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Rhabdoid tumor of the kidney is a malignant tumor of the kidney. These tumors usually occur in children younger than 2 years. Learn about rhabdoid tumors and find information on how we support and care for children with rhabdoid tumors of the kidney before, during, and after treatment.
The Solid Tumor Center at Dana-Farber/Boston Children's Cancer and Blood Disorders Center treats children and teens with a variety of solid malignancies, including bone and soft tissue tumors, liver and kidney tumors, neuroblastomas, retinoblastomas and rare tumors. Our doctors provide unparalleled expertise in the diagnosis, treatment and management of these diseases.
Your child's care team will include pediatric oncologists, radiation oncologists, surgeons, pathologists, radiologists, and nurses with expertise in treating your child's specific type of cancer.
Our physicians are focused on family-centered care: From your first visit, you'll work with a team of professionals who are committed to supporting your family's needs. We consider you and your child integral parts of the care team. Our specialists will collaborate with you to customize a treatment plan that takes the needs of your child and your family into account.
As well as providing access to a range of innovative clinical trials through Dana-Farber/Boston Children's, we are New England's Phase I referral center for the Children's Oncology Group, which means we're able to offer clinical trials unavailable at other regional centers.
Your child will have access to long-term treatment and childhood cancer survivor support through Dana-Farber's David B. Perini, Jr. Quality of Life Clinic.
From diagnosis through treatment and survivorship, our team will be able to answer all of your questions about your child's care.
Find out more about our Solid Tumor Center, including the diseases we treat and our specialized programs for bone and soft tissue tumors, liver tumors, neuroblastoma, rare tumors, and retinoblastoma.
Malignant rhabdoid tumor is a rare childhood tumor that commonly starts in the kidneys but also can occur in other soft tissues or in the brain, where it is referred to as atypical teratoid/rhabdoid tumor.
Malignant rhabdoid tumor occurs most commonly in infants and toddlers; the average age of diagnosis is 15 months old. There are about 20 to 25 new cases of malignant rhabdoid tumor diagnosed each year in the United States. Cells from a malignant rhabdoid tumor can spread (metastasize) to other areas of the body.
The treatment of malignant rhabdoid tumor involves a combination of therapies including surgery, radiation and chemotherapy. However, because this tumor is rare and aggressive, there is no defined standard of care, and treatment options may be tailored to your child's situation. Your child's doctor and other members of your care team will discuss the options with you in depth. Prompt medical attention and aggressive therapy are important for the best prognosis.
Dana-Farber/Boston Children's Cancer and Blood Disorders Center is a world-leading center in the research and treatment of rhabdoid tumors. Our vibrant program of basic and translational research into rhabdoid tumors is uncovering new opportunities to improve the care of children with malignant rhabdoid tumor. Our multidisciplinary treatment approach through our Kidney Tumor Program ensures in-depth discussion of each child and personalized treatment plans for every patient.
Find more in-depth information on malignant rhabdoid tumor on the Dana-Farber/Boston Children's website, including answers to:
The PDQ childhood brain tumor treatment summaries are organized primarily according to the World Health Organization classification of nervous system tumors.[1][2] For a full description of the classification of nervous system tumors and a link to the corresponding treatment summary for each type of brain tumor, refer to the PDQ summary on Childhood Brain and Spinal Cord Tumors Treatment Overview.
Dramatic improvements in survival have been achieved for children and adolescents with cancer. Between 1975 and 2002, childhood cancer mortality has decreased by more than 50%.[3] Childhood and adolescent cancer survivors require close follow-up because cancer therapy side effects may persist or develop months or years after treatment. (Refer to the PDQ summary on Late Effects of Treatment for Childhood Cancer for specific information about the incidence, type, and monitoring of late effects in childhood and adolescent cancer survivors.)
Primary brain tumors are a diverse group of diseases that together constitute the most common solid tumor of childhood. Brain tumors are classified according to histology, but tumor location and extent of spread are important factors that affect treatment and prognosis. Immunohistochemical analysis, cytogenetic and molecular genetic findings, and measures of mitotic activity are increasingly used in tumor diagnosis and classification.
Louis DN, Ohgaki H, Wiestler OD, et al., eds.: WHO Classification of Tumours of the Central Nervous System. 4th ed. Lyon, France: IARC Press, 2007.
Louis DN, Ohgaki H, Wiestler OD, et al.: The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114 (2): 97-109, 2007.
Smith MA, Seibel NL, Altekruse SF, et al.: Outcomes for children and adolescents with cancer: challenges for the twenty-first century. J Clin Oncol 28 (15): 2625-34, 2010.
Based on present biologic understanding, atypical teratoid/rhabdoid tumor (AT/RT) is part of a larger family of rhabdoid tumors. In this summary, AT/RT refers to central nervous system (CNS) tumors only and rhabdoid tumor reflects the possibility of both CNS and non-CNS tumors. Unless noted otherwise in the text, this summary is referring to AT/RT.
The exact incidence of childhood CNS AT/RT is difficult to determine because the tumor has been widely recognized only for the last decade. In two recent North American based prospective studies performed by the Children's Cancer Group and the Pediatric Oncology Group for children aged 3 years or younger at diagnosis, retrospective review disclosed that approximately 10% of children had AT/RTs.[1] A Taiwanese study found that AT/RTs account for 26% of primitive or embryonal tumors in children younger than 3 years.[2] The Austrian Brain Tumor Registry, conducted between 1996 and 2006, confirmed that AT/RTs represent the sixth most common malignant brain tumor in 311 newly diagnosed children (6.1%), with a peak incidence during the first 2 years of life.[3] The incidence in older patients is unknown. In the Central Nervous System Atypical Teratoid/Rhabdoid Tumor Registry (AT/RT Registry), 12 of 42 patients (29%) were older than 36 months at the time of diagnosis.[4]
Childhood AT/RT is a clinically aggressive tumor that primarily occurs in children younger than 3 years, but it also can occur in older children and has been reported in adults.[5][6] In about one-half of patients, the tumor is located in the posterior fossa, although it can occur anywhere in the CNS.[1]
Signs and symptoms related to the tumor are dependent on location. Young patients with posterior fossa tumors usually present with symptoms related to hydrocephalus such as early morning headaches, vomiting, and lethargy. They may also develop ataxia or regression of motor skills. Because AT/RT grows rapidly, patients typically have a fairly short history of progressive symptoms measured in days to weeks. Data from the AT/RT Registry suggest that approximately 20% of patients present with disseminated disease.[4] Dissemination is typically through leptomeningeal pathways seeding the spine and other areas of the brain. There are also reports of rare patients with synchronous renal rhabdoid and AT/RT.[7]
Prognostic factors that affect survival for AT/RTs are not fully delineated. Factors associated with a poor outcome include the following:
Most published information on outcomes for patients with AT/RT is based on small series and is retrospective in nature. Initial retrospective studies reported an average survival from diagnosis of only about 12 months.[1][5][10][11][12] In another retrospective report, 2-year overall survival was better for patients who underwent a gross-total resection than for those who had a subtotal tumor removal. However, the contribution of radiation therapy was less clear.[10] There are, however, reports of long-term survivors.[13] Notably, improved survival has been reported for those aged 3 years and older who received postoperative craniospinal irradiation and high-dose alkylator-based chemotherapy compared with those younger than 3 years with AT/RT. In this report, the incidence of leptomeningeal metastases was also higher in the infant group of patients.[14] In one prospective study of 25 children with AT/RT receiving intensive multimodal therapy, including radiation and intrathecal chemotherapy, the reported 2-year progression-free survival rate was 53%, and the overall survival rate was 70%.[15]
Packer RJ, Biegel JA, Blaney S, et al.: Atypical teratoid/rhabdoid tumor of the central nervous system: report on workshop. J Pediatr Hematol Oncol 24 (5): 337-42, 2002 Jun-Jul.
Ho DM, Hsu CY, Wong TT, et al.: Atypical teratoid/rhabdoid tumor of the central nervous system: a comparative study with primitive neuroectodermal tumor/medulloblastoma. Acta Neuropathol 99 (5): 482-8, 2000.
Woehrer A, Slavc I, Waldhoer T, et al.: Incidence of atypical teratoid/rhabdoid tumors in children: a population-based study by the Austrian Brain Tumor Registry, 1996-2006. Cancer 116 (24): 5725-32, 2010.
Hilden JM, Meerbaum S, Burger P, et al.: Central nervous system atypical teratoid/rhabdoid tumor: results of therapy in children enrolled in a registry. J Clin Oncol 22 (14): 2877-84, 2004.
Burger PC, Yu IT, Tihan T, et al.: Atypical teratoid/rhabdoid tumor of the central nervous system: a highly malignant tumor of infancy and childhood frequently mistaken for medulloblastoma: a Pediatric Oncology Group study. Am J Surg Pathol 22 (9): 1083-92, 1998.
Lutterbach J, Liegibel J, Koch D, et al.: Atypical teratoid/rhabdoid tumors in adult patients: case report and review of the literature. J Neurooncol 52 (1): 49-56, 2001.
Biegel JA, Fogelgren B, Wainwright LM, et al.: Germline INI1 mutation in a patient with a central nervous system atypical teratoid tumor and renal rhabdoid tumor. Genes Chromosomes Cancer 28 (1): 31-7, 2000.
Kordes U, Gesk S, Frühwald MC, et al.: Clinical and molecular features in patients with atypical teratoid rhabdoid tumor or malignant rhabdoid tumor. Genes Chromosomes Cancer 49 (2): 176-81, 2010.
Dufour C, Beaugrand A, Le Deley MC, et al.: Clinicopathologic prognostic factors in childhood atypical teratoid and rhabdoid tumor of the central nervous system: a multicenter study. Cancer 118 (15): 3812-21, 2012.
Lafay-Cousin L, Hawkins C, Carret AS, et al.: Central nervous system atypical teratoid rhabdoid tumours: the Canadian Paediatric Brain Tumour Consortium experience. Eur J Cancer 48 (3): 353-9, 2012.
Rorke LB, Packer RJ, Biegel JA: Central nervous system atypical teratoid/rhabdoid tumors of infancy and childhood: definition of an entity. J Neurosurg 85 (1): 56-65, 1996.
Athale UH, Duckworth J, Odame I, et al.: Childhood atypical teratoid rhabdoid tumor of the central nervous system: a meta-analysis of observational studies. J Pediatr Hematol Oncol 31 (9): 651-63, 2009.
Olson TA, Bayar E, Kosnik E, et al.: Successful treatment of disseminated central nervous system malignant rhabdoid tumor. J Pediatr Hematol Oncol 17 (1): 71-5, 1995.
Tekautz TM, Fuller CE, Blaney S, et al.: Atypical teratoid/rhabdoid tumors (ATRT): improved survival in children 3 years of age and older with radiation therapy and high-dose alkylator-based chemotherapy. J Clin Oncol 23 (7): 1491-9, 2005.
Chi SN, Zimmerman MA, Yao X, et al.: Intensive multimodality treatment for children with newly diagnosed CNS atypical teratoid rhabdoid tumor. J Clin Oncol 27 (3): 385-9, 2009.
Childhood central nervous system (CNS) atypical teratoid/rhabdoid tumor (AT/RT) was first described as a discrete clinical entity in 1987 [1] because of its pathologic and genetic characteristics. Prior to that, it was often misclassified as a medulloblastoma, primitive neuroectodermal tumor, or choroid plexus carcinoma. The World Health Organization began classifying it as an embryonal grade IV neoplasm in 1993.[2]
AT/RT is a rapidly growing tumor that can have an MIB-1 labeling index of 50% to 100%.[2] Immunohistochemistry for INI1 protein is useful in establishing the diagnosis of AT/RT. A loss of INI1 staining is noted in neoplastic cells, but staining is retained in non-neoplastic cells (e.g., vascular endothelial cells).[3][4][5]
Histologically, classic AT/RT is morphologically heterogeneous, typically containing sheets of large epithelioid cells with abundant eosinophilic cytoplasm and scattered rhabdoid cells, most often with accompanying components of primitive neuroectodermal cells (small round blue cells), mesenchymal cells, and/or glial cells.[6] Immunohistochemical staining for epithelial markers (cytokeratin or epithelial membrane antigen), glial fibrillary acidic protein, synaptophysin (or neurofilament), and smooth muscle (desmin) may help to identify the heterogeneity of differentiation, but will vary depending on the cellular composition.[7] Rhabdoid cells, while not present in all AT/RTs, will express vimentin, epithelial membrane antigen, and smooth muscle actin.
AT/RT is the first primary pediatric brain tumor for which a candidate tumor suppressor gene, SMARCB1 (also known as INI1 and hSNF5), has been identified.[8]SMARCB1 has been found to be abnormal in the majority of rhabdoid tumors, including CNS, renal, and extrarenal rhabdoid malignancies.[8] Alterations (mutations as well as gains/losses) in other genes are very uncommon in patients with SMARCB1-associated AT/RT.[9][10][11]SMARCB1 is a component of a Switch (SWI) and Sucrose non-fermenting (SNF) adenosine triphosphate-dependent chromatin-remodeling complex.[12] The exact function of the SMARCB1 gene is unknown, but it is likely that a mutation results in altered transcriptional regulation of downstream targets. Rare familial cases of rhabdoid tumors expressing SMARCB1 and lacking SMARCB1 mutations have also been associated with germline mutations of SMARCA4/BRG1, another member of the SWI/SNF chromatin-remodeling complex.[5][13]
In addition to somatic mutations, germline mutations in SMARCB1 have been reported in some AT/RT patients.[8][14] A study of 65 children with rhabdoid tumors found that 23 (35%) had germline mutations and/or deletions of SMARCB1.[3] Children with germline alterations in SMARCB1 presented at an earlier age than sporadic cases (median age, approximately 5 months versus 18 months) and were more likely to present with multiple tumors.[3] One parent was found to be a carrier of the SMARCB1 germline abnormality in 7 of 22 evaluated cases showing germline alterations, with four of the carrier parents being unaffected by SMARCB1-associated cancers.[3] This indicates that AT/RT shows an autosomal dominant inheritance pattern with incomplete penetrance. Gonadal mosaicism has also been observed, as evidenced by families in which multiple siblings are affected by AT/RT and have identical SMARCB1 alterations, but both parents lack a SMARCB1 mutation/deletion.[3][4] Screening children diagnosed with AT/RT for germline SMARCB1 mutations may provide useful information for counseling families on the genetic implications of their child's AT/RT diagnosis.[3]
All patients with childhood AT/RT should have magnetic resonance imaging of the brain and spine at the time of diagnosis. Unless medically contraindicated, patients should also have lumbar cerebrospinal fluid inspected for evidence of tumor. Consideration should also be given to renal ultrasound to detect synchronous tumors. There is no way to reliably distinguish AT/RT from other malignant brain tumors based on clinical history or radiographic evaluation. Embryonal tumors, especially in those younger than 3 years, should undergo immunostaining for loss of SMARCB1 (INI1, hSNF5) protein expression to confirm the diagnosis.[4]
A Rhabdoid Tumor Predisposition Syndrome (RTPS), related primarily to germline SMARCB1 alterations, has been clearly defined.[8][14] This syndrome is manifested by a marked predisposition to the development of malignant rhabdoid tumors in infancy and early childhood. Up to one-third of AT/RTs are thought to arise in the setting of RTPS, and the majority of these occur within the first year of life. The most common non-CNS malignancy of RTPS is the malignant rhabdoid tumor of the kidney, which is also noted in infancy. RTPS is highly suggested in patients with synchronous occurrence of renal malignant rhabdoid tumor and AT/RT, bilateral malignant rhabdoid tumors of the kidney, or malignant rhabdoid tumors in two or more siblings.
Kleihues P, Louis DN, Scheithauer BW, et al.: The WHO classification of tumors of the nervous system. J Neuropathol Exp Neurol 61 (3): 215-25; discussion 226-9, 2002.
Eaton KW, Tooke LS, Wainwright LM, et al.: Spectrum of SMARCB1/INI1 mutations in familial and sporadic rhabdoid tumors. Pediatr Blood Cancer 56 (1): 7-15, 2011.
Bruggers CS, Bleyl SB, Pysher T, et al.: Clinicopathologic comparison of familial versus sporadic atypical teratoid/rhabdoid tumors (AT/RT) of the central nervous system. Pediatr Blood Cancer 56 (7): 1026-31, 2011.
Hasselblatt M, Gesk S, Oyen F, et al.: Nonsense mutation and inactivation of SMARCA4 (BRG1) in an atypical teratoid/rhabdoid tumor showing retained SMARCB1 (INI1) expression. Am J Surg Pathol 35 (6): 933-5, 2011.
Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000.
McLendon RE, Adekunle A, Rajaram V, et al.: Embryonal central nervous system neoplasms arising in infants and young children: a pediatric brain tumor consortium study. Arch Pathol Lab Med 135 (8): 984-93, 2011.
Biegel JA, Tan L, Zhang F, et al.: Alterations of the hSNF5/INI1 gene in central nervous system atypical teratoid/rhabdoid tumors and renal and extrarenal rhabdoid tumors. Clin Cancer Res 8 (11): 3461-7, 2002.
Lee RS, Stewart C, Carter SL, et al.: A remarkably simple genome underlies highly malignant pediatric rhabdoid cancers. J Clin Invest 122 (8): 2983-8, 2012.
Kieran MW, Roberts CW, Chi SN, et al.: Absence of oncogenic canonical pathway mutations in aggressive pediatric rhabdoid tumors. Pediatr Blood Cancer 59 (7): 1155-7, 2012.
Hasselblatt M, Isken S, Linge A, et al.: High-resolution genomic analysis suggests the absence of recurrent genomic alterations other than SMARCB1 aberrations in atypical teratoid/rhabdoid tumors. Genes Chromosomes Cancer 52 (2): 185-90, 2013.
Biegel JA, Kalpana G, Knudsen ES, et al.: The role of INI1 and the SWI/SNF complex in the development of rhabdoid tumors: meeting summary from the workshop on childhood atypical teratoid/rhabdoid tumors. Cancer Res 62 (1): 323-8, 2002.
Schneppenheim R, Frühwald MC, Gesk S, et al.: Germline nonsense mutation and somatic inactivation of SMARCA4/BRG1 in a family with rhabdoid tumor predisposition syndrome. Am J Hum Genet 86 (2): 279-84, 2010.
There is no defined staging system for childhood central nervous system atypical teratoid/rhabdoid tumor (AT/RT). Patients are classified as having newly diagnosed or recurrent disease with or without neuraxis dissemination.
There is no established standard treatment for children with central nervous system (CNS) atypical teratoid/rhabdoid tumor (AT/RT). Given the highly aggressive nature of the tumor, most patients have been treated with intensive multimodal therapy. The young age of the majority of patients does, however, put some limitations on the extent of treatment, particularly radiation. Surgery is necessary to obtain tissue and make the diagnosis of AT/RT. Data from the AT/RT Registry suggest that patients who have had a complete resection may have a longer median survival, although complete surgical resection is often difficult given the invasive nature of the tumor.[1] Chemotherapy has been the main adjuvant therapy for very young children with AT/RT. Cooperative group studies that included children younger than 36 months, demonstrated poor survival when treated with standard chemotherapeutic regimens alone.[2] The Children's Cancer Group reported a 2-year event-free survival (EFS) of 14% for 28 children younger than 36 months treated with multiagent chemotherapy.[3]
Intensive regimens that utilize varying combinations of high-dose chemotherapy,[4][Level of evidence: 3iA]; [5][6][Level of evidence: 3iiiDi] intrathecal chemotherapy, and radiation therapy have led to prolonged survival for some patients. Thirteen patients in the AT/RT Registry were treated with high-dose chemotherapy with hematopoietic stem cell rescue as part of initial therapy.[1] Four of these patients, two of whom also received radiation, were alive without progressive disease 21.5 to 90 months following diagnosis at last report. Radiation therapy appears to have an impact on survival for AT/RT patients. Of the 42 patients in the AT/RT Registry, 13 patients (31%) received radiation therapy in addition to chemotherapy as part of their primary therapy.[1] The radiation field was to the primary tumor bed in nine children, and the tumor bed and the craniospinal axis in four children. Their median survival was 48 months, while the median survival of all patients on the registry was 16.75 months. Supporting the value of radiation therapy was a retrospective series of 31 patients with AT/RT from St. Jude Children's Research Hospital in which the 2-year EFS for patients older than 3 years was 78%, considerably better than 11% for patients younger than 3 years.[7] All but one of the surviving patients (seven of eight) in the older group received craniospinal irradiation and intensive chemotherapy with hematopoietic stem cell transplant; only 3 of 22 of the younger patients received any form of radiation therapy, two of whom are disease free. In a Surveillance, Epidemiology, and End Results registry review, radiation therapy was associated with improved survival in children younger than 3 years.[8]
Another therapeutic approach to treating patients with AT/RT is based on the Third Intergroup Rhabdomyosarcoma (IRS-III) Study. It utilized radiation therapy, intrathecal methotrexate, cytarabine, hydrocortisone, and systemic multiagent chemotherapy. The results of small retrospective series were encouraging,[9][10] leading to the first prospective study of multimodality treatment in this group of patients. Results of the prospective study demonstrated a 2-year progression-free survival of 53% ± 13% and an overall survival of 70% ± 10%, with results most favorable in children who were older, had a gross total resection, and had no metastatic disease at presentation.[11] Prospective cooperative group clinical trials for AT/RT are greatly needed to better understand how age and extent of therapy affect survival.
The following is an example of a national and/or institutional clinical trial that is currently being conducted. Information about ongoing clinical trials is available from the NCI Web site.
Geyer JR, Sposto R, Jennings M, et al.: Multiagent chemotherapy and deferred radiotherapy in infants with malignant brain tumors: a report from the Children's Cancer Group. J Clin Oncol 23 (30): 7621-31, 2005.
Nicolaides T, Tihan T, Horn B, et al.: High-dose chemotherapy and autologous stem cell rescue for atypical teratoid/rhabdoid tumor of the central nervous system. J Neurooncol 98 (1): 117-23, 2010.
Gardner SL, Asgharzadeh S, Green A, et al.: Intensive induction chemotherapy followed by high dose chemotherapy with autologous hematopoietic progenitor cell rescue in young children newly diagnosed with central nervous system atypical teratoid rhabdoid tumors. Pediatr Blood Cancer 51 (2): 235-40, 2008.
Finkelstein-Shechter T, Gassas A, Mabbott D, et al.: Atypical teratoid or rhabdoid tumors: improved outcome with high-dose chemotherapy. J Pediatr Hematol Oncol 32 (5): e182-6, 2010.
Buscariollo DL, Park HS, Roberts KB, et al.: Survival outcomes in atypical teratoid rhabdoid tumor for patients undergoing radiotherapy in a Surveillance, Epidemiology, and End Results analysis. Cancer 118 (17): 4212-9, 2012.
Zimmerman MA, Goumnerova LC, Proctor M, et al.: Continuous remission of newly diagnosed and relapsed central nervous system atypical teratoid/rhabdoid tumor. J Neurooncol 72 (1): 77-84, 2005.
There is no standard treatment for recurrent childhood central nervous system atypical teratoid/rhabdoid tumor. Entry into
studies of novel therapeutic approaches should be considered. Information about ongoing clinical trials is available from the NCI Web site.
Early-phase therapeutic trials may be available for selected patients. These trials may be available via Children's Oncology Group phase I institutions, the Pediatric Brain Tumor Consortium, or other entities.
This information is provided by the National Cancer Institute.
This information was last updated on April 2, 2013.
Many children with cancer receive treatment in the outpatient setting, which allows them to stay in school and continue to develop intellectually and socially. However, returning to school can be an emotional experience; our Back to School Program is designed to ease your child's transition back to the classroom.
Concierge Services is your one-stop place to learn about Dana-Farber programs, services and resources, as well as information on getting around Boston, finding lodging or restaurants, and activities in the area.
The Creative Arts program provides patients, family members and caregivers with a variety of options to support well-being during cancer treatment. From dance and drama to music and writing, the program offers a range of creative outlets to suit every interest.
Dana-Farber and Children's Hospital, including parking facilities, are fully accessible to people with disabilities. There are wheelchairs at the main entrance, and security staff can provide personal assistance. We also have many educational materials available in large print and audiotape formats.
The Ethics Consultation Service is available for patients and families who may be facing difficult decisions and choices regarding care. Our goal is to bring together patients, families and health care providers to talk about ethical concerns and help everyone involved arrive at a resolution that is right for all.
Find practical tips and suggestions for individuals caring for a family member or friend with cancer, including creating a caregiving plan, finding community resources, and looking after your own well-being.
Dana-Farber offers several services to help you and your family manage the financial side of cancer treatment. From creating bill payment schedules and estate planning advice to debt management and resource assistance for patients in need, our team is here for you.
Just for Teens provides programs and activities for teens and young adults with cancer at the Jimmy Fund Clinic and Children's Hospital Boston. We offer activities and events both inside and out of the hospital so that you have creative ways to pass the time and can meet other teens who are going through similar experiences.
The Eleanor and Maxwell Blum Patient and Family Resource Center and its satellite resource rooms are staffed by health care professionals and provide computer stations, books, brochures, videos, and CDs to help you find information and support on a variety of issues about cancer treatment and care.
The Dana-Farber pharmacy fills prescriptions for all pediatric and adult patients. Our pharmacists are an extension of the patient care team and work closely with your physicians to provide seamless, convenient, safe care.
More than 1,200 Dana-Farber patients and their families have enjoyed free trips to baseball games, theater shows, museums, and other attractions this year through the Recreational Resources program.
Through all stages of cancer treatment and survivorship, our Spiritual Care staff is available 24 hours a day to provide emotional and spiritual support for adults and pediatric patients and family members.
Integrative therapies, also known as complementary therapies, range from acupuncture and massage to nutritional guidance and music therapy. Patients treated at the Zakim Center credit its services with easing nausea, improving circulation, and reducing pain, stress, and anxiety associated with cancer treatment.
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Rep. Brian Bilbray is winning praise from the solar industry for casting the sole Republican vote this week against efforts to dismantle the federal loan guarantee program for clean energy linked to the Solyndra debacle.
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SEIA is the solar energy industry's go-to source for the latest coverage on solar power, including U.S. and international policy, research and polls, business and financing trends, and more. Our staff strives to support the media covering solar energy issues and guide our members on effective media outreach with clear statements, background materials, news and multimedia resources.
SEIA is committed to informing policymakers, the media, and the American public about the benefits of solar energy for today's communities, our economy, and our country.
Learn more from our statements and industry news below.
Envision Solar Sees Big Future in Middle East
Envision Solar, which builds high-quality and architecturally stunning solar canopies, is expanding into the Middle East.
Obama Solar Energy Plan Aims to Speed up Permitting Process
The Obama Administration has released a sweeping environmental plan for solar energy projects in California's Mojave Desert and five other western states that aims to expedite the permitting process while protecting sensitive lands and endangered wildlife.
Westerly to Consider Solar Energy Park
Westerly zoning officials are taking up a proposal from a company that wants to build a solar energy park as part of the town's green energy initiative.
With the Utility Regulators, Day 2: Portfolio Theory Makes Wind and Solar More Valuable
Any discussion about U.S. energy today inevitably turns to the new, abundant and cheap natural gas supplies being fracked from shale basins -- and how solar and wind can compete with it. But if you think of wind, solar and other renewable energy as an hedge against natural gas's price volatility, they start to look a bit more competitive.
Jefferson Airport Becomes State's First Fully Solar-powered Airstrip
A solar energy array now working at Jefferson County International Airport makes the small airfield the only airport in the state with operational reliance on solar power.
Contractors Seeing Work from Focus on Energy Savings
As the federal government promotes energy efficiency but faces declining budgets, contractors are expecting a greater focus on contracts that reward them based on the energy savings they provide.
Solar Bill May Get New Life in Alternate Committee
A frustrated state senator is taking his proposal to allow third parties to provide solar power to Georgia homes, businesses and other buildings to another committee on Thursday after he says the bill spent two weeks languishing on purpose.
DuPont Sees The Light In Solar Energy, Rakes In Billions
DuPont, the global chemicals giant, has decided to focus on solar energy as one of the major areas of growth.
Apple to Build Largest Solar Array
The creators of the iPad, iPhone, and iPod are going to be building America's largest end-user-owned, onsite solar array at their North Carolina data center.

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Arenth, Patricia
Ph.D., Ohio State University
Research Interests
My overall research interests are in the areas of rehabilitation and outcome following traumatic brain injury (TBI), including cognitive recovery, as well as adjustment to disability issues. My background in clinical neuropsychology has provided me with an acute awareness of the cognitive deficits frequently associated with TBI, and of the need to study the underlying causes, as well as to explore possible treatments for the disability produced by these types of impairments.
My current research interests focus on the use of neuroimaging techniques to study cognitive impairment associated with TBI. Despite the fact that there are few published functional neuroimaging studies of persons with TBI, these techniques appear to compliment other methods for the characterization of TBI related cognitive impairments. In addition, such studies have suggested significant changes in brain activation patterns when individuals with TBI are engaged in cognitive tasks, as compared with healthy controls. By evaluating such alterations in brain activation, we hope to gain further insights into the causes and possible treatments of observed functional impairments in cognition, such as the memory and executive functioning deficits that are so prevalent within the TBI population.
My interest in exploring possible treatments for cognitive deficits associated with TBI extends into the area of neuropharmacology: Certain pharmacological agents have been shown to improve cognitive recovery following TBI however, there has not been sufficient scientific validation of such agents for physicians to be confident in their choices for treatment. Functional neuroimaging techniques have the potential to objectively document functional change secondary to pharmacological intervention. By using neuroimaging to observe the effects of pharmacological agents on cerebral activation, we have the opportunity to gain a greater understanding of how these medications are efficacious, leading to the development of improved medical interventions.
In the past few years, I have been working closely with Dr. Joseph Ricker in his studies of alterations in cerebral blood flow and memory issues following TBI. We have employed functional neuroimaging techniques including Functional Magnetic Resonance Imaging (FMRI) and Functional Near-Infrared Spectroscopy (FNIRS)in these studies. I am currently initiating a project to study working memory issues following traumatic brain injury. We will study the effects of a neuropharmacological agent on working memory functioning through the use of baseline and follow-up neuropsychological testing and neuroimaging (fMRI).
Recent Publications


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VIP band room at the show in moncton.
the house insisted on using a smoke machine which made it hard to live, among other things.
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Posts Tagged 'The Bagel Project'
Urban Decay
The folks at Urban Decay did a write up on my series the bagel project. Click here to check out the whole project.
The Bagel Project- San Francisco
This past Friday I had a meeting with Ford Models in San Francisco and after I decided to meet up with my friend Lisa and do some Bagel Project photos. The first place we went was Dolores Park in the Mission.
The first individual we talked to went by Dromo. He was from Los Angeles and decided to move up to San Francisco because he said the people were nicer. His biggest passion was music and he said his most valuable possession was his mandolin. He had clearly done drugs in the past because his memory and thoughts weren't completely there but he was without a doubt one of the warmest and most caring people I had talked to. He was very interested in my life and was more into asking me questions than answering questions I asked him.
After talking to Dromo we left Dolores Park and walked towards Mission Street. Outside of a bookstore we came across a man with a headband, just sitting and enjoying the day. He introduced himself as Birdman. He was fairly quiet but I could tell he was extremely intelligent. After I asked him a few questions, he gave me and Lisa each a piece of paper with his thoughts. I will try to scan it and put it on my blog soon.
The final individual we talked to was schizophrenic so it was really hard to understand his thoughts. Here's a picture of him.
The Bagel Project
This past week, I left Los Angeles for the summer and came home (Silicon Valley) to work at a start-up company for the summer. I haven't done The Bagel Project in a while so I decided that since I'm in a new city, I should give it a shot.
I decided the best place to go would be Downtown San Jose since it's the closest urban city to where I live. I called up my friend Courtney to assist, we went and picked up a dozen bagels, and made our way to Downtown San Jose.
The first stop we made was St. James park. As we pulled up, it was very clear that this was going to be our best bet for meeting homeless people in the area; there were dozens of them, laying out on the grass, trying to stay warm on a chilly overcast morning.
We scoped out the area and found an African American man sitting under a tree alone so we decided to approach him. He introduced himself as Kenniker, a 52 year old, originally from Oakland California. Enthusiastic and easily relatable, Kenniker had no problem opening up and telling us about his life. One of the first things he told us was that he was bi-sexual, though he preferred males. He had multiple partners in the past and lost his husband Gary due to AIDS; Kenniker also told us he has been positive with HIV for 22 years. Due to his condition, he chose to become homeless 2 years ago because it put him at the top of the list for the HIV meds and he was also given them for free. He then said that he also wanted to leave the place he was living because of the rampant drug problems and prostitutes in the complex he was living. Kenniker said that he had a meth problem for 20 years and a drinking problem, but now he attends AA and has been sober since December of last year. One comment that Kenniker said that really stuck out to me was that he said he didn't feel like he had to go out of California to travel the world, the world comes here to California. When I asked him what his most prized possession was, he said it was his integrity. It's always interesting to see if people respond to that question with a material possession or not, I think it really reveals a lot about a person.
Carmella, the next lady we talked to, wasn't nearly as social. We approached her while she was sitting on the sidewalk, sipping on orange soda. She told us she was from East Palo Alto and her favorite thing was her son. She said that living on the street and being homeless can be scary due to the fights that occur. When I asked if I could take her picture, she was initially hesitant because she said she was embarrassed that her hair looked so bad since bugs were eating away at it; that comment really caught my attention and made me realize the safety hazards of not having basic shelter and access to showers.
The next individual we talked to was Mike, also known as Rambo. He said he's traveled all over, spending the majority of his time in Arizona, LA, and San Jose. He had a hard time hearing us because he was partially deaf, though he didn't let his disability inhibit communication. It was sad to realize how many of these homeless I've talked to have disabilities or emotional problems.
Next we talked to Don. He was extremely hard to understand due to how drugged out he was. He was one of the only homeless people I have met and talked to who was blatantly on drugs, making it pretty much impossible for us to communicate. When I asked him what his favorite thing was, he said himself.
Overall it was a great day!
The Bagel Project- Venice Beach
For the full photo series, go to my website.
Recently the weather has been pretty rainy which has put a damper on the shoots I've planned. The weather finally cleared up yesterday and I decided I wanted to do another chapter of The Bagel Project. This time I wanted to venture outside of downtown Los Angeles so I went to Venice Beach. My assistant for the day was my friend Devon Feldmeth who did a phenomenal job!
We got to Venice Beach, unloaded all the gear, and we started towards the main strip when we came across a man peacefully reading on the grass. His name was Elliot; he explained that he moved here after Hurricane Katrina washed away his place in New Orleans. He disclosed that his only love was his guitar and that it was all he needed to make him happy. Elliot explained that he watched youtube videos in the library to learn how to play the guitar. He claimed to know Justin Bieber personally which I found pretty funny. Elliot said he didn't want his picture taken so we decided to make our way to the main strip and look for some other interesting individuals.
Jan (The Queen of Venice)
After walking for a few minutes, we saw a cheerful lady posted on a bench with her belongings stowed safely by her side. She introduced herself in a raspy voice as Jan or The Queen of Venice. Jan explained that she was almost finished studying psychology in college when she was diagnosed with Hepatitis C. When the doctors revealed that she didn't have much time to live, she becamedepressed and could not finish school. Jan decided to leave South Illinois to come to California to say goodbye to her sister before she passed. Upon her arrival, Jan was surprised to find that her sister wasn't in the best situation, but was too embarrassed to tell Jan before having her come out to California to visit. Within a short time, Jan said that her sister ran into issues of her own and Jan found herself to behomeless on the streets of Hollywood. For reasons she didn't wish to disclose, Hollywood didn't work out for her and she decided to venture to Santa Monica.
Once she made her way to Santa Monica, she found herself in an environment that was not very "homeless friendly". Determiningthat Venice would be a better fit for her, she ventured down the beach. After being homeless for a while, she painfully revealed that she was kidnapped and underwent the most traumatic 4 days of her life. Following this harrowing event, Jan said that a woman took her in for a month to let her figure everything out and that literally saved her life.
Eventually Jan said that she got a better grip on things. She met with a guy who said that he was trying to start an organization to help the homeless. Eager to have her story heard, Jan started working with him and writing stories at the library explaining what she hadendured as a homeless person. After a few months she spoke at the Venice Council and was proud to say she's been an activist. Unfortunately she said that she felt like she was taken advantage of by this guy. She concluded he was just doing charitable work for the organization to impress his girlfriends. She said that after months with no communication from him, he would suddenly wake her up while she was sleeping to have Jan explain to his girlfriends how he saved her life. Jan went on to express her frustration, contending that he was just putting on act and didn't really care about the homeless cause.
Now Jan said she considers herself to the mother of many in Venice. She said that she tries to be the Mom for these younger individuals in Venice Beach who may lack direction. It was amazing to see that someone who had been through so much remained so positive and happy. I was amazed that she was 54 years old; she sure didn't look it, especially after being homeless for 3 years.
When we explained what The Bagel Project was, she then said that her friend Shane would have an interesting story to tell so we went and talked to him. Shane immediately caught our attention. The first story Shane shared was how he jumped in front of a man's knifeto take the blade for a lady and thought he was going to die within 3 minutes. He said then he tried stabbing the guy back to show him that he was not dead yet. He said he was eventually able to get away from the guy and kept praying, repeating a mantra, "If I see the sunrise I'll be ok… If I see the sunrise I'll be ok." As the sun came up, covered in ants and blood, he walked 2 miles down a steep road and was able to hitchhike 38 miles to the closest hospital.
After explaining his near death story, he went on to tell us was born in Utah and moved to Tuscon when he was 13, raised as a Jehovah's Witness. He said he graduated high school early at the top of his class and moved out of the house when he was 18 because he was being abused, raped, and beaten at home. Shane said that he no longer considers himself to be a Jehovah's Witness, but he still claimed to be a Witness of God.
He proclaimed that he could read 6 languages and was completely self taught. Realizing that we were in disbelief, he went on to speak Hebrew and to demonstrate to us that he really knew all these languages that he claimed to have taught himself. Shane said that the best thing his dad ever did was throw books at him, at the age of 5; he read the dictionary all the way through multiple times until he was 9. From ages 9-12, he said he studied every page of the Britannica Encyclopedia and illustrated to us a sample of the knowledge he had absorbed. Shane believes that E.E. Cummings is one of the world's most influential poets and that he greatly inspired him.
When I asked him to reveal his most cherished possession, he said it was his insight. This is always an interesting question to ask homeless people since they don't often have too many material possessions. I asked him what what his biggest dream was, he replied it was to be a father. He told me that he had a son that he hasn't seen since the son was 4 and has no idea what he's up to now. It was amazing to hear how many of the homeless people's aspirations are similar to those in the upper class society that I'm typically surrounded by.
After talking to Shane, I couldn't help but think about how brilliant and intelligent he was. It really made me wonder what he could have accomplished in his life if he had not suffered through such a difficult experience as a youth. It made me feel so fortunate to have such a positive upbringing and recognize the importance of my own nurturing childhood experience.
The next individual that we spoke to was Darren, a warm and charming man in his wheel chair. Darren immediately started talking about his rough upbringing; he said that in a matter of 4 years, he was in 8 foster homes. In 7 of his 8 foster homes, he was either physically, mentally, or psychologically abused; he went on to say he has so thankful that he was still able to turn out as well as he did. Darren was finally adopted when he was 6 years old and still lives with his Mom that adopted him. When Darren was 11, he said his dad had his first heart attack and ended up living until 1997 when he passed away from Parkinson's disease.
Darren later told us how he was in a coma for 27 days from an auto accident that occurred when his friend was driving and hit a pole. He explained that he had to learn how to do everything again; walk, eat, and even talk normally. It was clear when talking to Darren that he had suffered the trauma from some sort of brain injury, though considering the circumstances he was still very well spoken. It was incredible to see how positive and warm Darren was considering the terrible childhood he had experienced.
The last person we talked to for the day was Puck. Perched up on top of a grassy hill, Puck had the best set-up I'd ever seen: he had a solar panel that was running his plasma tv and stereo. Puck said that he moved out to California after Hurricane Katrina. Back in New Orleans, he said he was a chef at a restaurant, but due to his leg problems he could no longer work. He said that the next task on his to do list was to meet with a social security judge about getting financial assistance to pay for surgery for his leg. He also told me how he really wants to be married and have a wife. It seemed like a unifying desire of many of these homeless individuals was to eventually have a spouse and kids someday.
Doing The Bagel Project at Venice Beach was definitely an enlightening experience. I felt that the people I talked to were much happier and comfortable with the situations that they were in; I felt a strong sense of community amongst all the homeless people.
Clarence – The Bagel Project
After feeling so consumed with midterm studying and lack of time for photography, I decided it was time to do another chapter of The Bagel Project. Most of my friends have been pretty busy studying for finals, but fortunately my good buddy Aneesh Chaganty was free and happy to assist. We made our way to the bagel store, picked up the a dozen bagels, and went on our way. We parked at Wilshire and Grand and began the day.
We encountered our first individual, Clarence. I usually have a pretty keen sense of intuition, predictingwho will be interested in sharing their personal story versus who will likely be reluctant. Initially I thought he would be the latter, but I decided to give it a shot. When I first approached him, he was muttering and talking to himself. I asked if he had a second of his time to talk to us and he nodded. I sat down and introduced myself and Aneesh. As Clarence became more comfortable with us, he explained that he moved out from Maryland about five years ago searching for work and that he was a jack of all trades. After explaining his past, he expressed an interest in learning about mine: where I was from, what I was studying, and my plans for the future. Once I told him more about my past, he started to open up even more and told me he had done things he wasn't proud of; he'd been in fights with Hell's Angels, Black Panthers, and had even killed some people. He then went on to tell me that he had been run over by a car one night after getting knocked in the head; noticing that we were a bit confused, he explained that he had killed the man's brother. Once he finished telling his story, he grinned and told us he could still walk. After he finished, I offered him a bagel like usual. At first he seemed hesitant to take it, but I insisted. It's interesting that some of these people don't really even want a bagel, they really just want the opportunity to tell their story to someone who will listen.
The Bagel Project
This weekend I decided to start a personal series project since I've been focusing on commissioned work so much lately. I had done a series a while back in San Francisco of some homeless people and I wanted to do something again pertaining to homeless people but this time in Los Angeles. Also, I wanted to get people's stories instead of photographing them so quickly. I read Joey L's blog on a street series he did and realized that strobes are legal if you don't have them touching the ground so I decided to have some assistants help me out. Big thank you to Emily Ibarra, Anthony Pham, and Danny Erb.
Since the homeless people were giving something to me (their stories, expressions, and time) I wanted to give them something in return. I thought for a while about what would be good to give them and originally I was going to give them cup and noodles since they were inexpensive for me and would keep them warm. Unfortunately carrying around hot water in addition to cup and noodles would be difficult and they aren't that healthy. After giving it more thought, I figured bagels would be perfect; they are inexpensive, lightweight, and pretty much everyone likes them. So I went to a local donut shop and bought a dozen bagels.
On Friday I went out with my friend Emily to downtown LA but unfortunately the weather was pretty drizzly so we decided to walk around, scout locations, and see where most the homeless people were congregated. Last year I went to Skid Row for photos but I decided to seek out homeless people in new locations this time.
After having the knowledge of where some of the homeless people were in downtown, I went out on Saturday with my friend Anthony Pham. We used an octobox with an AB 800 and a vagabond II to power everything.
Roosevelt was my first subject of the day on Saturday. After talking to a few other homeless people who weren't interested in being photographed (I got rejected quite often), I asked Roosevelt if he would mind giving us a minute of his time to talk. Roosevelt moved out to Los Angeles from St. Louis about 35 years ago. He was wearing patriotic clothing and was in a wheelchair; I found it ironic that someone named Roosevelt, and a patriotic guy, was homeless. One of the first questions I asked individuals is if they have kids and Roosevelt told me he was a grandfather. It's always fascinating to me to understand how someone would let their parents end up in such a situation. Overall Roosevelt was warm, appreciative, and just a genuine man.
Pierre was sitting under an overhang by himself just looking out and watching the traffic when we approached him. He was pretty quiet and definitely had a gentle vibe. He said he had been homeless for about 4 years but besides that was pretty quiet and reserved.
Unknown Subject #1:
I tried talking to him but I'm pretty sure he couldn't speak English. I always try to get verbal consent from my subjects before photographing them but he was extremely confused, however when I gave him the bagel and motioned my camera he gave me a nod. This photo stood out to me because it seemed as though his two most prized possessions at the moment are his bagel and cigarette, two goods that many individuals wouldn't usually value.
Unknown Subject #2
This was the most upsetting individual to photograph by far. As we were winding up on Saturday, we saw across him across the street yelling uncontrollably in jiberish. We weren't sure if he was mad about something or just yelling for the sake of it. I'm pretty sure I saw him a while ago when I was doing a shoot in downtown for The Cataracs. Since he was yelling jiberish uncontrollably it was hard to have a conversation but I signalled giving him the bagel for some photos and he graciously accepted the offer. When I went back to shoot on Monday, I saw him walking with a box of coins and he wasn't yelling so I wonder what was going through his mind before. I gave him another bagel when I saw him again and I'm pretty sure he remembered me.
Daryl was the second subject I photographed on Sunday. When Danny and I approached him, I could immediately tell he was happy to talk and have someone to talk to. He was originally conversing with Leroy (below) but when we came over he gave us his full attention. Daryl said he moved out here from Indiana 2 years ago. This was hard for me to fathom seeing that he appeared to be just about my age; I could never imagine being homeless so young. I could definitely tell that he still had youth in him and full of emotion. I later realized that he came out to LA with his grandpa which I'll explain later.
As I mentioned earlier, Leeroy and Daryl were having a conversation when we first approached them. I could tell immediately that Leeory was going to be a character, given the charisma and charm he exerted. Leeroy had moved around from various areas but is originally from Syracuse, New York. He said that he has grand children and talks with his family a couple times a month, though he doesn't want to tell his kids how to raise their kids. I found it so fascinating how many of these homeless people seemed happier than many of my friends and people I communicate with. It really illustrated that material wealth doesn't correlate to happiness. Leeroy said that he's been homeless and in the area for so long that most of the people around the area respect and know him.
After talking with Leroy and Daryl, we saw another man sitting on the bench a few feet down who was looking at us and seemed fairly interested so we decided to approach him. He turned out to be Daryl's grandpa, he said he hitch hiked out here from Nashville a few years ago and Daryl offered to come with him. Prior to moving out here, Gramps was a chef and due to a heart attack, he was unable to keep that profession and decided to retire. He had some very interesting stories and much like Leeroy, he is well respected and people know not to mess with him. He was telling me how he doesn't mind the situation he's in and really enjoys reading; he said that he has a library card and goes there frequently. When I asked him about any run-ins with police offers, he said that since he's been out here, he's only been talked to by police twice and that was because he slept in later than he was supposed to. I asked him about how safe he felt and he said that since people respected him, he never has really felt uncomfortable. He said he's been saving up and in March he'll be going to Vegas to see some of his old friends and catch up with them.
Out of everyone we talked to, Mike was undoubtedly the most social. He had no problem talking and talking and talking, which was a change from most of the people we encountered. Mike said he moved to LA from Pomona about 30 years ago. Throughout our conversation, he frequently referred back to religion and God. When I asked him how he felt about being homeless, I found it fascinating that he said that he's living a great life since God's watching over him. Later in our conversation it came out that Mike was a photographer which I found very interesting, he definitely knew a thing or two about photography. He shared with me how last year someone promised to give him a camera for Christmas and sure enough, they gave it to him. He then went on to tell me that it got stolen by another homeless person a few months later, and he remembered the exact date which was remarkable. It really shows how losing an item like a camera can be so disappointing and upsetting to someone who doesn't have much. Mike said he has a place to move into all lined up so it was exciting to hear that some of the people would be moving out of this lifestyle.
Frank was the last subject we talked to of the day. He was extremely quiet and I think he may have been mentally handicapped. He was gentle and quite grateful for the bagel. Other than telling us he was native to Los Angeles, we didn't really get much of a story out of him.
All in all this has been one of the most amazing and fulfilling projects I have undertaken. I felt so much more connected with Los Angeles and homeless people in general and it was both amazing and painful to hear their stories. It made me realize that homeless people and if you give them the time to tell their story, they have some deep knowledge and insite. I think I'm going to continue this project, if anyone wants to join me feel free to let me know!


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Source: Journal of Forestry, Volume 38, Number 4, 1 April 1940, pp. 370-374(5)
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(Updates with RBS comment in the third paragraph.)
Oct. 20 (Bloomberg) -- Royal Bank of Scotland Group Plc. will cut about 30 jobs in Brazil as the lender abandons plans to start an investment bank in the South American country, said two people familiar with the matter.
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Brazil's National Monetary Council in June approved RBS's application to open an investment bank. The unit would have begun operations with 140 million reais ($78 million) of capital, Adalberto Gomes da Rocha, head of the central bank's department of financial system organization, said at the time.
--Editors: Peter Eichenbaum, Steve Dickson
To contact the reporters on this story: Cristiane Lucchesi in Sao Paulo at email@example.com; Francisco Marcelino in Sao Paulo at firstname.lastname@example.com
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Acadia Mountain Guides Climbing School
PO Box 121 92 Main Street Orono, ME US 04473
Open year round. In the winter we offer ice climbing instruction and guiding along with other mountaineering activities.
1-207-866-7562, 1-888-232-9559
Payments Accepted:
MC/VISA, Discover, Amex, Cash, Check
Share our passion for climbing!
"My daughter and I went rock climbing for the first time! We couldn't have asked for a more customized experience. AMG is the best!" Private half and full day courses are available for all ages and abilities. Great family activity. Equipment provided. AMG has been at the forefront of guide education in the US for two decades and stands out as the first local school to achieve and the only school to remain continuously accredited by the American Mountain Guides Association. Also accredited by the Professional Climbing Instructor's Association. All staff certified for the terrain they will take you on. Owner Jon Tierney is one of 80 US guides to achieve the internationally coveted IFMGA/UIAGM mountain guide award. Clients also receive a 15% lifetime discount on outdoor gear through AlpenglowGear.com. Reach your peak with AMG!
Maine Locations:
- Acadia
- Camden
- Clifton
- Katahdin
- West Branch of Penobscot River - Millinocket
- Kennebec River - The Forks
- Greenville area
A perfect vacation activity for families, individuals or couples. A great group activity for school, church, scout and camp groups. Available daily. Register today.
Surfing in Maine
Maine is well-known as a user-friendly surfing destination, with many miles of easily accessible sandy beaches. From Long Sands Beach in York, to...
From 10,000 feet in the skies over Maine you can see all the way from the Atlantic Ocean to the forests surrounding the mile-high granite monolith...
Rock Climbing
Imagine the exhilaration of climbing a granite wall with the thundering waves of the Atlantic Ocean breaking against the rocks below. Whether...
Hot Air Ballooning
Riding in a hot air balloon is a slow and gentle form of flight that affords you a 360-degree view of the landscape below. You'll fly over...
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Overcome Oxidative Stress
Scientific research conducted over a long period, has shown that damage to your bodys cells by free radicalsalso known as oxidative stress- is the root cause of aging at the cellular level. In fact, studies show that the metabolic wear and tear resulting from the accumulation of free radicals in cells accelerates aging and the problems associated with aging. In this way, oxidative stress has been shown to contribute to the development of more than 100 age related health conditions.
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Looked good in the catalog and the video. Different story out of the box. If it wasn't so bulky and difficult to send back, I would have
CASTLECREEK® 12' Paradise Gazebo
Item # WX2-234572
- Google+
- Details & Specs
CASTLECREEK® Paradise Gazebo. Fit for royalty! Portable palace of shade-filled comfort, PRICED LESS!
Paradise found! Free and easy summer living is here with this spacious open-air Shelter for family gatherings in the backyard, at a park or next to a body of water. Ideal, too, for tailgating at the big game or for selling goods at the flea market. This jumbo 12' diagonal Gazebo is also 12'h. Sets up in just minutes to provide instant shade... no more skin-scorched lobster-red sunburns. The double roof canopy also offers protection from a passing shower. Plus, a special buy means a HUGE amount OFF! Royal comfort, while leaving plenty of cash in your treasury!Take a look:
- Steel and aluminum accordion-design system easily unfolds for simple 1-person setup
- Awning-style shadow valance and inside valance for style
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- Mesh-covered central roof cupola for ventilation and style
- Storage bag included.
- Weighs approx. 48 lbs.
Place your order ONLINE now for shade-to-go-bliss!
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Customer Reviews
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CASTLECREEK® 13' Hexagon Garden Gazebo with NettingBuyer's Club $269.99 Non-Members $299.99


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Eat you all!!!This photo was shot on film. Taken by lemonjuice with a Minolta XG-A loaded with Kodak Color Plus 200 (35mm) film in constanta, Romania. These tags describe this photo: dog, funny, scream, teeth, and room. This photo can also be found in the album Some love!!!.
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he was on the floor laughing at my joke :)) !!!
great shot :)


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Unofficial best of Green Day's album trilogy
With the three albums receiving a wide range of reviews, Under the Gun has put together a informal "best of" compilation of music from Green Day's ¡Uno! , ¡Dos! and ¡Tré!. The 12-song Spotify playlist purports to be the best representation of the band's new material and was put together by the UTG staff.
via Punknews.org (http://pnkn.ws/12lxQzJ)
- buzzingphones likes this
- punknews posted this


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Vancouver, BCCanada V6Z 1V3
March 26, 2012
2-3 years as a member
n / a
n / a
love to draw
Hi, Anne, Welcome to Permaculture Gardening! It is said that plants always make people better, happier, and more helpful; they are sunshine, food and medicine for the soul. Do you agree? I look forward to seeing you on a Saturday and celebrating our love for nature, the soil and the earth by planting together. Quille
Hi Anne, great site. the tutorial is great. Cheers Enej
No worries! It was a spur of the moment meetup and not quite "urban sketching". But it was fun.
Hi Anne, want to meet at Dr. Sketchy's then? I plan to be there around 6:15 and can save you and Dave a seat. I usually end up somewhere on the far left side, but who knows.
Hi Anne, welcome, and I look forward to sketching together!
Welcome to Just Write Vancouver. Glad to have you part of our group. If you haven't already, remember to "Like" us on Facebook at: https://www.facebook.com/JustWriteVanc...
Thanks, Anne-appreciate the welcome and looking forward to learning Linux & helping where I can!!
Welcome, Anne!
Welcome to the group! I hope you'll join us for Newcomers Night, coming soon! http://www.meetup.com/ubuntuvancouver...
Hi Anne and welcome aboard. Please make sure you go to www.vanlug.bc.ca and get yourself signed up to our mailing list ([masked]) where we deal with all manner of tech issues. Our next tech meeting is the last Wednesday of this month, so please come and participate and take out a $10 membership in our society. And thanks for joining!
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Took this last weekend to our tailgate party. Everyone raved about it - even my husband, who is not known for eating anything out of the ordinary, loved it!
Sweet Potato Crostini with Goat Cheese and Grape Salsa
sarashaw Posted: 11/14/12
crimsongigi Posted: 11/05/12
These were so unusual so I had to try them. I prefer feta cheese to goat cheese so I subsituted. Great new appeitzer to use - everyone loved it at the party. I used the Alexia frozen sweet potato waffle fries (Winn Dixie).
Daily Specials


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Casa perto da Lagoa
Villa | 3 bedrooms | sleeps 6
|Key Info
Within just 500 metres from the Obidos Lagoon, our modern and spacious villa is a dream house for families and couples alike.
It's ideal for people who are looking for luxury living in a quiet and relaxing environment or those wishing to take advantage of all the outdoor activities including the use of our bicycles(2 adults' and 2 children's), 3 body boards and fishing rods.
Fantastic newly built luxurious Royal Obidos Spa and Golf Resort representing an investment of 200 million Euros, designed by Severiano Ballesteros, includes a touristic and residential complex, as well as an 18 hole golf course and is just in a very short distance from the house.
You are also close to World Class Golf Courses - Praia del Rey(6 min drive), Bom Sucesso(5min), Royal Obidos(5min).
You can explore the walks and cycle path around the Obidos Lagoon just two minutes away from the villa.
You can enjoy fantastic scenic beaches and spectacular seascapes of the Silver Coast . Just in a few minutes drive you will find a quiet beautiful sandy cove and a cosy beach, where you can relax unwind whilst watching rolling waves and a magnificent sunset over the Atlantic.
There are also lots of water activities from kayaking, sailing - to extreme kite and wind surfing on the Lagoon. For those interested in horse riding at every level there are some well established riding schools. Local vineyards offer wine tasting (wine is surprisingly good and afordable) within the area.
Few nice fish restaurants within minutes drive, offer panoramic views over Atlantic Ocean.
You can pamper yourself in Atlantic Coast Health Club and SPA at Marriot Hotel just within 10min drive.
You can find a number of experiences and options whether you stay with your partner, friends or family.
Discover the real Portugal in one of Europe's most serene and natural coastlines.
|Sleeps up to 6, 3 bedrooms
|Nearest beach
|Bom Sucesso beach 1 km
|Will consider
|Corporate bookings, Long term lets (over 1 month), Short breaks (1-4 days)
|Car essential
|Nearest Amenities
|1 km
|Nearest travel links
|Nearest airport: Lisbon 75 km, Nearest railway: Caldas da Rainha 15 km
|Family friendly
|Great for children of all ages, Suitable for people with restricted mobility
|No pets allowed, No smoking at this property
Features and Facilities
|DVD player
|TV, CD player, Wi-Fi available
|Kettle, Toaster, Iron, Hair dryer
|Clothes dryer, Cooker, Microwave, Fridge, Freezer, Washing machine
|3 bedrooms, 3 bathrooms of which 1 Family bathrooms and 2 En suites
|Single beds (4), Double beds (1), Cots (1), Dining seats for 6, Lounge seats for 4
|Linen provided, Towels provided
|Balcony or terrace, Private garden, BBQ, Bicycles available
|Further details indoors
Casa perto da Lagoa offers an open plan living area with 3 bedrooms and 3 bathrooms, fully equipped modern kitchen, 3 balconies and a terrace and a large garden which faces away from the estate and therefore not overlooked with private swimming pool.
Living room - spacious open plan lounge and dining area with large sliding doors opening to the surrounding garden, terrace and pool area. Contemporary style furniture contains 2seater and 3 seater sofas, coffee table, big dining table with 6 chairs, flat 37"TV screen, DVD player, Radio/CD/ MP 3 Player.
Kitchen - modern fully fitted and equipped with plenty of crockery, glasses and kitchen utensils.
Master bedroom - large room with double comfortable bed. Sliding doors on two walls lead onto the balcony with the views on the pine forest and Lagoon. Lots of wardrobe space.En suite bathroom contains bath and separate shower.
First floor bedroom is a large room with 2 single beds and sliding doors leading onto the balcony overlooking the garden and the pool. En suite bathroom with a shower.
Ground floor bedroom - 2 single beds, lots of wardrobe space, sliding doors leading onto the garden and patio area. The adjacent bathroom with shower.
|Further details outdoors
Neat turfed loans surround the villa, the barbecue area and swimming pool (4 x 6 meters) are not overlooked. There are two parking spaces near the house.
2 adults' and 2 children's bicycles are there for your enjoyment.
|Further details
WiFi is available
Suitable for children, High Chair and Cot available on demand
No smoking at this property
Welcome pack is available
No pets allowed
The Costa de Prata/Silver Coast/Central Portugal region
Less than one hour drive from Lisbon,
just a short driving distance (20 min) from a fishing village of Peniche, famous for it's fish restaurants, beaches, shops and watersports and Baleal (nice beaches with miles of sand, ideal for serfing). The area attracts suffers from all around the world. There are numerous of cosy surf bars along the coastal area serving fantastic local food.
About 10 min. drive to the historic town of Obidos (recently voted as one of the seven wonders of Portugal) with its variety of lovely restaurants, bars and shops, narrow cobblestone streets and white washed houses, churches and magnificent Moorish castle.
Caldas da Rainha- the thermal city (20 min.)-market every Saturday morning.
Sintra- beautiful World Heritage Centre ( worth a day trip).
Gorgeous shell shaped bay of Sao Martinho do Porto( 35 min.)- nice little town with promanade and number of fish restaurants. Rural village of Foz do Arelho with its fantastic beaches and sailing school ( just across the Obidos lagoon).
Berlenga Islands (about 35 min. by boat from Peniche) - they are under the scope of Natural Heritage of Portugal and are famous Bird Sanctuary and nature reserves .
Obidos Lagoon (5 min. walk)- the largest sea-water lagoon in Portugal, great for quiet walks, cycle tracks, fishing, swimming, water sports, including sailing, water skiing and wind surfing, horse riding. There are fantastic deserted beaches within 5 min. drive on the Atlantic Coast, the area is surrounded with pine forests and rural countryside.
There are several local vineyards nearby to visit which offer wine tasting (wine is good quality and value). Small local villages around will surprise you with the best Portuguese gastronomy with its superb value for money.
Three of the major golf courses in central Portugal are very close ( 5 min by car) and easily accessible - Bom Sucesso, Praia del Rey and a new Royal Obidos Golf Course and Spa Resort.
Obidos is the pride of the region, a fantastically preserved medieval Portuguese town. The whole town, which has been classified as a National Monument and a Heritage site, was traditionally the gift of the Kings of Portugal to their Queens.
Obidos is is a cultural centre of the Silver Coast and an all year round destination for tourists with it's famous festivals such as Medieval Festival, Chocolate Festival, Easter Celebrations, Opera and other cultural events.
Availability Your dates are available
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29 May 2014
"A Perfect Location for A Quiet Break"
I booked this long weekend break based on reviews I read on trip adviser and the reviews were right , this villa is in a quiet location near an area of outstanding beauty , The villa had everything yo… More
8 Nov 2012
SPA at your door step.
It was a fantastic holiday!
We liked everything a lot - wonderful house, very comfortable and great layout. Very good location- we walked to the Lagoon every day - it was so close, sometimes cycled. Some of us enjoyed swimming in the Lagoon, it was still so warm in October.
We planned our holiday in advance and travelled a lot to the nearest towns- Obidos, Alcobaca, Nazare with plenty of fish restaurants.
We visited Lisbon twice and spent a day in Sintra -it was beautiful. It wouldn't be possible without a car.
The motorway was not far to access what made our journeys fast and easy.
Local manager helped us a great deal with directions to the shops and other points of our interest.
We dined at local restaurants and were very pleased with the service and their authentic cuisine.
We found it easy to cook at home as well as it was fully equipped with everything we needed and the local supermarket offered a great choice of produce.
Non of us was fishing enthusiast, but we spotted fishing rods in the storage and the Lagoon was teeming with fish- it could be seen from the shore. It must be a heaven for fishermen.
We enjoyed very much amazingly delicious air from surrounding pine trees and eucalyptus combined with proximity of the Ocean! We've never encountered anything like this before. It's like having a permanent SPA at your door step. We slept very well indeed.
We had a great time, active going to places and relaxing back at the villa.
Many thanks to the owners for making the usual nightmare of booking the villa so easy.
We will definitely recommend the place and the villa to our friends and can consider to visit it in few years again.
28 Oct 2012
"A very chill-axed experience!"
We arrived late on a Saturday night and were delighted with our welcome pack to get us started. The house was exactly as described and it was absolutely spotless. The open living space works well and all the family can be together, yet doing their own thing. It is a rural location, up in the pine forest, yet you are 5 mins walk to the lagoon and 5 mins drive to the Atlantic ocean.
Our 3 young teenagers, never once said they were bored. Between the pool, the large T.V. with satellite stations and american comedy programmes,the DVD player and the bikes provided, they enjoyed themselves. Having their own bathrooms off the bedrooms was a big plus for them too.
The pool was cleaned twice during our 2 week stay and prior to our arrival. One evening, we realised there was a problem with the gas supply and were able to contact the property maintenance management easily, who knew what was happening and were able to get the problem sorted promptly.
The weather was blissful, hot but with a balmy breeze so you didn't perspire - I think this is the climate of Portugal for mid-July anyway. It was our first time in Portugal and the climate definitely suited us all.
There is a great supermarket in Obidos, 15 mins away, called Pingo Doce. We also picked up fresh bread down at one of the cafes on Bom Successo beach - great reason to get out for the early morning walk along the magnificent Lagoon Walkway.
Obidos is a jewel, set on a hilltop,and well worth walking down all of its streets. We loved the beach at Bom Successo, which is vast and we had no problem setting up camp. Water is shallow in places and great for small kids who want to paddle. There are also lifeguards on site.
As a family, we ate in both restaurants down at the beach and found them very good - lots of fish dishes, but you can also get steak and pasta. The kitchen is the house is well kitted out and encourages cooking at home. We were very relaxed on this holiday and happy to hang out at the house for the majority of our stay - thats the kind of place it is!!
24 Feb 2011
"Very nice place to stay"
We rented Jana's vacation house in Portugal for a week in March 2010. We really liked the quite of the area and the fact its located away from all types of commotion. Great place to relax, but cl… More
22 Feb 2011
"absolutely loved it!"
Have just returned from spending 2 weeks in the villa -four adults and two children (6 and 3), and they loved the sky TV! The villa was spotless, and extremely comfortable, bright and airy, and had ev… More
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Barry, Jana S.
- 4 Years listed
85% Response rate
Calendar last updated:27 Aug 2014
Based in United Kingdom
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Phoenix mom pleads not guilty to smothering baby
PHOENIX -- A 36-year-old Phoenix woman has pleaded not guilty to a first-degree murder charge accusing her of fatally smothering her newborn daughter.
Nina Koistinen was arraigned Monday in Maricopa County Superior Court.
She was arrested in late April after an autopsy found signs of suffocation in the April 8 death of the infant, who was named Maya.
Authorities initially were called to a home on a report of a baby who had stopped breathing.
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Surf Secrets Behind The New Blue Crush 2 Movie
Written on June 6, 2011 at 9:48 am , by Karla Walsh
Tomorrow, the follow-up to the popular surfing movie Blue Crush hits stores on DVD! We were lucky enough to get a sneak peek (which made us dream to have those surf skills) and meet with the film's stars (who seem to be great pals in real life). We asked the ladies for their best surf tips for beginners, and to top it off, we had them team up to create a killer beach playlist!
Blue Crush 2 Starter Surfing Hints
- "Be safe and have fun! Know your boundaries when it comes to the ocean, but don't be scared to get out there and give it a go!" —Sharni Vinson, also seen in Step Up 3D (Tara in the film)
- "At first you're going to fall a lot. But keep getting back up! And always wear your leash—never get into the water without it attached. Have fun and watch your body transform. It's such a great workout!" —Elizabeth Mathis, also seen in Unstoppable (Pushy)
- "Relax! Even if you don't stand up on your first try, you can still enjoy being in the ocean. A lot of surfing has to do with muscle memory, so if you are relaxed and keeping in mind how you are feeling on the board you will learn a lot faster." —Rosy Hodge, ROXY pro surfer from South Africa (Catherine)
- "It's very daunting and scary to go into the ocean at first, but I got the best advice from our free diving coach Hanli Prinsloo: When being tossed and turned underwater or held under, instead of being frightened, just smile and acknowledge that the ocean is 'playing with you.' It's easy to feel very small and powerless when you first surf, but if you switch your mindset it changes your experience drastically." —Sasha Jackson, also seen on One Tree Hill (Dana)
Blue Crush 2 Star's Surf-Friendly Playlist
- "Islands," XX
- "Land Down Under (Acoustic)," Jason Mraz
- "The Lazy Song," Bruno Mars
- "Pure Shores," All Saints
- "Sun is Shining," Bob Marley & The Wailers
Now tell us: What sporty movie inspires you to get up and move?
Categories: Celebrity, Fitness, The Fit Stop, Workouts | Tags: celeb playlist, celebrity workouts, movie, surfing
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