describe the precise clinical meaning of a given biomarker in a specific situation. Read more
UPDATE: 2006 Lung Cancer Study Retracted
The authors of a study published in the New England Journal of Medicine—and reported in this issue of the NCI Cancer Bulletin—have retracted their research article. Dr. Anil Potti and his colleagues requested a retraction of their article on a genomic model to refine the prognosis of early-stage non-small cell lung cancer because they "tried and failed to reproduce results supporting the validation of the lung metagene model" using data from studies conducted by the American College of Surgeons Oncology Group and the Cancer and Leukemia Group B cooperative groups.
Gene Model Predicts Recurrence Risk in Early-Stage NSCLC
Researchers have developed a lung "metagene" model that accurately predicts the risk of recurrence for patients diagnosed with early-stage (IA) non-small-cell lung cancer (NSCLC), according to results published in the August 9 New England Journal of Medicine.
Previous studies have shown the benefit of adjuvant chemotherapy after surgery for patients with later stages of NSCLC, but not for stage IA disease. However, about 25 percent of patients in that stage subsequently have a recurrence, suggesting a need to identify a subgroup that might benefit from adjuvant drug treatment, noted the researchers, led by Dr. Anil Potti of the Duke Institute for Genome Sciences & Policy at Duke University.
They combined gene-expression profiles in a cohort of 89 patients with early-stage NSCLC to create a metagene model that predicted the risk for recurrence. "The metagene represents the dominant average expression pattern of the gene cluster across the tumor samples," they explained. In the initial cohort, the lung metagene model predicted disease recurrence with an overall accuracy of 93 percent.
The investigators then evaluated the metagene model in two independent groups of 25 patients from an American College of Surgeons Oncology Group (ACOSOG) study and 84 patients from a Cancer and Leukemia Group B (CALGB) study. The model had an overall predictive accuracy for recurrence risk of 72 percent for the ACOSOG cohort and 79 percent for the CALGB patients. "The lung metagene model was consistently accurate across all the early stages of NSCLC," the researchers reported.
"Our study is a critical first step in the use of genomic tools to refine prognosis and improve the selection of NSCLC patients who are appropriate for adjuvant chemotherapy," noted the investigators.
The metagene model for NSCLC described in the study is similar to a potential genomic strategy for treating early-stage breast cancer, which is being tested in a large clinical study called TAILORx. In that study, a molecular test to analyze the expression patterns of certain genes in a woman's breast tumor that point to a high risk of recurrent disease are used to assign patients to an appropriate treatment regimen.
The researchers in the NSCLC study noted that the refinement of prognosis with the use of the metagene model "provides the opportunity for a prospective, randomized, phase III clinical trial that would evaluate the benefit of identifying a subgroup of patients with stage IA disease estimated to be at high risk for recurrence."
In the proposed study, patients initially classified as having clinical stage IA disease would undergo surgery, and the metagene model would then be used to identify patients predicted to be at high risk for recurrence. "Patients at high risk would then be randomly assigned to observation (the current standard of care for stage IA disease) or adjuvant chemotherapy, in order to evaluate the extent to which the use of genomic reclassification improves survival," the scientists suggested.
Dr. Martin Gutierrez, staff clinician in NCI's Center for Cancer Research (CCR), agreed on the need and value of testing the NSCLC metagene model in a follow-up clinical study. The use of adjuvant chemotherapy for stage I lung cancers "has been controversial," he noted. If the metagene model is confirmed by a phase III study, "it might help identify early-stage patients who are at high risk for relapse and decrease the likelihood of exposing low-risk patients unnecessarily to chemotherapy," Dr. Gutierrez suggested.
By Bill Robinson
Getting New Interventions to Patients More Quickly
There is much excitement in the cancer research community about the rapid discovery of biomarkers. These discoveries range from protein signatures that may predict recurrence or response to therapy, to new imaging technologies that measure the extent of drug-target interactions. The combination of these types of biomarker discoveries with studies that are demonstrating the predictive prowess of gene-expression profiles, like the one highlighted in this week's lead story, is generating tremendous optimism about the future of personalized oncology care.
Of course, advanced technologies have significantly improved our ability to discover potential biomarkers. But biomarker discovery is only the beginning. The harder part is to qualify or validate the biomarker - that is, conduct the clinical studies and develop the correlative data that definitively describe the precise clinical meaning of a given biomarker in a specific situation.
It is for these very reasons - the clinical promise that biomarkers represent and the importance of validating the biomarkers - that, earlier this year, NCI joined with two other Department of Health and Human Services (HHS) agencies, the Food and Drug Administration (FDA) and the Centers for Medicare & Medicaid Services (CMS), to launch the Oncology Biomarker Qualification Initiative (OBQI).
Broadly speaking, OBQI is intended to speed the development and evaluation of new cancer therapies. By bringing together public-private consortia to work on specific projects, OBQI represents the only nationally coordinated effort to validate oncology biomarkers for use in clinical trials.
One specific area of focus is the use of biomarkers as "surrogate endpoints" in clinical trials, meaning that assessments about an intervention's success or failure could be made after several months of treatment, instead of having to wait years to look at more traditional clinical measures. Of course, patients would still be followed to track longer term outcomes and ensure safety, but validated biomarkers that are proven to correlate with treatment response stand to greatly speed the translation of new therapies and technologies from the lab to patients.
An article in last week's issue of the NCI Cancer Bulletin explained how NCI is leading an effort to standardize studies to assess whether the results of FDG-PET imaging can be a biomarker of patient response to treatment. Interestingly, one of the first OBQI-supported projects, just recently approved, is a phase III clinical trial that, among several aims, will determine whether FDG-PET can help refine some already established indications of response to treatment for diffuse large B-cell lymphoma (DLBCL).
The trial, being led by CALGB, is important because it is attempting to definitively establish the best treatment protocol for DLBCL, the most common lymphoma type in the United States. Incorporating an FDG-PET biomarker correlative study into this trial (CALGB 50303) represents an important step toward establishing FDG-PET as a valuable component of clinical trials and improved patient care.
A second project that will be supported under OBQI is a phase II trial to assess whether FDG-PET can predict treatment response in patients with advanced NSCLC.
OBQI's importance is multifold. A truly collaborative effort, it not only will speed drug development, but also will allow FDA to make quicker, more informed decisions about drug approvals, and will enable CMS to make rational coverage decisions for new technologies and interventions. It also will hasten the development of standards, nomenclature, and tools for use in qualifying biomarkers of interest.
Collaborations such as these are no-lose propositions. I expect we will see more like them, and that is good news for cancer researchers and cancer patients.
Dr. John E. Niederhuber
Cancer Pain: Helping Patients Help Themselves
"About 50 percent of patients who are receiving outpatient therapy for cancer report moderate-to-severe pain. And as the disease progresses, as patients go into the terminal phases of their illness, 80 to 90 percent of those patients report moderate-to-severe pain," explained Dr. Christine Miaskowski, professor of nursing at the University of California, San Francisco, at the NIH Pain Consortium's first annual symposium, held April 17 - 18 at the NIH campus. "Those percentages…have not changed for 30 years."
Dr. Miaskowski is one of a growing group of researchers who are focusing on patient education as an important component in the fight against cancer pain. In the past, most experimental behavioral interventions designed to improve the treatment of cancer pain have targeted physicians. "And doctors have been responsive," said Dr. Miaskowski. "But the link between the prescription and what the patient is doing with it is the missing piece. You have to also educate the patient and their caregivers."
"If a patient is terrified of becoming addicted, then it doesn't matter if doctors are waiting in line to hand them pain pills - they're not going to take them," explained Dr. Betty Ferrell, a palliative-care researcher at City of Hope Comprehensive Cancer Center in Duarte, Calif., who is also working on education to improve pain treatment. "Overcoming fears and beliefs…is so important before you can move on to try to do something about managing a problem."
Both researchers have developed education-based pain-management programs to be integrated into patients' standard care regimens. In a recent randomized clinical trial, Dr. Miaskowski's PRO-SELF Pain Control Program significantly decreased pain intensity scores and increased the number of appropriate analgesic prescriptions in a group of patients with pain from bone metastases. The PRO-SELF program is based on the concept of academic detailing, which individualizes a teaching program for each patient based on that person's current knowledge and attitudes.
Patients in the PRO-SELF program are given a pain-control booklet, a pain-management diary, a script to help them communicate their pain-management needs, and a pillbox. After identifying the gaps in patients' knowledge, a participating nurse coaches them on timing and frequency of medication intake, how to assess their own pain and response to the medication, how to prevent or treat side effects from pain medications, and how to communicate with their physician about their pain and treatment.
Although the program is still being refined, clinicians have already adapted parts of the PRO-SELF program to their practice, says Dr. Miaskowski. The next step, she explained, is to understand what "dose" of the intervention is most effective. "How long does it take for someone who is dealing with the cognitive questions about taking analgesics to process the information?"
In 2004, to encourage research into new methods to improve symptom management, NCI released a Request for Applications (RFA) titled Reducing Barriers to the Delivery of Symptom Management and Palliative Care. Dr. Ferrell is one of the investigators funded by that RFA. In her project, she and her colleagues have created a hospital-wide system called Passport to Comfort, which incorporates patient education into a comprehensive teaching program addressing patient, professional, and systems barriers to adequate symptom management within the cancer center.
"For example," Dr. Ferrell explained, "a very common thing is that patients believe that if the pain is important then the doctor would ask about it. Patients also don't want to distract the doctor from their underlying cancer. To fix that problem, we not only need to teach patients that their pain is important and that they need to let their doctor know about it, but to also coach physicians to broach these topics, because the physicians may be coming from a perspective of 'if the patient has a problem, they'll tell me about it.'"
In addition to incorporating coaching on pain and fatigue management into their clinic for both patients and physicians, City of Hope researchers have worked on increasing awareness within the hospital environment by, for example, placing signs in every examination room, which include: the Passport logo and the message, "We care about your comfort;" the pain and fatigue rating scales; and reminders for patients and physicians to discuss these issues.
Dr. Ferrell's team is currently identifying the components of their system that are most effective, so they can be incorporated into a streamlined second phase. "One of the things NCI is interested in as we develop these interventions is the need to create models that can be replicated in other organizations, and models that are realistic, that can continue even when the study is over."
"We are at a time in 2006 when we have a variety of medications, as well as complementary modalities to treat pain; however, many patients with chronic cancer pain remain undertreated," said Dr. Ann Berger, chief of the Pain and Palliative Care Service at the NIH Clinical Center. "The barriers to proper care are many…and an important way of overcoming these barriers is to empower the patient and family to ask for what they need. Much like in the childbirth movement, when patients are empowered and request what they need, the health care system will ultimately be changed, and patients will have their pain adequately treated."
By Sharon Reynolds
Gene Signature Predicts Metastases in Hepatocellular Carcinoma
A team of researchers, including several from NCI, found a unique gene signature in the normal immune cells populating the liver tumor's microenvironment that could predict potential for metastasis, according to a study in the August Cancer Cell.
The study included 115 hepatocellular carcinoma (HCC) patients treated at the Zhongshan Hospital in Shanghai, China. Fifty-two patients had tumors that metastasized, and 63 had tumors that did not. In addition, samples from 22 patients with chronic liver disease and 8 patients with normal liver tissues were used as the controls. The researchers used a set of 17 genes, some which encode messages for cytokines, to analyze the gene expression signatures of immune cells in the nearby vicinity of the tumor. Earlier, they had analyzed gene expression within the liver tumors, but the profile from that study could only predict metastasis in 78 percent of the cases.
The latest study identified a unique 17-gene signature in the liver's normal immune cells that could predict if a liver tumor would metastasize in 92 percent of the samples. This unique signature is associated with anti-inflammatory and suppressed-immune responses. These combined activities are associated with a poor prognosis of cancer.
The study's lead author, Dr. Xin Wei Wang of the Liver Carcinogenesis Unit at NCI's CCR said, "This is the first example where we can stratify HCC patients to identify those who would benefit from certain postsurgical treatments to prevent metastases and recurrence."Breast Cancer Studies Highlight Need to Monitor Cardiac Health
Two new studies suggest that women treated for breast cancer should have their cardiac health monitored if they receive long-term therapy with trastuzumab (Herceptin) or radiation on their left sides. The findings, published early online August 14 in the Journal of Clinical Oncology, are particularly relevant to women who may be at risk for heart problems prior to treatment for cancer.
In the trastuzumab study, researchers at the University of Texas M.D. Anderson Cancer Center reported that the long-term use of the drug appears to be safe, but that some patients will develop cardiac toxicity. Forty-nine of 173 women with metastatic HER2-positive breast cancer in the study (28 percent) experienced a cardiac event after taking trastuzumab for at least 1 year.
The toxicity was reversible in the majority of patients, and some patients who experienced a cardiac event were considered for additional treatment with trastuzumab after recovering cardiac function. Trastuzumab is the standard treatment for metastatic HER2-positive breast cancer and, for this population, the overall risk of cardiac toxicity from long-term treatment involving trastuzumab is acceptable, the researchers concluded.
The second study, led by Dr. Eleanor Harris of the Moffitt Cancer Center, examined the long-term effects on cardiac health after irradiation of the breast using contemporary techniques. The researchers found that irradiation of the left breast was not associated with an increased mortality from cardiac disease for up to 20 years after treatment, but it was associated with a higher rate of coronary artery disease and myocardial infarction compared with treatment of the right breast.
The results of this and another study suggest that other known risk factors for cardiac disease may interact with the coronary artery that has been damaged by irradiation and further increase the risk of developing ischemic heart disease after treatment. Women treated for left-sided breast cancer should be monitored over the long term for hypertension and other risk factors, and treated accordingly, the researchers said.Americans Unclear on When to Get Cancer Screening Tests
While most Americans know that mammograms, Pap tests, and colonoscopies are screening exams for cancer, the majority of Americans do not know the appropriate ages at which initiation of these tests is recommended, according to the latest brief from the Health Information National Trends Survey (HINTS). HINTS, which was developed by NCI, is a nationally representative telephone survey of the general population that was designed to evaluate how the public accesses and uses information about cancer, and how this information can be delivered most effectively.
HINTS data collected in 2005 showed that 57 percent of American women were unaware that they should begin to receive mammograms to screen for breast cancer at age 40. Seventy-nine percent of women were unaware that they do not need to have a Pap test yearly to screen for cervical cancer - current general guidelines advise women to get Pap tests at least once every 3 years. Forty percent of all HINTS respondents could not name a test available to screen for colorectal cancer. However, 54 percent did know that screening for colorectal cancer is recommended for men and women age 50 or older, according to general recommendations.
"We must significantly increase our efforts to inform all Americans of what cancer screening tests are available so that we can catch cancer in its earliest stages when it is most treatable," said NCI Acting Director Dr. John E. Niederhuber in response to these results. "We need to get into communities with a renewed education effort."
How Some Tumors Evade Attack by Immune Cells
Researchers have identified a potential mechanism by which some tumors in mice evade attack by antitumor immune cells. Tumors produce a molecule called adenosine that normally serves as a "stop signal" to prevent inflammatory cells from attacking healthy tissue after an infection. The researchers found that when tumors produce adenosine, antitumor T-cell activity is suppressed, and an attack is averted.
"Tumors have hijacked a mechanism that evolved to protect normal tissues from collateral damage that occurs when the body mounts a defense against infection," said lead investigator Dr. Misha Sitkovsky of Northeastern University. Inflammation caused by the host's response to infection triggers the release of adenosine from surrounding cells, which binds to so-called A2A adenosine receptors on immune cells and slows the production of damaging inflammatory molecules.
In the study, the researchers genetically and pharmacologically inactivated A2A adenosine receptors in mice, using various substances, including caffeine, to render antitumor T cells less susceptible to inhibition by tumor-produced adenosine. Most of these mice displayed better antitumor immune responses and delayed tumor growth than mice with intact A2A adenosine receptors, according to findings reported early online this week in the Proceedings of the National Academy of Sciences.
"Antitumor T cells that lacked A2A adenosine receptors overcame this type of tumor defense mechanism and inhibited tumor growth in a majority of mice," said co-investigator Dr. Scott Abrams of NCI's CCR. The genetic inactivation strategy was not effective in about 40 percent of the mice, however. One reason may be the existence of other adenosine receptors in these mice; identifying these molecules will be a focus of future research.HPV16 and HPV18 Variants Related to Race
Genetic variants of HPV16 and HPV18 are linked to a woman's race and the persistence of HPV infection, according to a study in the August 2 Journal of the National Cancer Institute (JNCI).
Researchers from the University of Washington in Seattle analyzed HPV16 and HPV18 nucleotide sequence variations in 1,025 HPV16- and HPV18-positive women. Variants were compared with prototype sequences of HPV16 and HPV18, and were classified as European, Asian, North American, Asian American, African 1, and African 2.
The researchers found that HPV16 and HPV18 African variants were predominant in African American women, while HPV16 and HPV18 European variants were predominant in white women. These variants also are linked to the persistence of HPV infection among different racial groups. HPV16- and HPV18-positive white women with European variants had a greater likelihood of remaining positive for viral DNA than white women with African variants. In contrast, HPV16- and HPV18-positive African American women with European variants had a smaller likelihood of remaining positive for viral DNA than African American women with African variants.
"Given that women with persistent, compared with transient, HPV16 or HPV18 infections are at increased risk of cervical cancer, future studies should be conducted to examine possible mechanisms involving variant-specific immune evasion and their potential clinical therapeutic implications," the authors noted.
In a JNCI editorial, Drs. Robert D. Burk and Rob DeSalle stated that because of the unknown link between variants and race, "the 'tangle' is trying to figure out what these factors might be and how the relationships among virus variation, host variation, and persistence lead to cancer."
Following are newly released NCI research funding opportunities:
Dissemination and Implementation Research in Health
This is a renewal of PAR-06-071. This funding opportunity will use the R03 award mechanism. For more information, see http://cri.nci.nih.gov/4abst.cfm?initiativeparfa_id=3522. Inquiries: Dr. Jon F. Kerner - firstname.lastname@example.com
Dissemination and Implementation Research in Health
This is a renewal of PAR-06-072. This funding opportunity will use the R21 award mechanism. For more information, see http://cri.nci.nih.gov/4abst.cfm?initiativeparfa_id=3523. Inquiries: Dr. Jon F. Kerner - firstname.lastname@example.com
Exfoliated Cells and Circulating DNA in Cancer Detection and Diagnosis
This is a renewal of PA-06-423 and will use the R21 award mechanism. For more information, see http://cri.nci.nih.gov/4abst.cfm?initiativeparfa_id=3512. Inquiries: Dr. Padma Maruvada - email@example.com; Dr. Sudhir Srivastava - email@example.com
Pathophysiology of Bisphosphonates-Associated Osteonecrosis of the Jaw
This funding opportunity will use the R01 award mechanism. For more information, see http://cri.nci.nih.gov/4abst.cfm?initiativeparfa_id=3513. Inquiries: Dr. Roy Wu - firstname.lastname@example.com
Pathophysiology of Bisphosphonates-Associated Osteonecrosis of the Jaw
This funding opportunity will use the R21 award mechanism. For more information, see http://cri.nci.nih.gov/4abst.cfm?initiativeparfa_id=3514. Inquiries: Dr. Roy Wu - firstname.lastname@example.com
Pathophysiology of Bisphosphonates-Associated Osteonecrosis of the Jaw
This funding opportunity will use the R03 award mechanism. For more information, see http://cri.nci.nih.gov/4abst.cfm?initiativeparfa_id=3515. Inquiries: Dr. Roy Wu - firstname.lastname@example.com
Exploratory/Developmental Grant for Clinical Studies of Complementary and Alternative Medicine
This is a renewal of PAR-06-091. This funding opportunity will use the R21 award mechanism. For more information, see http://cri.nci.nih.gov/4abst.cfm?initiativeparfa_id=3519. Inquiries: Dr. Wendy B. Smith - firstname.lastname@example.com; Dr. Ann O'Mara - firstname.lastname@example.com; Dr. Nancy Emenaker - email@example.com
National Cancer Institute (NCI) Cancer Education and Career Development Program
This is a renewal of PAR-03-148. This funding opportunity will use the R25 award mechanism. For more information, see http://cri.nci.nih.gov/4abst.cfm?initiativeparfa_id=3520. Inquiries: Dr. Dorkina Myrick - firstname.lastname@example.com
Mentored Clinical Scientist Research Career Development Award
This is a renewal of PA-00-003. This funding opportunity will use the K08 award mechanism. For more information, see http://cri.nci.nih.gov/4abst.cfm?initiativeparfa_id=3521. Inquiries: Dr. David J. Eckstein - email@example.com; Ms. Belinda M. Locke - email@example.com
Combining Targeted Therapies for Metastatic Colorectal Cancer
Name of the Trial
Principal Investigator
Why This Trial Is Important
In this trial, researchers are combining cetuximab with another targeted drug called sorafenib (Nexavar) to treat patients with metastatic colorectal cancer whose tumors show EGFR activity. Sorafenib blocks the activity of two other proteins called vascular endothelial growth factor receptor (VEGFR) and Raf kinase. VEGFR stimulates the growth of blood vessels to tumors (a process called angiogenesis), and Raf kinase is a key molecule in relaying signals from growth factor receptors to the interior of the cell, where the signals are converted into changes in gene activity that lead to cell growth and multiplication.
"The majority of patients with metastatic colorectal cancer have tumors expressing EGFR," said Dr. Kummar. "Cetuximab is approved by the FDA to treat EGFR-expressing metastatic colorectal cancer, but unfortunately, it produces significant tumor shrinkage in only about 10 percent of patients when used as a single agent. With this trial, we hope to see an improved response rate by augmenting the activity of cetuximab with an additional drug that blocks other processes important for tumor growth and cell proliferation."
Who Can Join This Trial
Study Site and Contact Information
An archive of "Featured Clinical Trial" columns is available at http://cancer.gov/clinicaltrials/ft-all-featured-trials.
The National Cancer Advisory Board (NCAB) will meet September 5-7 on the NIH campus in Bethesda, Md., in Building 31, C Wing, Conference Room 10. More information will be posted at http://deainfo.nci.nih.gov/advisory/ncab.htm as it becomes available.
NCI to Hold PI Meeting for IMAT Program
The PI meeting will provide a forum for participants to share their ideas and progress, and discuss research and potential collaborations with investigators representing a broad range of scientific expertise. Information on complementary NCI programs and research resources also will be shared, and ideas on how NCI can facilitate progress in developing new molecular analysis technologies for cancer research will be solicited.
Meeting details can be found at http://otir.nci.nih.gov/tech/imat.html.
eHealth Research Conference Slated for September
The event will provide an interdisciplinary forum focusing on research methodologies that intersect information technology, health communication, behavioral science, medical science, and patient care research; existing and emerging technologies relevant to communications among patients and their health care teams; and conceptual issues related to patient-centered eHealth research.
NCI is sponsoring the conference in collaboration with the American Medical Informatics Association; the Health e-Technologies Initiative (with funding from the Robert Wood Johnson Foundation); and the HHS' National Library of Medicine, Office of Behavioral and Social Sciences Research, Office of Disease Prevention, Agency for Healthcare Research and Quality, and Office of Disease Prevention and Health Promotion.
For more details, go to https://www.ehealth-abstracts.com/Scripts/eHealthHome.asp.
Breast Cancer and the Environment Research Centers Chart New Territory
Researchers are taking a fresh approach to investigating environmental factors that may be associated with breast cancer risk by focusing on exposure during puberty. Four Breast Cancer and the Environment Research Centers (BCERCs) are exploring whether there are vulnerable times during development of the mammary gland when exposure to environmental agents may influence risk for breast cancer later in life.
"Traditionally, epidemiologic studies of breast cancer and the environment have focused on adult females with breast cancer," said NCI's Dr. Deborah Winn, acting associate director of the Epidemiology and Genetics Research Program (EGRP) in the Division of Cancer Control and Population Sciences (DCCPS). "Early puberty is an established risk factor for breast cancer, and puberty may be an important window of susceptibility to the cancer. These centers are unique in their focus and approach."
BCERCs are enrolling 1,200 girls aged 6 to 8 to examine relationships between breast development, age at first menses, and factors such as hormonal changes, diet, exercise, obesity, family medical history, psychosocial stressors, environmental exposures, and genetic characteristics and biomarkers. In parallel, using rat and mouse models, they are conducting animal studies to characterize the molecular features of the mammary gland over the lifespan and determine how exposure to potential carcinogens during these times influences cancer risk.
Begun in 2003, the research initiative is a 7-year, $35 million endeavor jointly funded by the National Institute of Environmental Health Sciences and NCI. Through DCCPS, NCI contributes 40 percent of this total. Additional support is provided by private organizations.
The centers are located at the University of California, San Francisco, with Dr. Robert Hiatt as principal investigator; the University of Cincinnati, with Dr. Sue Heffelfinger; Michigan State University, with Dr. Sandra Haslam; and the Fox Chase Cancer Center, with Dr. Jose Russo. Each center has a biology and epidemiology component, except Michigan State, which is not participating in the epidemiological study. The centers also have affiliated networks of research and advocacy organizations.
From the outset, breast cancer advocates have been instrumental in the creation of BCERCs and are integral to the project. Each center has a Community Outreach and Translation Core (COTC) comprised chiefly of advocates to translate and disseminate findings, and develop public health messages and other educational materials. Along with COTC, the epidemiology and biology groups work together not only at each center, but also across the centers in their respective areas.
"The centers are structured so that the laboratory research informs the epidemiologic research and vice versa, and consumer involvement is central. Scientists and advocates collaborate throughout the project," said Dr. Winn.
Last month, BCERC members met in Bethesda, Md., to discuss their progress and how to incorporate a transdisciplinary approach to improve their effectiveness. This involves jointly working to integrate discipline-specific concepts, methods, measures, and approaches to produce a new, more powerful conceptual framework for investigating breast cancer etiology.
"The vertical and horizontal integration of science is very much a central topic of focus now at NCI and across NIH," said Dr. Robert Croyle, DCCPS director. "How these centers integrate basic and epidemiologic science and the different types of evidence from each could provide a prototype to use in many different contexts and diseases."
To learn more about the BCERCs, visit www.bcerc.org.


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Hayward AQL-CHEM Sense and Dispense ORP and pH Sense, ORP Dispense
Short Description
The Hayward Sense and Dispense is an automation device that maintains ORP and pH levels in swimming pools.
Automatic Control Features:
The Hayward Sense and Dispense is an automation device that works in conjunction with Aqua Rite Pro or Pro Logic salt chlorination systems to maintain ORP and pH levels in swimming pools. Using preprogrammed intelligence, it continuously tests pool water by sampling pH and sanitizer activity before adjusting chemical feeding based on your pool's needs.
The Sense and Dispense's professional grade ORP probe samples water directly from your pool filtration system, sending signals to the salt chlorinator that depicts oxidation-reduction potential (ORP) as a way to determine water quality. Once the water quality of your pool is measured, the ORP probe instructs the Aqua Rite or Aqua Pro chlorinator to dispense a specific amount of pure chlorine, keeping your pool appropriately sanitized at all times. A pH probe is also included, and is designed to sample water and determine acidity levels.
The Hayward Sense and Dispense includes the Sense and Dispense system, an ORP probe, a pH probe, a probe cell, a Pro Logic Relay, pH dispense pigtails, a 15' cord and all the necessary tubing, tubing connectors, and mounting hardware for installation.
Please note: The Hayward Sense and Dispense is designed to work with the Aqua Rite Pro and Pro Logic systems. Its probes will detect pH levels, however, in order to self-regulate pH levels, the Hayward Sense and Dispense pH Dispense 120V Solenoid Valve for CO2 - AQL-CHEM2 OR the Hayward Sense and Dispense pH Dispense, 240V Solenoid Valve for CO2 - AQL-CHEM2-240 must also be purchased. It plugs directly into the pH dispense pigtails located on the Hayward Sense and Dispense and will distribute the appropriate amount of chemicals based on your pool's demand.
Frequently Bought Together


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The Seattle Seahawks hit the practice field for the second time since training camp opened and the biggest storyline was one of the players not participating.
Receiver Percy Harvin again sat out due to an injured hip. The Seahawks are hopeful that their new addition will avoid surgery, according to USA Today Sports. Surgery would make his return this season questionable. Harvin will seek a second opinion in New York on Tuesday.
In other news, this training camp is much different from last year's due to the fact that the Seahawks have a starting quarterback in place. Russell Wilson is in command of the offense and the chemistry doesn't have to be built.


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GREY'S ANATOMY - "Idle Hands" - As the hospital continues to make positive changes under the new management, the doctors begin to realize that owning a hospital comes with its own set of problems and responsibilities. Meanwhile, Meredith worries about the wellbeing of her unborn baby, Callie and Arizona try to get the spark back in their relationship, and Alex gives Jo's new boyfriend a run for his money.
Use a Facebook account to add a comment, subject to Facebook's Terms of Service and Privacy Policy. Your Facebook name, photo & other personal information you make public on Facebook will appear with your comment, and may be used on ABC's media platforms. Learn more.


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At the world-renowned AFI Conservatory, a dedicated
group of working professionals from the film and television
communities serve as mentors in a hands-on, production-based environment nurturing the talents of tomorrow's
With an emphasis on narrative visual storytelling and
personal expression, each class breaks into teams that
mirror a real production environment. Those teams
collaborate on and produce more films than any other
graduate level film program.
The 2015 application is now available!
If you have any questions about the application or the requirements, please contact the admissions office at 323.856.7628 or email@example.com.
AFI alumni are celebrating a banner year in critical recognition, including wins at the Academy Awards (Wally Pfister, INCEPTION, cinematography class of 1988), Emmy Awards (Dante Di Loreto, TEMPLE GRANDIN, producing class of 1991), Tony Awards (Anne Garefino, "The Book of Mormon," producing class of 1988) and the Grand Prizes at the Cannes Film Festival (Terrence Malick, TREE OF LIFE, directing class of 1969) and Sundance Film Festival (Drake Doremus, LIKE CRAZY, directing class of 2005). Most recently, multiple AFI alumni received 2011 Emmy Award nominations, including Patty Jenkins (THE KILLING, directing class of 2000), Anne Garefino (SOUTH PARK, producing class of 1988), Brad Falchuk (GLEE, screenwriting class of 1996), Dante Di Loreto (GLEE, producing class of 1991), Bradley Buecker (GLEE, directing class of 2003), Jeremy Podeswa (BOARDWALK EMPIRE, directing class of 1984), Manny Cotto (DEXTER, directing class of 1984) and Paul Starkman (TOP CHEF, cinematography class of 1998).
Established in 1969, the two-year Master of Fine Arts program provides training in six filmmaking disciplines: Cinematography, Directing, Editing, Producing, Production Design and Screenwriting. Mirroring a professional production environment, Fellows collaborate to make more films than any other graduate level program. Admission to AFI Conservatory is highly selective, with a maximum of only 140 graduates per year.
Over 4,100 artists have graduated from
the AFI Conservatory. Their collective work is a promise
fulfilled — to educate the next generation of filmmakers.
We invite you to join them.


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The hotel offers amenities like air-conditioned public areas, airport transportation (complimentary) , bar/lounge , business center ,multiple conference/meeting rooms , dry cleaning/laundry service ,fitness facilities , wired (high-speed) Internet access - surcharge ,parking (surcharge) ,porter/bellhop , and restaurant(s) in hotel . Pets not allowed .
The hotel rooms include air conditioning ,free local calls ,voice mail ,hairdryer ,iron/ironing board ,desk ,rollaway beds ,cable TV service ,flat-panel TV , and in-room safe (accommodates laptop) .
|Check-in Policy
|Check-out Policy
|# Of Rooms
|# Of Floors
Hotel B3
Bogota, Colombia Hotels & Resorts
Relax and recharge at Hotel B3 -- a cozy, comfortable business amenity hotel nestled in the heart of Bogotá....
Starting at $94 Per Night
Business Travel
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The highest level of personalized service and elegant touch have created eminent identify for each of its Hotels: Casa Medina Charleston Bogota Charleston Cartagena...
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Bh El Retiro
Bogota, Colombia Hotels & Resorts
The Hotel bh El Retiro is located two miles away from the Bogota El Dorado International Airport (BOG). ...
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Hotel Estelar Suites Jones
Bogota, Colombia Hotels & Resorts
Located in Bogota's financial area, this is definitely an extraordinary hotel with its own special charm, vibrate colors, and comfortable suites. ...
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Es By Hilton Bogota Rosales
Bogota, Colombia Hotels & Resorts
The five - star International-rated Embassy Suites Bogota - Rosales Colombia hotel located north of Bogota in the financial/commercial district is walking ...
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Hotel San Francisco
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The San Francisco Hotel located in Centro Historico, Bogota, Colombia is eight miles away from the El Dorado International Airport (BOG). ...
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Hotel Ms Oceania - Centro Internacional - Bogota
Bogota, Colombia Hotels & Resorts
The Hotel Ms Oceania is less than a mile from the Planetarium, the Modern Art Museum and the National Museum. It is a 20-minute drive from El Dorado International ...
Jazz Apartments
Bogota, Colombia Hotels & Resorts
Unique, modern and exclusive, Jazz Apartments is a proposed new housing in the best business and entertainment area of the city of Bogotá, surrounded by ...
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Hotel Estelar Windsor House
Bogota, Colombia Hotels & Resorts
The Hotel Estelar Windsor House is very close to Parque Del Chico and is seven miles away from the El Dorado International Airport (BOG). ...
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Hotel Porton Bogota
Bogota , Colombia Hotels & Resorts
Hotel Porton Bogota is ideally located in the north of the city, at the exclusive area of La Cabrera. ...
$218 Per Night
Adventure the Amazon with Turamazonas
Leticia, Colombia Eco Tours
We offer a wide variety of tours for everybody here in the Amazon region. Our specialty is deep jungle tours for the adventurer that wants to go all out on pure survival in the Amazon jungle. Visit three countries in one trip; Brazil, Colombia & Peru...
$200 Per Person
Learn Spanish & Volunteer in Amazonas - Colombia
Amazonia, Colombia Language Schools
Learn Spanish in Colombia. The Amazon Spanish College offers a opportunity to study Spanish, Amazon studies, volunteer and discover the Amazon rainforest. We offer spanish courses at all levels, free social and cultural activities and volunteer work....
Starting at $250 Per Week
Hostel Caldas
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Hostel Caldas is established in typical colonial style house of the nineteenth century, in calm and relaxing ambience, just 50 meters from the Plaza Caldas and close to the main attractions of Popayan....
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Visit Leticia and the amazon rainforest
Amazonia, Colombia Hotels & Resorts
Welcome to Amazonas. Stay in our comfortable bungalows in the heart of Leticia on the triple border between Colombia, Peru and Brazil and only few minutes away from the Amazon River and its spectacular eco-system. ...
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Luxury Apartments at Hostel Prices
Caribbean Coast, Colombia Youth Hostels
We offer the best of the Caribbean at hostel style pricing! We offer apartments out of season on the beaches of the Caribbean with incredible facilities at prices an average traveler can afford....
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Modern Furnished Apartment In Zona Rosa Bogota
Bogota, Colombia Vacation Rentals
Again Bogotainsider offering you the best furnished apartment rentals in Bogotá: Park 93, zona rosa, Santa Barbara. This apartment is located in zona rosa, is a modern, loft style 1 open bedroom, all inclusive, cleaning once per week....
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Luxury New Apartment in Bogota
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Brand new apartment in Bogota! This modernly furnished 3 bedroom apartment has everything you need for your next visit! Comfortably Sleeps 4 people- Master Bedroom with Double Bed and 2 additional rooms with a twin bed in each room. 2 Full Bathroom...
Furnished apartments cali colombia
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HABITA offers you a wide-range of living alternatives so that you may select that special apartment suited to all your needs and budget, classified by location in the city, areas and prices. All apartments are extremely well located and completely fu...
Starting at 116,789 Per Night
Alegria's Hostel
Bogota, Colombia Youth Hostels
Alegria�s Hostel B&B is located in the main historic, cultural, politic and touristic neighborhood in Bogota, La Candelaria...
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The Pit Stop Hostel
Medellin, Colombia Youth Hostels
The PitStop Hostel is situated five minutes walk from the Zona Rosa (bars/ clubs/ restaurants) of Medellin....
$11 Per Night
|Link Code


text:
Customised Card from previous range?
Were you looking for one of our cards but you landed here instead?
Every year Card Aid refreshes its range, so if you click though to a card from an external link or web search it may no longer be available. Sorry about that.
Follow the links below to browse our current range of:
Alternatively, you can contact us to see if a card from a previous range is still in stock in our warehouse.


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After this weekend many folks will be thinking "That sure is a lot of ham to get through". If you also have a bowl of coleslaw left over, get some good Rye or Pumpernickel bread and toss that ham and coleslaw in between 2 slices and go to town! Thinly sliced Swiss or Provolone adds a nice touch.
If you want your sandwich to stay looking like a sandwich, don't forget to butter your bread. That's even more important if you don't use cheese or your beautiful plate will look like the end of Easter dinner.


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September 21, 2014
The 28th Annual Broadway Flea Market & Grand Auction, which benefits Broadway Cares/Equity Fights AIDS, is held Sept. 21 in Shubert Alley and along W. 44th St., between Broadway and Eighth Avenue.
Vincent Kartheiser and Elisabeth Moss, who star on AMC's "Mad Men," are both headed for New York stages. With Peggy Olson and Pete Campbell headed for New York, Playbill.com wondered in what role Don Draper — a.k.a. Jon Hamm — should grace the Great White Way.
DIVA TALK: A Fall Diva Season Preview Plus Betty Buckley's Haunting "Ghostlight"
News, views and reviews about the multi-talented women of the musical theatre and the concert/cabaret stage.
Broadway on Location: Touring Real-Life Spots from West Side Story to In the Heights
Part Two of Playbill.com's spotlight on real-life New York locations featured in Broadway musicals.
STAGE PORTRAIT: Bedbugs!!! Stars Chris Hall, Grace McLean and Brian Charles Rooney
Acclaimed illustrator Ken Fallin's drawings of the greatest stars and scenes of the theatrical world are a recurring part of Playbill.com.
At Home With Aladdin's Adam Jacobs, a Disney Prince's Castle in Queens
Playbill.com's new column offers readers an exclusive inside look at the homes of Broadway's stars and behind-the-scenes movers and shakers.
THEIR FAVORITE THINGS: Shoplifters and Fish in the Dark Star Jayne Houdyshell Shares Her Theatregoing Experiences
A Fine Showmance: Kinky Boots Co-Stars Timothy Ware and Eugene Barry-Hill On Life Together, On and Offstage
PLAYBILL PLAYLIST: Varla Jean Merman and Members of Ryan Landry's Seven Bottoms Pick Novelty Songs
Musical comedy troupe The Gold Dust Orphans bring Ryan Landry's glitter-filled new musical Snow White and the Seven Bottoms to New York's Theatre 80: Varla Jean Merman, Landry and more pick novelty songs.
PLAYBILL VIP SPOTLIGHT: Students Explore Rage and Love in First College Production of American Idiot
The 2010 Tony Award-nominated rock musical American Idiot will be given its first college staging Sept. 26-Oct. 4 at Shenandoah University.
State Manager, Technical Diector
Roxy Regional Theatre
AD: Adults 18+ On-Camera Workshop with Huge L.A. CD
A Class Act NY
Mary Poppins, The Music Man, Measure for Measure, etc.
Stage Managers - 2 Plays, 1 Conversation reading series
NY Shakespeare Exchange
THE BOOK SHELF: Stanley Green's "Broadway Musicals" and Scripts of Provocative, Award-Winning Plays
The Good, the Bad and the Ugly: The Best and Worst Boyfriends on Broadway
Tom Stoppard Returns to Childhood Dreams with Rare Revival of Indian Ink
Marjorie Prime, With Lois Smith, Opens at Center Theatre Group/Mark Taper Forum Sept. 21
"I Could Have Danced All Night": The Top 10 Musical Theatre Showstoppers
PHOTO SPECIAL: Looking Back at Over 20 Years of Broadway Flea Market Memories
THE CALL BOARD: Upcoming Audition Listings
STAGE VIEWS: 50 Shades! Star Amber Petty On Les Misérables, Side Show, Angela Lansbury and More
Jake Epstein Departs Broadway's Beautiful Tonight; New Gerry Goffin in the Wings
Understudies from Beautiful, Mormon, Newsies and Cabaret Stand in the Spotlight Tonight
Uncle Vanya, Story of "Agony, Ecstasy and Absurdity," Opens at Pearl Theatre Company Tonight
Sing For Your Health! How Showtunes Improve Outlook For The Elderly
Lauren Pritchard and Julia Mattison Join "Rising Star" Alice Lee for Free Rockwood Concert Tonight
CELEBRITY BUZZ: Barbra Streisand's New Album, Angela Lansbury to Tour with Blithe Spirit, Rosie Back on "The View" and More
Josh Duhamel and Fergie Grooming "The Last Unicorn" as Broadway Musical
PLAYBILL ON OPENING NIGHT: Love Letters — A Very Special Delivery
Stockard Channing Temporarily Out of It's Only a Play On Doctor's Orders
PLAYBILL.COM'S THEATRE WEEK IN REVIEW, Sept. 13-19: Angela Lansbury Will Tour, Jessie Mueller Will Not; Plus Some Love Letters for Love Letters
"Smash" Star Megan Hilty and Actor Brian Gallagher Welcome First Child
Broadway's Chicago Will Welcome New Matron "Mama" Morton
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Roxane Farabi
From EastKingdomWiki
(Difference between revisions)
Phillip.reed (Talk | contribs)
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*[[Countess]], Sep 2002
*[[Countess]], Sep 2002
*[[Lady of the Rose]], Sep 2002
*[[Lady of the Rose]], Sep 2002
*Companion of the [[Maunche]], Nov 2001
*Companion of the [[Maunche]], Nov 2001
*King's Order of Excellence, Apr 2005
*King's Order of Excellence, Apr 2005
Revision as of 15:59, 27 January 2010
Duchess Roxane Farabi Shazadeh
|Awards & Offices
16th century Persian noblewoman
Offices & Positions
- Duchess, Sep 2003
- Countess, Sep 2002
- Lady of the Rose, Sep 2002
- Companion of the Maunche, Nov 2001
- King's Order of Excellence, Apr 2005
- Queen's Cypher (Svava), Apr 2005
- Valiant Tyger, Aug 2002
- Companion of the Burdened Tyger, Sep 2000
- Award of Arms, May 1988
Event Staff
- Youth Marshal at large-East Kingdom
- Heavy Marshal at large-Outlands and the East Kingdom
- Pennsic A&S staff 4 years (my sister and I organized and ran the first SCA fashion show at Pennsic)
- Chronicler-College of St. Golias (Outlands) and Shire of Blak Rose
- Herald-College of St. Golias (Outlands) and Shire of Blak Rose
- Knights Marshall-College of St. Golias (Outlands)
- Event autocrat-multiple events in the East and in the Outlands
- Apprentice - Baroness Katrina MacAulish
- Baron Afrasiyab al Isfahani
- Baronness Viennet de la Mer
- Student - Maîtresse Jehannine de Flandres
- Student - Lord Thorlaeifr Hvitskegg
Projects & Publications
Recent projects completed by myeself, students/apprentices as well as Baronness Catheryn Shadwell, Lady Eleanor, Lady Katheryn Fontaine, Lady Theresa and Lady Kay Fontaine:
- Regalia for our many friends has consumed our 'sweatshop' of late. Recent regalia projects:
-Pelican cope for Maîtresse Jehannine de Flandres
-Pelican cope for Master Ryan McWhite
- Viking outfit for Their Majesties Konrad II and Brenwen II
Current Projects:
- 13th century Mongolian-this is the culmination of research by myself and Master Safi Al Khansa over the last few years-male Mongolian 'trial piece' was completed last summer. I will be moving on to a more formal Male clothing this year with the hopes to teach at Pennsic, female 'trial piece' is the current project.
- 16th century Italian
Info coming soon!
Other people's memories of the individual
More Information
- [to come]


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David Yurman uses color fearlessly, combining gemstones in unconventional ways to create truly distinctive and captivating palettes. "Fashion has color moments," he says, "but the reality for me is it's not about trends. There are moments when you want something soft and muted, and moments when you want something deep and rich. I like the idea of mixing colors that you don't often see together, which might feel a bit odd, yet the result is refreshing."
Cerise means "cherry" in French. Round, shiny, and delectable, the fruit's name is apt for these sculptural designs that pay homage to the beautiful symmetry of the circle. In every piece, the center gemstone is highlighted by a bezel of diamonds, adding contrast, brilliance, and texture.


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By Roop RajFox 2 NewsDETROIT (WJBK) -- Detroit's top money experts, the budget and finance directors, asked the city council on Tuesday to help put a bandage on a bleeding pension fund that they discovered was under funded. It's the latest chapter in Detroit's own fiscal cliff."We're to a point now where I don't know that we can cut any more without really having a negative impact on services in the city, so there are things that we're going to have to do to change the trajectory," Mayor Dave Bing said by phone.The mayor is in San Francisco as part of a bet he lost after the Tigers were defeated in the World Series.The city itself is losing money, $84 million in the hole by June it's approximated. The first step is to figure out a way to budget for the pension fund. That's Wednesday morning."Many of these projects are worked on by the administration for weeks and months in advance, and then it's brought to council and they want us to vote on it in 24 hours when they've had 24 weeks, in some cases, to work on it," said council member Saunteel Jenkins.The idea of furlough days has been tossed around as a way to save the city some cash, but City Council President Pro Tem Gary Brown said that's not a long-term fix."Furlough days allow employees to maintain health care and benefits, so you don't create the savings you do with layoffs, and as draconian as that sounds, that's the reality. We have to save money, and furlough days we've already seen, at least on the surface, don't save us very much."So what's next? A group is being put together to tackle the financial crisis -- three members from the mayor's office and another three from city council. The council meets Wednesday morning to vote on a pension budget amendment. Then there's money the State of Michigan will release to Detroit, up to $30 million of bond money, if the city approves a contract to bring on the Miller Canfield law firm. Many on council don't want the firm on board. The mayor's office is encouraging them to approve it or the state may hold back that money."Hopefully council will be able to act up or down on the issues that we'll bring to the table, but we want to work collaboratively with council so that we can make the structural changes that are necessary," Bing said."The key for us right now is that we have to react, and that reaction really comes by us looking at furloughs and looking at layoffs," Deputy Mayor Kirk Lewis said.Lewis claims the city is not at risk of losing money in the month of December. In fact, he thinks they have enough cash to last until the spring, but it's time, he feels, to find long-term solutions.
KMSP-TV11358 Viking DriveEden Prairie, MN 55344
Phone: (952) 944-9999Fax: (952) 942-0455


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As tax regimes in our region become more developed, and as the appetite for international business transactions and agreements continues, our clients increasingly require a range of expanding tax services. In 2009 we moved to strengthen our role as trusted tax advisor, with the launch of our Middle East international tax services center of excellence.
Operating from its base in Dubai, the center is equipped by a growing team of experienced tax advisors, leveraging decades of international tax expertise. We provide regional businesses with a full suite of services that includes structuring groups with inbound and outbound investments within the Middle East, transfer pricing services, VAT services and transactional tax services.