text:
Improving Urban Services in Nairobi
A recent OED impact evaluation 1/ finds that five World Bank-supported urban services projects in Nairobi increased the supply of potable water and affordable housing to the poor, improved sanitation and environmental conditions in project sites, and increased access to social services.
The improved and expanded infrastructure brought critical water and sewerage services to rapidly growing business areas and poor neighborhoods in the eastern section of Nairobi, helping in the economic growth of the city. But the cost of water for the poor remained high because of the irregular pricing practices of kiosk operators. And homeownership among transient groups did not materialize as hoped, partly because the project had taken a top-down approach to project design, leading to an inaccurate assessment of the target groups' housing need. Finally, loan recovery for the housing projects was poor, showing once again that public agencies are less adept at collecting loans than private mortgage companies or nongovernmental organizations.
Among the lessons, the OED evaluation points to the importance of interspersing technical assistance projects between investment interventions to ensure that project activities are continually improved based on experience. Proper sequencing proved one of the strengths of the water supply projects, and the lack of technical assistance in the less successful housing projects an important weakness of those operations.
Project goals
Water supply projects
Until the 1970s, Nairobi's principal source of water supply was the Kabete Scheme, which for many years had managed to keep pace with demand. But the city's rapidly growing population and high water losses severely strained the aging system's capacity. Throughout the 1970s and early 1980s water shortages were common.
The First and Second Nairobi Water Supply projects (WS I and WS II), approved in 1970 and 1978 respectively, sought to expand the supply of water (by developing the new Chania Scheme), improve and expand the distribution of treated water, and improve the availability and affordability of water for the poor. An important consideration of WS II was cost recovery through setting progressive tariffs to ensure the financial viability of the Nairobi City Council's Water and Sewerage Department (WSD).
The Nairobi Third Water Supply Engineering Project, approved in 1985, provided strong technical assistance and training, primarily to develop WSD's capacity to prepare the third phase of the water supply investment project and to strengthen the department's operational efficiency and financial management.
The sequencing of the three water operations proved highly beneficial. First, the two investment projects were planned far enough apart to allow the lessons of the first to influence the design of the successor projects. Second, the technical assistance project that followed the two investment operations helped WSD make critical operational improvements. Even more important, the project helped WSD overcome key constraints on its ability to plan and implement the follow-on project.
Urban development projects
The Urban I and II projects (approved in 1975 and 1978 respectively) took an integrated approach to improving living conditions in three eastern sites in Nairobi. The projects sought to increase the supply of affordable housing to the poor, expand the sewerage system to project sites, and improve social services. A major objective was the promotion of homeownership among transient groups to reduce the proliferation of informal settlements, which the government continually destroyed.
The projects followed an incremental self-help model to promote homeownership. The projects sought first to provide enough serviced small lots to meet rapid growth in demand, thus tempering land-price increases. The projects would then make loans available for housing construction and renovation. Finally, with beneficiaries paying utility tariffs and municipal fees and making loan repayments, the city government would have the funds needed to operate and maintain infrastructure.
Urban I was to be the precursor to other sites and services projects in Kenya, serving as a model for government programs to provide urban shelter and infrastructure to low-income groups. The projects were complex, both in scope and design, requiring the involvement of different municipal departments with strong management and planning capacities. But unlike the water operations, the urban projects provided little if any technical assistance to strengthen the relevant city departments, even though the projects included technical assistance components. Institutional weakness thus continued, adversely affecting the proper implementation of project components. Moreover, the two projects closely overlapped, leaving little time for implementation experience to pass from one to the other.
All five projects achieved their physical objectives, albeit with long delays. But only for the water supply projects was outcome rated satisfactory at completion.
In 1994, OED evaluated the medium and long-term impacts of the projects. The five projects were evaluated together because they all focused on improving urban services to the poor, provided technical assistance to weak municipal departments, and were interconnected: water services were essential to the development of the housing schemes. The evaluation drew on a field survey of households, on-site observations of infrastructure facilities, key informant interviews, and a review of relevant documents and records to assess the impacts of the projects at the household, neighborhood, and city levels.
Water supply and sanitation
Water supply improved, as did the efficiency of the water supply system. The water supply projects have markedly improved the availability of water over the last 10-15 years, enabling supply to keep pace with population growth. From 1976-95, Nairobi's population increased almost threefold. During the same period, gross water availability increased from 165 liters per capita (lpc), to more than 200 lpc, and is expected to hover around 200 lpc to the year 2005 after which another expansion phase will be needed (see figure).
As the availability of water improved, the projects were able to expand the reticulation system into previously unserved and poorly served areas. Extensions under the two projects, including the construction of critical new mains, improved water service to the city center and for the first time expanded the water supply network into the eastern section of the city.
With assistance from the Engineering Project, WSD greatly improved the operation and maintenance of the water supply facilities of Nairobi. The project helped WSD install a metered zoning system to monitor water supply and pressure at delivery points. The system enabled WSD to control leaks and significantly reduce water losses, helping the department to avert critical water shortages during the late 1980s to mid-1990s. WSD also implemented a sound program for increasing metered house connections. Over the 15-year period, the customer-to-connection ratio has improved, indicating that supply expansion has more than kept pace with population growth.
The poor's access to treated water improved, but irregular practices kept costs high. To make water more accessible and affordable to the poor, WSD increased the number of water kiosks in lowincome areas from about 150 in 1978 to nearly 1,500 in 1994 and maintained a low tariff for kiosk operators. The increase in the number of kiosks reduced the distance to water sources, thus the time spent on obtaining water. Women in particular benefited from closer access, since they were the ones largely responsible for fetching water. The beneficiary survey revealed a high level of confidence in the quality of water, and most respondents indicated sufficient supply for basic hygiene, such as cleaning and bathing. But the number of households sharing the services of a single kiosk was still high. A single kiosk sometimes served as many as 50 households.
WSD sought to keep kiosk rates low by providing kiosk operators with water well below cost. And it introduced licensing to regulate operator practices. But licensing proved ineffective as a regulating mechanism; kiosk operators still charged up to six times the lowest rate for house connections. Consequently, WSD has turned to new approaches to lower water prices for the poor. In some neighborhoods residents have formed committees to manage their own kiosks; in others NGOs are becoming involved. WSD is encouraging both trends and is pursuing the possibility of installing house connections for the poor by establishing a funding mechanism for recovering the cost of the connections.
Projects improved sanitation and the environment, but poor maintenance and inadequate garbage collection threaten sustainability of benefits. Urban I completed a major expansion of Nairobi's sewerage system, including expanding coverage into project sites. With the new infrastructure the dumping of liquid waste in open drains has declined considerably, improving both health and environmental conditions in project sites. The water quality of the Nairobi River has also improved since 1987.
The vast majority of survey respondents now use water-borne toilets, a significant improvement in their standard of living from ten years ago when one-third used pit latrines. But access to private toilets has declined, increasing the number of households that must share toilet facilities. Moreover, the dumping of liquid waste in nonproject areas continues, posing serious health hazards that can ripple into the newly improved project areas. Poor maintenance of the sewer system and sanitation facilities poses another serious problem, which, along with woefully inadequate garbage collection, threatens the sustainability of the projects' benefits. The Department of Public Health can only collect about 20 percent of the estimated total amount of waste generated in Nairobi.
Social services
Access to social services improved, but efforts at employment generation failed. The urban projects increased beneficiaries' access to primary schools and health centers, although the impact was not uniform across project areas. All the schools promoted primary education for girls. Moreover, survey respondents indicated a trickle down effect in access to education, with children in nonplanned sites attending schools in a neighboring project site. But the projects' attempts at constructing market stalls to generate employment failed. Project designers had envisaged the construction of the stalls, but not the vendors' need for credit and business counseling. Land and housing markets
The urban projects had some of the demonstration effects sought by their designers. The increased supply of serviced small plots helped temper land-price increases in the project areas, helping to provide greater supply of affordable housing for low-income groups. Although prices initially escalated because of the improved infrastructure, increased supply kept the rate of price changes lower than elsewhere in Nairobi.
Although not their intended goals, the projects also significantly increased the supply of rental units and improved the efficiency of the rental market. Average rent has declined over the last ten years in Nairobi. But the percentage of owner-occupiers has also declined, contrary to the projects' expectations. Over the last ten years, almost the entire demand for housing has been satisfied through rentals, a trend the projects were unable to reverse for two reasons. First, the municipal department was unable to manage the allotment of property and housing appropriately, leading to unauthorized sales and land speculation, as well as homeownership dominated by absentee landlords instead of owner-occupiers. Second, the projects had incorrectly assumed that the majority of transient groups preferred to own their homes, while in reality most wanted to rent, intending to keep their rural residence as their permanent home.
Half of the original allottees were women, who benefited from the first phase of the program. However, selection criteria and the self-help model did not favor poor women, who had neither the required substantial down payment nor the skills to build on their property. As a result, women who were able to keep their plots tended to belong to higher income groups.
Institutional development
Capacity building. All five projects had technical assistance components to strengthen the capacity of the relevant municipal departments to plan, implement, and manage new investment projects. But only the Engineering Project provided a sufficiently strong technical assistance and training program to turn WSD into such an institution. The project helped the department create a more qualified pool of mid-level staff, reducing staff turnover and significantly improving staff efficiency, as demonstrated by the ratio of 8.5 staff to 1,000 connections. Although the operations and management capacity of WSD has improved over the past 10 to 15 years, gains made are likely to be compromised if the inadequate supply and deteriorating condition of the department's vehicles, equipment, and meter repair workshops are not addressed soon.
In contrast to WSD, none of the departments involved in implementing the urban projects received adequate support to improve institutional capacity. Their operations were badly hampered by staff inefficiency and lack of equipment.
Cost recovery. Cost recovery was an important objective of both the water supply and urban development projects, but only WSD managed to achieve financial viability through its costrecovery scheme. WS II helped the water department introduce a progressive block tariff structure that raised tariffs on average every two years between 1982 and 1993, by about 90 to 135 percent during 1987-93. The tariffs enabled WSD to earn an annual rate of return of 8 percent.
Cost recovery in the municipal housing projects has deteriorated steadily since 1980. By mid 1994 cumulative arrears in loan repayments reached 57 percent of the total amount due that year. The arrears were caused largely by the municipal government's deteriorating financial and administrative structure, which compromised its ability to contain delinquencies, increasing perceptions among homeowners that the enforcement terms were lax. Low-income housing projects managed by private mortgage companies and NGOs had a much better cost-recovery record (see box).
Lessons and recommendations
- Municipal services projects in weak institutional environments need strong and well-targeted technical assistance. Ensuring the sustainability of results requires interspersing technical assistance support with investment operations, as was done in the case of the water supply projects and was missing from the housing projects.
- Investment projects need to integrate various service provisions so that the benefits of an improved service (such as drainage) are not negated by the absence of improvements in another service (waste collection). Such coordinated interventions will reinforce the outcome of investments and the sustainability of benefits.
- Housing programs should include market analysis, which in Kenya would have enabled project designers to better balance the demand for owner-occupied and for rental housing. Programs should consider modifying the policy framework and regulations for housing development. And, they should promote cooperation with local NGOs and private mortgage companies experienced in housing the poor to help in loan recovery, enabling the program to maintain benefits and expand services. Beneficiary participation should be central to shelter projects. Participation requires fostering community cohesion, strengthening the community's capacity to focus on neighborhood management, and promoting employment generation. Trends in the availability of water in Nairobi, 1975-2005 Community participation in a small-scale project In Nairobi, the Undugu Society (an NGO) helped implement an urban shelter and services project comparable to Urban I and Urban II. In 1982, Undugu provided building-material loans of KSh 5,000 per unit and technical assistance to the urban poor for the self-help construction of 500 dwellings in Kitui Village. The remarkable performance of this project--cost recovery exceeded the amounts due--was attributed to the community's involvement and "ownership," the adoption of a business approach to shelter (subletting was a means for generating income), and the provision of technical and financial assistance. The conditions for sustainability were realized: a high level of community commitment and involvement and effective cost recovery.
1/ Impact evaluation: "Kenya: Development of Housing, Water Supply, and Sanitation in Nairobi," by Tauno Skytta and Jean-Francois Landeau. Report No. 15586, April 1996. Precis written by Farah Ebrahimi.
© 2012 The World Bank Group, All Rights Reserved. Terms and Conditions


text:
MUCH valuable time has been spent in discussing whether or not an acquired trait may be transmitted to descendants. As one moves along in life, he grows less and less sure of a conclusion. One instance clearly supports one side of the controversy--only to be flatly contradicted by a later instance.
Therefore I do not attempt to say how far a certain slender, dark-eyed boy was influenced by the fact that his father had a great interest in oratory and was himself a forceful speaker. Judge Bryan took his son with him to court, and the boy from his seat on the steps of the platform, listened to the arguments of the counsel and to the decisions of the bench.
The first recorded efforts of declamation show that at the age of seven or eight he committed to memory his geography lesson, and then was placed on a little table where he declaimed the same.
Looking through our letters, I find light upon the feeling which he had for his father.
"Our church has no pastor, so we had a kind of prayer meeting in the forenoon on Sunday. I spoke. Afterwards Mr. Chance (Jakie's father) said: 'While our young brother was speaking, I thought of his good old father. How he used to encourage us by repeating the promises of the Bible, and my heart went up in silent prayer that the mantle of Elijah might fall on Elisha, and then I prayed that he might become a shining light and that his influence might be felt far and wide for good.' I tell you, I could not help weeping, nor was I alone, for I felt so un-

subset: commoncrawl


text:
KEYWORDS: asbestos, mesothelium, malignant pleural mesothelium, pleural effusion, talc poudrage
- Kelly Hubbard
- 3 years ago
- Views:
1 J Fran Viet Pulm2011; 02(02): JFVP. All rights reserved. JOURNAL FRANCO-VIETNAMIEN DE PNEUMOLOGIE Journal of French-Vietnamese Association of Pulmonology REVUE GENERALE Mesothelioma in 2010 Mesothéliome en 2010 Y. Aelony Clinical Professor, Harbor UCLA, Los Angeles, California - USA SUMMARY Over 80% of malignant pleural mesothelium (MM) cases are linked to occupational exposure to croccidolyte asbestos. The natural history of MM is quite variable, although many studies suggest an average of 6-12 months survival. A study of untreated MM, however, showed a 5 year survival of 8%. Most cases present with a unilateral pleural effusion with a lymphocytic predominant exudate. Other cases may present with localized or diffuse pleural masses. Medical thoracoscopic talc poudrage under local anesthesia (TTP) resulted in a 19-month median survival (mean 24 months) for consecutive MM patients presenting with pleural effusion. Medical thoracoscopic talc poudrage under local anesthesia (TTP) resulted in a 19-month median survival (mean 24 months) for consecutive MM patients presenting with pleural effusion. Chemotherapy with platins and antifolates improved survival by over 2 months compared to platins alone, but quality of life declined during therapy. Optimal management of this uncurable disease remains uncertain, in the absence of controlled studies. KEYWORDS: asbestos, mesothelium, malignant pleural mesothelium, pleural effusion, talc poudrage RESUME Plus de 80% des cas de mésothéliomes pleuraux malins (MM) sont liés à l exposition professionnelle à l amiante. L incidence du MM continuera à s accroître au Viet Nam dans les 20 à 30 ans depuis l importation et l usage de l amiante, en particulier dans la construction et la contruction navale, au cours des dernières décennies en Asie. L histoire naturelle du MM est assez variable, malgré de nombreuses études suggérant une survie moyenne de 6 à 12 mois. Néanmoins, une étude sur les MM non traités a montré un taux de survie à 5 ans estimé à 8%. De nombreux cas de MM se présentent avec une pleurésie unilatérale exsudative à prédominance lymphocytaire, d autres avec des masses pleurales localisées ou diffuses. Le talcage pleural sous anesthésie locale aboutit à une médiane de survie de 19 mois (moyenne de 24 mois) pour des patients consécutifs présentant un épanchement pleural. La chimiothérapie à base de platines et d antifolates a prolongé la durée de survie de 2mois comparé aux platines seules, mais la qualité de vie a diminué au cours de la cure. La prise en charge optimale de cette maladie incurable demeure incertaine en l absence d études contrôlées. MOTS CLES: asbestose, mésothéliome, mésothéliome pleural malin, épanchement pleural, talcage pleural Auteur correspondant: Pr Yossef AELONY. Clinical Professor, Harbor UCLA, Los Angeles, California - USA 11
2 Y. AELONY MESOTHELIOMA IN 2010 INTRODUCTION Malignant pleural mesothelioma is a relatively rare malignancy, affecting only 2000 to 3000 patients in the United States in recent years. Its importance is augmented, however, by the inadequacy of effective treatments, which so far have resulted in no apparent cures. Public interest has focused on its causation, since approximately 80% of cases are related to occupational exposure to amphibole asbestos (usually blue asbestos known as crocidolite). This product was widely used in the 20 th century for insulation in the shipping industries, in pipefitting, in production of automobile brakes, mixed in cement, and in many other applications. Although use of amphibole asbestos has been curtailed in recent decades, the delay in manifestation of disease for 20 to 60 years has lead to an increasing incidence. This is especially true in Europe, where the incidence of mesothelioma is not expected to peak for another ten years. One estimate suggests 1% of all European deaths in males born in the 1940s will be associated with mesothelioma in In Asia, a similar peak incidence in 2020 may be surmised. However, the diagnosis of this pleural -based disease requires an informed physician community and highly specialized pathologists. In countries where smoking is widespread, lung cancer is much more common and the less-familiar mesothelioma is underdiagnosed. In Vietnam, where new -onset tuberculosis (TB) occurs in 150,000 people annually, malignant pleural mesothelioma would seem less important. The World Health Organization has estimated that perhaps 775 cases annually of mesothelioma ought to be found in Vietnam. While this number is relatively small, nearly all cases die within a few years, whereas most of those afflicted with tuberculosis, for instance, will survive, if given appropriate therapy. The 20% of mesothelioma patients who deny any asbestos exposure presumably have been exposed to other fibers. In addition, high dose irradiation can induce mesothelioma after many years and genetic factors also play a role in pathogenesis of the disease. It is believed (& hoped) that chrysotile asbestos, which is still massively mined, does not cause mesothelioma when inhaled. under direct vision through the thoracoscope reveals an epithelial pattern in about 80% of the patients. The remainder have a spindle cell or fibrosarcomatous pattern, which may be mixed with epithelioid cells. The greater the presence of fibrosarcomatous cells, the worse the prognosis. The diagnosis of malignant pleural mesothelioma has been difficult even for experienced pathologists, so we have sent all of our suspicious specimens to an international committee of experts for review. NATURAL HISTORY An international survey of malignant pleural mesothelioma in 1982 revealed that the median survival after diagnosis was only 6-12 months [1]. This figure has been used by some investigators to prove that their patients benefited from various treatments, whenever they lived longer than 12 months. This has thus far led to false conclusions, since, as in many tumors, there are wide variations in the aggressiveness of the disease. The wise investigator selects the best early-stage candidates for aggressive treatment. When these patients live longer than 12 months, investigators falsely conclude that the prolonged survival is due to the treatment rather than the natural course of the disease. The only way to avoid this selection bias is to randomize patients into treatment and non-treatment groups for comparison, which has rarely been done in this disease. Rather than assuming a 6-12 month survival, one has to look to a study by Law in 1984 that found that 8% of untreated patients lived for 5 years [2]. One of these patients lived for 16 years with no treatment. Thus, controlled phase III studies are necessary to establish benefits for a given treatment. CLINICAL PRESENTATION AND PATHOLOGY Most patients with malignant pleural mesothelioma will present with shortness of breath, due to the presence of a unilateral exudative, lymphocyticpredominant pleural effusion, which usually recurs if removed by thoracentesis. As the disease advances, the patients present with no effusion but with pleural masses. Biopsy of the parietal pleura with a closed biopsy needle (Cope or Abrams) or FIGURE 1. Postmortem view of mesothelioma. Note circumferential thickening of parietal pleura and early invasion of lung via the fissure. 12
3 MESOTHELIOMA IN 2010 DIAGNOSIS Diagnosis in the past was largely made by thoracocotomy. However, in the 21 st century clinical suspicion and biopsy by less invasive means have taken precedence, and thoracotomy should be reserved for research centers that are trying new modalities of therapy. A major search is underway for serum markers of early mesothelioma that would permit earlier detection and treatment of the disease. So far Epithelial membrane antigen (EMA), Mesothellin, Osteopontin, & Podoplanin have shown promise but have sensitivities and specificities less than 80% [3]. Today, closed or thoracoscopic parietal pleural biopsy are the mainstay of diagnosis. STAGING OF DISEASE Staging is very important in advising the patient of his immediate prognosis and in making prelimary comparisons between the results of published studies. It is also used to assess patients for aggressive surgical therapy. Staging has been unsatisfactory partly because the natural tendency in the last century was to assume that malignant pleural mesothelioma acts like lung cancer. However, since this disease arises in the parietal pleura not the lung, its progression is different from lung cancer, which begins in the parenchyma and moves sequentially to the locoregional lymph nodes and then metastasizes Y. AELONY to the mediastinum and throughout the body. Contrarily, mesothelioma in the parietal pleura drains directly to the mediastinum nodes via lymphatics, perhaps explaining why mesothelioma has not been cured by early detection: the tumor appears to spread widely via lymphatics prior to any symptoms, thus prior to diagnosis and treatment. When the tumor is grossly confined to the parietal pleura, the prognosis is better as it is earlier in the course of the illness. This is stage Ia by the International Mesothelioma Interest Group (IMIG) protocol [4]. Survival is shorter as soon as it invades the visceral pleura, (stage Ib) or the lung (stage II). Visible unilateral lymph node involvement in the mediastinum or invasion of the chest wall, pericardium, or diaphragmatic muscle is stage III, with a still worse prognosis. Aggressive surgeons argue that they can remove all the visible tumor at this stage, although until now it has always recurred afterwards. Stage IV includes contralateral involvement, distant metastatic disease, or whenever extensive disease cannot be grossly removed surgically. The usual staging procedures in lung cancer have proved misleading in malignant pleural mesothelioma. CT scans miss 16% of nodes seen at mediastinoscopy. Mediastinoscopy failed to find + lymph nodes which were seen at thoracotomy later in 2/3 of cases [5]. So thoracotomy seems to be necessary for accurate staging. But until thoracotomy can be shown to have a survival benefit, it may be inhumane to do a thoracotomy at this time, with the FIGURE 2. CT scan shows circumferential disease surounding the lung. FIGURE 3. PET scan. Note that mesothelioma begins in the parietal pleura, rather than in the lung, as in lung cancer. It eventually tracks along the fissures & invades the lung parenchyma. FIGURE 4. Typical nodules on the parietal pleura. Early disease may show only nonspecific findings which progress to a carpet of tumor obliterating all the normal features. FIGURE 5. Epithelioid mesothelioma pattern, seen in up to 80% of malignant pleural mesothelioma. FIGURE 6. Sarcomatoid pattern of malignant pleural mesothelioma which is less frequent than the epithelioid pattern and tends to progress more rapidly. 13
4 Y. AELONY MESOTHELIOMA IN 2010 possible exception being as part of a prospective randomized phase III therapeutic trial. Prognostication (i.e. staging) is currently being refined in nonsurgical groups in chemotherapy trials [6-8]. Curran et al. [6] showed a statistically significant difference in survival using the European Organization of Research and Treatment of Cancer criteria: negative prognostic factors included a white blood cell count > /ml, Eastern Cooperative Oncology Group performance status 1, sarcomatoid tumor cell type, male sex, and probable versus possible histologic diagnosis versus definite diagnosis. Three or more of these factors defined the high-risk group. Median survival was 10.8 months in the low-risk group and 5.5 months in the high-risk group (p = ). Similar findings were detected using the Cancer and Leukemia Group B staging scheme, in which patients were grouped by similar prognostic factors, including performance status, chest pain, dyspnea, platelet count > 400,000/μl, weight loss, serum lactate dehydrogenase level > 500 IU/l, pleural involvement, low hemoglobin level, high white blood cell count, and age > 75 years (versus age < 49 years) [8]. A preliminary study on positron emission tomography (PET) scanning reports that the intensity of 18 F- fluoro-deoxyglucose uptake was superior to histological grade (well-differentiated versus poorly differentiated tumor) in predicting survival [9]. Moreover, the distribution of uptake correlated well with tumor burden observed at surgery. The importance of PET scanning when considering extrapleural pneumonectomy was also emphasized, because presence of extrathoracic disease contraindicates a surgical attempt at cure. Recently, tumor necrosis which correlated with angiogenesis was shown to be an independent indicator of poor prognosis [10]. Whereas the median survival was 8.3 months for patients whose specimens failed to show tumor necrosis, median survival was 5.3 months for patients whose biopsy did show tumor necrosis (p = 0.008). The difference was even greater with epithelial mesothelioma. We recently demonstrated that pleural ph is an important staging modality in malignant epithelial mesothelioma, with ph above 7.32 predicting twice the mean survival rate as ph < 7.32 (13 versus 26 months) [11]. The pleural ph must be quickly determined with the same accuracy as arterial ph, using calibrated blood gas machines. Use of urine test tapes for pleural ph has been shown to be too insensitive for this use. Unfortunately, no one yet has sought to stage patients prospectively using all of the above noninvasive modalities. TREATMENT Many options have been tried with variable survival [12]. 1. No treatment or palliation only was associated with 18 month survival after onset of symptoms and 8% of 5 year survival [2]. 2. Thoracoscopic Talc Pleurodesis: up to 19 month median survival [13]. 3. Thoracoscopic Talc Pleurodesis in stage Ia disease : 33 months median survival [14]. 4.Pleurectomy in stage I disease: 34 month survival [15]. 5. Pneumonectomy, radiation therapy, and chemotherapy have been tried separately or as combined trimodality treatment, with variable results [12,16]. 6. Trimodality : 1% of 5 year survival if all patients evaluated are included in the denominator [16]. As indicated previously, all studies are difficult to generalize due to conscious or unpreventable selection of patients. Many studies do not compare their survivals to the survival of the patients who were refused entry into the study. Palliative treatments have been recommended as being most humane, since virtually no cures have occurred. Hospice care has greatly helped patients and most important the patient needs to be followed by a physician team who are both well informed about the disease and sympathetic to patient complaints [12]. Thoracoscopic talc poudrage (pleuroscopy under local anesthesia) has been shown to have a % effectiveness in preventing recurrence of pleural effusion for months to years afterwards [13, 14]. Survival is related to the stage of disease [11, 14]. There is no proven anti-neoplastic effect of talc, but it clearly is the most effective pleurodesic agent studied so far in malignant pleural mesothelioma. Research scientists have shown apoptosis effects of talc in vitro, but these studies have so far not been accepted as relevant to the human disease [17]. Indwelling catheters to drain pleural effusion have been used in lieu of talc pleurodesis, especially in advanced disease with a short life-expectancy. Published data shows that this is an option even for patients who are not yet in a terminal condition, but the mesothelioma survivals published are much shorter than those treated with talc poudrage; furthermore, those who spontaneously pleurodesed during long-term catheter drainage lived 3.5 times longer than those who did not pleurodese, suggesting that pleurodesis itself may prolong life in malignant effusions [18, 19]. Reports of mesothelioma pleurodesis with agents other than talc are so rare that presumably they have been tried and failed. Tetracycline specifically has been shown to be ineffective in the pleural ph range of most mesotheliomas [20]. Decortication of visceral pleura and parietal pleurectomy has been described in early stage mesothelioma [15]. This has a lower morbidity and mortality than extrapleural pneumonectomy. 14
5 MESOTHELIOMA IN 2010 The 34-month survival was ascribed to the surgical treatment, but this was not significantly better than simple thoracoscopic talc poudrage in stage Ia patients-33 months [14]. Both studies confirm that limiting patients to those with early stage disease results in a longer survival after the procedure. The staging at thoracotomy is more accurate than at thoracoscopy, so it would not be possible to conclude that the two approaches are equally effective without doing a prospective randomized study. Radiation therapy (XRT) is very effective at suppressing mesothelioma outgrowths to the chest wall along the needle track of prior thoracentesis or a surgical procedure, but is ineffective in controlling the internal disease because it is very widespread already at the time of presentation. Some centers offer 4000 rads of prophylactic irradiation to any needle or surgical tract in mesothelioma, but we found only 1 outgrowth in 40 mesothelioma thoracoscopies (unpublished data), so we reserve XRT for the occasional symptomatic outgrowth. Chemotherapy has been very disappointing with responses of less than 25%. Recently, combining Pemetrexed (& other anti-folates) with cis-platin (& other platins) has been endorsed by oncologists who found that those taking both drugs lived about 2 months longer than those who took only cis-platin [21]. However, the few quality of life studies published with these drugs & their congeners suggest that most patients experience fatigue, 15 % have nausea & vomiting, & a significant number have hematological & other life-threatening side effects. All but one study failed to systemically control pleural effusions with talc poudrage; a major benefit of most studies was relief of dyspnea, which could have been controlled by the non-toxic talc poudrage. The failure to do pleurodesis prior to chemotherapy biases nearly all the studies reported. We sorely need prospective randomized studies of talc poudrage versus combined chemotherapy. Extrapleural pneumonectomy and thoracic surgery in general have made tremendous strides in the past Y. AELONY 30 years, reducing 30 day mortality from about 30% to only 5-10% in most recent studies, from the centers where this kind of aggressive therapy is performed on a regular basis [16]. This surgery requires reconstruction of the diaphram and partial removal of the pericardium. The most experienced surgical team, at the Harvard Medical School in Boston still reported in 2010 major morbidity in 35% of patients, 12% vocal cord paresis, 5% tracheostomy, reoperation for bleeding in 4%, empyema 5% [22]. Other studies have noted < 10% reoperations for rupture of the repaired diaphragm [23]. In the past, frequent suicide in operated patients was reported but recent data is unavailable. The survival data are difficult to credit in the large 1999 study because there was only a mean 13 month followup [16]. The published long-term survivals were statistical estimates rather than true values. They reported 50% 5 year survival in early stage disease, those with < 1cc of residual tumor after surgery. But their 50% represented only 7 of 14 patients followed for 5 years. The discussion of the paper brought out that they interviewed between 700 and 800 mesothelioma patients in order to select about 183 patients for surgery. FIGURE 10. My survival curve for consecutive patients receiving talc poudrage compared to all other malignant pleural mesothelioma patients in my institution who were not referred for talc poudrage. FIGURE 7. Typical medical thoracoscopy (pleuroscopy) suite. FIGURE 8. Talc insufflator. FIGURE 9. Talc is applied directly to the pleural surfaces to enhance pleurodesis. 15
6 Y. AELONY MESOTHELIOMA IN 2010 paper brought out that they interviewed between 700 and 800 mesothelioma patients in order to select about 183 patients for surgery. Thus the 7 patients actually alive after 5 years only represented 1% of the total, compared to 8% in untreated patients [2]. The former patients had trimodality therapy and it is impossible to allocate which, if any, of the 3 modalities was most important. FIGURE 11. Most patients present with a pleural effusion which develops slowly over many weeks to months, but which recurs quickly after drainage. After 11 years, the actual survival data on the cohort of 183 operations has not been reported. A prospective study comparing surgical and non-surgical treatments has been initiated in the United Kingdom, and may be reported in Simple debulking of mesothelioma surgically to increase effectiveness of chemotherapy seems logical but has not been shown to prolong survival or improve quality of life. Gene therapy and interferon gamma have shown promise in a few examples of very early disease, but research is still in its infancy. I had a patient who was asymptomatic while working fulltime in construction for 4 years after talc poudrage alone. Undoubtedly, he had a slow growing process. Clearly some mesotheliomas are slow growing, so a handful of selected patients who have longer survivals after treatment must be considered as only possible beneficiaries of the treatment. CONCLUSION FIGURE 12. Xrays illustrate the absence of pleural fluid 7months after talc poudrage. Thus the 7 patients actually alive after 5 years only represented 1% of the total, compared to 8% in untreated patients [2]. The former patients had trimodality therapy and it is impossible to allocate which, if any, of the 3 modalities was most important. The survival data are difficult to credit in the large 1999 study because there was only a mean 13 month followup [16]. The published long-term survivals were statistical estimates rather than true values. They reported 50% 5 year survival in early stage disease, those with < 1cc of residual tumor after surgery. But their 50% represented only 7 of 14 patients followed for 5 years. The discussion of the In conclusion, we have shown that survival is short, but variable in this unfortunate disease process. Diagnosis requires a high index of suspicion and sophisticated pathological analysis. Some patients have an indolent form of the disease and live for several years, even without treatment. Treatment considerations should be focused on symptoms, with thoracoscopic talc poudrage creating a demonstrated benefit in quality of life, by relieving dyspnea. Aggressive treatment with surgery, irradiation, and chemotherapy should ideally be limited to research centers doing prospective studies, since the putative benefits are uncertain and information is not available to completely allow balancing of side effects and hazards of treatment (as in immediate death from surgery or chemotherapy complications) with quality of life and length of survival. Hopefully future phase III studies will demonstrate some beneficial treatments of this disease. In both industrialized countries and countries with emerging economies, scarce monetary resources should be funneled to research centers, to humane hospice care programs, and to measures that further limit exposure to amphibole asbestos. 16
7 MESOTHELIOMA IN 2010 Y. AELONY CONFLICT OF INTEREST No conflict of interest. REFERENCES 1. Hillardal G. Malignant Mesothelioma 1982: review of 4710 published cases. Br J Dis Chest 1983; 77: M R Law, A Gregor, M E Hodson, H J Bloom, and M Turner-Warwick Malignant mesothelioma of the pleura: a study of 52 treated and 64 untreated patients. Thorax 1984; 39(4): Robinson BWS et al. Mesothellin-family proteins and diagnosis of mesothelioma. Lancet 2003; 362: Rusch VW. A proposed new international TNM staging system for malignant pleural mesothelioma. From the International Mesothelioma Interest Group. Chest 1995; 108: Rice et al. Extended surgical staging for potentially resectable malignant pleural mesothelioma. Ann Thorac Surg 2005; 80: Curran D et al. Prognostic factors in patients with pleural mesothelioma: the European Organization for Research and Treatment of Cancer Experience. J Clin Oncol 1998; 16: Herndon JE, Green MR, Chahinian AP, Corson JM, Suzuki Y, Vogelzang NJ: Factors predictive of survival among 337 patients with mesothelioma treated between 1984 and 1994 by the Cancer and Leukemia Group B. Chest 1998; 113: Edwards JG, Abrams KR, Leverment JN, Spyt TJ, Waller DA, O Byrne KJ: Prognostic factors for malignant mesothelioma in 142 patients: validation of CALGB and EORTC prognostic scoring systems. Thorax 2000; 55: Gerbaudo VH, Britz-Cunningham S, Sugarbaker DJ, Treves ST: Metabolic significance of the pattern, intensity and kinetics of 18 F-FDG uptake in malignant pleural mesothelioma. Thorax 2003; 58: Edwards JG, Swinson DE, Jones JL, Muller S, Waller DA, O Byrne KJ: Tumor necrosis correlates with angiogenesis and is a predictor of poor prognosis in malignant mesothelioma. Chest 2003; 124: Aelony Y, Yao J, King R. 'Prognostic Value of Pleural Fluid ph in Epithelial Malignant Mesothelioma after Talc Poudrage. Respiration 2006; 73: Aelony Y: Treatment of mesotheliomatous pleural effusion: experimental therapy versus thoracoscopic talc poudrage? Pro: talc poudrage therapy. J Bronchol 2001; 8: Aelony Y, Yao J. Prolonged survival after talc poudrage for malignant pleural mesothelioma: case series. Respirology 2005; 10: Boutin C et al. Thoracoscopy in pleural malignant mesothelioma: A prospective study of 188 consecutive patients. Part 2: Prognosis and staging. Cancer 1993; 72/2; Rusch VW, Venkatraman ES. Important prognostic factors in patients with malignant pleural mesothelioma, managed surgically. Ann Thorac Surg 1999; Sugarbaker DJ, Flores RM, Jaklitsch MT, Richards WG, Strauss GM, Corson JM, et al: Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg 1999; 117: 54 63; discussion Najmunnisa N, Mohammed KA, Brown S, et al. Talc mediates angiostasis in maligant pleural effusions via endostatin induction. Eur Respir J 2007; 29: Tremblay A, Michaud G. Single-center experience with 250 tunneled pleural catheter insertions for malignant pleural effusion. Chest 2006; 129: Aelony Y. Tunneled pleural catheters in malignant pleural effusion (letter). Lancet 2007: 370; Sahn SA, Good JT Jr: Pleural fluid ph in malignant effusions. Diagnostic, prognostic, and therapeutic implications. Ann Intern Med 1988; 108: Vogelzang NJ, Rusthoven JJ, Symanowski J, Denham C, Kaukel E, Ruffie P, et al: Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol 2003; 21: Wolf et al. characteristics of malignant pleural mesothelioma in women. Ann thorac Surg 2010; 90: Byrne JG, Karavas AN, Colson YL, Bueno R, Richards WG, Sugarbaker DJ, Goldhaber SZ. Cardiac decortication (epicardiectomy) for occult constrictive cardiac physiology after left extrapleural pneumonectomy. Chest 2002; 122(6):
JFVP. Mesothelioma in 2010 Mésotheliome en 2010. Tạp Chí Hô Hấp Pháp-Việt. Revue générale (en anglais) Y. Aelony
JFVP Journal Franco-Vietnamien de Pneumologie Tạp Chí Hô Hấp Pháp-Việt Volume 2 - Numéro 1; Janvier 2011 Revue générale (en anglais) Mesothelioma in 2010 Mésotheliome en 2010 Y. Aelony Clinical Professor,More information
بسم هللا الرحمن الرحيم
بسم هللا الرحمن الرحيم Updates in Mesothelioma By Samieh Amer, MD Professor of Cardiothoracic Surgery Faculty of Medicine, Cairo University History Wagner and his colleagues (1960) 33 cases of mesotheliomaMore information
Mesothelioma. Malignant Pleural Mesothelioma
Mesothelioma William G. Richards, PhD Brigham and Women s Hospital Malignant Pleural Mesothelioma 2,000-3,000 cases per year (USA) Increasing incidence Asbestos (50-80%, decreasing) 30-40 year latencyMore information
Extrapleural Pneumonectomy for Malignant Mesothelioma: Pro. Joon H. Lee 9/17/2012
Extrapleural Pneumonectomy for Malignant Mesothelioma: Pro Joon H. Lee 9/17/2012 Malignant Pleural Mesothelioma (Epidemiology) Incidence: 7/mil (Japan) to 40/mil (Australia) Attributed secondary to asbestosMore information
Objectives. Mylene T. Truong, MD. Malignant Pleural Mesothelioma Background
Imaging of Pleural Tumors Mylene T. Truong, MD Imaging of Pleural Tumours Mylene T. Truong, M. D. University of Texas M.D. Anderson Cancer Center, Houston, TX Objectives To review tumors involving theMore information
Mesothelioma. 1. Introduction. 1.1 General Information and Aetiology
Mesothelioma 1. Introduction 1.1 General Information and Aetiology Mesotheliomas are tumours that arise from the mesothelial cells of the pleura, peritoneum, pericardium or tunica vaginalis [1]. Most areMore information
Malignant Mesothelioma
Malignant Malignant mesothelioma is a tumour originating from mesothelial cells. 85 95% of mesotheliomas are caused by asbestos exposure. It occurs much more commonly in the chest (malignant pleural mesothelioma)More information
Malignant Mesothelioma
Malignant mesothelioma is a tumour originating from mesothelial cells. 85 95% of mesotheliomas are caused by asbestos exposure. It occurs much more commonly in the chest (malignant pleural mesothelioma)More information
Sternotomy and removal of the tumor
Sternotomy and removal of the tumor All thymomas originate from epithelial thymic cells 4% of them consist of a pure population of epithelial cells Most have mixed populations of lymphoid cells to aMore information
Understanding Pleural Mesothelioma
Understanding Pleural Mesothelioma UHN Information for patients and families Read this booklet to learn about: What is pleural mesothelioma? What causes it? What are the symptoms? What tests are done toMore information
Mesothelioma: Questions and Answers
CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Mesothelioma: QuestionsMore information
L Lang-Lazdunski, A Bille, S Marshall, R Lal, D Landau, J Spicer
Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine and systemic chemotherapy in malignant pleural mesothelioma. A 10-year experience. L Lang-Lazdunski, A Bille, S Marshall, R Lal,More information
Therapy of pleural effusions Modern techniques
Therapy of pleural effusions Modern techniques Dr. Melanie Toffel Sugery of the chest Pleural effusion Ethiology In the normal pleural space there is a steady state in which there is a roughly equal rateMore information
Update on Mesothelioma
November 8, 2012 Update on Mesothelioma Intro incidence and nomenclature Update on Classification Diagnostic specimens Morphologic features Epithelioid Histology Biphasic Histology ImmunohistochemicalMore information
Malignant Mesothelioma State of the Art
Malignant Mesothelioma State of the Art Paul Baas The Netherlands Cancer Institute August 12, 2011, Carlsbad, CA Summary Diagnosis; epithelial type subdivided Pleiomorphic vs other Staging: IASLC-IMIGMore information
Round Table with Drs. Anne Tsao and Alex Farivar, Case 2: Mesothelioma
Round Table with Drs. Anne Tsao and Alex Farivar, Case 2: Mesothelioma I d like to welcome everyone, thanks for coming out to our lunch with experts. The faculty today are great people in the thoracicMore information
Malignant Mesothelioma Current Approaches to a Difficult Problem. Raja M Flores, MD Thoracic Surgery Memorial Sloan-Kettering Cancer Center
Malignant Mesothelioma Current Approaches to a Difficult Problem Raja M Flores, MD Thoracic Surgery Memorial Sloan-Kettering Cancer Center Malignant Pleural Mesothelioma Clinical Presentation InsidiousMore information
MESOTHELIOMA. Not Just a Late Night Commercial. Graciela Hoal, RN, MSN, ACNP-BC
MESOTHELIOMA Not Just a Late Night Commercial Graciela Hoal, RN, MSN, ACNP-BC Saturday Session Thoracic Surgery Nurse Practitioner Greater Los Angeles Veteran Affairs Objectives Course Objectives: DiscussMore information
For media outside the US, UK and Canada only P L E U R A L M E S O T H E L I O M A 1. Overview 2. What is pleural mesothelioma? 3. How common is pleural mesothelioma? 4. What are the risk factors for pleuralMore information
Management of mesothelioma
Management of mesothelioma email@example.com Amsterdam, March 6, 2010 1 management Palliation Symptomatic care Pain Breathlessness Radiotherapy Chemotherapy Surgery Radical (intention to cure)More information
Screening, early referral and treatment for asbestos related cancer
Screening, early referral and treatment for asbestos related cancer Marc de Perrot, MD, MSc, FRCSC Toronto Mesothelioma Research Program University of Toronto Asbestos related diseases Mesothelioma LungMore information
Disease/Illness GUIDE TO ASBESTOS LUNG CANCER. What Is Asbestos Lung Cancer? www.simpsonmillar.co.uk Telephone 0844 858 3200
GUIDE TO ASBESTOS LUNG CANCER What Is Asbestos Lung Cancer? Like tobacco smoking, exposure to asbestos can result in the development of lung cancer. Similarly, the risk of developing asbestos induced lungMore information
Treatment of mesothelioma in Bloemfontein, South Africa
European Journal of Cardio-thoracic Surgery 24 (2003) 434 440 www.elsevier.com/locate/ejcts Treatment of mesothelioma in Bloemfontein, South Africa W.J. de Vries*, M.A. Long Cardiothoracic Department,More information
GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER BY Ali Shamseddine, MD (Coordinator); firstname.lastname@example.com Fady Geara, MD Bassem Shabb, MD Ghassan Jamaleddine, MD CLINICAL PRACTICE GUIDELINES FOR THE TREATMENTMore information
Pre-workshop exercise
Setting research priorities for mesothelioma workshop 10 th November 2014 Pre-workshop exercise Your individual ranking of unanswered questions about the diagnosis, treatment and care of mesothelioma PleaseMore information
Mesothelioma. 1995-2013, The Patient Education Institute, Inc. www.x-plain.com ocft0101 Last reviewed: 03/21/2013 1
Mesothelioma Introduction Mesothelioma is a type of cancer. It starts in the tissue that lines your lungs, stomach, heart, and other organs. This tissue is called mesothelium. Most people who get thisMore information
Surgical therapy of. who should be operated
SAMO Interdisciplinary Workshop on Chest Tumors Lucerne, 13th and 14th January 2012 Surgical therapy of mesothelioma, who should be operated Walter Weder MD Professor of Surgery University Hospital ZurichMore information
Treatment Guide Lung Cancer Management
Treatment Guide Lung Cancer Management The Chest Cancer Center at Cleveland Clinic, which includes specialists from the Respiratory Institute, Taussig Cancer Institute and Miller Family Heart & VascularMore information
Malignant Pleural Mesothelioma in Singapore
RESEARCH COMMUNICATION C SP Yip 1, HN Koong 2, CM Loo 3, KW Fong 1* Abstract Aim: To examine the clinical characteristics and outcomes of malignant pleural mesothelioma (MPM) in Singapore. Methods andMore information
A Practical Guide to Advances in Staging and Treatment of NSCLC
A Practical Guide to Advances in Staging and Treatment of NSCLC Robert J. Korst, M.D. Director, Thoracic Surgery Medical Director, The Blumenthal Cancer Center The Valley Hospital Objectives Revised stagingMore information
Malignant Mesothelioma: an Update
Malignant Mesothelioma: an Update Nico van Zandwijk Asbestos Diseases Research Institute Bernie Banton Centre University of Sydney Australia Physicians Week RACP 19-5-2009 Health Risks of Asbestos FibersMore information
Malignant Pleural Diseases Advances Clinicians Should Know F Gleeson
Malignant Pleural Diseases Advances Clinicians Should Know F Gleeson The following relevant disclosures, conflicts of interest and/ or financial relationships exist related to this presentation: ConsultantMore information
Surgeons Role in Symptom Management. A/Prof Cliff K. C. Choong Consultant Thoracic Surgeon Latrobe Regional Hospital GIPPSLAND
Surgeons Role in Symptom Management A/Prof Cliff K. C. Choong Consultant Thoracic Surgeon Latrobe Regional Hospital GIPPSLAND Conditions PLEURAL Pleural effusion Pneumothorax ENDOBRONCHIAL HaemoptysisMore information
Recommendations for the Reporting of Pleural Mesothelioma
Recommendations for the Reporting of Pleural Mesothelioma Association of Directors of Anatomic and Surgical Pathology * DOI: 10.1309/6A30YQHBMTHEJTEM It has been evident for decades that pathology reportsMore information
Clinical cases in Malignant Pleural Mesothelioma: Adherence to the ESMO Clinical Practice Guidelines
Clinical cases in Malignant Pleural Mesothelioma: Adherence to the ESMO Clinical Practice Guidelines Wieneke Buikhuisen The Netherlands Cancer Institute Amsterdam The Netherlands Case (1) Male, 56 yearMore information
Characteristics of Malignant Pleural Mesothelioma in Women
Characteristics of Malignant Pleural Mesothelioma in Women Andrea S. Wolf, MD, MPH, William G. Richards, PhD, Tamara R. Tilleman, MD, PhD, Lucian Chirieac, MD, Shelley Hurwitz, PhD, Raphael Bueno, MD,More information
Malignant Pleural Mesothelioma. NCCN Guidelines for Patients
Malignant Pleural Mesothelioma NCCN Guidelines for Patients Presented with support from the national law firm of Baron & Budd Also available at NCCN.com About this booklet Its purpose Learning that youMore information
Lung cancer forms in tissues of the lung, usually in the cells lining air passages.
Scan for mobile link. Lung Cancer Lung cancer usually forms in the tissue cells lining the air passages within the lungs. The two main types are small-cell lung cancer (usually found in cigarette smokers)More information
Lung Cancer: Diagnosis, Staging and Treatment
PATIENT EDUCATION patienteducation.osumc.edu Lung Cancer: Diagnosis, Staging and Treatment Cancer begins in our cells. Cells are the building blocks of our tissues. Tissues make up the organs of the body.More information
There are a number of other carcinogens (cancer causing agents) that are believed to be associated with lung cancer, and are reviewed elsewhere.
Lung Cancer What is cancer? First, some background on the way the body is built. Organs, like the heart, liver, and lung, are made up of tissues, such as blood vessels and muscle. Tissues, in turn, areMore information
Clinical Indications and Results Following Chest Wall Resection
Clinical Indications and Results Following Chest Wall Resection for Recurrent Malignant Pleural Mesothelioma Ali SO, Burt BM, Groth SS, DaSilva MC, Yeap BY, Richards WG, Baldini EH and Sugarbaker DJ. DivisionMore information
Malignant pleural mesothelioma P/D vs. EPP
3 rd International Thoracic Oncology Congress Dresden, September 13 15, 2012 Malignant pleural mesothelioma P/D vs. EPP Walter Weder, MD Professor of Surgery Dokumentenname Datum Seite 1 Extrapleural PneumonectomyMore information
Non-Small Cell Lung Cancer
Non-Small Cell Lung Cancer About Your Lungs and Lung Cancer How do your lungs work? To understand lung cancer it is helpful to understand your lungs. Your lungs put oxygen into the blood, which the heartMore information
Malignant pleural mesothelioma: outcome of limited surgical management
Interactive Cardiovascular and Thoracic Surgery 2 (2003) 30 34 Institutional review Thoracic general Malignant pleural mesothelioma: outcome of limited surgical management Peter G. Phillips a, George AsimakopoulosMore information
Treatment Algorithms for the Management of Lung Cancer in NSW Guide for Clinicians
Treatment Algorithms for the Management of Lung Cancer in NSW Guide for Clinicians Background The Cancer Institute New South Wales Oncology Group Lung (NSWOG Lung) identified the need for the developmentMore information
Ahmed Farouk Abd El-Hafez, MD
Presented By Ahmed Farouk Abd El-Hafez, MD Lecturer of Cardiothoracic Surgery Assiut University Asbestos exposure : amphibole fibers especially crocidolite asbestos Nonasbestos Causes : Silicate fibersMore information
Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma
Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma Marc de Perrot, Ronald Feld, Natasha B Leighl, Andrew Hope, Thomas K Waddell, Shaf Keshavjee,More information
INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER Prospective Mesothelioma Staging Project
INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER Prospective Mesothelioma Staging Project Data Forms and Fields in CRAB Electronic Data Capture System - Reduced Set - Pivotal data elements for developingMore information
Lung Cancer: Diagnosis, Staging and Treatment
PATIENT EDUCATION patienteducation.osumc.edu Lung Cancer: Diagnosis, Staging and Treatment Cancer starts in our cells. Cells are the building blocks of our tissues. Tissues make up the organs of the body.More information
What is Mesothelioma?
What is Mesothelioma? Mesothelioma is a rare type of cancer that develops in the mesothelial cells found in one s body. These cells form membranous linings that surround and protect the body s organs andMore information
Surgery. Wedge resection only part of the lung, not. not a lobe, is removed. Cancer Council NSW
The treatment you receive will depend on your lung cancer type, for example, whether you have a non-small cell lung cancer Adenocarcinoma or Squamous cell carcinoma, and if this is a sub-type with a mutation.More information
Mesothelioma is almost always caused by exposure to asbestos and can develop decades after the exposure.
Mesothelioma Summary Mesothelioma is a rare type of cancer that can develop decades after exposure to asbestos. Mesothelioma usually targets the outer membrane of the lungs (pleura), but can also occurMore information
Columbia University Mesothelioma Applied Research Foundation - 2009 - www.curemeso.org. Mesothelioma Center www.mesocenter.org
Columbia University Mesothelioma Center www.mesocenter.org Multimodal clinical trials, treatment (surgery, radiation, chemotherapy) Peritoneal mesothelioma program Immunotherapy translational, experimentalMore information
Small cell lung cancer
Small cell lung cancer Small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung. The lungs are a pair of cone-shaped breathing organs that are found withinMore information
understanding mesothelioma
C U R E P R E S E N T S understanding mesothelioma u n d e r s t a n d i n g m e s o t h e l i o m a Copyright 2009 by CURE Media Group, L.P. Published by CURE Media Group 3102 Oak Lawn, Suite 610 Dallas,More information
Treating Mesothelioma - A Quick Guide
Treating Mesothelioma - A Quick Guide Contents This is a brief summary of the information on Treating mesothelioma from CancerHelp UK. You will find more detailed information on the website. In this informationMore information
Small Cell Lung Cancer
Small Cell Lung Cancer Types of Lung Cancer Non-small cell carcinoma (NSCC) (87%) Adenocarcinoma (38%) Squamous cell (20%) Large cell (5%) Small cell carcinoma (13%) Small cell lung cancer is virtuallyMore information
Subtle mediastinal pleural thickening on computerised tomography as a predictor of mesothelioma
Subtle mediastinal pleural thickening on computerised tomography as a predictor of mesothelioma Poster No.: C-1794 Congress: ECR 2011 Type: Scientific Exhibit Authors: A. Roy, S. ellis, T. Iyngkaran ;More information
Lung Cancer Treatment Guidelines
Updated June 2014 Derived and updated by consensus of members of the Providence Thoracic Oncology Program with the aid of evidence-based National Comprehensive Cancer Network (NCCN) national guidelines,More information
International Journal of Case Reports in Medicine
International Journal of Case Reports in Medicine Vol. 2013 (2013), Article ID 409830, 15 minipages. DOI:10.5171/2013.409830 www.ibimapublishing.com Copyright 2013 Andrew Thomas Low, Iain Smith and SimonMore information
Principal Investigator: Valerie W. Rusch, MD, FACS, Chief, Thoracic Surgery Memorial Sloan-Kettering Cancer Center
Protocol 1101-1088 Phase I study of intra-pleural administration of GL-ONC1 in patients with malignant pleural effusion: primary, metastases and mesothelioma Principal Investigator: Valerie W. Rusch, MD,More information
Epidemiology, Staging and Treatment of Lung Cancer. Mark A. Socinski, MD
Epidemiology, Staging and Treatment of Lung Cancer Mark A. Socinski, MD Associate Professor of Medicine Multidisciplinary Thoracic Oncology Program Lineberger Comprehensive Cancer Center University ofMore information
Management of Non-Small Cell Lung Cancer Guide for General Practitioners
Management of n-small Cell Lung Cancer Guide for General Practitioners Clinical Stage I Cancer only in one lobe of lung andMore information
PET Scanning and Lung Cancer- A Surgeon s Perspective
PET Scanning and Lung Cancer- A Surgeon s Perspective Disclaimer Member of advisory board Pfizer Changing Environment Incidence Biology Detection Technology/treatment options Canadian Cancer StatisticsMore information
A Case of Advanced Malignant Pleural Mesothelioma Treatment with Chemotherapy and Photodynamic Therapy
CASE REPORT http://dx.doi.org/10.4046/trd.2015.78.1.36 ISSN: 1738-3536(Print)/2005-6184(Online) Tuberc Respir Dis 2015;78:36-40 A Case of Advanced Malignant Pleural Mesothelioma Treatment with ChemotherapyMore information
Summary of treatment benefits
Risk Management Plan PEMETREXED Powder for concentrate for Solution for infusion Pemetrexed is also indicated as monotherapy for the maintenance treatment of locally advanced or metastatic non small cellMore information
People Living with Cancer
Patient Guide ASCOInformation for People Living with Cancer ADVANCED LUNG CANCER TREATMENT Recommendations of the American Society of Clinical Oncology Welcome The American Society of Clinical OncologyMore information
Diseases. Inflammations Non-inflammatory pleural effusions Pneumothorax Tumours
Pleura Visceral pleura covers lungs and extends into fissures Parietal pleura limits mediastinum and covers dome of diaphragm and inner aspect of chest wall. Two layers between them (pleural cavity) containsMore information
Asbestos Related Diseases
Asbestos Related Diseases Asbestosis Mesothelioma Lung Cancer Pleural Disease Asbestosis and Mesothelioma (LUNG CANCER) Support Group 1800 017 758 www.amsg.com.au ii Helping you and your family throughMore information
Primary -Benign - Malignant Secondary
TUMOURS OF THE LUNG Primary -Benign - Malignant Secondary The incidence of lung cancer has been increasing almost logarithmically and is now reaching epidemic levels. The overall cure rate is very lowMore information
MALIGNANT PLEURAL MESOTHELIOMA Yossef Aelony, M.D., Clinical Professor of Medicine (Pulmonary), Harbor-UCLA Thoracoscopic Talc Poudrage in Malignant Pleural Effusions. Effective Pleurodesis Despite LowMore information
General Information About Non-Small Cell Lung Cancer
General Information About Non-Small Cell Lung Cancer Non-small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung. The lungs are a pair of cone-shaped breathingMore information
LYMPHOMA IN DOGS. Diagnosis/Initial evaluation. Treatment and Prognosis
LYMPHOMA IN DOGS Lymphoma is a relatively common cancer in dogs. It is a cancer of lymphocytes (a type of white blood cell) and lymphoid tissues. Lymphoid tissue is normally present in many places in theMore information
PSA Screening for Prostate Cancer Information for Care Providers
All men should know they are having a PSA test and be informed of the implications prior to testing. This booklet was created to help primary care providers offer men information about the risks and benefitsMore information
MesoPDT. Photodynamic Therapy for malignant pleural mesothelioma ONCO-THAI. Image Assisted Laser Therapy for Oncology
MesoPDT Photodynamic Therapy for malignant pleural mesothelioma ONCO-THAI Image Assisted Laser Therapy for Oncology Unité Inserm ONCO-THAI «Image Assisted Laser Therapy for Oncology» Inserm ONCO-THAI "ImageMore information
Avastin: Glossary of key terms
Avastin: Glossary of key terms Adenocarcinoma Adenoma Adjuvant therapy Angiogenesis Anti-angiogenics Antibody Antigen Avastin (bevacizumab) Benign A form of carcinoma that originates in glandular tissue.More information
Lung Cancer and Mesothelioma
Lung Cancer and Mesothelioma Robert Kratzke, M.D. John C. Skoglund Professor of Lung Cancer Research Section of Heme/Onc/Transplant Department of Medicine University of Minnesota Medical School MalignantMore information
Malignant Mesothelioma
Malignant Mesothelioma What is malignant mesothelioma? Malignant mesothelioma is a cancer that starts in cells in the linings of certain parts of the body, especially in the linings of the chest or abdomen.More information
PET POSITIVE PLEURAL PLAQUES DECADES AFTER PLEURODESIS: MESOLTHELIOMA? Ellen A. Middleton 1. Jonathan C. Daniel 2. Kenneth S.
PET POSITIVE PLEURAL PLAQUES DECADES AFTER PLEURODESIS: MESOLTHELIOMA? Ellen A. Middleton 1 Jonathan C. Daniel 2 Kenneth S. Knox 1 Kathleen Williams 1 Departments of Medicine 1 and Surgery 2, UniversityMore information
Asbestos and your lungs
This information describes what asbestos is and the lung conditions that are caused by exposure to it. It also includes information about what to do if you have been exposed to asbestos, and the benefitsMore information
Lung Cancer Treatment
Scan for mobile link. Lung Cancer Treatment Lung cancer overview More than one in four of all diagnosed cancers involve the lung, and lung cancer remains the most common cancer-related cause of death amongMore information
Detection and staging of recurrent prostate cancer is still one of the important clinical problems in prostate cancer. A rise in PSA or biochemical
Summary. 111 Detection and staging of recurrent prostate cancer is still one of the important clinical problems in prostate cancer. A rise in PSA or biochemical recurrence (BCR) is the first sign of recurrentMore information
Post-operative intrapleural chemotherapy for mesothelioma
Post-operative intrapleural chemotherapy for mesothelioma Robert Kratzke, MD John Skoglund Chair for Lung Cancer Research Section of Heme-Onc-Transplant University of Minnesota Medical School EfficacyMore information
Canine Lymphoma Frequently Asked Questions by Pet Owners
Canine Lymphoma Frequently Asked Questions by Pet Owners What is lymphoma? The term lymphoma describes a diverse group of cancers in dogs that are derived from white blood cells called lymphocytes. LymphocytesMore information
Understanding Your Surgical Options for Lung Cancer
Information Booklet for Patients Understanding Your Surgical Options for Lung Cancer Understanding Lung Cancer If you have just been diagnosed with lung cancer, this booklet will serve as an informationalMore information
Mesothelioma Understanding your diagnosis
Mesothelioma Understanding your diagnosis Mesothelioma Understanding your diagnosis When you first hear that you have cancer, you may feel alone and afraid. You may be overwhelmed by the large amount ofMore information
EPEC -O. Education In Palliative And End-Of-Life Care For Oncology. Self-Study Module 3m: Symptoms; Malignant Pleural Effusions
EPEC -O Education In Palliative And End-Of-Life Care For Oncology Self-Study Module 3m: Symptoms; Malignant Pleural Effusions Module 3m: Symptoms; Malignant Pleural Effusions Abstract... 3 Introduction...More information
Thoracoscopy in Pleural Malignant Mesothelioma
Diagnostic and Therapeutic Endoscopy, 1997, Vol. 3, pp. 147-151 Reprints available directly from the publisher Photocopying permitted by license only (C) 1997 OPA (Overseas Publishers Association) AmsterdamMore information
prognostic scoring systems. We
Thorax 2000;55:731 735 731 Original articles Prognostic factors for malignant mesothelioma in 142 patients: validation of CALGB and EORTC prognostic scoring systems J G Edwards, K R Abrams, J N Leverment,More information
Protein kinase C alpha expression and resistance to neo-adjuvant gemcitabine-containing chemotherapy in non-small cell lung cancer
Protein kinase C alpha expression and resistance to neo-adjuvant gemcitabine-containing chemotherapy in non-small cell lung cancer Dan Vogl Lay Abstract Early stage non-small cell lung cancer can be curedMore information
FREQUENTLY ASKED QUESTIONS about asbestos related diseases
FREQUENTLY ASKED QUESTIONS about asbestos related diseases 1. What are the main types of asbestos lung disease? In the human body, asbestos affects the lungs most of all. It can affect both the spongyMore information
Protocol for Planning and Treatment The process to be followed in the management of: SMALL CELL LUNG CANCER Patient information given at each stage following agreed information pathway 1. DIAGNOSIS NewMore information
Francine Lortie-Monette, MD, MSc, CSPQ, MBA Department of Epidemiology and Biostatistics University of Western Ontario 2003
ASBESTOS Francine Lortie-Monette, MD, MSc, CSPQ, MBA Department of Epidemiology and Biostatistics University of Western Ontario 2003 Asbestosis Asbestosis is a model for other dust diseases as well asMore information
9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH
9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH Differentiated thyroid cancer expresses the TSH receptor on the cell membrane and responds to TSH stimulation by increasingMore information
Neoplasms of the LUNG and PLEURA
Neoplasms of the LUNG and PLEURA 2015-2016 FCDS Educational Webcast Series Steven Peace, BS, CTR September 19, 2015 2015 Focus o Anatomy o SSS 2000 o MPH Rules o AJCC TNM 1 Case 1 Case Vignette HISTORY:More information
Malignant Mesothelioma
Malignant Mesothelioma What is malignant mesothelioma? Malignant mesothelioma is a cancer that starts in cells in the linings of certain parts of the body, especially in the linings of the chest or abdomen.More information
Lung Cancer Understanding your diagnosis
Lung Cancer Understanding your diagnosis Lung Cancer Understanding your diagnosis When you first hear that you have cancer you may feel alone and afraid. You may be overwhelmed by the large amount of informationMore information
Choosing a Clinical Trial for Advanced Mesothelioma
Choosing a Clinical Trial for Advanced Mesothelioma RN Taub (Onc) J Chabot (Surg) A Borczuk (Path) J Sonnet (Surg) M Kluger (Surg) R Fawwaz (Nuc. Med) E Hare (Onc) Columbia University Mesothelioma CenterMore information
Male. Female. Death rates from lung cancer in USA
Male Female Death rates from lung cancer in USA Smoking represents an interesting combination of an entrenched industry and a clearly drug-induced cancer Tobacco Use in the US, 1900-2000 5000 100 Per CapitaMore information
SUNY DOWNSTATE MEDICAL CENTER SURGERY GRAND ROUNDS February 28, 2013 VERENA LIU, MD ROSEANNA LEE, MD
SUNY DOWNSTATE MEDICAL CENTER SURGERY GRAND ROUNDS February 28, 2013 VERENA LIU, MD ROSEANNA LEE, MD Case Presentation 35 year old male referred from PMD with an asymptomatic palpable right neck mass PMH/PSH:More information


text:
I've promised to try and keep up with the blog again, now that K is older I can sometimes manage to get some work done.
This weekend, D is turning 3! What a crazy 3 years! From a tiny 18.5 in. & 6#8oz bundle, to a (still on the small side) 35 in. & 27# kid. Watching him grow and learn has been extraordinary. We've had a lot of ups and downs, dealing with food allergies (milk, egg, & peanut) on top of the usual first time parent/baby problems. We're still navigating the food issues, now with new toddler-isms to tackle!
This weekend also marks the start of Spring trade show season! I'll be at the Glengarry in Truro on Sunday at the Spring Has Sprung sale with a selection from the shop and some specials.
Then, just 5 days after D's bday, I am turning the "Big 3-0". I don't feel any different? Am I supposed to? I'm going to be a real adult now right? Nothing special planned, but I have already decided that I must watch the Friends episode "the one with all the birthdays" 🙂 My "baby" sister also turns 14 just a week later, if that doesn't make me feel old, I don't know what will lol Baby K looks a lot like her auntie and gets called her name more often than I like to admit! Easter is late this year, so we get a small break, but then K turns 1 just a few days later (SHE'S 1 ALREADY???!!!!), followed by…..
We're going big this year! It's been a long stretch of planning, but the payoff will be fantastic! We have 20 local vendors set up for a family shopping event Saturday, April 26th 2014 from 10-2pm to accompany the change (10:30am). Along with Andrea of Enchanted Forest, we welcomed Jessica of Branching Out to our co-hosting team! We have 27 pre-registered participants already!! To register, go to http://gcdctrurons.eventbrite.ca
You can also like us on Facebook: www.facebook.com/gcdctrurons
SO! To celebrate all of the birthdays and GCDC, I'm going to be running some great promos and games over on our Facebook Page. Starting March 22 and running until April 23, make sure you have our page set to "follow" and to "show in newsfeed". Coupons, prizes, and games!


text:
Photography Event at Chuck E Cheese's -Whitby, Ontario
Another tough challenge with photographing a birthday party in a very dim set-up 😛 My SB-900 stayed on all the time and I used 3 different lenses to capture different moments; 50mm 1.8, 24-120 3.5-5.6 and my 70-300mm 4-5.6. I ended up with some half decent shots not really knowing what to expect.
And this last photo is a selective colour shot which is something that I love creating. What's different though is I've added a boarder to it. Thanks to @martinbailey for sharing this wonderful LR2 plugin. There will be some fine tuning with it, I'm hoping to get some opinions on whether people like the framing or not. 🙂
1st Event of 2010 – Family/Portrait Photography at the Toronto Zoo
Saturday February 21st, some ol' school friends (literally) took advantage of my offer to have some photo's taken of their family. The Kelly's suggested that we meet at the Toronto Zoo and see if we can't come up with a couple of nice portraits of their daughter, Elizabeth.
It was a perfect day, sunny but very brisk. The major challenge for me was capturing moments in the midday sun without over exposing and blowing out highlights.
We stopped by the Tundra Trek first and visited the Polar Bears.
After the Tundra Trek, we decided to head inside to a pavilion where it was a little warmer…HUGE mistake a my part. I've heard it a million times on podcasts about transitioning from one extreme to another and what happens to your lenses, but do you think I listened? Noooooooooo 😛 My 24-120 was pretty much useless for the rest of the adventure…all fogged up : So I pulled out nifty fifty and my SB-900 for the indoor shots.
It was a great time, Elizabeth was a great sport and a cute subject!
Thanks to the Kelly Family for helping me out and I hope we can do it again some time. 🙂
My 365 – Day 2
" I think I need a long straw"
SB-900 attached to a SC-29 TTL cord for backlighting.


text:
When it comes to Thanksgiving dinner, everyone has their personal favorites, but it's safe to say stuffing is at the top of most lists. This savory casserole of hearty bread baked with seasonal vegetables and rich stock is homey and comforting, whether it's cooked inside the bird or out. Here are some of our best renditions of the side dish we look forward to year after year.
|Gluten-Free Stuffing with Bacon and Kale
Those who avoid eating gluten don't need to be deprived of the quintessential Thanksgiving side when they use our gluten-free stuffing mix. The addition of hearty kale and fragrant bacon means that everyone will be fighting over the last serving.
|Jalapeño Cornbread Stuffing with Chorizo and Pepitas
This slightly spicy Southwestern-inspired stuffing will add some unexpected heat to the Thanksgiving table. Be sure to buy fresh (uncooked) Mexican chorizo rather than the cured Spanish variety.
|Focaccia Stuffing with Leeks and Wild Mushrooms
Here, wild mushrooms and leeks add an extra depth of flavor to a focaccia-based stuffing for a satisfying Thanksgiving side.
|Focaccia Stuffing with Chestnuts, Bacon and Apples
Our Italian-inspired focaccia stuffing mix forms the foundation of this sensational stuffing. For added crunch and savory flavor, we add in roasted chestnuts, bacon and chunks of sweet apple.
|Chestnut and Chanterelle Dressing with Chive Biscuits
This dish from Chefs Bryan and Michael Voltaggiouses homemade chive biscuits as the foundation of the stuffing. Additions of chestnuts and mild chanterelle mushrooms add a taste of autumn.
|Herbed Quinoa and Red Rice Stuffing with Kale and Pine Nuts
Gluten-free whole grains can make a wonderful, hearty stuffing, as this recipe proves. Here, we add healthful Tuscan kale and fresh oregano, plus pine nuts for a bit of crunch.
|Crunchy Bread Dressing with Bacon and Leeks
This simple stuffing combines crisp, savory bacon with rustic country bread and a medley of vegetables. Don't let the basic ingredient list fool you — it's packed with flavor.
|Gluten-Free Spoon Bread with Guanciale
This hearty side is made with Blackberry Farm's Gluten-Free Cornbread Mix, so it makes a creative alternative to traditional cornbread. Michael Sullivan, the butcher at farm, adds guanciale, an unsmoked Italian bacon made from the pig's jowl, to the batter before baking, although thick-cut bacon is a great stand-in.
|Hazelnut and Shiitake Mushroom Stuffing
Shiitake mushrooms and hazelnuts make this aromatic dish stand out, but it's the deeply flavorful onions, cooked with sherry vinegar and honey, that are the secret to its success.
|Corn Bread-Apricot Dressing with Rosemary
Dried apricots add an unexpected but welcome sweetness to this stuffing, accented with a range of fresh herbs.
|Gluten-Free Focaccia Stuffing with Mushrooms and Fennel
You can still enjoy the rich flavor of focaccia if you're avoiding wheat. The secret is our gluten-free focaccia stuffing (bonus: this recipe is vegetarian, too!)
|Smoky Bacon-Biscuit Dressing
In this savory dressing, homemade cream biscuits stand in for the traditional bread, while crispy bacon adds delicious smoky flavor.
|Corn Bread Dressing with Chestnuts
Here, toasted corn bread soaks up the flavors of turkey stock and vegetable juices, while dried cranberries and chestnuts add sweetness and texture.
|Apple, Shallot and Herb Dressing
Fresh apples, refreshing fennel and sturdy celery root lend their unique characteristics to this vegetarian stuffing.
|Corn Bread and Ham Stuffing with Caramelized Apples and Fennel
The saltiness of the ham plays off the sweetness of the apples, fennel and corn bread in this hearty stuffing. To streamline prep, the recipe relies on ourstuffing mix, made from corn bread, wheat bread, and aromatic sage and thyme.


text:
The National Weather Service has issued this Hazardous Weather Outlook for our entire Illinois listening area
.DAY ONE…TODAY AND TONIGHT… A strong storm system will bring isolated to scattered thunderstorms through afternoon today and an additional 1 to 1.5 inches of rainfall through tonight. There is a marginal to slight risk of severe thunderstorms that may contain hail over 1 inch diameter, wind gusts over 60 mph, and the possibility of an
isolated tornado. Flooding of rivers and streams may develop or increase due to the accumulation of recent rainfall. Flooding will continue on portions of the Wabash River. Minor snow accumulations of less than 1 inch mainly on grassy areas are possible north of I-74 late tonight.
Much colder temperatures Thursday night may result in areas of below freezing temperatures that may damage early growth on some fruit trees. Another storm system is possible for Monday. It is too early to determine potential severe weather impacts.
Flooding will continue along the Wabash river upstream of Vincennes through early next week. Flooding may develop on the Little Wabash river near Clay City on Thursday morning.


text:
Creative way to approach Easter season
If you are looking for some creative fun for the Easter season, join Salado Wine Seller, 841 N. Main St. in Salado, for Ostrich Egg Painting on April 13. There will be a 2-4 p.m. session and a 4-6 p.m. session. Paint, dye, and embellish your ostrich egg while you sip some locally made wine. The Salado Wine Seller will provide the egg, a glass of wine, decorating materials and instructions. Hop on down and enjoy this festive way to prepare for Easter! Tickets are $40 per person and can be purchased online.


text:
Research output: Contribution to journal › Article
Rights statement: This is the peer reviewed version of the following article: Rebollo-Neira, L. (2017). Effective sparse representation of X-Ray medical images. International Journal for Numerical Methods in Biomedical Engineering, in press, which has been published in final form at [Link to final article using the http://dx.doi.org/10.1002/cnm.2886. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Accepted author manuscript, 3 MB, PDF-document
|Original language
|International Journal for Numerical Methods in Biomedical Engineering
|in press
|Early online date
|7 Apr 2017
|Publication status
|E-pub ahead of print - 7 Apr 2017
Final published version
Employable Graduates; Exploitable Research
Copy the text from this field...


text:
"We're Not Moving. We're Returning Home!"
From Bushman
- SeeMore Photos from QPR's First Time at Park Royal (Courtesy Bushman Archives)
- QPR's New Stadium: Compilation of Articles
- See Photos from QPR's First Time at Park Royal (Courtesy Bushman Archives)
From Wikipedia -
"Queens Park Rangers played on two grounds within Park Royal.
The first was the Horse Ring, the site of the now-demolished Guinness Brewery, on the Royal Agricultural Society's show grounds from 1904 to 1907 which had a capacity of 40,000.
When the Society sold the grounds in 1907, QPR moved to the Park Royal Ground, 400 yards south, an almost exact replica of Ayresome Park, with a capacity of 60,000.
The club were forced to move out in February 1915 as the ground was taken over by the Army.[4] Wikipedia
QPR Official Site History of QPR
Because of poor finances, QPR had to move to St. Quintin's Avenue in 1901. Players had to change in a public house and walk to the pitch. The inhabitants of the area complained that QPR were lowering the tone of the neighbourhood and in 1902 QPR moved back to Kensal Rise!
In 1904/05 they moved to The Royal Agricultural Society Ground at Park Royal which could hold 40,000 spectators. In 1905/06 QPR won the Western League Cup, but in 1906/07 they finished in a disappointing 18th place in the 20 team Southern League.
In 1907/08 QPR moved to another new ground at Park Royal, capable of holding 60,000 spectators.
They won the Southern League for the first time. At the end of the season they met Manchester United for the first Charity Shield match. They drew 1-1 - only to succumb to a heavy 4-0 defeat in the replay.
QPR expected to be elected to Division Two as they had won the Southern League and resigned from it. However, Tottenham, who finished eighth, were elected, and QPR had to seek re-admission. They had to play all their matches in mid-week as the fixture list had been completed by the time they were re-admitted.
In 1911/12, QPR won the Southern League for the second time. In 1912, because of a coal strike, QPR played two of their matches at White City, and also went on their first tour of Europe - scoring 40 goals in eight matches!
In 1914, Mr Cowan, who had been manager since the club turned professional, left and Mr Hewie took over. In 1914/15, because the First World War had started, the army took over QPR's ground at Park Royal, and QPR played the rest of their fixtures at Harvist Road.
QPR then took over the ground of the amateur club Shepherd's Bush - who played at Loftus Road. In 1920/21 QPR were elected to the newly-formed Third Division. They also had a new manager, Mr Ned Liddell. They finished third in the table behind Crystal Palace and Southampton. QPR


text:
Delivery Information
Spend $200 & get free delivery to most of Australia
Click here for all Australian freight rates
Typical delivery times - not guaranteed*
- Melbourne 1-3 working days
- Sydney 2-3 working days
- Brisbane 3-5 working days
- Adelaide 3-5 working days
- Perth 5-10+ working days
For express service, call 1800 069 295 for a quote.
International deliveries click here We cannot ship to all countries.
There are currently no reviews for this product.
2004 Pewsey Vale Museum Reserve The Contours Riesling
Eden Valley, South Australia, AUSTRALIA
Subscribe to stock alerts
Please enter your email address to receive stock alerts for this product:
- Cellar Drink Now - 3 years (2009-2012)
- Closure: Screw Cap
This wine is given 5 years bottle age before being released and the fruit is sourced from Pewsey Vale's oldest vines, planted in contoured rows in 1962.
A superb aged Riesling.Deep straw yellow colour with straw hue – showing signs of development. The nose displays good intensity with aromas of toasted honey followed by citrus, spice and a whiff of kero as an end note. Mouthfilling texture with flavours of lemon, honey, toast and spice. Clean dry finish with acidity holding up well. Excellent length with a very long aftertaste of lemon, spice and toasted honey.
Drink now or cellar a further 2-3 years (2009-2012)
12.5% Alc


text:
For over 30 years, Donald Sterling, according to public opinion, has not only served as one of the worst owners of the NBA, but in all of professional sports. His latest controversy, which was a hot-button issue during May, consisted of many racist statements recorded in a conversation with his then-mistress V. Stiviano. While it had been publicly documented previously of Sterling's supposed racial ideology, his controversy as an owner had, for many years, more to do with the losing ways of his team. As much trouble as Donald Sterling has been to his Los Angeles Clippers, his era appears to have come to an end, after a judge ruled that his wife, Rochelle (Shelly) Sterling, can sell the team for $2 billion to Micorsoft CEO Steve Ballmer, in hopes to focus on a winning future.
On Monday, Judge Michael Levanas stated that Shelly Sterling had executed the correct steps, legally, in removing her estranged husband, Donald, from the Sterling trust. As a result of the ruling, Shelly's reported sale of the Los Angeles Clippers to Ballmer could be conducted, without any appeal of the purchase from Donald and his team of lawyers. This is not to say that Sterling cannot counter-sue for monetary damages.
Most likely, Donald Sterling will come back at his estranged wife, Adam Silver, and the NBA over this result and his eradication from the league. If this first court case of Sterling, the forced sale of the Clippers, is any in indication, it is unlikely that any future court cases will favor him. It, in all likelihood, does not matter to the controversial billionaire though. He has shown his bitterness, anger, and unquestionably irrational behavior, throughout not only this court case, but throughout the duration of his tenured ownership of the Clippers. Sterling's best move, quite simply, is to end his charade. He wants to sue the NBA until he is dead, but he is best served to exit and live what time he has left.
Despite all the blows he has delivered to his Los Angeles Clippers team through the years, his time with the team is finished. The new owner, Steve Ballmer, will take over the team sometime within the next few weeks. In turn, it will be the beginning of a new era for the Los Angeles Clippers. Not only will the Clippers be removed from the controversial distinction of having a supposed racist real estate billionaire as owner, but the franchise's focus will be spotlighted on basketball only.
Never has it been a better time for the Clippers to break into a new era. With a team led by championship coach Doc Rivers, along with his key players of Chris Paul, Blake Griffin and DeAndre Jordan, they have, unquestionably, become the star team in town. Oftentimes over the last 30 years, sans a couple glimmers of hope, the Clippers were looked at as a disgrace of a team that only made the playoffs seven times in the last 30 years. Additionally, they only made it into the second round of the playoffs three times, two of which coming within the last three years.
During that time, it was the Los Angeles Lakers who were the popular team in Hollywood, having such legendary squads that included Jerry West, Kareem Abdul Jabbar, Magic Johnson, Shaquille O'Neal and Kobe Bryant. The Lakers are a team that won 16 championships, whereas the Clippers have not won a single one. However, with the Lakers in a rebuilding mode that will, likely, take many seasons to rebuild, the Clippers have officially become the team of Los Angeles.
Steve Ballmer will now inherit a team that has a past of controversy, a past he can steer the team away from. He can oversee this Clippers team to a winning culture that the people of Los Angeles and the NBA alike can be proud of. No longer will Donald Sterling take his seat at midcourt, taking potshots at his players. Instead, his era concludes while the Ballmer-era Los Angeles Clippers begins, with a positive focus on the future. Finally, three years into the making, the NBA can shed its controversial owner. After all the heartache, the Clippers can focus on one thing and one thing only — basketball.
Commentary by Simon Mounsey
Bleacher Report
SB Nation
NY Times


text:
When we came up with the idea of SapGreen, we were in fix. We didn't know if we should start this
as an NGO, in the old fashioned way and people to donate money or to start this a profit making company. After few days of discussion we decided to go with the idea of a company.We had our reasons.
- Accountability : To make sure our clients trusts us, we had to make sure we were accountable. We were ready to pay tax. We knew tax exemptions given by govt. to NGO/NPOs was a good thing, but it turns out be a play ground for the rich and mighty politicians. Just to narrate an incident, one my ex-colleagues had taken a receipt of 5 lac INR from an NGO to save his tax and the NGO in turn converted it's black money to white. He refused to tell me the name of the NGO.
- Sustainability: By making a profitable business it not only helps us make sure the trees survive but also to make sure we grow. At the same time we could make sure to replace dead trees and monitor them.


text:
Product Highlights
The Bolide Technology Group BP0033/PM150W is a zip cable consisting of two cables; a 95% coverage RG59U video cable and a two conductor 18 gauge electrical cable all in two separate PVC jacketed cables. This cable is great for use with CCTV equipment, offering the connectivity the user needs to connect a camera within one cable. This cable is 150' feet in length.
|Packaging Info
|Package Weight
|4.715 lb
|Box Dimensions (LxWxH)
|9.85 x 9.7 x 2.7"


text:
The color isn´t quite right, but much better from the pictures I took in the sunlight.
I have improvised this dress all the way, and knitted it out of Kampes cottonyarn 8/8, with a 4 mm needle.
There are some ugly decreases and increases in places when my brain wasn´t with me, but I was soooo over this dress and refused to rip back. The arm decreases is the worst. But I´m wearing it and I´m loving it. It is so super comfy with leggings underneath that I forgive myself for it.
It is a bit big, but I wanted it that way, although I did not think about how cottonyarn expands. So it is a bit bigger than I wanted. But as I said, I´m loving it. It is a dress I will wear a lot. But if I could go back in time I would cast on more stitches at the beginning, it would be nice if the neckline were a little bigger than it is. But thats what you get when you improvise without calculation or a plan.


text:
What's the value of
your home?
Use our tools
to find out
Community reports
Powered by realtor.com®
Enter a ZIP code to create a report. Enter a second ZIP to compare two communities.
View statistics on population, education, housing, transporation, income, employment, net worth, cost of living and climate.
Compare amenities such as public services, places of worship, recreation and leisure facilitles, shopping and restaurants.Get a report
How big is an acre? What is an option?
Do I need hazard insurance?
Take a look at our real estate glossary to learn definitions of common words and phrases used in the industry.
Lowest Inventory in Six Years
The total homes listed for sale continue to move downward. The latest decline in October to 3.33 million was partly seasonal, as autumn and winter months nearly always have fewer listings in comparison with spring and summer months.
Click Here
Source: The National Association of REALTORS®


text:
Schnack Wins Two Titles in Berkeley
Oct. 5, 2009
LOS ANGELES - Women's tennis players Yasmin Schnack and Andrea Remynse enjoyed a successful showing while competing at the Cal/Nike ITA Invitational over the weekend in the Bay Area.
Schnack, who was seeded third in the Flight A singles draw, won five straight matches to win the event. She knocked off top-seeded and fourth-ranked Jana Juricova from Cal, 6-2, 6-3 in the semifinals before downing 18th-ranked Marina Cossou, also from Cal, 6-3, 6-3 in Sunday's final.
Schnack also teamed with Remynse to claim the doubles title at the event, winning all four of their matches. Seeded second in the Flight A draw, Remynse and Schnack upset the top-seeded Cal duo of Juricova/Mari Andersson, 9-7 in Sunday's final.
Complete results from the event can be accessed by clicking HERE.
Back here in Los Angeles, UCLA had several players competing in the pre-qualifying for the Riviera/ITA All-American Championships. Bruin freshman Stephanie Hoffpauir won two matches and was one win away from reaching the qualifying draw, however she fell to Aerial Ellis of Texas, 6-3, 6-2 on Sunday. Freshman Pamela Montez and sophomore Nina Pantic both fell in first round singles action.
Montez and Pantic did advance through the pre-qualifying draw in doubles, however, winning three matches over the weekend. Complete draws from the Riviera/ITA All-America Championships can be accessed HERE.
Cal Wins Two Pac-10 Titles On Day TwoMar 4 '04
Pac-10 Titles Up For Grabs In BerkeleyMay 13 '10
Airing on:
- Pac-12 Network
TODAY | 6:00pm PTLive
Airing on:
- Pac-12 Network
- Pac-12 Arizona
- Pac-12 Oregon
TODAY | 8:00pm PTLive
Airing on:
- Pac-12 Network
- Pac-12 Bay Area
- Pac-12 Washington
Pac-12 PlaylistTODAY | 9:00pm PTLive
Airing on:
- Pac-12 Network
- Pac-12 Washington
- Pac-12 Bay Area


text:
This blog is where you will find community council information, including meeting times, minutes and agenda. Do please comment on postings.
Monday, 15 February 2016
Fancy a snowdrop walk? Taking place on 27 and 28 Feb at Newington Cemetery
Posted by ajvphilp at 17:31
No comments:
Subscribe to: Post Comments (Atom)