text:
Topic: Systemic Chemotherapy in General for Cholangiocarcinoma patient.
Hi, Pamela,
Here is the list of chemo agents that mostly used for CCA that I can find at this point. most of them are used in combination to get the best results (synergy) out of the combo that used in the regimen.And most often,with regard to side effects of the drugs that are listed below,it may be occur as an individual event for an individual patient only and not every patient will experience every or any adverse events of the medication..
The following link is very useful in understanding the current trend of using chemotherapy and targeted therapy in treating BTC( biliary tract carcinoma) as of 7/2012. It is for medical professional but it summarized the treatment basis very well. Title: Personalized treatment of advanced biliary tract cancer.
http://www.discoverymedicine.com/Daniel … t-cancers/
I strongly recommend you to read the above one first to understand the current thinking of treating cholangiocarcinoma (CCA) then if you have time and interest ,then read the following links to increase your understanding about the potential treatments of CCA in the future.
The link below is related to the new trend of using immunology ( ie: vaccine and adoptive cell therapy like TIL) in treating cancer. ( as of 2/2013).
http://www.cholangiocarcinoma.org/punbb … 482#p72482
The following link discuss the future of mAbs( ie: Avastin etc) and small molecules ( ie: the TKI such as sorafenib and erlotinib) and the newer approach of using peptide immunology for cancer treatment.( as of 4/2/2013)
http://www.discoverymedicine.com/Megan- … rapeutics/
Taken by Mouth:(not necessary FDA approval indications for CCA but doctors can use them out of protocol or for "off-label use")
Part I individual chemotherapy and targeted agents
1.Capecitabine(Xeloda--an oral form of 5FU)-see 5Fu below;diarrhea and hand and foot symptoms are the most common side effects.
fatigue,back pain, hyperbilirubinema, and constipation too.
Patient on Coumadin(Warfarin) should decrease the dose and monitor the INR level closely by medical professional for potential bleeding drug-drug interaction of Xeloda and Warfarin. Personally, the side effects are not bad for me , I am on it for 18 months and counting -- anemia,and fatigue are the two that bother me the most but very tolerable without affecting my quality of life. I take ferrous sulfate 300mg(iron pill) once daily to counteract the side effect of diarrhea if it occurs often.(info added as of 5/3/2013).
1a. S1 (tegafur+DDP inhibitor+OPRT inhibitor) similar to Xeloda.widely use in Asia mostly, side effects expected to be similar to capecitabine.
2.Erlotinib(Tarceva)---EGFR cell pathway inhibitor(tyrosine kinase inhibitor);
inhibit angiogensis (cut off blood supply to cancer cells and cause them to die);cause cell death by interrupting the reproduction of cancer cells;smoking will decrease the drug effects by 24% which may result in treatment failure.
Side effects included pneumonitis,pneumonia ,bronchiolitis,rash,diarrhea, anorexia,pruritus,conjunctivitis.
Drug-drug interaction include proton pump inhibitors like protonix ,H2 blockers like Pepcid and blooding thinning agent like Warfarin
3.Sorafenib.(Nexavar)---Multiple cancer cell pathways(RAF/MEK/ERK and VEGFR-2/PDGFR) inhibitor; inhibit cell proliferation and angiogenesis(cut of blood supply to cancer);
Side effects include: Rash,hand foot and skin reaction,pruritus, diarrhea, cardiac toxicity like QT prolongation and fatigue.
Durg-drug interaction included: caoboplatin,paclitaxel,methadone,erythromycin and clarithromycin,class Ia and Class III antiarrhythmics,modafinil and Warfarin in general.
4. Celecoxib-an antiflammatory agent belongs to the COX2 family.--an enzyme family.but use much less recently .
Side effects: peptic ulcer disease,myocardial infarction,stroke, and GI bleeding.
Drug-drug interaction: Cidofovir ,cisplatin,methotrexate,ginkgo,ginkgo biloba,Fluconazole and other antifungal agents;pemetrexed.
I am taking it as 200 mg twice daily ( half of the recommended dose for cancer treatment)for almost 18 months now without any obvious side effect. On the other hand, there are no absolute indicator for me to measure the actual benefit of celecoxib in such use along with the oral chemotherapy agent capecitabine I take twice daily except I am still CT scan clean for that 18 months.
5. Newer MEK inhibitors targeted agents such as Selumetinib (AZD6244): had 12% response rate (RR) in 28pts in a clinical trial; and for another MEK inhibitor--MEK 162, 8% RR in 26 pts in a phase I study.---2012 ASCO; newer VEGF inhibitor like Cediranib (AZD2171) has been used in clinical trial for cholangiocarcinoma recently.
Taking as Intravenous Infusion:
1. 5FU.---a chemo agent belongs to the Antimetabolite family that inhibits RNA synthesis and function ; may also on DNA synthesis but to the less degree. in doing so,cause cancer cell to die.
Overall response rate(OR) is 0-34%;Higher OR in using infusional 5FU pump or continuous IV infusion; and leucovorin-modulated 5FU day 1-5,every 3-4 weeks OR=32%.
Side effects include: Cardiotoxicity such as ST-segment elevation, angina.
Neurotoxicity such as headache,visual disturbances;
GI toxicity:stomatitis,esophagitis,mucositis,diarrhea;nausea/vomiting (30%)
Hematological toxicity=Neutropenia,anemia and leucopenia and thrombocytopenia Skin=Photosensitivity(cover up body &/or use sunscreen lotion with PF>15).
Drug-drug interaction: with anticoagulants like warfarin,vaccines, antibiotics like Septra or Bactrim and filgrastim.
Regimens that combine short term infusion pump for 5 FU with leucovorin are better tolerated than bolus injection
2.Gemcitabine (Gemzar)---a chemo agent belongs to the Antimetabolite family that inhibits the DNA synthesis in the cancer cells;induce tumor cell death (apoptosis);some study indicated Gemzar is more effective in treating CCA than 5FU,but both 5FU and Gemzar are FIRST LINE chemotherapy agents of choice to combine with other chemo agents in CCA regimens;other study indicated effectiveness of both agents are more or less the same.
Toxicity includes anemia(68-89%),thrombocytopenia(24-85%),elevated hepatic enzymes; neutropenia (61-90%), nausea and vomiting.But as a patient,I tolerated it for 18 months without any serious side effects except nausea and vomiting at the end of the treatment.Each individual is different .
Drug-drug interactions may include filgrastim,nonsteroidal antiinflammatory drugs(NSAIDS) , salicylates and anticoagulants such as Warfarin.
3.Cisplatin---1st generation of the platinum family, an alkylating agent affects cell DNA replications thus causes cancer cell death(apoptosis);may cause kidney impairment and impairs hearing (ototoxicity);usually use in combination with Gemzar or 5FU to provide the synergistic effect of the regimen of GEM/CIS or 5FU/cis.
Black box warning(that means serous contraindications) of cisplatin include bone marrow suppression,hearing impairment,platinum compound hypersensitivity,renal failure and renal impairment.
Side effects include dose-limiting toxicity like nephrotoxicity; acute renal failure and electrolyte abnormalities esp. in dehydration patients;peripheral neuropathy ;blurred vision.Neutropenia,anemia and thrombocytopenia but is relatively less severe than other antineoplastic agents. Severe nausea and vomiting will occur in almost 100% of the patients if not pre-treated with antiemetics. Cisplatin is one of the MOST potent emetogenic agents used.
4.Oxaliplatin--- the 3rd. generation of the platinum family;less kidney impairment than cisplatin but more patients experienced peripheral neuropathy.(ie:when exposes to cold objects). Unlike cisplatin or carboplatin, oxaliplatin is not associated with significant renal or auditory toxicity.and hematological toxicity(ie:blood cell counts ) is usually mild.
side effects included anxiety,depression,fatigue,peripheral edema and increase bilirubin and increase in hepatic enzymes; peripheral neuropathy
,weight loss ; increase serum creatinine level when use with 5FU(grade 3-4 severity is around 1%)which will affect kidney function. Nausea/vomiting; diarrhea or constipation;abdominal pain;anorexia; stomatitis; flatulence, hiccups and heartburn are the GI adverse reactions
5.Carboplatin--- the 2nd generation for the platinum family;
Side effects:decrease platelet production;much less toxicity on the kidney compare to others in the platinum family; cause less peripheral neuropathy than oxaliplatin.However mylosuppression (dose-limiting) toxicity is higher but is less emetogenic (ie: nausea & vomiting) than cisplatin.Overall, carboplatin has a more favorable adverse effect profile than cisplatin.
6.Avastin(bevacizumab)-a VEGF cell pathway inhibitor--- an angiogensis inhibitor to cut of blood supply to tumor cells.and cause cancer to die.
Side effects:Hypertension,colon perforation, abdominal abscesses ,electrolytes imbalance,proteinurea,nephrotic syndrome,congestive heart failure (<1%),GI bleeding,gum bleeding and vaginal bleeding,pulmonary hemorrhage,abdominal pain (50-61%,severe 8%), colitis,anorexia, constipation,diarrhea,dehydration,dyspepsia,gastritis,nausea,oral ulceration and vomiting.
Drug-drug interaction: Co-administration of bevacizumab(Avastin) with sunitinib is not recommended.
7.Erbitux(cetuximab)-an EGFR cell pathway inhibitor;blinds to the cancer cells surface receptor of EGFR and block their stimulation;therefore renders the cell pathway useless.
Neurotoxicity include:Headache(26%),hypomagnesemia(55%),which may lead to severe fatigue,cramps ,confusion,pain,insomnia,anxiety and fever.
Pulmonary toxicity include: severe infusion reactions like broncho spasm(2.5-20%);pulmonary fibrosis and fatal interstitial lung disease has been reported post-marketing.dyspnea(17-48%),cough(11-29%)
GI toxicity include: diarrhea (37%);elevated hepatic enzymes, abdominal pain(26-59%),constipation,nausea,vomiting,weight loss,anorexia,stomatitis and xerostomia(11%).
Dermatologic side effects include: acneiform rash (76%),rash(89%),dry skin and pruritus(11-40%) and nail change/disorder(16%).
Cardiotoxicity: peripheral edema(10%) cardiopulmonary arrest esp. when patients receiving radiation therapy in combination with cetuximab.
8.Leucovorin(folinic acid), it is not a chemo drug but used to enhance 5 FU effect.
9.FUDR(Floxurdine)-it is an analog of 5FU,belongs to the Antimetabolite family. Administered via the hepatic artery(pump);hepatic toxicity is high.
10.Epirubicin--- a chemo agent belongs to the Anthracyclines family which is less used nowadays.
11.Adriamycin---a chemo agent belongs to the Anthracycline family;interrupt the DNA and RNA synthesis in cancer cells and cause cell death;used in chemoembolization in CCA;major BOX warning by FDA is myocardial toxicity ;also neutropenia and leukopenia(75%)
12.Irinotecan(Camptosar)-inhibits DNA synthesis in tumor cells by inhibiting an enzyme called topoisomerase1 ; useful but tough to take.
General Adverse Reactions include: asthenia(69%),fever(45%),pain(24%).headache(17%), back pain(14%), chills(14%) and edema(10),weight loss about (30%).
Hematologic side effects are anemia(60-96%),neutropenia(30-96%),and thrombocytopenia(96%). All adverse drug effects are dose-related and reversible.
GI toxicity: diarrhea,nausea and vomiting(70-86%), abdominal pain(57-67%),anorexia(43-59%),constipation(30%),mucositis .
Neurological side effects include: dizziness(15-21%)drowsiness(9%).
confusion(2.7%), vertigo and syncope.
Pulmonary side effects include: dyspnea (22%), and cough (17-20%). and pulmonary embolism.(PE)
Other adverse events include: exfoliative dermatitis,hand skin and foot syndrome(10%) when give with 5FU;hyperbilirubinemia (83%).
Cardiotoxicity include: angina,thrombosis,stroke,DVT,myocardial infraction. Muscle cramps and paresthesias have been reported in post-marketing reports with irinotecan.---from clinical pharmacology-ip.com 12/6/2011
Drug-drug interaction : severe interaction with St.John's Wort, Atazanavir.Less severe with anticoagulants ,Sorafenib, anticonvulsive agent llike carbamazepine, phenytoin and primidone.
13.Docetaxel-chemo agent belongs to the Taxane family,interrupt the mitosis of the cancers cells cycle to reproduce and cause tumor death.
Additional info: OR=20% in 25pts (Eur J Cancer.2001 Oct;37(15):1833-8.Currently as of 6/2012, Docetaxel is being studied with Oxaliplatin.. Minimal activity for the combination of gemcitabine and docetaxel.
14.Mitomycin- a chemo agent belongs to the Alkylating family; inhibit DNA and RNA synthesis and thus cause cancer cell death ;use in chemoembolization for CCA and can be combined with 5FU or its oral prodrug capitabine for treating CCA .It had a higher response rate (31 vs 20%) as compare with gemcitabine and mitomycin regimen.
15.Panitumumab: similar to cetuximab ;but the difference from it is that this is the first 100% HUMAN monoclonal antibody direct against EGFR cell pathway; therefore you may expect less allergic reaction from Panitumumab.side effects similar to cetuximab.
16.Paclitaxel-(Taxol) a chemo agent in the Taxane family that primary inhibits the cell cycle during mitosis;thus the tumor cell cannot duplicated and die;Taxol should be given before cisplatin if both drugs are used at the same time for maximum benefit of the combo.;also inhibits angiogenesis but is very tough to take.
Additional info: 0/15 response rate ,(JCO August 1996 vol.14 no8 2306-2310. Newer agent like Nab-paclitaxel studies will come later.
Part II The regimens.
The principles of using combination therapy are to use:
(1) agents with different pharmacological actions.
(2) drugs with different organ toxicities.
(3) agents that are active against the tumor and ideally synergistic when used together.
(4) agents that do not result in significant drug interactions.
In general, the more agents used together in a regimen,the development of resistance may be slowed,but increased toxicity may result.
Most systemic treatment (chemo) for CC are based on experiences in treating pancreatic cancer since the molecular pathogenesis are similar.
Chemo agents like mitomycin,doxorubicin,docetaxel,oxaliplatin,irinotecan also have been used for treatment of CC in regimens combined with gemcitabine or 5FU.
According to"systemic therapy for advanced cholangiocarcinoma"in uptodate .com The "overall response rate" (OR) of the regimen
(which include partial (PR)=tumor shrinkage>30% and complete response (CR)=100% shrinkage;stable (SD)=no change ) examples are as following.
1.Gemcitabine alone in two studies are 22.6% (2009)and 26.1%(2005).OR 4% in 24 pts (Valencak,et al);30% in 23 pts (Kubicka et al.);36% in 39 pts; (Arroyo,et al).
1b. Gemcitabine+5FU Overall response 33% in 9pts,(Murad 2003); 9.5% in 42pts,(Jacobson D -ASCO 2003); 19% in 26 pts,(Hsu C,et al-ASCO 2003).
2.Gemcitabine + cisplatin regimen in five studies are 17.1%(3/2007),27.8%(2009),27.5%(2005),32%(2006),34.5%(3/2006);grade 3-4 neutropenia.Additional data; 33% in 24 pts,(Thongprasort,et al GI ASCO); 48% of 42 pts,(Reyes,Vidal,et al GI ASCO the COCCHI trial). Recently in south Korea, a trial was conducted for gemcitabine + weekly low dose cisplatin as different from the 21 day cycle of giving cisplatin on day 1 and gemcitabine on day1,8 ,every 21 days.
this link is to compare this GEM/CIS regimen to CAPOX, an alternative regimen .
2b. Gemcitabine+Carboplatin: one study 30% of 13 pts(at ASCO 2003).
3.Gemcitabine+ capecitabine (GEMCAP)in 3 studies are 25%.(2008) & 26% in 35 pts,(Knox J,et al. in 2004 GI symposium);31%(2005).grade 3 and 4 toxicities were fatigue , leukopenia and anorexia. Also there were 34-42% of the patients had a stable response.Another study of 56 patients, there were 2 complete and seven partial responses ( 16% OR) and a good number of patients had prolonged periods of stable disease.Again, this regimen works better on extra hepatic CCA than intra hepatic CCA.
4.Gemcitabine + oxaliplatin(GEMOX) in 2 studies the response rate are 36%(bilirubin<2.5xnormal);22%(bil.>2.5xnormal)-(9/2004.);and 50% -including 1 complete response and 11 partial response in a population of 24 patients(Ann Oncol.2006 Jun17(suppl_7):vii68-vii72. Oxaliplatin is a potentially better-tolerated agent than cisplatin(ie: less kidney toxicity ).
In some treatment center, this GEMOX regimen is used more often than the GEM/CIS regimen,it is more tolerable .(info. added on 5/3/2013)especially when using in combination with targeted agents.
5. Erlotinib (Tarceva)-an oral tyrosine kinase inhibitor ,does provide good result.According to uptodate.com,in one study,42 patients with advanced biliary cancer,57% of whom had received prior chemotherapy,received erlotinib(Tarceva)150mg daily.There were 3 partial responses and 7 additional pts remained progression-free at six months(stable response). Further experience with this drug is needed, particularly combined with cytotoxic chemotherapy.
Additional info: Single phase II trial in 42 pts with 7% moderest benefit of response rate and 17% were progression-free at 6 months.
However use in combination with GEMOX with" pulsed erlotinib" between doses of GEMOX in a phase I study with both pancreas and biliary pts . 4 out of 9 pts(44%) had partial response,and 75% progression-free at 6 months
6.ECF regimen consist of epirubicin, cisplatin and infusional continuous 5-FU pump; in a small trial of 32pt including 7 liver cancer pt;the objective response rate was 40%;and associated with less acute toxicity. However using Xeloda to substitute for 5FU continuous treatment,similar result of 40 % was also achieved but the grade 3 and 4 neutropenia(serious low WBC count) and mucositis were the major side effects;Additional phase III trial,however indicated a lower OR around 19% but associated with less toxicity.
7.Capecitabine+mitomycin regimen had a higher response rate than gemcitabine+mitomycin (31% vs 20%).
8. Infusional 5FU +cisplatinone study of 25 patients,PD=24%;a second study of 29 patients, the OR is 34%.
9. Gemcitabine+ irinotecan regimen: pt pop=16 with only 6 were CCA and the rest were gallbladder;there were 2 complete response and 6 stable response;grade 3-4 myelosuppression(50%) and thrombocytopenia(low platelet count)(28% of the patient population)
10.Capecitbine+oxaliplatin regimen(CAPOX);had overall 16 % response rate and a large number of patients had stable reponse;in another study(CCA patient pop=65;) In EXTRAhepatic CCA(ECCA) there were 2 complete and 8 partial responses as compare to NO complete or partial responses for the INTRAhepatic CCA(ICCA)patients;grade 3-4 peripheral neuropathy and 2 had allergic reaction to oxaliplatin.Somehow, for unknown reasons capecitabine works better for ECCA than ICCA and has a higher overall response rate for gallbladder cancer than cholangiocarcinoma.
see link below for comparison of this CAPOX regimen to GEN/CIS regimen;
11.Erlotinib+bevacizumab regimen:(pt pop=53,43 had CCA the rest were gallbaladder);9 had partial response and 51 patients had stable responses.
grade 3-4 cerebral thrombosis or low blood flow(ischemia)and rash.
12.GEMOX+bevacizumab(Avastin) regimen:(pt pop=35;CCA=25 and 10 were gallbladder)41% had partial responses ;grade 3-4 toxicity was hypertension,proteinuria ,thrombosis(blood clot) cardiac ischemia and not relate to this study but later FDA gives a black box warning of 2% chance for developing of colon perforation from Avastin.
13.GEMOX+cetuximab regimen:(pt pop=30 with 27 CCA patient and 3 gallbladder)19 patients had objective responses (63% of the pop);3 had complete response(tumor was gone) and 9 patients of the study had enough shrinkage to permit resection later.BUT the review board since long term outcome of this study was not known ,therefore further study of this combination is warranted. Update: during the ASCO poster session in June,2012 the poster presenter of the final analysis of a randomized phase II "Bingle trial" indicated that GEMOX+cetuximab is NO more effective than GEMOX regimen alone.
14.5FU continuous infusion daily for 5 days+cisplatin regimen:(pop=25 pt)
24 % had partial responses ;another study(pop-29pt) indicated there were 34% partial response.
15.Gemcitabine+ irinotecan + Panitumumab (7 Kras mutant pts) had a 34% response rate and OS(overall survival)=12.7months (Gruenbergere,et al. The Lancet Oncology vol 11, issue 12, Pages 1142-1148.)-from 6/2012 ASCO.
16.GEMOX + erlotinib in 268 patients studied using erlotinib 100mg daily,the OR is 30% vs 16 % who are only on GEMOX regimen ; grade 3 and 4 toxicities were uncommon in both groups. But more patients needed dose adjustment for toxicities in the erlotinib group.. (64 vs 43%)
17.Other regimens like
Gemcitabine+Xeloda+Avastin; GEMOX+panitumumab
or sorafenib; FOLFOX6+bevacizumab
are under clinical studies and at this time they have not been reviewed by the uptodate.com-from uptodate.com- literature review version 19.3:Jan.2012
18. FOLFIRINOX=5FU+leucovorin+irinotecan+oxaliplatin.
http://www.cholangiocarcinoma.org/punbb … 793#p72793
19.Trastuzumab (Herceptin)+paclitaxel (1 patient.)study for metastatic CCA who has HER2/neu amplification by FISH analysis ; patient experienced dramatic response after 9 weeks of treatment.Patient had not responded to GEM/CIS; GEMCAP and GEMOX prior to the new regimen.
(Lisa Y. Law http//jco.ascopubs.org/cgi/doi/10.1200/JCO.2012.42.3061)
20. clinical trial on FOLFIRI+Cetuximab
(still on trial,results may not have been reported please check the links below). Below, separately, it may helps to understand the trial a bit more.
21. EGFR/VEGF ( panitumumab+ bevacizumab ; erlotinib+ bevacizumab. And Sorafenib + Erlotinib )
A recent case report of dual therapy with panitumumab and bevacizumab in a patient with widely metastatic GBC unfit for any cytotoxic therapy demonstrated a significant PR and improvement in performance status for 7 months (Riley and Carloss, 2011). A phase II study of 49 evaluable patients with chemotherapy-naïve aBTC investigated EGFR/VEGF inhibition with erlotinib and bevacizumab (Lubner et al., 2010). Six confirmed PRs were noted with a median duration of response being 8.4 months in those patients. Overall mTTP was 4.4 months and mOS was 9.9 months. Exploratory analysis of EGFR mutational status showed that those with EGFR truncation variant III or those with KRAS mutation suggested a less likely response to erlotinib; serum VEGF expression was not noted to change from baseline between responders and nonresponders. Recently, the SWOG 0941 trial enrolled 30 evaluable patients to receive first-line therapy with daily sorafenib and erlotinib with primary endpoint to improve PFS from 4 to 8 months (El-Khoueiry et al., 2012b). Two patients had a PR and 8 had SD as their best response, but there were 3 deaths while on study with one possibly related to treatment. The mPFS/OS was 2 and 6 months and the trial was stopped early due to a weak efficacy signal. Further studies are required to assess whether there may be benefit in certain subsets of patients.
21. GTX. (Gemcitabine+Taxotere+Xeloda)
Additional chemotherapy and radiation treatment that members of this board had been used.(Jan2011-April,2012)
1.Gemzar750mg/m2+Capecitabline 1120/m2+erlotinib 150mg daily.
2.GEMOX+panitumumab for 18 cycles+radioembolization.
3.Gemzar+Xeloda+Avastin (clinical trial)
4.Capecitabline mono oral therapy.
6.IBRT + Xeloda +Gemzar after radiation.(for ECC)
7. Radioembolization (for ICC)
8.GEMOX+ temsirolimus.
9. Chemoembolization with cisplatin,mitomycin , Adriamycin with/ or without RFA or microwave ablation.
11. Gemcitabine+5FU continous pump infusion with or without targeted agents like sorfenib or erlotinib
12. Xeloda as maintenance therapy.
13. clinical trial on Folfiri+cetuximab
14. GEMOX+cetuximab+radioembolization.
15. Gemzar, clinical on MK2206
16.clinical trial on Crizotinib
17. cyberknife(IMRT)
18. PDT(photo dynamic therapy)
19 clinical trial on RFA using in extrahepatic CCA.
20.Chemoembolization(TACE)+RFA in intrahepatic CCA.
21. TIL (Tumor Infiltrating Lymphocyte immunotherapy.) clinical trial@NIH.
22. GTX (gemcitabine+ taxotere and Xeloda) clinical trial.
23. DCA for extra hepatic CCA.
24. IRE (irreversible electroporation).
Below will give you a general idea about some medical professional thinking in the current treatment of CCA; both in print and in convention as of June 1-5,2012.I think it is important to know about it first in order to understand the pros and cons of using antineoplastic agents and targeted therapy to treat this disease.
Surgery(liver resection) provides the only possibility for a cure and among patients who undergo potentially curative resection,long term outcomes vary according to location and stage of the primary lesion,extent of surgery,associated comorbidities(other health problems like diabetes),and treatment-related complications. Recurrence is very common(>75% for ICCA & around 50% for ECCA).
Other" treatment options for locally and/or advanced cholangiocarcinoma" include radiation therapy like EBRT,IBRT, IMRT,SBRT,PDT,cyberknife(a form of IMRT),Radio Frequency Ablation (RFA) ,Macrowave ablation, Radioembolization and chemoradiotherpy;chemoembolization and orthotopic liver transplantation.
Clinical trials is another option for advanced cholangiocarcinoma.
Summary: there is no single chemotherapy agent or combination regimen consistently provides for tumor response or objective shrinkage due to the heterogeneous disease of CCA;multiple and different locations compounded the difficulty in understanding the pathology of CCA and thus develop the appropriate or the most effective treatment plans for the patient.-from uptodate.com
In a review of the systemic adjuvant therapy by Horgan AM,etul JCO June1,2012 vol.30 1934-1940. He concluded that
1. Chemotherapy is the standard for biliary tract cancers.
2. The level 1 evidance standard is gemcitabine and cisplatin chemotherapy.
3. Other combination regimens have activity.
4. The future of this disease should lie in targeted therapies and there are a lot of targets. These (agents)should be applied wisely.However, these are rare tumors and subdividing them by biomarkers may prove difficult.
5.Other cytotoxic agents such as 5FU, oxaliplatin, taxanes and irinotecan may or do have efficacy,but we are near the limit of where we will get with cytotoxics(chemotherapy agents like gemcitabine.)
and finally ,there is no definitive evidence we have ever benefited patients with adjuvant therapy for biliary tract cancers and the role of radiation may vary depending on site of primary.--- June,2012,convention ASCO
I hope the above updates help to give you a general idea fo some of the regimens used in the cholangiocarcinoma chemotherapy; and since chemotherapy is only one side of the CCA treatment triangle; so please don't forget the radiation oncology (including interventional radiology)side and the surgical oncology side of the treatment triangle.
Additional study from ASCO 2012 convention;
http://www.cancer.org/acs/groups/cid/do … 06-pdf.pdf
http://www.cholangiocarcinoma.org/punbb … p?id=63531
Additional web site such as the one below is worthiness to look at too.
http://chemoregimen.com/Biliary-Tract-C … 27-37.html
Additional links for abstracts related to systemic adjuvant chemotherapy:
http://www.cholangiocarcinoma.org/punbb … 604#p70604
God bless.
PS. Most of the information comes from Uptodate.com;clinicalpharmacology-ip.com . and section 16.,chapter 85," Cancer Chemotherapy and Treatment" by Dianne Brundage.,Pharmacotherapy-principles & practice,2007 edition ; and poster and oral presentation sessions at ASCO, (American Society of Clinical Oncology) convention,June 1-5,2012 in Chicago.


text:
Crosspoint Cross Country Oct. 11 results
October 21, 2012 · 8:14 PM
SEATAC League
Crosspoint Cross Country
Coach: Marty Prehm
Athletic Director: Christine Cattell
Results located at: http://www.athletic.net/CrossCountry/School.aspx?SchoolID=571
Meet Name/Location: SEATAC League Meet 5 / Erlands Point Preserve; Crosspoint Home Course
Our boys continue to dominate the league races coming in first for the team scores this means that for all five League Meets this season Crosspoint came in first in boys team scores. At this meet we honored our seniors as this was our last regular home meet.
Our next meet is the SEATAC League Championship on Thursday, 18 October, at the Erlands Point Preserve, Bremerton, WA, Girls 4:00, Boys 4:45. The following meet is the District Championship where the boys will be competing at American Lake and the girls will be competing at Evergreen State University.
Team Scores:
1 Crosspoint 35
2 Shoreline Christian 41
3 Chief Leschi 46
Garrett Boyd, Shorewood Christian, 18:15
Crosspoint Team (place, name, time, grade):
2, Russell Melin, 18:15, Senior
5, Seth Huschka, 19:07 Freshman
7, Mikal Pattee, 21:27, Senior
14, John Reichel, 19:52, Senior
16, DJ Degnan, 21:36, Junior
18, Daniel Melin, 21:50, Sophomore
28, Brayden Banks, 22:50, Freshman
Team Scores:
1 Chief Leschi 15
Laurel Aaronson, Northwest Yeshiva, 23:58
Crosspoint Team (place, name, time):
2, Bridgit Gibson, 24:28, Junior
4, Jamie Shaw, 25:50, Sophomore
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Lloyd Wright may have been grossly overshadowed by his father, Frank Lloyd Wright, but the esteemed modernist architect was deserving of his name, which undoubtedly planted a T-square in his hand by age 2. Unfortunately, the Wright surname was not quite enough to save junior's 1958 Moore House from destruction. The nimble walls and protruding eaves of the Palos Verdes beach home were razed just last Wednesday, and there's nothing quite like a before-and-after comparison to illustrate what Architects' Newspaper deemed the "archi-crime of the year":
Number of downloads: 29
Moore_after.jpeg (324.31K)
Number of downloads: 23
According to Curbed, the owner of the property purchased the Moore House in 2004 with no knowledge of the architect and big plans to replace the house with a Mediterranean-style mansion. The plans were met with an appeal by the Los Angeles Conservancy, which was subsequently denied by the city council. At least the property owners will finally have space for their new pool, spa and barbecue area. Party on…
- Kelly Chan


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Welcome to the Vidicode Partner Program, you'll find information and marketing tools, to help you sell and support Vidicode Products and Solutions for our mutual success.
The countries we export to:
Reference list |
Below you will find a reference list, which is by no means complete. We supply our equipment exclusively through resellers and distributors all over the world. The organizations listed here are merely a handful of the larger companies using Vidicode solutions:


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BSI Texas Longhorns Champion Years 28x40 Banner
Item no: 11222378 Price: $25.99
AVAILABILITY: In stock, leaves warehouse in 2 - 3 full bus. days. - (Details)
Standard Ground Service Available (normally $5.99) - (Details)
Note: Shipping restrictions may apply.
Remember, no sales tax except in FL, IL, KY, NY, OH, PA and TX.
Product Information
Is your home missing that certain piece of NCAA® flair? Add some with this banner from BSI Products. It features a heavy-duty polyester construction, boasts a 1.5" pole sleeve, and is decorated with vibrant graphics.
Product Features
Features- 100% polyester banner
- 1.5" pole sleeve
- Decorated with colorful graphics
- Dimensions: W 28" x H 40"
- Officially licensed
- Made in Taiwan


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Marcus Orchestra Fall Flower and Pecan Sale
The Marcus High School Orchestra will be holding a fall flower and pecan sale. The sale will be held for three weekends beginning Oct 6. Flats of flowers will be $18. Assorted flower bowls will also be available. The pecans are fresh from the grower and will be on sale for $9 per bag. The last date of the flower sale is Oct 21st. Pecans will be sold until they are gone. You can find the sale at Marcus High School located at 5707 Morriss Rd Flower Mound TX 75028. Hours will be 9am to 4 pm. Please see www.marcusorchestra.com or contact Dr. Goodrich at firstname.lastname@example.com.


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Lights 200-300 Lights 300-600 Lights LED Technology Lights Pistol Lights Primary Lights Underwater Kinetics Lights
This product has a limited lifetime warranty.
www.uwkinetics.com(858) 513-9100
Whats in the box:Light, Batteries, Pistol Grip, Wrist Lanyard, Lens Boot, Pelican 1200 Hard Case w/ Pick 'N Pluck Foam and Owner's Manual
(based on 15 reviews)
Ratings Distribution
5 Stars
4 Stars
3 Stars
2 Stars
1 Stars
of respondents would recommend this to a friend.
Best Uses
Most Liked Positive Review
I dive with it day and night.
I dive with this light day and night. For anything under about 8 metres it really brings out the colours and details so I can really see what I'm down there to see. For ...Read complete review
I dive with this light day and night. For anything under about 8 metres it really brings out the colours and details so I can really see what I'm down there to see. For crevices, underhangs, and caves its great - I spot things I wouldn't normally see. I sometimes use it as an auxillary light for my buddy's photography. For night diving, well, it's fantastic. While my buddies are straining to see something with their dim 15cm spot of light, the beam on this thing swings over like an SUV just drove past and they think "Oh, that's better". It has low output mode if you don't want so much light.There's a bit of weight, but that's all due to carrying 8 batteries; the unit itself is lightweight. It's tough; I do shore diving in Sydney so getting bashed by waves is common. I just clip it to my BCD and it's fine. Clip and extension coil are solid. I've dropped it when washing my gear - no problem. The other thing is that I've done about 35 to 40 hours of diving with it and I haven't had to replace the batteries yet.Only small glitch is that the switch is 'buggy'. On mine it's possible to lock the mechanism to the 'off' position but it is still on (in low output mode). It's no problem since battery life is so good. i just put my hand in front to check it if its daytime then wiggle the switch and it turns off.Because it's LED you can use it above water too. I use it to spot wildlife and to find and catch the fish in my fishpond when I'm cleaning it.Of all my dive gear, this is one of the items I'm most happy I bought.
Most Liked Negative Review
Switch doesn't work well.
The switch stopped working after only a couple months so the light would not turn on. After a week of correspondence with customer support they acknowledged there was a known issue with the switch so...Read complete review
The switch stopped working after only a couple months so the light would not turn on. After a week of correspondence with customer support they acknowledged there was a known issue with the switch so they paid for return shipping and sent me a replacement. The same thing happened with the replacement. I paid to ship it back and they credited my account which I used to buy a different light.
Reviewed by 15 customers
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Does the Job
By duncomatic
from Seattle
About Me Beginner
Comments about Underwater Kinetics Sunlight "C8 eLED" Dive Light with Pistol Grip:
Works well. I usually use low beam, then flick to high if needed.
Comment on this review
Works well
By Duncomatic
Toggle switch is easy to use with gloves.Battery indicator would be a nice add on.
(1 of 1 customers found this review helpful)
Great Light BAD switch
By Jay
from Gresam, Oregon
About Me Advanced
switch failed during a wreck dive, had to use my backup, and end the dive. This is a stupid problem, bad switch on an otherwise fantastic dive light. This is a common problem, and its only a matter of when not if this switch will fail. UK should recall this light.
Great light - bad switch
By Mike D
from Cayman Brac, Cayman Islands
The light itself is excellent, i loved it until the switch started to fail. First it became flaky (turning off during the dive) eventually it would turn on only occasionally. I took it apart, it appears the problem is with the plastic slider that actuates the switch, not the switch itself - the actuator simply has too much play - incredibly cheap setup. I'm trying to jury rig it.
Great light
By DiveBooger
from Ocoee, Fl
About Me Casual/ Recreational
Works great-lightweight
Copyright © 2006 LeisurePro Ltd. All Rights Reserved LeisurePro • 42 West 18th Street • New York, NY • 10011 • 1.800.637.6880 For technical difficulties please contact our webmaster


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"American Idol" trimmed itself down to a modest hour Thursday night for the first time this season to swing through Baton Rouge, La. -- the hometown, we were reminded, of the "dawg" himself, forever judge Randy Jackson.
That meant that interspersed with the auditions were lots of shots of leafy bogs and hungry reptiles, and oft-expressed speculation about whether the next Idol winner would be "born on the bayou." We also got to see Mariah Carey give Jackson a special spiff-up for the occasion (Who knew she was a beauty school dropout?) and were treated to an interesting jambalaya of contestants.
Among those making it through:
Miss Baton Rouge Megan Miller didn't let a leg injury requiring immediate surgery stop her from auditioning. She hobbled in on heels and crutches and wowed the judges with "Something's Got a Hold on Me," at one point using a crutch as a faux mic. An "undeniable superstar," Nicki Minaj said.
The self-described "socially awkward" Charlie Askew charmed the judges, too, with his clear voice and "seemingly dark, strange, but cool" persona, as Jackson described it. Mariah Carey identified with the way Askew used music as an escape. Keith Urban thought his voice was, like David Bowie's, "not of a gender." "I mean that in a really glowingly complimentary sort of way," he reassured the 17-year-old.
Maddie Assel, whose grandmother had "nominated" her, had found out only the previous night (at New Orleans' famous Café du Monde) that she'd won an audience with the judges (hope she didn't eat too many beignets), but she nailed the Beatles' "Oh! Darling" anyway. Despite the peculiar roster of the influences she claimed – Beyonce, Adele and Haley Reinhart – the judges felt she had her own style and sent her through. After she delivered the news to her family, her delightfully wacky grandma said she wanted to "kidnap" Ryan Seacrest and take him home with her. Oh, grandma!
Also inspired by a grandparent: Paul Jolley, who wanted to "give back" to the world, as had his grandpa, who'd recently died. His take on Rascal Flatts' "I Won't Let Go" moved Minaj to compliment the texture and color in Jolley's voice, as well as his "vibe" and the "sparkle" in his eye.
And did anyone really think handsome Dr. Calvin Peters, who helps veterans with physical rehabilitation and said he's known as "the singing doctor," wouldn't make it through? He was so excited with the four yeses his Maxwell song earned him he couldn't wait to show the doctors and patients at the hospital his golden ticket, noting that they'd think it was "sick." Pretty sure the pun was not intended.
If dishy doctors aren't your speed, the Baton Rouge auditions also brought us a fetching fireman, Dustin Watts. Even before Watts sang Garth Brooks' "She's Every Woman," Minaj was coyly inquiring whether he had a girlfriend. Afterward, she told him he looked like a country star and hollered after him, "You save lives every day. We love you, fireman!"
But the one who stole everyone's heart was 19-year-old Hurricane Katrina survivor Burnell Taylor. The judges looked skeptical when he announced he'd be singing "I'm Here" from "The Color Purple," but then everyone but Minaj gave him a standing ovation. Carey was moved to tears. Minaj said Taylor was "what we came for" and that he had "that thing that gives everybody chills and goose bumps." Urban called Taylor's voice "killer" and told him, "Somewhere there's a spotlight right now waiting for you to walk into it."
Even Seacrest had flattering words for Taylor. "I think you just changed that panel," he said. Meaning, perhaps, no more fighting? Fingers crossed.
What did you think of the Baton Rouge auditions?
'American Idol' recap: Chicago comes out singing
American Idol' recap: Charlotte, N.C., shows its stuff
'American Idol' recap: New season, new judges, New York


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Recent Posts »
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this morning
31 comments:
These photos are so great! Good eye. My fav is the one with the bench to the left and the bridge in full view. I would LOVE to play around with these in photoshop! I'm jealous of all your snow. I'm in GA and we don't get much down here - although we did get some to play in this past weekend.
ReplyDeleteWow what a great photos you have captured. That is one of my favorite things to stumble upon something to photograph and then they turn out to be breath-taking photos. The snow may dampen your day but it looks picturesque in your photos.
Chic de Cru 'Vintage Chic'
Handcrafted Jewelry & Gifts
Thank you for taking the time to comment, I love hearing your thoughts! If you have a question, I will try and answer back in the comment section ASAP. If I don't, please shoot me an email. Also, please feel free to check the FAQ tab for answers. Thanks for stopping by!


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We booked this motel via internet by mistake. I thought I had booked at a different motel and would have cancelled the booking but it was a last minute thing and it was too late to cancel and as it turned out it was a real bonus for us. We believe this motel is one of the secret gems in... More
- Also Known As:
- Knights Inn London Hotel London
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- London Knights Inn
- Knights Inn London Ontario
- Reservation Options:
- TripAdvisor is proud to partner with Booking.com, Hotels.com, Travelocity, Venere, Olotels, Expedia, Priceline, Wyndham and Tingo so you can book your Knights Inn London reservations with confidence. We help millions of travellers each month to find the perfect hotel for both holiday and business trips, always with the best discounts and special offers.


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As of March 24 at 8:45 PM
All LU Transit service wil be suspended at 5:00 PM due to overall road conditions of all primary and secondary roads. The last buses will depart Green Hall at 5:00 PM.
Monday - Liberty will open for Convocation (10 AM); intensive classes begin at 10 AM:
Routes 71, 72, 73, and 74 will begin at 7:30 AM. Commuter routes 85 and 86 will start at 8:30 AM. Route 76 to the Aviation Academic Center operate its regular schedule after Convocation.
Like Liberty University Transit Services Facebook page to receive service announcements on Facebook.
Starting Tuesday, a circulator shuttle will operate between Annex I and II. The shuttle will operate every few minutes during the following times:
Monday – Friday Dinner Hours: 4:45 PM – 7:30 PM
Tuesday, Thursday Lunch Hours: 10:45 AM – 1:30 PM
Liberty University Transit Services is now operating all on campus bus routes between 7 AM - midnight. All of our bus routes converge at Green Hall for easy transferring at the top of the hour, :20, and :40. If you are on campus for an intensive, here is quick reference for you to use to get around the campus and surrounding area.
Route 74 - Liberty Mountain
Route 71 - Liberty Campus
Route 72 - East Campus
Several changes will be made to accommodate the residence hall tower construction.
Route 71 - Liberty Campus
This route will need to be altered to avoid the construction area. Service to the Ravine bus stop (Residence Hall 5/7) has been suspended. The bus will need to travel to Residence Hall 32 in order to turn around. A new stop at Dunkin Donuts will be added and the old bus stops along South Campus Dr will be utilized again. Service frequency will not be impacted.
Route 73 - LU Residential Annex
This route has been extended to also include Residential Annex II (former Quality Inn). Two additional buses have been added to this route to maintain service frequency. Route 73 start time has been extended to 5:30 AM on weekdays. Weekday evening/night service frequency will be improved from every 30 minutes to 15 minutes between 6 PM midnight. Service frequency between 1 PM - 9 PM on weekends will be improved to every 15 minutes.
Route 74 - Liberty Mountain
This route will now operate from 7 AM - midnight on weekdays and 8 AM - midnight on weekends. Service to the Liberty Mountain Snowflex Centre and Liberty Mountain Intramural Complex will be made during operating hours of each facility.
All bus service will end for the fall semester on Friday December 14, 2012 at 8:00 p.m. During the Holiday break GLTC will continue to run the 4F with a stop at Green Hall every 60 minutes (:08 after the hour) Monday thru Saturday. Make sure to check GLTC's website for their Holiday Schedule. There will be no campus bus service from December 15th thru January 6th.
Regular service will return on Monday January 14, 2013 at 4:30 a.m. During orientation week January 7th thru January 11th we will be running all routes(71, 72, 73, 74) from 7:00 am to 12:00 am. January 12th and 13th we will run the regular weekend schedules. Route 74 servicing the Wingate by Wyndham hotel, Liberty Mountain Conference Center and Green Hall will operate 7 AM - 7 PM Monday-Friday between Dec 30 and Jan 11. DeMoss Hall will be added to the route during this time.
Several improvements will be implemented Monday August 27 based on feedback we have received during the first week of classes.
The Cornerstone and Airport Campus bus routes will be separated. Route 76 will provide service to the from Green and DeMoss Halls to the Aviation Academic Center and Freedom Aviation Hangar. Route 85 will service the Cornerstone property and will be operated with two buses. Please see links to both routes for new schedules. These schedules have been posted at the corresponding bus stops as well.
Changes to the schedules are being implemented on Route 86 to accommodate for the increase in traffic at certain parts of the day. Through 5 PM bus service frequency will be reduced from 30 minutes to 35 minutes. Between 5 PM and 7 PM bus service frequency will be reduced from hourly to 70 minutes and hourly service will resume beginning at 7 PM. Please click on link above for schedule. Updated schedules have been posted at route 86 bus stops.
Liberty University students will continue to be able to ride GLTC city routes for free by obtaining GLTC bus passes. Free fixed route and para transit bus passes are available for pickup at Card Services beginning August 1, 2012. They are located in Green Hall room 1957 near the Tilley Theater. Card Services office hours are Monday thru Friday from 8:30 am to 4:30 pm. Please make sure to bring a valid Liberty Flames Pass with you when you come.


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Designed to introduce you and your dog to beginning obedience including socialization and basic commands such as off, sit, down, stay and come. The class will also addresses basic behavioral issues such as housebreaking, jumping, chewing, mouthing, barking, etc…
Class is part of:
Obedience / Companion Dog Tract
Functional Areas:
Concentration & Focus
Self-Control & Restraint
Meets one day a week.
6 weeks


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Alaska Sales And Service - Anchorage 1300 E 5th Ave Anchorage, AK Map
Hello, my name is and I live in . You can contact me at . The best time to contact me is during the day (before 5) at night (after 5) .
» add more to this message Thank You,


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Zengobi Forums
Talk about all things Zengobi.
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Mindmap automatic rearrange when subfolders are "closed
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Joined: 27 Aug 2009
Posts: 12
Posted: Wed Mar 03, 2010 2:58 pm
Post subject: Mindmap automatic rearrange when subfolders are "closed
Thanks for a great app!
I have the latest app, and love it. We use it at work, and all employees have a folder ("Sibling") in a company mindmap with "future tasks, todo, and done pr. name"..
We have now started to get a long "done" folder, and therefor it is usually closed (so we only see the "done" name). However. When its closed it would be natural that that level (Done) move close to the same levels "sibling" (future tasks / todo). Today it stays fixed positioned so when you open all "contained" tasks (make "done" subtree visible again) it stays in the same position regardless if its open or not.
This results in uneccessary long "lines" on my screen.
Hope this could be improved, and if I have missed something please tell me where to add this so it is more dynamical in positioning itself after "
Thanks for any input!
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Site Admin
Joined: 14 Sep 2007
Posts: 1987
Posted: Wed Mar 03, 2010 3:27 pm
Post subject:
Yes, I think we should reorganize the nodes as well to make them tighter.
Currently, the reason why the maps nodes stay in place even when collapsed is so you can easily click to expand / click to collapse and you don't have to move your mouse pointer to "refind" the expand/collapse point.
But, looking at some other mind mappers, they rearrange the tree when a branch collapses or expands and I think that makes sense. That way you don't have odd huge spaces in your mind map when many items are collapsed.
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Joined: 27 Aug 2009
Posts: 12
Posted: Thu Mar 04, 2010 10:19 am
Post subject:
Thanks for your answer! The point is usually that theory doesnt work "as well" in practice
I agree totally with you, and must say that Zengobi is outstanding for listening to "user needs" in their forums and by support. This means a lot to me so thank you for a quick reply!
Firstly I think all users meet the mentioned "problem" when they dive "enough" into using the Curio mindmap functionality. In that I mean "with enough hidden content" turned on / off. This has always been my way of "mindmapping" -so there has to be others out there too
However: I do think that you can have the best of both worlds. That is to "get the hierarcical nodes closer together" but also that you could have "shortcut keys" to make the node visible / not visible in a quick way. In that you wouldnt mind that the node itself "moved" on the stage...
I moved from Mindjet´s MindManager because there was hardly "any" deveopment on the tool for Mac users. The package solely focus on Windows users, and then when I saw Curio I fell in love. However I now have HUGE mindmaps in Curio and now use A LOT of time scrolling the maps. Some are HUGE and by being positioned like they now are I can not use the print functionality. I think Zengobi however should peek at the way Mindjet does the "node" handling since it is very good, and to get that into Curio with ALL the other Curio features (that Mindjet lacks) I would be in heaven!
I therefor hope this is on a high-pri on your end. When could some fix for this be expected?
Thanks again for a quick and positive reply!!
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Site Admin
Joined: 14 Sep 2007
Posts: 1987
Posted: Thu Mar 04, 2010 10:45 am
Post subject:
We do have a shortcut key to expand/collapse a node: Just hit the spacebar.
(If the node is an asset figure the spacebar would do the Quick Look preview so in those cases hit Option-Spacebar.)
I'll add this to the Curio 7 list which already has a number of mind map to-do's.
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Joined: 27 Aug 2009
Posts: 12
Posted: Thu Mar 18, 2010 5:15 pm
Post subject:
[quote="george"]We do have a shortcut key to expand/collapse a node: Just hit the spacebar.
(If the node is an asset figure the spacebar would do the Quick Look preview so in those cases hit Option-Spacebar.)
I'll add this to the Curio 7 list which already has a number of mind map to-do's.[/quote]
Very cool! When do you think Curio 7 will hit the streets?
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Joined: 14 Sep 2007
Posts: 1987
Posted: Thu Mar 18, 2010 6:25 pm
Post subject:
It's a long way out... much later this year... Too much to add to it!
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Site Admin
Joined: 14 Sep 2007
Posts: 1987
Posted: Fri Mar 26, 2010 2:50 pm
Post subject:
Wait a sec...
Curio > Preferences > Idea Space > Collections > Mind maps shrink as nodes collapse.
Try checking that checkbox.
It was released when we rolled out Curio 6.0. Here's the blurb from the release notes:
Mind Map Smart Sizing -- By extremely popular demand, the mind map figure will now automatically shrink or grow as the nodes within the mind map are collapsed or expanded. This default setting can be controlled via the new "mind maps shrink as nodes collapse" option in Curio's Preferences. Note, however, if you manually resize a mind map then it will not automatically shrink when collapsed.
I'm working too hard....
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Dr. Rajiv Shah serves as the 16th Administrator of USAID and leads the efforts of more than 9,600 professionals in 80 missions around the world.
Since being sworn in on Dec. 31, 2009, Shah managed the U.S. Government's response to the devastating 2010 earthquake in Port-au-Prince, Haiti; co-chaired the State Department's first review of American diplomacy and development operations; and now spearheads President Barack Obama's landmark Feed the Future food security initiative. He is also leading "USAID Forward," an extensive set of reforms to USAID's business model focusing on seven key areas, including procurement, science & technology, and monitoring & evaluation.
Before becoming USAID's Administrator, Shah served as undersecretary for research, education and economics, and as chief scientist at the U.S. Department of Agriculture. At USDA, he launched the National Institute of Food and Agriculture, which significantly elevated the status and funding of agricultural research.
Prior to joining the Obama administration, Shah served for seven years with the Bill & Melinda Gates Foundation, including as director of agricultural development in the Global Development Program, and as director of strategic opportunities.
Originally from Detroit, Shah earned his medical degree from the University of Pennsylvania Medical School and his master's in health economics from the Wharton School of Business. He attended the London School of Economics and is a graduate of the University of Michigan.
Shah is married to Shivam Mallick Shah and is the father of three children. He lives in Washington, D.C.
Development attracts many of the best students, brightest minds and strongest spirits. Open-source development can help keep all of us inspired by offering the true reward of being successful—combining productivity with meaning.
When you bring your expertise, your ideas, your ingenuity to the task; when you can see that something you're learning in a classroom is helping communities to withstand natural disasters, or when you commit yourself to a career in the service of others—those are deeply rewarding results for you—and millions of people everywhere.
Today we celebrate the historic partnership between the United States of America and the Republic of Malawi. At this ceremony we mark the signing of bi-lateral agreements between The United States Agency for International Development and Malawi's Ministry of Finance and Development Planning for programs in education, health, economic growth, democracy and good governance. This cooperation is implemented through NGOs, international organizations and Government of Malawi partnerships that support Malawi's own development priorities.
For more than 50 years we have worked together for the good of all Malawians. Throughout Malawi's recent history I am proud to say that the United States has remained a steadfast partner as the largest overall donor.
Looking around the room, it's clear that our university's commitment to serving our nation and all nations has not changed one bit since John F. Kennedy's legendary visit in 1960. President Kennedy's impromptu remarks that day on the steps of the Michigan Union challenged students to give two years of their lives to help people in the developing world.
He inspired a movement on campus that led to one the most remarkable service projects in American history, the Peace Corps. That was over fifty years ago. Before the Foreign Assistance Act, before even the U.S. Agency for International Development, there was you.
Since then, the University of Michigan and the Ford School of Public Service have embraced their role as leaders in the global effort to tackle the greatest challenges of our time. You are the number four all-time contributor to Peace Corps, with a total of more than 2,450 volunteers since 1961.
This is an exciting and important time for development. We're beginning to see incredible results taking shape—results that aren't just impacting individuals or communities, but entire nations. El Salvador has achieved 96 percent primary school completion rates for boys and girls—up from 81 percent 10 years ago. In Ethiopia, in the last six years, under-5 mortality has fallen by almost 30 percent—thanks, in part, to efforts to empower 30,000 community health workers with live-saving tools.
And in Afghanistan—probably one of the hardest places on earth to see clear development results—we've helped reduce maternal mortality to one-fifth of what it was a decade ago and expand basic services from only 6 percent of the country to 64 percent. Some of these results have brought us above and beyond our MDG targets, as we've seen this past year, when the world met the goals of reducing poverty by 50 percent and halving the proportion of people without access to clean drinking water.
We are here not only because we have a deep appreciation of the importance of food security, but also because we understand that hunger and undernutrition have a long-term impact on our nations' health, economies and security.
Around this time last year, the worst drought in 60 years had put more than 13.3 million people at risk across the Horn of Africa
At the same time, a similar emergency was building across eight nations in the Sahel, where a devastating combination of drought, conflict and displacement was affecting millions. Last November—even as we were responding to the crisis in the Horn—we began sending humanitarian supplies to the Sahel.
Remarks as Prepared
It is a pleasure to join you today, because I believe we have a real opportunity at this moment in development. For decades, our community has talked about the importance of building community resilience to perennial disasters, like droughts and floods.
But every year, as many as half of our emergency workforce mobilizes to East Africa. And every year, communities from the Horn of Africa to the Sahel brace for a possible season of lost livelihoods—a season of starvation.
We know that more than 90 percent of the adult population in the developing world is unbanked. And more than 2 billion of these unbanked individuals are already using mobile phones in deeply innovative ways. In fact, I've seen the real potential for this work myself not far outside of Nairobi, where I met a dairy farmer named Gitau who didn't have access to the electric grid or running water. But by using a mobile phone app called iCOW, he could invest in his business, vaccinate his animals, improve their feedstock, and track milk output and local prices. "Information is power," he told me.
There's an exciting opportunity here for those of us working in this field. An opportunity to usher in a new era of development by forming public-private partnerships that change the way we do business—while expanding opportunity to millions. That's why we came together to build a network called the Better Than Cash Alliance—to accelerate the adoption of electronic payments around the world and to bring electronic payments and mobile money into our USAID programming with an eye towards greater gender equality and financial inclusion.
Time and again, the U.S. Agency for International Development has turned to the researchers, professors, and students here at FIU to help us tackle some of the greatest challenges of our time: from minimizing the risk of disasters in El Salvador to ensuring the sustainability of some of our most precious natural resources, like the Mara River in Tanzania. It's a partnership that has not only grown over time, but has delivered some extraordinary results for people around the world.
In the late 1980s, FIU and USAID partnered on the Agency's first major media initiative, which focused on training journalists across Latin America in investigative journalism and election coverage. Within a few years, it brought media owners and journalists together to produce the first journalist ethics code for Central America. This effort built on a long-standing partnership—dating back to 1984—to strengthen the capacity of justice systems in Latin American countries.
At USAID, we believe we have the opportunity today build a new, more open model for development that builds on our strong legacy of university engagement to solve some of the greatest development challenges of our time. In food security, that challenge is more pressing than ever. By 2050, the world will need to double agricultural production in order to feed a world of 9 billion people. At the same time, a changing climate will lead to warmer temperatures, more erratic rains, and longer more severe droughts.
Here in Mississippi, you know this better than anyone. The Mississippi river has fallen to near record lows—and a stretch of the mighty river near Greenville has had to close briefly. And rural communities across the country continue to feel pressure from a parched land. But the truth is that our nation has some remarkable systems in place to support farmers and ranchers in a time of significant drought. They can buy insurance products, access our government's real-time data monitoring, and count on the USDA and universities like MSU to study the problem and foster new solutions.
The United States, President Obama and Secretary Clinton, have been very clear that we are calling on the Assad regime to end its brutal treatment and attacks on its own people. And President Obama has also asked us, the United States, to do everything we can to support the critical humanitarian needs that are in this region.
That's why we've already provided more than $82 million of support for humanitarian priorities, reaching more than 700,000 Syrians with food, water and medical support. And that's why, today, I'm quite pleased to announce an additional $21 million commitment. In this case to our colleagues at the World Food Programme, who are taking responsibility for providing effective food access to people who are in dire need, here in this camp, throughout parts of Syria and in other parts of the region.
Last updated: April 30, 2013


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You must earn 10,000 points to post other members' whiteboard
Welcome aboard buddy, have a nice week
Congrats on 1104 cons days. Saw some of your comments on a buddy site. I would like to be your buddy
Congratulations on having the dedication to post for 1,100 consecutive days. Keep up the Great Work. Want to become buddies??? Warren {:-)
A BIG CONGRATS on 1,000 consecutive days! Really awesome! Wow, another milestone has arrived! : ) For most GBs (8M plus) they don't seem to have the dedication or the persistence it takes to come back and post gas prices each day for other GBs! Or they just run out of gas! :( Hang onto your speed lines, it only takes one day to lose them! I'm sure you know! But, even clicking on news articles links, which are the easiest points here on GasBuddy, when you can't or didn't post gas prices before midnight will save your consecutive days! : ) WARNING! Every day GBs lose their consecutive days, many with big numbers, the #1 reason, "oops, I just forgot!" :( If you ever lose your consecutive days; that is NO FAULT of your own, please contact the mods! Keep posting each day to save your consecutive days! Keep going like a PRO Dayton GasBuddy! Have a nice week! Thanks buddy! Ron
Congrats on a thousand straight days !!! ... and belated Happy Birthday congrats as well as hitting the million-point mark ...
Congratulations on 1,000 consecutive days!
Congratulations on reaching 1,000 consecutive days! Great job!
Hope you had a great Christmas and will have an even better Happy New Year!
Have a nice week and Merry Christmas, a Happy New Year, Happy Holidays, and a prosperous 2013 to you and your family! Thanks for a another great year! Ron
thanks for being my newest buddy, Hope your holidays are merry and great.


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Steve Knorr
Vice President for University Relations
309 University Hall
Columbia, MO 65211
(573) 882-2726
News and Updates
News Releases
- May 09, 2013 - University of Missouri System Announces 2013-2014 TWA Scholarship Recipients
- May 08, 2013 - Thomas Richards named University of Missouri System interim vice president of Finance
- Apr 26, 2013 - UM System President continues Show Me Value Tour in Farmington, Lebanon
- Apr 04, 2013 - University of Missouri System invests up to $250,000 in an MU start-up venture to spur statewide eco
- Apr 01, 2013 - Media Advisory: University of Missouri System supporters to rally at State Capitol
University Relations
The Office of University Relations is responsible for strategic communications, government relations, and external affairs at the national, state and local levels. The office is committed to ensuring the citizens of Missouri and the elected officials who represent them understand, appreciate, and support the unique role and value of the four campus system in advancing Missouri's future.
The office leads a statewide integrated marketing communications effort, including internal and external constituent outreach, media relations, executive communications, Web development, advertorials and a variety of social media initiatives. The university relations team also is responsible for fostering relations between the local, state and federal government and the University of Missouri System, and developing legislative priorities and action agendas. Read more
Vicki Sauter wins UM President's Award for University Citizenship
Award recognizes Sauter's 30-plus years of leadership, mentoring and service. Full story » -
Hessler's Homecoming
Renowned writer and Columbia native earns MU honorary degree. Full story » -
We're No. 1
UMKC ranks No. 1 in national recycling competition. Full story »


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The StreetPilot 2730 offers real-time XM NavTraffic, XM WX Weather, and XM Radio capabilities. It comes ready to go, right out of the boxthere's no need to download maps from your PC.
The XM Traffic, Weather, and Audio capabilities give the StreetPilot 2730 great utility, even when drivers know exactly where they are. XM NavTraffic is the first nationwide satellite-based data traffic information service to enable an overlay of current traffic conditions. The StreetPilot 2730 uses this data [1] to automatically calculate and suggest faster alternative routes long before traffic starts backing up.
Accidents, road construction, or other incidents affecting traffic are graphically represented as icons on the navigation map. Precise information relating to a traffic incident is also available, including the precise location of the incident, the lanes affected, and the predicted duration. Roadways are color-coded to indicate directional traffic flow speed.
Additionally, the StreetPilot 2730 can also receive XM weather data[1]. Current weather conditions for over 2,000 locations, and weather forecasts for 162 cities, are displayed on-screen. United States county storm and flood warnings are also highlighted, allowing motorists to make prudent driving decisions.
The StreetPilot 2730 also offers more than 150 channels of XM satellite radio[2], featuring 100-percent commercial-free music, as well as more than 30 channels of news, sports, talk, and entertainment. Users can send XM and navigation audio to their car stereo through the StreetPilots integrated FM wireless transmitter or 3.5 mm stereo headphone/line-out plug.
The StreetPilot 2730 also comes equipped with an MP3 player that lets users take their personal music collection on the road and browse music by artist, album, song, or genre. Loading music is drag-and-drop easythere's no need for special software. The StreetPilot 2730 also works as an audio book player, with content available for purchase from Audible.comfeaturing more than 70,000 hours of audio programs from more than 200 content partners.
In addition to the turn-by-turn voice prompted navigation available in earlier StreetPilot models, the 2730 actually announces the name of upcoming streets and points of interestletting drivers keep their eyes on the road while navigating through busy traffic. Highly-detailed maps featuring nearly six million points of interest (POIs) throughout the U. S., Canada, and Puerto Rico (destinations like hotels, restaurants, gas stations, and attractions) come pre-loaded on the units solid-state memory. If a driver strays off-course, the StreetPilot 2730 automatically recalculates a new route.
With POI Loader, users can also augment the pre-loaded maps with custom POIssuch as school zones and safety cameras. In addition, a proximity alert option can warn the driver of upcoming custom POIs. (This safety feature is designed to help reinforce the importance of traveling at appropriate and legal speeds.)
Garmins GXM 30 antenna, which is included with the StreetPilot 2730, receives and processes all XM traffic, weather and audio data. For maximum portability, the magnetic, waterproof, puck-size GXM 30 can be placed on the dashboard or the roof of the vehicle.
The StreetPilot 2730 boasts a WQVGA automotive-grade color TFT display with touchscreen that automatically adjusts the units backlight for optimum viewability in any amount of light. Drivers can also view the map in either a three-dimensional perspective or a top-down track-up or north-up view.
[1] XM NavTraffic subscription required.[2] XM Radio subscription required.
INSTALLATION OF THE GARMIN GTM 10: The Garmin GM 10 FM TMC Traffic Receiver must be installed between your vehicle radio and it's antenna. Using the cables supplied*, unplug the existing antenna cable from your radio and connect the the GTM 10 Radio Out connector. Now connect the GTM 10 Radio In connector, with supplied cables (extra cables may be required), to the antenna cable end. The 1.5m Mini USB Cable from the GTM 10 can now be connected to your compatible GPS unit.


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They may be each other's soulmates, but when it comes to sex and love the ladies of SATC couldnt be more different. Take this quiz to find out which character you're most like.
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These days theres more than one way to feed your Cosmo fix. You can get your subscription to the print magazine as you always have, or if youd prefer to get it sent to you as a digital edition to read on your iPad, tablet, or Nook, weve got you covered. And, when you just cant get enough Cosmo, well give you even morecheck out our Sex Position of the Day app for your iPhone or Android-enabled device. Now hows that for a turn-on?
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Frontier Natural Products, English Breakfast Tea, 16 oz (453 g)
- Shipping Weight: 1.32 lbs (0.6kg)
- Product Code: FRO-01007
- UPC Code: 089836010070
- Package Quantity: 16 oz (453 g)
- Dimensions: 2.3 x 8.3 x 7 in, 1.05 lbs (0.48kg)
- Expiration Date: Feb 2016
Product Overview
- Kosher
This popular blend of black teas has a full, robust, malty (and slight citrus) flavor. It's a good choice for those who prefer a bit of milk or sweetener in their tea.
English Breakfast is a tea hearty enough to pair with a full breakfast or a tea-time repast of freshly baked scones. This traditional tea is often accentuated with sugar or honey and milk.
Suggested Use
To enjoy, pour 6 oz simmering water (185F preferred) over one teaspoon of tea. Steep 4-5 minutes, strain and serve immediately.


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One on One Help Sessions
Do you need extra help when it comes to computers? Come to a help session with your specific questions about Internet searching or applications like Microsoft Word, Facebook, Email or get help downloading onto your e-reader device. These one-on-one sessions are an opportunity to work with a library staff member to provide some extra help on questions you have. Help sessions are a half hour each


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Dr Michael Tarren-Sweeney
Work Phone | +64 3 3642 418 |
firstname.lastname@example.com | |
Position |
Conjoint Senior Lecturer
School of Medicine and Public Health
Office | University Of Canterbury |
- Graduate Diploma in Epidemiology, University of Newcastle
- Bachelor of Arts, University of New England
- Bachelor of Arts (Honours)(Psychology), Macquarie University
Research keywords
- Attachment disorders
- Developmental psychopathology
- Foster care
- Kinship care
- Psychiatric Epidemiology
- Social care policy
Research expertise
The inner world and subjective distress of children who have been harmed and emotionally deprived is mysterious and largely unknown. My journey towards understanding the minds of such children, as well as the causes of their psychic impairment, began in 1989, when I started to work as a child and family psychologist in child protection and alternate care. Aside from realising that working with such children was a great privilege, I was struck by the absence of empirical knowledge about their mental health and well-being of the lack of conceptual frameworks, of various phenomenological mysteries, and a reliance on non-standardised and subjective measurement tools. Few people in the world had researched these issues for maltreated children, and even fewer had looked in any detail at the problems of children in care. Over time I resolved to devote my lifes work to pursuing such research questions, and to develop more specific measurement tools, in the hope that this might lead to better prevention, identification and treatment of the psychological problems manifested by such children. I was also motivated by a strong intellectual curiosity. With this in mind I completed graduate training in psychiatric epidemiology, established a Psychologists Research group in the NSW Department of Community Services, and embarked on the Children in Care study.
Both the Children in Care study and the development of the Assessment Checklist for Children (see descriptions below) represent groundbreaking research in this specialised field. The findings from these studies are contributing to re-conceptualisation of the development and psychiatric problems of children in care. For example, patterns of aberrant eating behaviour have been identified for the first time in this population, leading to the proposal of a syndrome (termed Food Maintenance Syndrome). Some of the findings and theoretical formulations that have come from this research are published or submitted for publication (see publication list), while further research questions are to be addressed in a follow-up study (commencing later this year). With over half of the several hundred thousand children residing in long-term alternate care in the developed world estimated to have some form of psychiatric disturbance, my research program has major public health significance.
Research interests
- Developmental psychopathology, with special interest in the epidemiology, phenomenology and determinants of psychopathology among maltreated children, and children in alternate care
- Social policy for high-risk children (especially regarding primary prevention of psychopathology)
- Measurement and screening of mental health problems and attachment difficulties among children in care
- Attachment disorders, and the spectrum of attachment difficulties
- Significance of loss and disrupted attachments among maltreated children entering care
- Mental health of inter-country adoptees
- Mental health of indigenous children
- The mental health and wellbeing of children in rural and remote communities
- Teaching health equity
- Remote problem-based learning
Research skills / experience
- Large-scale epidemiological research
- Test development, psychometrics, mental health screening
- Phenomenological investigations and enquiry
- Qualitative methods
- Data analysis (STATA) and database management
- Meta-analysis and clinical reviews
Fields of Research
Code | Description | Percentage |
170100 | Psychology | 50 |
169900 | Other Studies In Human Society | 30 |
111400 | Paediatrics And Reproductive Medicine | 20 |
Centres and Groups
Body relevant to professional practice.
- Member - Australian Psychological Society
- Full Member - Australian Psychological Society
Committee/Associations (relevant to research).
- Trustee - Cholmondeley Children's Home, Christchurch
- Member - Member of the Research Advisory Committee, Life Without Barriers Fostering Service
Editorial Board.
- Member - Clinical Child Psychology and Psychiatry
British Academy Visiting Fellow
The British Academy (United Kingdom) |
01/04/2009 - 01/12/2009 |
Visiting Research Fellow
for Policy Studies, University of Bristol (United Kingdom) |
01/05/2009 - 01/05/2010 |
Senior Lecturer (Above the Bar) in Child and Family Psychology
University of Canterbury, NZ (New Zealand) |
01/01/2009 |
Deputy Director of Health Sciences
University of Canterbury, NZ (New Zealand) |
01/01/2008 |
Conjoint Senior Lecturer in Psychiatry
University of Newcastle (Australia) |
01/01/2006 |
Tarren-Sweeney, M. Out-of-Home Care Outcomes for Children What works best? Seminar presentation for the NSW Department of Community Services, Sydney June 30, 2005
NSW Department of Community Services, Australia (Conference Presentation - non published.) |
2005 |
Tarren-Sweeney, M. Assessment of Children in Care. Invited presentation at Clinical and Psychometric Assessment in Child and Adolescent Mental Health Practice conference
Sydney University, Australia (Conference Presentation - non published.) |
2004 |
Administrative expertise
University of Newcastle
2004 - 2005 Member of the Medical School Executive
2003 - 2006 Director of Health Equity training, responsible for academic supervision of six academic stream coordinators within the Health Equity Selective
2003 - 2006 Member of the Bachelor of Medicine Program Committee
University of Canterbury
2006 - present Acting Programme Director, Postgraduate Child and Family Psychology programme
2007 - present Coordinator of Postgraduate Studies, School of Educational Studies and Human Development
2006 - present Chair of the Postgraduate Examination Committee, School of Educational Studies and Human Development
2006 - present Privacy officer, School of Educational Studies and Human Development
2007 - present Standing Faculty representative on the Academic Appeals Committee
Course co-ordination
University of Newcastle
1996 - 2006 MEDI6190 Psychiatric Epidemiology (Postgraduate)
2004 - 2006 MEDI6290 Psychological Solutions (Postgraduate)
2003 - 2006 MEDI3014 Health Equity Selective (Year 3, Bachelor of Medicine)
2001 - 2006 Coordination and delivery of all Psychiatry training in Year 3 of the medical degree
University of Canterbury
2006 - present EDUC623 Professional development in Child and Family Psychology (Practicum year)
EDUC624 Child and Family Psychology practicum (Practicum year)
EDUC501 Advanced academic development (Internship year)
EDUC502 Advanced professional practice in Child and Family Psychology (Internship year)
EDUC503 Structuring and examining professional practice (Internship year)
2007 EDUC616 Applied Developmental and Paediatric Psychology (Foundation year - co-coordinator)
Research management
1997 - ongoing Chief investigator of the Children in Care Study. (Recruited and supervised three research staff)
1999 - 2000 Project manager of the Disruptive Behaviour Study (Recruited and supervised seven research staff)
Teaching keywords
- Development of multidisciplinary mental health learning modules
- Ecological analysis and complex formulations
- Health Equity Training in Medicine
- Problem-based learning for trainee Psychologists
- Professional training in Child and Family Psychology
Teaching expertise
University of Canterbury
2006 - Engaged to teach in the Master of Education (Child and Family Psychology) and Post-Grad Diploma in Child and Family Psychology. Lecturing in the practicum and internship years.
Practicum Year: Professional Development in C+F Psychology
C+F Psychology Practicum
Internship Year: Advanced Academic Development
Advanced Professional Practice
Structuring and Examining Professional Practice
2006 - 2007 Supervision of 5 Masters research theses and dissertations
University of Newcastle
1996 - 2005 MEDI6190 Psychiatric Epidemiology
Postgraduate 1 semester course. Initially internal, later distance learning
Elective for postgraduate programs in Population Health (Clinical epidemiology, Health Social Science, etc), Drug and Alcohol Studies, Nursing and Psychology.
2004 - 2005 MEDI6290 Psychological Solutions
Postgraduate, 1 semester course by distance learning. Elective for postgraduate programs in Population Health (Clinical epidemiology, Health Social Science, etc), Drug and Alcohol Studies, Nursing and Psychology
2003 - 2006 MEDI3014 Health Equity Selective
Year 3, Bachelor of Medicine. Offered four times a year. Innovative approach to medical education, replacing the traditional clinical health elective. Students focus on social disadvantage, access to care, and health inequity. Consists of a common week of teaching and an eight-week health equity field placement in one of eight streams: Aged and Community Care; Indigenous health (mostly in remote Aboriginal communities); Global Health (in developing countries); Rural Health (with rural physicians); Mental Health; Child Health; Prison Health; and Drug and Alcohol health.
2001 - 2006 Coordination and delivery of all Psychiatry training in Year 3 of the medical degree
2001 - 2005 Supervision of mental health clinical reviews by Year 3 medical students (NUGGETS)
2005 Problem-Based Learning Tutor for Year 2 medical students


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November 9, 2011 | Community Development Council Member | Kitchener | Volunteer #2011-008
Date: | November 9, 2011 |
Position: | Volunteer: Community Development Council Member |
Location: | 120 Ottawa St South, Kitchener |
Duration: | Ongoing – 6 times per year |
Positions Available:
• Secretary
• General Council Members
Position Summary:
The Canadian Hearing Society serves Culturally Deaf, oral deaf, deafened and hard of hearing communities. In our effort to further improve the scope of services provided, a Community Development Council (CDC) was established in all regions of the province.
We are currently seeking community members to join the Waterloo CDC and make a difference for all consumers of services offered in the region. Involvement of committed community representatives is essential in creating an enhanced awareness of The Canadian Hearing Society, ensuring the service delivery reflects priorities of the community and in supporting fundraising.
A qualified applicant may have one or more of the following skills:
• Community involvement
• Experience with public speaking
• Ability to work independently
• Ability to provide leadership
• Experience with Board development
• Fundraising, marketing and planning skills
• Board experience is an asset.
Interested and qualified candidates are invited to send their resumes to:
Victoria Baby
Regional Director
The Canadian Hearing Society
120 Ottawa St South, Kitchener ON N2H 3K5
519-744-6811 Phone
519-744-2390 Fax
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Kids' Dot Fade E-Reader Cover
Item # 420363-AL0
Cover it!
- Neoprene shell protects your e-reader from bumps, scratches & scrapes
- Durable nylon stitching
- Spot clean with mild detergent
- E-reader is secured with bungees at the corners
- Monogram it! View all monogram thread color options
Safety for your reader in fun printed neoprene. Imported. 7″Hx5″Wx 1/2″D


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United Kingdom
If visiting nearby Sherwood Forest here's a good and inexpensive place to spend a couple of hours. Crumbling, haunted ruins of a medieval monastery and later country house, contemporary craft centre, modern sculpture trail, attractive park and lake, shops, cafe and restaurant with good value cooked lunches. Unusual things for the kids to discover like the camera obscura, the dragon gateway and the 'stone harp'. www.nottinghamshire.gov.uk/ruffordcp
About 20 miles north of Nottingham on the A614, 3 miles south of Ollerton. It's on the old Great North Road which once ran through Sherwood Forest.
Send your feedback or queries to firstname.lastname@example.com
Search Been there


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Home » NewHampshire.com » Neighborhood News
History made: White perch wins Great Meredith Rotary Ice Fishing Derby
His victory marked the first in the history of the derby that an angler has won with anything other than a rainbow trout.
Under the old rules, the largest prizes went to the largest rainbow trout, but this year, derby organizers decided to hold a drawing among the anglers bringing in the top fish in all categories - lake trout, rainbow trout, white perch, yellow perch, cusk, pickerel, and black crappie.
It was Head's first derby victory. For his catch of a 2.76 white perch, caught on Big Squam Lake, he was entered into the final drawing. He couldn't believe his ears, he said, when his name was called for the top prize, $15,000 cash.
"I can't believe it," he said. When asked what he would do with the prize money, he answered, "I don't know yet."
Second place, a prize of $5,000, went to Lawrence Shipley of Belmont. Third place, $3,000, went to Thomas Knight of Hampton.
In past years, the top three prizes have been vehicles and fishing equipment. This year, having learned that some recent prize winners had sold their prizes for cash, and given the slow economy, derby organizers decided to award cash as prizes.
- Hooksett school board members grapple with district's future - 0
- Dodgeball returns to Windham schools - 0
- How Rosaly's garden grew into organic Peterborough farm - 0
- Bedford maintains highest credit rating from Moody's - 0
- Damn Yankees at Leddy Center July 12-28 - 0
- Dan Brown and Joe Stevens Join Prescott Park Arts Festival's Summer Movie Series - 0
- Loeb School Offers Cartooning for Kids Workshop - 0
- Jim Beauregard's Tasting Notes: Samples from the world of Pinot Noir - 0
- Moose Hunt Lottery Drawing Is Friday, June 21, 2013 - 0


text: Yes we have a young QB but look at what the Falcons did with their young QB last year. And I like the Jets roster better than Atlanta's from last year. The way Rex Ryan coaches, those close games that the Jets would always blow to teams we thought they should beat (especially under Herm) won't happen as much.Originally Posted by dabomb2045


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Welcome to Oil Gardens new online Aromatherapy destination
Value, Quality, Uncompromised
Oil Garden is the number one Retail aromatherapy brand in Australia and we pride ourselves that our oils are 100% pure, natural and TGA listed.
Aromatherapy is the holistic art and science of blending and using Essential Oils for Health and Wellbeing. Aromatherapy is based on holistic principles as it affects both the body and mind.
Essential Oil extracts are taken from tiny oil glands in flowers, roots, stalks, bark, seeds, leaves, gum or rind of the plant, with each essential oil having unique therapeutic properties.
With the natural benefits of aromatherapy being appreciated by more and more people, we have created this website to fill all your aromatherapy needs - from handy hints, to recipes, to purchasing our products.
Enjoy your aromatherapy experience!
From all at the Oil Garden team
In winter we retreat, we hibernate and we restore in preparation...
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Anantara Veli Resort & Spa, Maldives
About a half hour from the Male airport in the Maldives, these 50 bungalows are drenched in luxury, though not the actual Indian Ocean.
See more info about these overwater bungalows on the Anantara Veli Resort website.
Related Photos
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The Maldives' Newest Resort: Ayada
Ayada Resort is one of the newest resorts to open in the Maldives. They have 122 rooms, each with private butler service and stunning views of the ocean.
Travel Tales: Maldives
Find more island stories in the Travel Tales Article Archive.
Best Private Islands: Maldives' Veli and Dhigu
This pair of resorts in a destination full of them truly stand out
Micro-resort Planned for Turks and Caicos
Turks and Caicos is poised to score another luxury resort. Grace Bay Resorts is building its first-ever standalone residential villa enclave at the Caribbean hot spot. Dubbed The Residences, the complex will feature custom-designed homes each with a private beachfront.
New Resort set to Open in Roatán
Fans of Roatán are about to get a new resort option for their favorite Caribbean island. Las Verandas Hotel & Villas is planning to lift its curtain on March 1. The resort includes a championship golf course, the Palapa Bar & Restaurant, two infinity edge pools, 1,000 feet of private beach and six villas with Caribbean views.
This U.S. Virgin Islands Trip Offer is Ladies Only
It might be odd timing given that Valentine's Day is upon us, but Eco Serendib Villa and Spa in St. John, USVI, is encouraging ladies to leave their husbands behind for its latest trip offer. The resort's five-night "Serendipitous Escape" for up to six gal pals and offers plenty of pampering, starting with an arrival via ferry where a chosen theme song -- Girls Just Wanna Have Fun, Single Ladies, This One's For the Girls -- greets guests along with with cold towels, freshly brewed lemongrass tea, champagne and hors d'oeuvres.
Time Running Out for Valentine's Day Travel Deals
Jewelry and chocolate is nice. But if you want to seriously get the attention of your significant other, a plane ticket to a tropical destination would make for the perfect Valentine's Day gift. Thankfully, some of our favorite resorts are offering some great deals, but you better hurry: For some of these deals, you'll have to book by the end of this week.
Editor's Pick: The Luxury Hideaway That Rihanna Loves
I'll never look like Rihanna. But maybe I can enjoy her lifestyle — if only for a moment — at Sandy Lane, the posh Barbados hotel she calls home away from home. What lures her here? For starters, an unparalleled respect for privacy that even includes the installation of underground passageways so Rhi-Rhi never even has to glimpse a bellhop. Then there's the swanky spa, where I plan to be daubed head to toe in pink clay and, eventually, emerge red-carpet ready. And afterward, just like the Bajan star, I'll sashay down the marble staircase to the terrace for afternoon tea. But no photos, please. Because ...
If You've Never Slept in an Island Treehouse...
My whole life I've wanted a treehouse, a solitary refuge between the in and outside worlds. And now our jeep is inching down the steep driveway toward it. Lights glow from behind the dense canopy, and I glimpse slivers of sharp edges in the dark. My heart races as if on a first date. I'm dropped off at two-bedroom Zing-Zing, and as my attendant, Maggie, gives me the tour, pointing out pristine appliances, a book collection and Dominican red-cedar furniture, I mouth "Oh my God!" over and over. I breathe in the fragrance of Guyanese greenheart, and contentment washes over me. And later, when I perch my pinot grigio on the wood-encased bathtub, slip in and gaze blissfully through floor-to-ceiling windows into Dominican jungle, I feel ...
The New Secret Belize Resort With Nature AND Luxury
I've never really been the rough-and-ready outdoorsy type. Truth is, I'd rather go barefoot than wear Birkenstocks; shopping is my cardio; and my favorite trips usually incorporate some combination of butler service, air-conditioning and spa services galore. So Belize — which I've always unfairly associated with bare-bones lodges, sweaty jungle treks and creepy-crawlies galore — was never on my travel to-do list. But it turns out that Belize has its share of plush digs, including El Secreto resort. The Ambergris Caye retreat promises 13 slick villas tricked out with contemporary furniture; 400-thread-count sheets; a pillow menu; outdoor whirlpools and showers; and (yes!) air-conditioning. Sounds like the kind of place where even a high-maintenance traveler like me might ...


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As the debate about the future of Europe gathers pace, the European Commission is reaching out to citizens by visiting towns across Europe and asking them directly for their views.
Antonio Tajani, European Commission Vice-President responsible for Industry and Entrepreneurship
Debate on the future of Europe
Piazza Castello, Ventotene Island
Past events Future events
All dialogues09/05/2013 - Estonia's interests would be better protected in a federal than a confederal EU, Estonian President Toomas Hendrik Ilves said at a debate on 9 May.
08/05/2013 - Commission calls for significant progress on completing the internal energy market and tackling growing tax fraud and evasion ahead of leaders' meeting.
08/05/2013 - New proposals would remove remaining obstacles to living, working and shopping anywhere in the EU.


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Cyber-Rain is the leading smart sprinkler controller. It uses your PC to check the weather via the internet and automatically adjusts sprinkling times. It's Smart Scheduling Wizard helps you set a water-wise sprinkling schedule customized to your yard - no more confusing knobs or dials!
Cyber-Rain recommends watering times based on plant type, landscape conditions and location. Pictures are provided for easy setup. Cyber-Rain easily incorporates local watering restrictions into your schedule. Simply check when watering is allowed. You can even access and change your schedule from the Internet. This controller will automatically water, wait and water again when landscapes are sloped or have dense soil. No need to enter separate start times. The XCI System also tracks how many minutes you water and how much watering time is saved.
1. Insert Valve Wires
Cyber-Rain Wireless Smart Irrigation Controller Accesories: