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"Business casual" is the trickiest code to crack. There isn't an exact definition as to what constitutes business casual. In a nutshell, it is the informal version of business professional attire. As Wikipedia puts it, "business casual is a kind of middle ground between formal business wear and street wear." Translation: Mix traditional business formal pieces with everyday clothing items (save for your weekend wear).
While business casual is applicable to a wide variety of workplaces, it is often interpreted in varying degrees. Needless to say, there is a delicate balance that must be reached to achieve the perfect business casual look. Depending on your work environment, you should be able judge what level of business casual you ought to be wearing based on your superior's attire. If your office is on the more formal end of the spectrum, lean toward clothing items that fall into the business professional category. However, if you're in a laidback workplace you may have more flexibility when it comes to incorporating casual items into your daily ensembles. Regardless of where your office falls on the scale between casual and dressy, you should aim to look professionally dressed, but in a relaxed yet pulled together type of way.
There's a wide range of options for business casual wear–skirt/pant + blouse, dress + cardigan/jacket/sweater, skirt/pant + sweater/cardigan… The possibilities are endless. Unlike business professional, you can wear a wider variety of colors and prints as well.
Here are some basic tips for achieving the perfect business casual look:
- Follow these commandments on 9 to 5 style.
- Steer clear of denim. Instead, opt for bottoms in cotton, silk, or blends.
- Avoid anything neon or shiny, unless it's an understated accessory. This includes sequin tops, rhinestone pants, and neon bellbottoms. Disco style was left in the 1970s for a reason.
- If you would wear it to a club, you shouldn't wear it to work. Just because a top is "dressy" doesn't mean it's office-friendly. Modesty is key.
- All clothing should be clean, pressed, and wrinkle-free.
- Hats are not okay for the office, ladies. Please leave your fedoras at home.
- Closed-toe shoes are ideal. But, if your office is more lax, nice sandals (not thongs or flip-flops) during warmer months are probably okay.
Now for some outfit inspiration… Below, I've put together five simple yet stylish looks for the "biz-cas" gal.
1. Cozy-Chic:
JC Penny Color Craze Necklace, Elizabeth & James Manor Booties, Carven Cropped Wool Sweater, LC Lauren Conrad Pleated Chiffon Skirt
2. Two-Tone Tomboy:
RJ Graziano Polished Gold Cuff, Vanessa Bruno Mohair Sweater, JC Penny 14K Stud Earrings, Topshop Marcus Loafers, J.Crew Cafe Cropped Pants
3. Edgy Lady:
Madewell Hole Punch Tee, Valentino Crystal & Pearl Necklace, Banana Republic Channing Eyeglasses, Club Monaco Leather Pencil Skirt, Banana Republic Parker High-Heel Penny Loafers
4. Black Base Babe:
2028 Flower Stud Earrings, See by Chloe Cherry Print Blouse, 3.1 Phillip Lim Tuxedo Pant, Dorothy Perkins Purple Marry Jane Heels
5. Go-Getter:
Miss Selfridge Fluro Cardigan, Club Monaco Mary Kate Belt, LC Lauren Conrad Flats, LC Lauren Conrad Mixed Media Dress, LC Lauren Conrad Flower Earrings
Style Tip: If your skirt or dress is too short, add tights!
One of the best basic business casual outfits is a simple pair of cotton-blend trousers, a nice blouse or tank (floral and print tops are always nice) with a pretty cardigan layered over. Top it off with a pair of comfortable ballet flats or oxfords for an easy yet professional "business casual" ensemble.
Like I said before, putting the term business casual into a box and labeling it is a difficult task to do since there are many different interpretations of what constitutes the ideal outfit. At the very least, keep in mind that you want to preserve a professional image. And ultimately, you want to look polished, stylish, and put together. In the words of Tommy Hilfiger, "You want to look fashionable and put-together, not like you hit every sale rack this season." I couldn't have said it better myself.
What's your go-to business casual outfit?
Upload a photo of your favorite work outfit to your LaurenConrad.com profile and link the image in the comments below. I'll feature my favorite photo submissions in a Member Spotlight post soon!
Click here to learn how to upload and submit photos.
Next up in my Dress Coding series is casual work attire!
XO Lauren
P.S. When in doubt, remember this tip: Keep it 50% formal (as in business formal attire). For instance, if you're going to wear a casual sundress, throw on a sharp blazer. It is always best to err on the side of caution than to risk a run in with the fashion police.


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iExplorer HD by Zhigang Chen
by via_web on
May 17, 2012
Filed under App DB, Productivity
With iExplorer HD, you can manage/view files on your remote servers (Windows sharing server/FTP server/WebDAV server/SkyDrive/Live Mesh/Google Docs/CloudMe/DropBox/Box.Net …) in home, office and anywhere. iExplorer also is a good eBook reader, media player, photo viewer, and work assistant. You can read CHM, ePub, PDF and large text/PDB files with outline/bookmark/annotation support, play musics and movies without copying them to your device, view large photos on your PC/NAS and share to friends, edit spreadsheets on your Google Docs and save them as different formats, print any viewable documents.
iExplorer HD v2.0+ is totally rewritten from version 1.x. It improves a lot in User Interface, usabilities and functions.
Please send mail to us if you encounter any problems, because we cannot reply your comment on App Store.
* Access files on iPad or Windows Sharing Files/NAS server/FTP Server/Cloud server (WebDAV servers, iDisk, FilesAnywhere, Box.Net, CloudMe, DropBox, Microsoft Live Mesh, SkyDrive, Google Docs …)
* Transfer files/folders/subfolders between iPad and remote servers
* Transfer files with Bluetooth between iOS devices
* Transfer files between iPad and PC with USB cable
* Manage files on local or remote server (Rename/Delete/Move/Email/…)
* Sort files by Name/Size/Date/File Type
* Zip & Unzip files on local or NAS server/FTP server
* Edit text file
* Edit Google spreadsheet, download google docs as pdf, Microsoft office document, zip, image, open office document, text files and so on.
* Open files in other apps. Open file from Safari, Mail and other apps.
* Stream html/Microsoft office files/keynotes/numbers/pages from NAS/FTP/Cloud servers
* Search files in folder/subfolders (support both local and remote servers)
* Sync files from NAS/FTP/Cloud server. View offline files if the server is not reachable
* Adjust priorities for transferring file tasks
* Print & tweet any viewable documents/ebooks (Printer needs support AirPrint).
* Stream photos from your NAS/FTP/Cloud servers (WebDAV servers, iDisk, FilesAnywhere, Box.Net, CloudMe, DropBox, Microsoft Live Mesh, SkyDrive …)
* Support large images
* Smoothly zoom/scroll photos, view thumbnails
* Stream Audio/Video from NAS/FTP/Cloud servers (WebDAV servers, iDisk, FilesAnywhere, Box.Net, CloudMe, DropBox, Microsoft Live Mesh, SkyDrive …)
* Support subtitle files (ssa/ass/srt) for video playback
* Multitasking supported for Audio stream
File Viewer
* Embedded PDF viewer, support outlines, bookmarks and annotations.
* Embedded CHM viewer, support outlines and bookmarks. Optimized for iPad
* Embedded ePub reader, support outlines ,bookmarks, font style, fast scroll, auto scroll
* Fast large text/PDB reader, support font style, fast scroll, auto scroll, multiple encodings
* Remember last read position for PDF, CHM, ePub, large text/PDB files
* Microsoft Office files, iWork files, Web files …
* Code viewer, syntax highlighted for C, C++, Objective C, C#, Java, Php, JS, CSS …
* Fullscreen mode for viewer in iPad (iExplorer HD only)
More features are under developing:
* More Cloud servers (iCloud, SugarSync, Evernote)
* Web Browser
Developer Website: http://www.opuis.com/

subset: commoncrawl


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This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
Childhood soft tissue sarcoma is a disease in which malignant (cancer) cells form in soft tissues of the body.
Soft tissues of the body connect, support, and surround other body parts and organs. The soft tissues include the following:
Soft tissue sarcoma may be found anywhere in the body. In children, the tumors form most often in the arms, legs, or trunk (chest and abdomen).
There are many different types of soft tissue sarcomas.
The cells of each type of sarcoma look different under a microscope. The soft tissue tumors are grouped based on the type of soft tissue cell where they first formed.
See the following PDQ summaries for more information:
This summary is about the following types of soft tissue sarcoma:
Fibrous (connective) tissue tumors
Fibrohistiocytic tumors
Fat tissue tumors
Smooth muscle tumors
Peripheral nervous system tumors
Bone and cartilage tumors
Tumors with more than one type of tissue
Tumors of unknown origin (the place where the tumor first formed is not known)
Blood and lymph vessel tumors
Besides rhabdomyosarcomas, the most common soft tissue sarcomas in children are in joint tissue, connective tissue, and nerve tissue.
Soft tissue sarcoma occurs in children and adults. Soft tissue sarcoma in children may respond differently to treatment, and may have a better outcome than soft tissue sarcoma in adults. (See the PDQ summary on Adult Soft Tissue Sarcoma Treatment for more information on treatment in adults.)
Having certain diseases and inherited disorders can increase the risk of developing childhood soft tissue sarcoma.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for childhood soft tissue sarcoma include having the following inherited disorders:
Other risk factors include the following:
The most common sign of childhood soft tissue sarcoma is a painless lump or swelling in soft tissues of the body.
A sarcoma may appear as a painless lump under the skin, often on an arm, a leg, or the trunk. There may be no other symptoms at first. As the sarcoma grows larger and presses on nearby organs, nerves, muscles, or blood vessels, symptoms may occur, including pain or weakness.
Other conditions may cause the same symptoms that soft tissue sarcomas do. A doctor should be consulted if any of these problems occur.
Diagnostic tests and a biopsy are used to detect (find) and diagnose childhood soft tissue sarcoma.
The following tests and procedures may be used:
If these tests show there may be a soft tissue sarcoma, a biopsy is done. One of the following types of biopsies may be used:
In order to plan the best treatment, a large sample of tissue may be removed during the biopsy to find out the type of soft tissue sarcoma and do laboratory tests. Tissue samples will be taken from the primary tumor, lymph nodes, and other areas that may have a tumor. A pathologist views the tissue under a microscope to look for cancer cells and to find out the type and grade of the tumor. The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the cells are dividing. High-grade and mid-grade tumors usually grow and spread more quickly than low-grade tumors. Because soft tissue sarcoma can be hard to diagnose, patients should ask to have the tissue sample checked by a pathologist who has experience in diagnosing soft tissue sarcoma.
One or more of the following laboratory tests may be done to study the tissue samples:
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
The prognosis also depends on how the tumor responds to chemotherapy and/or radiation therapy.
After childhood soft tissue sarcoma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body.
The process used to find out if cancer has spread within the soft tissue or to other parts of the body is called staging. There is no standard staging system for childhood soft tissue sarcoma. Two methods that are commonly used for staging are based on the amount of tumor remaining after surgery to remove the tumor and/or the grade and size of the tumor and whether it has spread to the lymph nodes or other parts of the body. It is important to know the stage in order to plan treatment.
The following tests and procedures may be used in the staging process:
The results of the sentinel lymph node biopsy and CT scan are viewed together with the results of the diagnostic tests and initial surgery to determine the stage of the soft tissue sarcoma.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
One method used to stage childhood soft tissue sarcoma is based on how much cancer remains after surgery to remove the tumor and whether the cancer has spread:
Nonmetastatic childhood soft tissue sarcoma
In nonmetastatic childhood soft tissue sarcoma, the cancer has been partly or completely removed by surgery and has not spread to other parts of the body.
Metastatic childhood soft tissue sarcoma
Another method used to stage childhood soft tissue sarcoma is based on the size of the tumor and whether cancer has spread to lymph nodes or other parts of the body.
This staging system is based on the following:
Pea, peanut, walnut, and lime show tumor sizes.
Stage I
Stage I is divided into stages IA and IB:
Stage II
Stage II is divided into stage IIA and stage IIB:
Stage III
In stage III, the tumor is either:
Stage IV
In stage IV, the tumor is any grade, any size, and may have spread to nearby lymph nodes. Cancer has spread to distant parts of the body such as the lungs.
Recurrent childhood soft tissue sarcoma is cancer that has recurred (come back) after it has been treated. The cancer may come back in the same place or in other parts of the body. Progressive childhood soft tissue sarcoma is cancer that did not respond to treatment.
There are different types of treatment for patients with childhood soft tissue sarcoma.
Different types of treatments are available for patients with childhood soft tissue sarcoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.
Children with childhood soft tissue sarcoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other health care providers who are experts in treating children with soft tissue sarcoma and who specialize in certain areas of medicine. These may include a pediatric surgeon with special training in the removal of soft tissue sarcomas. The following specialists may also be included:
Some cancer treatments cause side effects months or years after treatment has ended.
Side effects from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include:
Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.)
Seven types of standard treatment are used:
Surgery to completely remove the soft tissue sarcoma is done whenever possible. If the tumor is very large, radiation therapy or chemotherapy may be given first, to make the tumor smaller and decrease the amount of tissue that needs to be removed during surgery. The following types of surgery may be used:
A second surgery may be needed to:
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy or chemotherapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy.
External radiation therapy uses a machine outside the body to send radiation toward the cancer. Stereotactic radiation therapy aims radiation directly to a tumor, causing less damage to normal tissue around the tumor. The total dose of radiation is divided into several smaller doses given over several days. This procedure is also called stereotactic external-beam radiation therapy and stereotaxic radiation therapy.
Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
See Drugs Approved for Adult and Childhood Sarcoma for more information.
Hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working. Antiestrogens (drugs that block estrogen) may be used to treat childhood soft tissue sarcoma.
Watchful waiting
Watchful waiting is closely monitoring a patient's condition without giving any treatment until symptoms appear or change. Watchful waiting may be done when complete removal of the tumor is not possible, no other treatments are available, and the tumor does not place any vital organs in danger.
Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs (such as aspirin, ibuprofen, and naproxen) that are commonly used to decrease fever, swelling, pain, and redness. In the treatment of soft tissue sarcomas, an NSAID called sulindac may be used to help block the growth of cancer cells.
Liver transplant
The liver is removed and replaced with a healthy one from a donor.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to find and attack specific cancer cells without harming normal cells. Imatinib (Gleevec) is a type of targeted therapy called a tyrosine kinase inhibitor. It finds and blocks an abnormal protein on cancer cells that causes them to divide and grow.
Other targeted therapies being studied in clinical trials include angiogenesis inhibitors. In cancer treatment, angiogenesis inhibitors prevent the growth of new blood vessels needed for tumors to grow.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Nonmetastatic Childhood Soft Tissue Sarcoma
For treatment of hemangiopericytoma (in infants and young children) and infantile fibrosarcoma
If an infant or young child has fibrosarcoma or hemangiopericytoma, treatment will be surgery whenever possible. Other treatments may include chemotherapy to reduce the size of the tumor, followed by surgery.
If an older child or adolescent has fibrosarcoma or hemangiopericytoma, treatment will be surgery whenever possible. Other treatments may include the following:
For treatment of desmoid tumor
Treatment of desmoid tumor will be surgery whenever possible. Other treatments may include watchful waiting, chemotherapy, or surgery followed by internal radiation therapy.
If surgery to completely remove the tumor is not possible, treatment to shrink the tumor before surgery may include the following:
For treatment of alveolar soft part sarcoma
Treatment of alveolar soft part sarcoma will be surgery whenever possible. Other treatments may include the following:
For treatment of clear cell sarcoma
Treatment of clear cell sarcoma will be surgery whenever possible. Radiation therapy may be given after surgery.
For treatment of desmoplastic small round cell tumor
Treatment of desmoplastic small round cell tumor may include surgery, chemotherapy (which may be given before surgery), and radiation therapy.
For treatment of extraosseous osteosarcoma
See the PDQ summary on Osteosarcoma and Malignant Fibrous Histiocytoma of Bone Treatment for more information on the treatment of extraosseous osteosarcoma.
For treatment of malignant peripheral nerve sheath tumor
Treatment of malignant peripheral nerve sheath tumor will be surgery whenever possible. Radiation therapy may be given after surgery.
For treatment of plexiform histiocytic tumor
Treatment of plexiform histiocytic tumor is surgery to completely remove the tumor.
For treatment of synovial sarcoma
Treatment of synovial sarcoma may include the following:
For treatment of undifferentiated soft tissue sarcoma
There is no standard treatment for undifferentiated soft tissue sarcoma. Treatment may be within a clinical trial for patients with nonrhabdomyosarcomatous soft tissue sarcomas (NRSTS).
For treatment of angiosarcoma and lymphangiosarcoma
Treatment of angiosarcoma and lymphangiosarcoma may include the following:
For treatment of hemangioendothelioma
Treatment of hemangioendothelioma in children younger than one year may include the following:
Treatment of hemangioendothelioma in children aged one year and older may include the following:
For treatment of aggressive fibromatosis, dermatofibrosarcoma, and angiomatoid malignant fibrous histiocytoma
Treatment of these tumor types will be surgery whenever possible. Other treatments may include the following:
For treatment of epithelioid sarcoma, leiomyosarcoma, liposarcoma, and mesenchymal chondrosarcoma
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with nonmetastatic childhood soft tissue sarcoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Metastatic Childhood Soft Tissue Sarcoma
Treatment of metastatic childhood soft tissue sarcoma may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with metastatic childhood soft tissue sarcoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Recurrent and Progressive Childhood Soft Tissue Sarcoma
Treatment of recurrent or progressive childhood soft tissue sarcoma may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent childhood soft tissue sarcoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
For more information from the National Cancer Institute about childhood soft tissue sarcoma, see the following:
For more childhood cancer information and other general cancer resources from the National Cancer Institute, see the following:
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
Chat online
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." In the United States, about two-thirds of children with cancer are treated in a clinical trial at some point in their illness.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. For additional help in locating a childhood cancer clinical trial, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).
The PDQ database contains listings of groups specializing in clinical trials.
The Children's Oncology Group (COG) is the major group that organizes clinical trials for childhood cancers in the United States. Information about contacting COG is available on the NCI Web site or from the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).
Last Revised: 2012-05-25
If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.
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To learn more visit Healthwise.org
© 1995-2012 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.


text:
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
The PDQ childhood brain tumor treatment summaries are organized primarily according to the World Health Organization classification of nervous system tumors.[1,2] For a full description of the classification of nervous system tumors and a link to the corresponding treatment summary for each type of brain tumor, refer to the PDQ summary on Childhood Brain and Spinal Cord Tumors Treatment Overview.
Dramatic improvements in survival have been achieved for children and adolescents with cancer. Between 1975 and 2002, childhood cancer mortality has decreased by more than 50%.[3] Childhood and adolescent cancer survivors require close follow-up because cancer therapy side effects may persist or develop months or years after treatment. (Refer to the PDQ summary on Late Effects of Treatment for Childhood Cancer for specific information about the incidence, type, and monitoring of late effects in childhood and adolescent cancer survivors.)
Primary brain tumors are a diverse group of diseases that together constitute the most common solid tumor of childhood. Brain tumors are classified according to histology, but tumor location and extent of spread are important factors that affect treatment and prognosis. Immunohistochemical analysis, cytogenetic and molecular genetic findings, and measures of mitotic activity are increasingly used in tumor diagnosis and classification.
Central nervous system (CNS) germ cell tumors (GCTs) may arise from the pineal and/or suprasellar regions as solitary or multiple lesions. Pineal region tumors are twice as frequent as suprasellar tumors, but approximately 5% to 10% of patients have both suprasellar and pineal gland involvement at the time of diagnosis.[4] Involvement of both sites is most commonly seen in pure germinomas. Males have a higher incidence of GCT than females, with males having a preponderance of pineal region primaries. Other areas that may be involved, though rare, include the basal ganglia, ventricles, thalamus, cerebral hemispheres, and the medulla.[5,6]
Radiographic characteristics of CNS GCTs cannot reliably differentiate germinomas from nongerminomatous germ cell tumors (NGGCTs) or from other CNS tumors. The diagnosis of GCTs is based on clinical symptoms and signs, tumor markers, neuroimaging, and cytological cerebrospinal fluid (CSF) and histological confirmation. Patients with intracranial GCTs often present with pituitary dysfunction including diabetes insipidus (DI), with an increased presence in patients with tumors involving the suprasellar region. Two-thirds to 90% of patients with a GCT of the suprasellar region present with DI.[7,8] Patients with tumors in the pineal region may also present with DI without imaging evidence of third ventricular and suprasellar involvement. Visual loss, growth hormone deficiency, precocious puberty (suprasellar tumors), and Parinaud syndrome (pineal tumors) are also common.[8] Nonspecific symptoms such as enuresis, anorexia, and psychiatric complaints can lead to delays in diagnosis, whereas signs of increased intracranial pressure or visual changes tend to result in earlier diagnosis.[9]
Appropriate staging is crucial since patients with metastatic disease should receive different total radiation doses and more extended radiation fields. All patients with a suspected CNS GCT should have the following tests:
Diagnosis of GCTs often requires a tumor biopsy, except in cases with characteristic increased tumor markers in the serum and/or CSF. When the tumor markers are negative or mildly elevated but below diagnostic criteria, or if there is any noncharacteristic finding, a tumor biopsy should be done.
Childhood central nervous system (CNS) germ cell tumors (GCTs) are a heterogeneous group of lesions that commonly arise from the pineal and/or suprasellar regions of the brain. In Western countries, GCTs represent less than 4% of primary brain tumors in children, while in series from Japan and Asia, CNS GCTs account for approximately 11% of pediatric CNS tumors.[1,2,3]
The pathogenesis of intracranial GCTs is unknown. The "germ cell theory" proposes that CNS GCTs arise from primordial germ cells that have aberrantly migrated and undergone malignant transformation. An alternative hypothesis, "the embryonic cell theory," proposes that GCTs arise from a pluripotent embryonic cell that escapes normal developmental signals and progresses to CNS GCTs.[4,5] Recent investigations comparing the genomic alterations found in GCTs are very similar, whether they are tumors of CNS, gonadal, or extragonadal origin. These findings lend support that all GCTs have common pathogenetic mechanisms.[6]
The World Health Organization has classified CNS GCTs into the following major groups:[7]
Nongerminomatous germ cell tumors (NGGCTs), commonly referred to as secreting tumors, include embryonal carcinoma, yolk sac tumors, choriocarcinoma, and mixed GCTs. Alternative classification schemes have been proposed by others, including the Japanese Pediatric Brain Tumor Study Group for CNS GCTs, who base their stratification on the therapeutic grouping of the differing histologic variants as shown in Table 3.
The classification of a childhood brain tumor is based on both the histopathologic characteristics of the tumor and its location in the brain.[6] In addition to the microscopic appearance of the various CNS GCTs, tumor markers (proteins secreted by the tumor cells) found in the serum and cerebrospinal fluid (CSF) aid in diagnosis (see Tables 1 and 2).[1,8,9]
For some CNS GCTs, elevations of tumor markers along with the imaging findings are diagnostic of a CNS GCT and may obviate the need for initial biopsy or resection of the tumor mass. The tumor markers alpha-fetoprotein (AFP) and beta subunit human chorionic gonadotropin (beta-HCG) are the most commonly followed, although other markers such as placental alkaline phosphatase and c-kit are being investigated. The laboratory tests used to detect tumor markers have become more reliable during the last decade, but the interpretation of specific results varies within study groups. Some European and Asian groups consider tumors with serum and/or CSF AFP ≥50 ng/ml and/or beta-HCG ≥100 IU/L to be secreting GCTs, whereas others in the United States and Europe consider tumors as secreting if serum and/or CSF AFP ≥10 ng/dl and/or serum and/or CSF beta-HCG ≥50 IU/L. Pure germinomas and teratomas usually present with negative markers, but very low levels of beta-HCG can be detected in germinomas (with syncytiotrophoblastic cells) and elevations of AFP can be seen in teratomas.[9] Both AFP and beta-HCG have predictable half-lives, making these markers useful in diagnosing some CNS GCTs, and in monitoring response and early detection of recurrence.
Alternative classification schemes for CNS GCTs have been proposed by others, including the Japanese Pediatric Brain Tumor Study Group, who base their stratification on the prognostic grouping of the differing histologic variants as shown in Table 3. Pure germinomas and mature teratomas fall into the good prognostic group; choriocarcinoma, yolk sac tumor, embryonal carcinoma, or mixtures of these three histologic subtypes fall into the poor prognostic group.[8]
There is no universally accepted staging system for germ cell tumors (GCTs), but a modified Chang Staging System has been traditionally used. In addition to whole-brain magnetic resonance imaging (MRI), MRI of the spine is required. When medically permissible, lumbar cerebrospinal fluid (CSF) should be obtained for the measurement of tumor markers (alpha-fetoprotein [AFP] and beta subunit human chorionic gonadotropin [beta-HCG]) and for cytopathologic review. Serum tumor markers are often obtained for AFP and beta-HCG; however, they do not serve as a substitute for CSF tumor markers.[1] Patients with localized disease and negative CSF cytology are considered to be M0 (no metastasis); patients with positive CSF cytology or patients with drop metastasis in the spine or cranial subarachnoid space are considered to be M+ (metastatic-positive). Appropriate staging is crucial since patients with metastatic disease should receive different total radiation doses and more extended radiation fields. Staging of patients with bifocal intracranial germinomas limited to the suprasellar and pineal region remains controversial, with some classifying these tumors as localized disease and others classifying such presentations as disseminated disease.[2]
GCTs can disseminate throughout the neuraxis at diagnosis or at any disease stage. Rarely, extracranial spread to lung and bone has also been reported.[3,4]
Teratomas, germinomas, and nongerminomatous germ cell tumors (NGGCTs) have differing prognoses and may require different treatment regimens. For older children (aged >3 years) and adults, radiation therapy has been an important component of therapy for germinomas and NGGCTs, although the total dose and fields are debated. The addition of chemotherapy has shown central nervous system GCTs to be chemotherapy sensitive. Regimens that utilize both chemotherapy and radiation therapy have been investigated for germinomas and NGGCTs. These combined regimens have been adopted to increase survival (NGGCTs) or to allow for reduction in the field or dose of radiation therapy (germinomas and NGGCTs).[1,2,3,4]
Treatment Options
Germinomas are highly radiosensitive and have been traditionally treated with radiation therapy alone; historically, craniospinal irradiation with a boost to the region of the primary tumor has been utilized. This has resulted in 5-year overall survival rates greater than 90%.[1]; [2][Level of evidence: 2A]; [3,4][Level of evidence: 3iA] These excellent survival rates have allowed investigators to focus on reducing radiation treatment volume and intensity in an attempt to decrease late effects.[2,5] Patterns of relapse following craniospinal irradiation versus reduced-volume radiation therapy (whole-brain or whole-ventricular radiation therapy) have strongly suggested that craniospinal irradiation is not necessary for localized germinomas.[6,7] Based on these results, the treatment for patients with localized germinomas has been modified to cover the whole ventricular system followed by a boost to the primary site, rather than to deliver radiation therapy to the entire craniospinal axis or even to the whole brain. This change has not resulted in worse outcomes and is expected to minimize the acute and long-term toxicity of radiation therapy.
Chemotherapy has been explored in an effort to reduce radiation therapy doses and associated neurodevelopmental morbidity. Several studies have confirmed the feasibility of this approach maintaining excellent survival rates, but the number of treated patients is still small.[8,9,10]; [11][Level of evidence: 2A]; [12][Level of evidence: 3iiiC] Chemotherapy agents such as cyclophosphamide, ifosfamide, etoposide, cisplatin, and carboplatin are highly active in central nervous system (CNS) germinomas. Management of patients receiving chemotherapeutics that require hyperhydration (e.g., cyclophosphamide, ifosfamide, and cisplatin) are often quite challenging to manage because of the high prevalence of diabetes insipidus in this population.[13] An international group of investigators have explored a chemotherapy-only approach primarily for younger children. They were able to achieve a complete response in 84% of patients with germinomas treated with chemotherapy alone. Fifty percent of these patients relapsed or progressed; many recurrences were local, local plus ventricular, and ventricular alone and/or with leptomeningeal dissemination throughout the CNS requiring further therapy including radiation.[14] Subsequent studies have continued to support the need for irradiation following chemotherapy and the likely requirement for whole-ventricular irradiation when chemoradiotherapy is used in order to avoid ventricular recurrence.[15][Level of evidence: 2A]; [16][Level of evidence: 3iiiA]
The appropriate dose and field of radiation therapy given following chemotherapy has not been established. The treatment options for localized pure germinoma include whole-ventricular radiation therapy with 24 Gy followed by a boost to the primary tumor for a total dose of 45 Gy to 50 Gy. Chemotherapy followed by reduced-dose radiation therapy could also be considered. However, the extent of dose reduction of radiation therapy has not been established, and whether the whole-ventricular irradiation dose (following chemotherapy) can be further reduced to primary tumor bed alone has not been established.
Optimal management of bifocal lesions is unclear. A meta-analysis of 60 patients demonstrated excellent progression-free survival after craniospinal irradiation alone. Chemotherapy plus localized radiation, including whole-ventricular irradiation, also resulted in excellent disease control.[17][Level of evidence: 3iiDiii]
The following two standards of care exist for the treatment of newly diagnosed germinomas:
Treatment Options Under Clinical Evaluation
The following is an example of a national and/or institutional clinical trial that is currently being conducted or is under analysis. Information about ongoing clinical trials is available from the NCI Web site.
Teratomas are designated as mature or immature based on the absence or presence of differentiated tissues. The Japanese Pediatric Brain Tumor Study Group stratifies teratomas for classification and intensity of treatment (chemotherapy and radiation) for mature versus immature into the good- and intermediate-risk groups, respectively (see Table 3), while the Children's Oncology Group includes immature teratomas with other NGGCTs.
The treatment for teratomas should include maximal surgical resection. Adjuvant treatment in the form of focal radiation therapy and/or adjuvant chemotherapy for subtotally resected tumors is controversial, with small institutional series suggesting potential utility for the use of radiosurgery (stereotactic radiosurgery).[1,2][Level of evidence: 3iA]
The prognosis for children with nongerminomatous germ cell tumors (NGGCTs) remains inferior in comparison to germinomas. While difficult to state definitively due to the small number of patients, it appears that patients with NGGCTs and higher elevations in tumor markers, particularly alpha-fetoprotein (AFP), have a worse prognosis.[1,2] With the current treatment regimens, the 10-year overall survival (OS) for NGGCTs is between 70% and 80%.[3,4] NGGCTs are radiosensitive; however, survival following standard craniospinal irradiation alone has been poor, ranging from 20% to 45% at 5 years. The majority of NGGCTs relapse within 18 months. OS rates can be stratified by histologic subtypes. Patients with pure choriocarcinoma, yolk sac tumor, or embryonal carcinoma appear to have the worst outcomes compared with patients with pure germinoma or teratoma mixed with other NGGCT elements. The addition of chemotherapy has been shown to improve OS rates. Effective agents include carboplatin, etoposide, bleomycin, ifosfamide, and vinblastine.[3,4] As with patients with germinoma, the administration of chemotherapy requiring hyperhydration can be complex when the patient has a comorbidity of diabetes insipidus.[5]
The optimal treatment regimen for NGGCTs remains unclear. The addition of chemotherapy to radiation therapy has increased survival, but the specific chemotherapy regimen and length of therapy and the optimal radiation field, timing, and dose remain under investigation.[3,6,7] Some investigators have proposed radiation therapy fields that are smaller than craniospinal irradiation (e.g., focal or focal whole ventricular) for nondisseminated NGGCT patients. Results of these trials appear promising, although controversy exists over the pattern of relapse for patients treated with chemotherapy and focal radiation.[3,4,8]
Commonly, patients treated with chemotherapy may have normalization of tumor markers with a less than complete radiographic response. A second-look surgery can help determine if the residual mass contains teratoma or fibrosis versus residual NGGCT.[4] Occasionally, the mass continues to expand in size even though tumor markers may have normalized; this may be due to the growing teratoma syndrome and not a failure to treat the NGGCT component.[9,10] In such circumstances, surgery is usually required for debulking and histologic confirmation.
High-dose chemotherapy with autologous stem cell rescue has shown promise as consolidation therapy for some high-risk germ cell tumors.[11]
The most common type of relapse is local recurrence at the primary tumor site, but 30% of relapses are outside the primary site and/or combined with leptomeningeal spread. The outcome for patients with relapse, especially those with nongerminomatous germ cell tumors (NGGCTs), remains poor.
Salvage therapies have included surgery, focal or craniospinal radiation, chemotherapy with re-irradiation, and myeloablative chemotherapy with autologous stem cell rescue. Patients with germinoma that have been treated initially with chemotherapy only benefit from chemotherapy followed by radiation therapy.[1,2] Re-irradiation following chemotherapy at recurrence has been utilized.[2] For pure germinoma patients who previously received radiation therapy, myeloablative chemotherapy with stem cell rescue has been used.[3,4] High-dose chemotherapy and autologous stem cell rescue may also have curative potential for some relapsed systemic NGGCTs.[3,4,5,6]
Enrollment on clinical trials should be considered for all patients with recurrent disease. Information about ongoing clinical trials is available from the NCI Web site.
A significant proportion of children with central nervous system (CNS) germ cell tumors (GCTs) present with endocrinopathies including diabetes insipidus and panhypopituitarism; in most cases, these endocrinopathies are permanent despite tumor control and will need continued replacement therapy.[1,2,3]
Although significant improvements in the overall survival of CNS GCTs have occurred, patients still face significant late effects secondary to the location of their primary tumor and its treatment. Each chemotherapeutic agent has its own characteristic long-term side effects. Radiation therapy to the areas commonly affected by GCTs is known to cause visual field impairments, extraocular movement disturbances, endocrine disorders, decline in patients' performance status, and learning disabilities.[4,5] Second tumors have been identified in this population, some of which are felt to be related to prior irradiation.[6] Current clinical trials and therapeutic approaches are directed at minimizing the long-term sequelae of the treatment of CNS GCTs.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood central nervous system germ cell tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
General Information About Childhood Central Nervous System (CNS) Germ Cell Tumors
Added text to state that the PDQ childhood brain tumor treatment summaries are organized primarily according to the World Health Organization classification of nervous system tumors (cited Louis et al. [IARC Press 2007] and Louis et al. [Acta Neuropathologica 2007] as references 1 and 2, respectively). Also revised text to state that for a full description of the classification of nervous system tumors and a link to the corresponding treatment summary for each type of brain tumor, refer to the PDQ summary on Childhood Brain and Spinal Cord Tumors Treatment Overview.
Added Weksberg et al. as reference 4.
Stage Information for CNS Germ Cell Tumors
Added text to state that staging of patients with bifocal intracranial germinomas limited to the suprasellar and pineal region remains controversial, with some classifying these tumors as localized disease and others classifying such presentations as disseminated disease (cited Weksberg et al. as reference 2).
Treatment of Newly Diagnosed Germinomas
Added text to state that optimal management of bifocal lesions is unclear. A meta-analysis of 60 patients demonstrated excellent progression-free survival after craniospinal irradiation alone; chemotherapy plus localized radiation, including whole-ventricular irradiation, also resulted in excellent disease control (cited Weksberg et al. as reference 17 and level of evidence 3iiDiii).
Added Treatment Options Under Clinical Evaluation as a new subsection.
Treatment of Newly Diagnosed Nongerminomatous Germ Cell Tumors
This summary is written and maintained by the PDQ Pediatric Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of childhood central nervous system germ cell tumors. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Pediatric Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Childhood Central Nervous System Germ Cell Tumors Treatment are:
Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Pediatric Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."
The preferred citation for this PDQ summary is:
National Cancer Institute: PDQ® Childhood Central Nervous System Germ Cell Tumors Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/childCNS-germ-cell/healthprofessional. Accessed <MM/DD/YYYY>.
Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.
Based on the strength of the available evidence, treatment options may be described as either "standard" or "under clinical evaluation." These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Coping with Cancer: Financial, Insurance, and Legal Information page.
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More information about contacting us or receiving help with the Cancer.gov Web site can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the Web site's Contact Form.
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For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
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Is it better to reward existing customers for loyalty — or spend your marketing dollars on attracting new ones? Here is a framework to help you decide.
Charlie, a loyal customer of his local bank, had never thought of taking his business elsewhere, but the offer from a competing bank to refinance his mortgage at an extremely low interest rate seemed too good to pass up. He asked Rick, the loan officer he had been dealing with for years, if the bank could match the offer. Rick knows lowering Charlie's mortgage rate won't be good for the bank's bottom line, but he thinks making a long-time customer happy is worth the investment. Should the bank match the offer, or should it let Charlie go?
This anecdote, while fictional, represents a real customer management dilemma faced by many companies nowadays: Should we offer better deals to current customers or to new ones? In particular, at what cost should we keep current customers, as opposed to seeking out new ones? The question is simple, but the answer is not.
A quick scan of offers found in the marketplace does not reveal obvious commonalities and provides little insight. While airlines give lavish frequent-flyer packages to their most loyal customers, wireless carriers generally focus on wooing new customers through introductory deals. Hotels often do both. Apparel catalog retailers send special discount "value" catalogs to existing customers, whereas magazines, newspapers and software companies often offer discounts to new customers by offering them lower introductory prices.
But would it, for example, be more profitable for a newspaper to offer a better price for subscription renewal rather than new subscriptions? Should a wireless carrier instead offer lower rates to its high-volume customers who have stayed with the carrier for a long time? Should a hotel, airline or retailer offer better rates to new customers it aims to acquire? Ultimately, how can a manager reconcile the demands of current customers with the need to
attract new customers?
Expert opinions on this subject conflict. On one side, you can find people who argue that careful attention to the needs of existing customers like Charlie deepens the relationship between customer and company. That, in turn, leads to continuous increases in customer satisfaction, loyalty and company profitability in a virtuous cycle of mutual benefits. Customers get better rewards, and the companies get more business from those customers.


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Aviva Premiership
Sale confirm death of David Tait
ESPN Staff
December 13, 2012
David Tait spent five years with Sale Sharks © Getty Images
Former Sale player David Tait has died at the age of 25, the Aviva Premiership club have confirmed.
Tait is understood to have fallen from an apartment block in Hong Kong, according to reports in the Manchester Evening News. His Premiership rugby career was cut short by injuries, and he became a corporate finance manager for multinational firm KPMG.
Tait, a back-row forward, spent five years with Sale, who signed him as a teenager. He was part of England's training squad for the 2008-09 International Rugby Board world sevens series, but did not play. He later played for Scotland at the 2009 Dubai Sevens.
"The rugby community will be shattered by the passing of such a gifted and popular young man who was respected by everyone he played alongside," Rugby Players' Association chief executive Damian Hopley said.
"He wasn't simply a talented rugby player, he was also extremely bright and successful in his life outside of rugby. We will do everything we can to help support David's family and the players who played alongside him. His family and friends are in our thoughts and prayers."
Former Sale and England captain Jason Robinson said on Twitter: "Holding back the tears thinking about the loss of David Tait. Lovely young man who will be greatly missed. Thoughts & prayers to his family".
Premiership Rugby chief executive Mark McCafferty said: "At this desperately sad time words can hardly do justice to the way everyone involved with Aviva Premiership Rugby will feel about David's passing. Everyone at Premiership Rugby would like to offer their condolences and support to David's family and friends at this very difficult time."
RFU CEO Ian Ritchie said: "David is well remembered by staff at the RFU as a talented player who represented England whole-heartedly in our age grade sides. He will be greatly missed by the rugby community and our thoughts are with his family and friends at such a sad time."
Tait represented Scotland sevens at tournaments in Dubai and South Africa in 2009. Stephen Gemmell, who was then Scotland sevens head coach and is now Scottish Rugby Union head of performance development, said: "He became an important member of the squad and fitted in really well with the other players.
"David was a pleasure to work with and had a bright future ahead of him, both within and outwith the game. The thoughts of all at Scottish Rugby are with David's family, friends and colleagues at this difficult time."
Harlequins and England player Danny Care tweeted: "Couldn't believe the news y'day. Lost a good friend and an absolute legend of a bloke David Tait. RIP mate. Sending all my love to his family."
Wasps rugby player James Haskell tweeted: "Very shocked to wake up to the news of former Sale player David Taits death. Very sad news. Top player and man."
Adam Powell of Saracens wrote on Twitter: "So sad to hear about Dave Tait. Absolutely gutted!"
Northampton Saints player Ryan Lamb tweeted: "Terrible news about the death of David Tait. Top player and a top bloke, had some awesome times playing through the age groups with him. Thoughts go out to his family and to the sale lads in such a bad time. #RIP"
Danny Cipriani described it as "devastating news!" and tweeted: "Horrible news about David Tait, he was a legend of a bloke and very talented. Thoughts with his family sending my love."
© ESPN Sports Media Ltd.
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Assisted Partner Notification to Augment HIV Treatment and Prevention in Kenya (APS)
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
|ClinicalTrials.gov Identifier: NCT01616420
Recruitment Status : Completed
First Posted : June 11, 2012
Last Update Posted : April 10, 2017
- Study Details
- Tabular View
- No Results Posted
- Disclaimer
- How to Read a Study Record
The main purpose of this implementation science study is to find out if providing aPS at 18 different Ministry of Health (MOH) VCT clinics in Kenya works and is cost-effective. This would enable co-investigators in the Kenyan MOH to justify funding to scale-up these services.
The primary aim of the study is to find out whether providing aPS to sexual partners of newly tested HIV-infected individuals can result in more sexual partners getting counseled and HIV tested and linked to HIV care programs for initiation of ART if appropriate. The investigators hypothesize that aPS will increase rates of case-finding, linkages to care, and ART initiation and will not result in social harm.
The second aim is whether aPS is cost-effective in the Kenyan setting. The investigators will estimate how much it costs (when compared to standard methods) to identify and link HIV-infected persons into care. The investigators will also determine how successful aPS is at preventing future HIV transmission events and other outcomes associated with untreated HIV infection. The investigators hypothesize that HIV prevalence among partners in the immediate aPS arm will be high enough to make this approach cost-effective from the payer and societal perspective.
Finally, with the Kenya MOH, the investigators want to establish a nationwide monitoring system to evaluate why Kenyans are testing for HIV. In the future, when aPS is rolled out nationally, this will help Kenyan public health officials define the contribution of aPS to HIV case-finding. The investigators hypothesize that the proportion of newly tested HIV-infected individuals who report testing because of known exposure to a person with HIV will represent a significant proportion of new cases and the investigators will be able to identify places in Kenya where aPS will have the greatest impact on HIV treatment and prevention.
|Condition or disease
|Other: Assisted-partner notification services
|Not Applicable
Diagnosing HIV soon after infection can benefit individuals and also has important public health benefits. It has been shown that starting antiretroviral therapy (ART) before HIV has progressed results in a better response to treatment and gives the person a better chance of long-term survival with HIV. Treating HIV can also reduce the risk that someone will transmit HIV to his or her sexual partners. The first step in achieving these individual and population level benefits is testing people for HIV. Unfortunately, in many parts of the world, including Kenya where we plan to conduct this study, many people are not tested regularly and do not know that they are infected. This study involves providing a public health service, notification of an exposure to a communicable disease and HIV testing, to sexual partners of those who test HIV-positive at voluntary counseling and testing (VCT) clinics in Kenya. Sexual partners are identified voluntarily by the person who tests at the VCT. A public health provider then goes to the home of the sexual partners to offer them HIV counseling and testing. This process is called provision of assisted partner services (aPS).
We propose a cluster randomized clinical trial which will be conducted in collaboration with the Kenya Ministry of Health (MOH) at 18 rural and urban voluntary counseling and testing (VCT) facilities across Kenya. Proposed activities will assess the effectiveness and cost-effectiveness of providing aPS, improve capacity for program implementation in Kenya, and lay the foundation for evaluating the program's impact at the national level.
|Study Type :
|Interventional (Clinical Trial)
|Actual Enrollment :
|2424 participants
|Intervention Model:
|Parallel Assignment
|None (Open Label)
|Primary Purpose:
|Health Services Research
|Official Title:
|Assisted Partner Notification to Augment HIV Treatment and Prevention in Kenya
|Study Start Date :
|June 2012
|Actual Primary Completion Date :
|August 2015
|Actual Study Completion Date :
|August 2015
|No Intervention: Delayed aPS
|Experimental: Immediate aPS
Other: Assisted-partner notification services
Assisted-partner notification services (aPS) is a public health service which notifies the partners of those who test positive for a communicable disease of their exposure.
Other Names:
- Number of partners testing for HIV [ Time Frame: 6 week period following index case enrollment ]The number of partners of an index participant that were tested for HIV (offset will be the number of partners with locator information provided by the index participant).
- Newly tested HIV-infected partners [ Time Frame: 6 week period following index case enrollment ]The number of partners of an index participant identified as HIV-infected (offset will be the number of partners of that index participant who were HIV tested).
- Number of partners linking to HIV care [ Time Frame: 6 week period following index case enrollment ]The number of partners of an index participant who were linked to HIV care (offset will be the number of partners of an index participant identified as HIV-infected and analysis will be limited to index participants with at least one HIV-infected partner.)
- Incremental cost-effectiveness from payer and societal perspectives [ Time Frame: 6 week period following index case enrollment ]
- Proportion of individuals with newly diagnosed HIV infection who report testing because of known exposure to a person with HIV [ Time Frame: 6 week period after index case enrollment ]
- Costs of identifying >1 partner per index case [ Time Frame: 6 week period after index case enrollment ]
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
|Ages Eligible for Study:
|18 Years and older (Adult, Older Adult)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
- Written informed consent is required of all participants. All participants must be 18 years or older.
- Index case participants must be HIV-seropositive, and willing and able to provide locator information for sexual partners in the past three years.
Exclusion Criteria:
- Index cases will be excluded from participation if they are pregnant, or have reported intimate partner violence during the last month. There is no exclusion criteria for partner participants.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01616420
|Karuri VCT
|Kiambu, Kenya
|Kiambu Hospital VCT
|Kiambu, Kenya
|Kirwara VCT
|Kiambu, Kenya
|Chulaimbo Health Centre
|Kisumu, Kenya
|Joo Trh Vct
|Kisumu, Kenya
|Kisumu East District Hospital
|Kisumu, Kenya
|Kombewa VCT
|Kisumu, Kenya
|Maseno Mission
|Maseno, Kenya
|Baba Dogo VCT
|Nairobi, Kenya
|Casino VCT
|Nairobi, Kenya
|Huruma Lions
|Nairobi, Kenya
|Kariobangi VCT
|Nairobi, Kenya
|Kenyatta National Hospital (KNH) VCT
|Nairobi, Kenya
|Mama Lucy Kibaki VCT
|Nairobi, Kenya
|Mbagathi VCT
|Nairobi, Kenya
|Pumwani VCT
|Nairobi, Kenya
|Abidha Health Centre
|Siaya, Kenya
|Ongielo Health Centre
|Siaya, Kenya
|Principal Investigator:
|Carey Farquhar, MD, MPH
|University of Washington
|Study Chair:
|Peter Cherutich, MBChB, MPH
|Kenya Ministry of Health
|Study Chair:
|Matthew Golden, MD, MPH
|University of Washington
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
|Responsible Party:
|Carey Farquhar, Professor, University of Washington
|ClinicalTrials.gov Identifier:
|NCT01616420 History of Changes
|Other Study ID Numbers:
|First Posted:
|June 11, 2012 Key Record Dates
|Last Update Posted:
|April 10, 2017
|Last Verified:
|April 2017
assisted partner notification services
linkage to HIV care


text: BASSMIDI MIDI synthesiser for Windows XP/Vista/7 Reply #75 – 2011-06-25 17:16:10 Quote from: mudlord on 2011-06-25 10:29:57I am personally curious how that ass solved it in that coolsoft synth.LOL! I think that's what he did.. install the files to their own subdirectory.Quote from: mudlord on 2011-06-25 10:29:57I suppose that would be one solution, methinks. (installing in own directory).Yeah, I'm sure that would fix it. As long as the PopCap games (or any other games that use BASS.DLL) don't find it in one of the system "path" directories, it should work just fine.Kind of similar to the hex-edit hacks that I did to rename the files (that I mentioned over at VGMusic)... the games in question can't find a BASS.DLL in one of the system path directories, so it simply uses the one that is installed and located within it's own game directory.Quote from: mudlord on 2011-06-25 10:29:57I am rewriting that installer script anyway for the XG Win7 synth (since that expects VSTis for synths instead of BASS).though legally, thats in a minefield of its own. Maybe I should do in-memory patching of the synth in the driver itself whenever a XG VSTi is loaded, to crack it. Or risk distributing a no-longer published VSTi since Yamaha can't get off its arse and support it. So I ended up having to recrack the synth myself anyway to no longer require a registry key or even installation for it to work in foo_midi properly without a installer.Hehe, all that code talk boggles my mind <grin>. In a nutshell though, it sounds as if you're attempting to get the S-YXG50 to function under Vista/7? If so, that would be extremely cool I've been using the S-YXG50 WDM softsynth for quite sometime now (under Windows XP), and it would be great if Vista/7 users had an easier way to install it as well . Would it act as a "global" kernel driver of sorts (like it does under Windows XP, and like the BASSMIDI Driver does), or would it still be a "VSTi" sort of thing (requring a virtual MIDI patch cable)?P.S. BTW, dunno if any of this is of help, but a collection of XG type stuff here -> http://www.cmoo.com/snor/weeds/Yamaha_XG/


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Check the new video of Berlin Boom Orchestra feat. #SaraleneDajou #Ganjaman #JonMoon #LongFingah #TontoAddi #PupaSock #Jahcoustix #MalElve (irie revoltes) #PacoMendoza (RaggaBund) #Jimmy I Muze (SattaTree)
SattaTree in the Irie Mag magazine, get here:
Irie Mag world reggae magazine
Welcome to to our webpage.
you are great! thx thx thx.
Thank U 4 support.
Du möchtest noch mehr Musik von Sattatree hören und weitere neue
You want to hear more music of Sattatree and see more new music-videos, as well, informed about the latest news and concert dates. Then you should be connected with these roots. Just fill your name & email-address in the
For your entry in our newsletter, there are currently a further free download title-human legalization. Here we go.
Hear SattaTree on Spotify & napster:
About SattaTree / Biographie
( Roots-Reggae/Dub )
Sattatrees lead singer and composer Jimmy I Muze is touching the audience with his message. Located in the multicultural center of Berlin,the roots-reggae band Sattatree found itself in 2007.
In 2008 Sattatree produced songs like "Judgement Day ", " Rootsman " and their hit " Babylon." Two years later appears Sattatrees debut album " Rootsman " at the Berlin based Reggae and Dublabel One Drop Music. A half year after the release of " Rootsman " the label coupled out the single "Babylon" . Within a few weeks the single was internationally sold out . Together, the band won the 2012 European Reggae Contest for Germany and the German speaking countries. They performed concerts nationally and internationally. Meanwhile, the band Sattatree has become an institution in the reggae scene, experiencing a whole new hype especially in Berlin.
Just in time for Summer 2013 Sattatree released their new album "Human Legalization " . They recorded the new songs at Planet Earth studio in Berlin Kreuzberg . Aldubb mixed and mastered the album and it appeared again on the successful One - Drop Music label .
In 2015 SattaTree played as the opening act of the legendary reggae band Inner Circle on the ReggaeInBerlin Festival. The current band members are Kwame Sometimer Gbemu from togo (bass & backing vocals), Jan Kordas from germany (piano/keys), Miguel Alejandro Miranda Lagos from chile/germany (drums & backing vocals), Jimmy I Muze from nigeria/germany (singer, guitar, composer, producer, songwriter).
Currently SattaTree plan the album no. 3 and recordings and the mixing takes place in Planet Earth Studio.
Recently SattaTree (Ekow Alabi Savage - percussion & Jimmy I Muze - guitar/vocals) won on the 11.08.2018 the "Grand Prix Picknick Konzerte" street-musician-contest-festival as the favorit of the audience.
coole Sommermusik, Reggae Band buchen
Contact & Booking inquiries
Foto by: Manuel Genolet, Thomas Fischer, Sunrise Reggae & Ska Festival & Klaus Gollin
News & Dates
B-Day-Bash live with SattaTree Band
B-Day-Bash live with SattaTree Band in Zwickau / Crimmitschau. mehr
REGGAE PARTY MIT SATTATREE live in Ortrand (reggaestory.de)
Der Ortrander Kultur-Güter-Schuppen lädt zur großen Reggae Party. Als Live Act wird Sattatree mit feinsten Roots Reggae die Besucher verzaubern, der seinesgleichen in Deutschland sucht. Unterstützt von Aldubb,... mehr
SattaTree-Band live @ culture comtainer - Berlin
Kind of crowd founding. You will come and support the live recording concert of SattaTree only with a 5€ dontation. Next we will present you soon a live album or an ep with few tunes. Na miss the chance , come... mehr
Let's Jam live with Jimmy I Muze aka SattaTree
Let's Jam live with Jimmy I Muze aka SattaTree mehr
PICK'N'DROP live in Berlin
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Music-productions / Musikproduktionen
Video "Babylon"
Friends & Partners
Planet Earth Studio http://planet-earth-studios.de/en/
Puto Production http://putoproduction.de/
Soulfire Artists http://soulfire-artists.de/


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Learn more about what the McKinley Health Center offers to our students.
We are a division of student affairs AT Illinois
Several important forms can be downloaded from our website
Immunization compliance can seem complicated. Learn more about the requirements
Visit the MyMcKinley portal to request a prescription refill or transfer to McKinley.
Many medications are included with your Health Fee. Visit our formulary for more info.
Schedule and appointment with your Primary Provider
Download the forms you need before your next appointment
We have several Health Resource Centers for your convenience.
Visit our Wellness Guide for timely info about campus resources
Learn more about the specific costs and deadlines for services at McKinley Health Center
Take a look at a few commonly asked questions by new students
We are located at the Souteast corner of campus. Use the campus map to navigate.
If there is any information you cannot find on our website, give us a call.