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Non-Small-Cell Lung Cancer
Non-Small-Cell Lung Cancer
Lung cancer has been the leading cause of cancer death among men in the United States for years, and since 1988, it has become the number-one cause of cancer death among women. An estimated 224,210 new cases of lung cancer are expected in 2014, and 159,260 deaths due to this disease are expected to occur, roughly 27% of all cancer deaths. This exceeds the combined number of deaths from cancer of the next leading sites (breast, prostate, and colon). Lung cancer accounts for 6% of all deaths in the United States.
Lung cancer develops from pulmonary parenchymal or bronchial supportive tissues. Although multiple cell types are often found within a single lung tumor, one type usually predominates. Based on the therapeutic approach, there are two major subdivisions of lung cancer: small-cell lung cancer (SCLC) and non–small-cell lung cancer (NSCLC). Non–small-cell tumors account for approximately 85% of all lung cancers. The three major tumor types included under this category are adenocarcinoma, squamous cell carcinoma, and large-cell carcinoma.
This chapter provides basic information on the epidemiology, etiology, screening, prevention, and signs and symptoms of lung cancer in general and then focuses specifically on the diagnosis, staging, pathology, and treatment of NSCLC, as well as on the pulmonary evaluation of lung cancer patients and follow-up of long-term survivors.
A separate chapter provides information on the staging, pathology and pathophysiology, and treatment of the far less common SCLC and concludes with brief discussions of mesothelioma and thymoma.
FDA Approvals
In May 2013, the US Food and Drug Administration (FDA) approved erlotinib (Tarceva) for the first-line treatment of patients with metastatic NSCLC whose tumors have epidermal growth factor receptor (EGFR) gene exon 19 deletions or exon 21 (L858R) substitution mutations. The approval was based on the results of a randomized, multicenter, open-label trial comparing erlotinib (n = 86) to platinum-based doublet chemotherapy (n = 88) in patients with metastatic NSCLC whose tumors had EGFR exon 19 deletions or exon 21 (L858R) substitution mutations determined by a clinical trial assay. The trial's primary endpoint was investigator-assessed progression-free survival. Secondary endpoints included overall survival and objective response rate. The median progression-free survival was 10.4 months in the erlotinib arm and 5.2 months in the platinum-based chemotherapy arm (hazard ratio [HR] = 0.34; 95% confidence interval [CI], 0.23–0.49; P < .001). The median overall survival was 22.9 months in the erlotinib arm and 19.5 months in the platinum-based chemotherapy arm (HR = 0.93; 95% CI, 0.64–1.35; P = .6482). The overall response rate was 65% for patients in the erlotinib arm and 16% in the platinum-based chemotherapy arm. The majority of the patients in the platinum-based chemotherapy arm (82%) subsequently received an EGFR tyrosine kinase inhibitor following investigator-determined disease progression.
In July 2013, the FDA approved afatinib (Gilotrif) tablets for the first-line treatment of patients with NSCLC whose tumors have EGFR gene exon 19 deletions or exon 21 (L858R) substitution mutations as detected by an FDA-approved test. The safety and efficacy of afatinib have not been established in patients whose tumors have other EGFR mutations. Concurrent with this action, FDA approved the therascreen EGFR RGQ PCR Kit (QIAGEN) for detection of EGFR exon 19 deletions or exon 21 (L858R) substitution mutations. The approval of afatinib was based on the demonstration of improved progression-free survival in a multicenter, international, open-label, randomized (2:1) trial. This trial enrolled 345 patients with metastatic NSCLC whose tumors tested positive for EGFR mutations. Patients were randomized to receive afatinib at 40 mg orally once daily (n = 230) or pemetrexed/cisplatin, (n = 115, with pemetrexed given at 500 mg/m2 and cisplatin at 75 mg/m2 intravenously once every 21 days, up to six cycles. A statistically significant prolongation of progression-free survival determined by the independent review committee was demonstrated for patients assigned to the afatinib treatment arm (HR = 0.58; 95% CI, 0.43–0.78; P < .001, stratified log-rank test). The median progression-free survival was 11.1 months in the afatinib arm and 6.9 months in the chemotherapy arm. Objective response rates were 50.4% and 19.1% in the afatinib and chemotherapy arms, respectively. No statistically significant difference in overall survival between the two arms was demonstrated. In patients whose tumors have exon 19 deletions or exon 21 (L858R) substitution mutations, the median progression-free survival was 13.6 months in the afatinib arm and 6.9 months in the chemotherapy arm.
In November 2013, the FDA approved crizotinib (Xalkori) capsules for the treatment of patients with metastatic NSCLC whose tumors are anaplastic lymphoma kinase (ALK)-positive as detected by an FDA-approved test. This approval was based on demonstration of superior progression-free survival and overall response rate for crizotinib-treated patients compared with chemotherapy in patients with ALK-positive NSCLC with disease progression after platinum-based doublet chemotherapy. An open-label, active-controlled, multinational, randomized trial enrolled 347 patients with ALK-positive, metastatic NSCLC. Patients were required to have progressed following platinum-based chemotherapy and to have ALK expression in tumor specimens detected by fluorescence in situ hybridization on central laboratory testing. Patients were randomized to receive either crizotinib at 250 mg orally twice daily (n = 173) or chemotherapy (n = 174). Approximately 64% of patients on the chemotherapy arm subsequently received crizotinib. The trial demonstrated significantly prolonged progression-free survival for patients treated with crizotinib compared with chemotherapy (HR = 0.49; 95% CI, 0.37–0.64; P < .0001). Median progression-free survival was 7.7 months and 3 months on the crizotinib and chemotherapy arms, respectively. The overall response rate was significantly higher for patients on the crizotinib arm (65% vs 20%), with median response durations of 7.4 months and 5.6 months in the crizotinib and chemotherapy arms, respectively. No difference in overall survival was noted between the two arms (HR = 1.02; 95% CI, 0.68–1.54) in a planned interim analysis, however 64% of patients on the chemotherapy arm subsequently received crizotinib, thus potentially confounding the overall survival measure.
Meeting and Study Highlights
Kratz et al found that, in stage I NSCLC, a quantitative polymerase chain reaction 14-gene expression assay on formalin-fixed paraffin-embedded tissues was found capable of identifying low-, intermediate-, and high-risk patients for recurrence (P = .0003).
Long-term lung cancer survivors who engaged in regular physical activity for 30 minutes or more 5 days per week had higher QOL scores and better symptom control than their less active counterparts (Solberg et al: Lung Cancer 2012).
RTOG 0617 was a randomized phase III comparison of standard dose (60 Gy) vs high dose (74 Gy) conformal radiotherapy (RT) with concurrent and consolidation carboplatin/paclitaxel with or without cetuximab in patients with stage III non-small lung cancer (NSCLC). The results showed a significantly lower survival on the high vs. standard dose RT arm (20 months vs 29 months median survival, P = .0007). While there was a higher rate of grade 3+ esophagitis on the high dose vs standard dose RT arm (21% vs 7%), there was no clear reason for the poorer survival on the high dose (RT) arm. Possible explanations include unreported toxicities, increased heart dose, increased local failure, or possibly a combination of these factors. RTOG is exploring new strategies (involving functional imaging) to more effectively escalate the radiation dose in this setting. Results recently presented at IASLC showed that there was no survival difference based upon the use of cetuximab.
Movsas et al presented the quality of life (QOL) analysis of the RTOG 0617 study at the plenary session at ASTRO 2013. QOL was collected prospectively by a validated lung cancer instrument: Functional Assessment of Cancer Therapy-Trial Outcome Index (FACT-TOI), which includes the Physical Well-Being (PWB), Functional Well-Being (FWB) and the Lung Cancer Subscale (LCS). The primary QOL hypothesis predicted for a clinically meaningful decline (CMD) in the lung cancer subscale (LCS) on the high-dose RT arm at 3 months. Indeed, the CMD in LCS for the 74 Gy arm was significantly higher at 3 months than for the 60 Gy arm (P = .024), confirming the primary QOL hypothesis. This difference in QOL decline between arms resolved by 12 months. The baseline QOL significantly predicted for survival on multivariate analysis. While this study was not randomized by technology, intensity modulated RT (IMRT) was used to treat patients with higher stages and larger volumes. Nevertheless, significantly fewer patients who received IMRT (vs 3D conformal RT) had a clinically meaningful decline in the lung cancer subscale (LCS) at 12 months (P = .005), suggesting that improved RT treatment techniques may help enhance the therapeutic window of patients with lung cancer.
At ASCO 2013, Sorensen et al presented the results of a prospective randomized phase III trial by the Nordic Thoracic Oncology Group studying the role of surgery for pathologically verified N2 NSCLC. The chemotherapy involved paclitaxel and carboplatin. Of note, the study was stratified by histology. Overall, the trial showed no improvement in survival with the addition of surgery to chemotherapy and radiation alone. However, there was a significant benefit in survival in the surgical arm for patients with adenocarcinoma (as well with T1N2 stage). Of note, the chemotherapy and radiation in this trial were administered sequentially, not concurrently. While N2 status was confirmed preoperatively, the N2 nodal localizations and numbers were not recorded.
At ASCO 2013, Butts et al presented the results of a phase III randomized study of L-BLP25 (tecemotide) antigen–specific cancer immunotherapy for unresectable stage III NSCLC. MUC1 is a mucinous glycoprotein which is overexpressed in many human malignancies. L-BLP25 is a peptide vaccine strategy that targets the exposed core of MUC1 tumor associated antigen. Overall, this strategy did not meet the primary endpoint of significantly improving overall survival. However, in a prespecified group treated with initial concurrent chemoradiation (N = 806), a 10-month difference in median overall survival favored the patients who received L-BLP25. Overall, the treatment was well tolerated. Further studies are required to confirm these observations.
The American College of Radiology (ACR) has published appropriateness criteria (AC) to guide the use of postoperative adjuvant therapy in NSCLC (Decker et al: Am J Clin Oncol 2011). The ACR appropriateness criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development includes an extensive analysis of current medical literature and the application of a consensus methodology (modified Delphi) to rate the appropriateness of treatment recommendations by the panel. The ACR appropriateness criteria also include other topics related to lung cancer and other disease sites.
Findings with programmed death-1 (PD1) and programmed death-ligand 1 (PD-L1) immune checkpoint blockade have shown promise in advanced NSCLC. At ASCO 2013, Brahmer et al reported a 17.2% overall response rate with the anti-PD1 antibody, nivolumab, in heavily pretreated advanced NSCLC; the median duration of response was 18.5 months, much longer than expected with non immune-based therapy. The anti-PD-L1 antibody, MPDL3280a, has also led to prolonged responses in advanced NSCLC, with an overall response rate of 21% and 24-week progression-free survival of 45% reported at ASCO 2013.
Also at ASCO 2013, the addition of ganetespib, an inhibitor of heat shock protein 90 (HSP-90), to second-line docetaxel chemotherapy significantly improved progression-free and overall survival compared with docetaxel alone in a phase II trial of patients with advanced NSCLC. The effect on progression-free and overall survival appeared to be amplified in patients with a diagnosis of advanced disease for > 6 months, and a phase III study is under way in this group.
In the United States, the estimated number of new lung cancer cases for 2014 is 116,000 for men and 108,210 for women. Although the incidence of lung cancer had been rising in women, the figures have stabilized and begun to decline recently. The incidence is decreasing in men.
The age of patients at which lung cancer is diagnosed varies widely, but the median age at diagnosis is approximately 70 years.
In the United States, the highest incidence of lung cancer in men and women is found in African Americans (94.7/100,000 for men and 50.4/100,000 for women), followed by Caucasians (82.9/100,000 for men and 59.9/100,000 for women).
There are geographic variations in the incidence of lung cancer, with the highest rates worldwide observed in North America and Eastern Europe; in the United States, the highest rates are found in northern urban areas and along the southern coast from Texas to Florida. The state with the highest incidence of lung cancer is Kentucky, with an incidence of 125.9/100,000 in men and 80.3/100,000 in women.
The overall 5-year survival rate for lung cancer is 18%; this has improved from a rate of approximately 12% in the 1970s.
Etiology and Risk Factors
Cigarette Smoking
Approximately 87% of all cases of lung cancer in the United States are related to cigarette smoking. There is a relatively strong dose-response relationship between cigarette smoking and the development of this cancer. The greater the number of cigarettes smoked on a daily basis and the greater the number of years of smoking, the greater is the risk of lung cancer. An individual who smokes one pack of cigarettes daily has a 20-fold increased risk of lung cancer compared with a nonsmoker.
The overall incidence of cigarette smoking decreased from 1974 through 1992. Smoking cessation decreases the risk of lung cancer, but a significant decrease in risk does not occur until approximately 5 years after discontinuation, and the risk remains higher in former smokers than in nonsmokers for at least 25 years. The benefit of smoking cessation is greater if it occurs at a younger age.
Smoking cessation is difficult. Recent data have suggested that a variety of hereditary factors increase the risk of addiction to nicotine among some individuals. Nevertheless, millions of former smokers have quit successfully. Smoking cessation programs that address both physical withdrawal from nicotine and psychological dependence appear to be more effective than either of these approaches alone. In addition, continued efforts are needed to prevent adolescents and preadolescents from beginning to smoke and to encourage them to quit after a brief period of experimentation.
Several cancer centers have recently reported that more than half of their patients with newly diagnosed lung cancer are former smokers, having quit more than 1 year before diagnosis. Healthy ex-smokers represent a large group of individuals who may benefit from effective tools for early detection and/or chemoprevention of lung cancer.
Secondhand Smoke
Not only is smoking risky for those who smoke, but it also poses a hazard to nonsmokers who either live or work with smokers. It is estimated that approximately 3,000 lung cancer deaths per year in the United States are due to secondhand smoke. Individuals who live in a household with a smoker have a 30% increase in the incidence of lung cancer compared with nonsmokers who do not live in such an environment.
Asbestos Exposure
Exposure to asbestos is another risk factor for lung cancer. Cigarette smokers who are exposed to asbestos develop lung cancer at an extremely high rate. There is a 90-fold increase compared with unexposed individuals. Exposure to asbestos is also a major risk factor for the development of mesothelioma (see discussion of this cancer in the chapter on small cell lung cancer).
Radioactive Dust and Radon Exposure
Uranium miners who have been exposed to radioactive dust and radon gas also have an increased incidence of lung cancer. Although there has been some controversy about the risk posed by exposure to residential radon gas, a study conducted in Sweden showed an increased incidence of lung cancer in individuals who were exposed to a high level of radon in their homes.
Human papilloma virus (HPV) has been implicated as a cause of NSCLC; nearly 25% of cases in non-smokers may be associated with the virus. Recurrent respiratory papillomatosis (RRP) is a disease typically found in young patients with laryngo-tracheobronchial HPV polyps. RRP may cause cough and obstruction, and may eventually degenerate into malignancy. HPV 16/18 infection is associated with the p53 mutation.
Family history has been considered a risk factor, and often a smoking-related history is uncovered. More recently, inheritable mutations have been discovered. One in particular is T790M, a germline mutation of EGFR gene, and is associated with adenocarcinoma.
Air Pollution
Particulate matter in air pollution has been shown to increase the risk of lung cancer, especially adenocarcinoma. The risk is associated with the size and volume of the particulate matter.


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I shot some photos of a store's interior for a blog that was highlighting that particular store. Is it legal for me to sell prints of the interior of that store? The photo just includes chocolate in a display case. In this case I am referring to a store in New York state (USA).
IANAL, and this advice is U.S.-centric 'cause that's where I live and work... but this is how my lawyer explained it to me for my own photography business... If the picture was taken on private property and the store is identifiable, you do need to get a location release in order to be able to sell it. If, however, the store is not identifiable, you can go ahead and use it as you see fit with no need to acquire additional releases.
Of course this correctly brings up the question of 'identifiable to whom?' Generally the test is that if the image is inflammatory or libelous towards the business owner and is not being used in an editorial capacity then the test is 'is the image identifiable to the owner of the business.' If it is not an inflammatory or libelous photograph then the legal test is less strict- 'is the business identifiable to the general public.'
Now I will say again, IANAL, this is U.S.-centric advice, and is general advice... The laws and policies in your specific jurisdiction may vary from these general guidelines, so do your homework and/or hire a lawyer if need-be.
Tough question. If you show the owner and or current manager the respect of asking, more times than not I would imagine that they would be ok with it. You might as well have them sign some kind of release if they are agreeable just to be on the safe side. The reality of it is that most places would love the extra PR!
Obviously if a business is media oriented and they depend on that for their source of income, it would be a different situation.

subset: commoncrawl


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What type of hiking do you need to be doing where you absolutely need hiking boots? I'm looking to do some hiking in SE Asia and South America, but won't have room in my pack for boots. What reasons and terrain would I absolutely need to have boots for where shoes wouldn't suffice?
It's true you might not actually need hiking boots but you have to decide.
Personally I didn't like the kind of backpackers that seemed to have all the expensive brand name gear whether they needed it or not. Felt a bit phoney to me when I was younger. So while others had $200 brand name hiking boots I had my cheap supermarket sneakers. I also felt the blingy stuff looked like $$$ dollar signs to potential thieves.
I'm not a serious hiker but I wore plain old sneakers all over the world in my travels for twenty years, including climbing volcanoes and in snow.
This finally changed a bit when I took up hitchhiking last year. I had a heavy pack and spent a lot of time on the edges of roads which were often crumbly or wet or had a steep camber. A couple of times I came close to twisting my sneakers off my feet! Then I found myself near a cheap chain outdoor gear shop on the edge of some Polish city while they had a sale on.
For about $22 I got a decent pair of cheap non brand name non blingy functional hiking boots that are perfectly practical, that I knew wouldn't last forever, and that nobody would bother to steal.
Quechua hiking boots are definitely something I would buy again. They got me from Poland to Armenia, back to Frankfurt, up and down Korea and Japan a couple of times, and now from Istanbul to Albania and have finally started to let in a bit of water a year and a bit later. That's great value for me! I no longer carry sneakers travelling at all.
I always wear my bulky stuff while I'm actually moving about. My jeans and my biggest shoes or hiking boots and the smaller stuff in the pack. When I'm at a city or beach the big stuff stays in the room and I'll wear the shorts and flipflops.
After many miles put on my old sneakers, I wear hiking boots whenever and wherever I travel now. There is nothing so miserable as getting a hole in the sole of your sneakers in a snow storm. Now, I always wear a pair of brown leather hiking boots that have some class when I travel, so I can wear them to dinner or on a hike.
I have another set of boots that lace up nice and high that I use for climbing the craggy types of mountains such as the Pacific Asian mountains, Andes, Rockies, Alps, etc. Mountains like a Appalachians, you can probably get away with a running style shoe, bit I would highly advise against it.
Generally, you need solid ankle support if you are hiking... especially in a location where you don't know how to get help.
I would say either find a way to get boots into your pack, or ditch your shoes for a pair of socially acceptable hiking boots so you don't need to fit an extra pair or footwear in your travel bag.
There are two main things that good hiking boots do (and most regular shoes don't):
So the more uneven and rocky the terrain gets, the more you need hiking boots. I'd say that's pretty much it.
It depends on how much ankle support you personally need and how heavy your pack is. If you regularly go hiking in sneakers in rough terrain with a backpack, and don't roll your ankles, then you probably won't need hiking boots. If that's not you, then bring a pair of hiking boots.


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Great protection for the oil system of your R1200GS. Keeps most pranksters out and lets most service mechanics in.
NOTE: A torx T50 tool is included in R1200GS tool kit by BMW, to 2005. For 2006, on see GCT50
The simplicity and function of the T50 oil cap make this our top choice.


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If I try to start OpenVPN, I get this error:
/etc/init.d/openvpn start
* Starting virtual private network daemon(s)...
* Autostarting VPN 'server'
* Already running (PID file exists)
But OpenVPN is not running, what should I do?
Did you read the error message? A Process ID file already exists. Usually this indicated that OpenVPN is already running. When you cleanly shut openVPN down it will remove this file.
If the laptop crashed, OpenVPN crashed or for some other reason this file did not get deleted then you can manually do that.
(In Other words: Make sure that OpenVPN really is not running, then remove the PID file You should find it in


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The end of project
We have finished doing our project 30.04.2009 r. The best presentions we published.
Students have to develop a career path for rear but interesting professions, according to information given by the teacher, available on the Internet. Rules of the project: 1. The competition is open to all the students of partnership schools 2. The main objective is to learn about the world of professions, in particular, to present new and little known professions. 3. The task is to identify the jobs , which might not be widely known , but still are interesting and worth of attention. 4. The information to be collected by the participants are: - the nature of the job - the necessary qualifications for the job - education needed for the job - kinds of schools which offer preparation for doing the job - workplace Publication of the work / presentations Power Point, including movies and images / are to be published on the website.
We have finished doing our project 30.04.2009 r. The best presentions we published.


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May 10, 2012
Obama gay marriage Tweet: How about honeymooning in Cape Town?
Capetonians have come out in support of United States President Barack Obama, who announced on Wednesday that he is in support of same-sex marriage.
In an interview with ABC News as well as on Twitter, Obama said, "At a certain point I just concluded that for me, personally, it is important to go ahead and affirm I think same-sex couples should be able to get married."
Cape Town resident, LGBT (lesbian, gay, bisexual, transgender) activist and newly wed Tracey Fared said, "I think it's progressive for President Obama to have made the comment. The LGBT community in the US has had a long struggle for equal access to marriage. This is a huge stepping stone for a liberal country such as the US. It's also a sign to the rest of the world that there is something to learn, and gives hope for equal rights and privileges."
Same-sex marriage has been legal in South Africa since the Civil Union Act came into force on November 30, 2006. Cape Town is indeed one of the most gay-friendly cities in the world, hosting events such as Gay Pride and The Mother City Queer project, and has long been a destination of choice for LGBT travellers.
Are you getting married soon? Why not consider Pink Cape Town as the ideal honeymoon destination, where most don't bat an eyelid?
In 2011, Out Now Consulting, an agency that provides gay and lesbian marketing strategy, announced Cape Town as one of its Top 20 LGBT holiday cities worldwide. Recently, the UK's Guardian newspaper recognised Cape Town as one of the 10 most popular gay destinations in the world, and the US publication, Out and About, named the Mother City a worldwide favourite.
Check out our list of top pink places to stay in Cape Town.
Check out Cape Town Pride 2012:


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Is Boot Camp some sort of virtualization system, or will it run Windows 7 on a Mac the same way it runs on a Dell or an HP machine? I need to run Visual Studio in Windows 7. and I need it to work smoothly.
Bootcamp allows you to install and run Windows 7 natively on your Mac as if it were just any other PC.
It allows you to co host a Windows installation on the same drive as your Mac OS one, allowing you to dual boot. In addition to being what is effectively a simple boot manager, it includes a full package of drivers for all your integrated peripherals like the trackpad, FaceTime camera, odd Mac keyboard layout etc etc, that makes it easier to use without having to struggle getting things to work.
It does not allow you to virtualise Windows to run within Mac OS, but a handy side affect is that many virtualisation tools such as VMWare Fusion and Parallels desktop will open your bootcamp partition as if it were a virtual machine, allowing you access without a reboot at the cost of performance. Booting directly into windows via bootcamp should be just as fast as on any comparable spec PC
From the Apple KB doc:
So, to answer your question, no, Windows is not virtualized on your computer through Bootcamp, but actually running natively on your hardware. You shouldn't have any problems with running applications on Bootcamp. However, your hardware may not be supported for that application, so you may need drivers.
Bootcamp is a multi boot utility. You use it to create a windows partition on which you install Windows 7 like any PC.
Up till now, most Windows-based computers have used what is called the BIOS, or Basic Input Output System, to launch the operating system. The BIOS detects the Windows bootloader, then puts it into memory to start up Windows.
Intel-based Macs have never had a BIOS. Instead, they have the more advanced EFI, or Extensible Firmware Interface, to perform the same task.
The BIOS and the EFI are not compatible with one another, which is why OS X will not natively boot on a PC, and why Windows shouldn't be able to boot on a Mac.
However, you can boot Windows on a Mac. This is thanks to Apple's Boot Camp. Boot Camp is a set of tools, including a set of drivers, a partitioner, and, most importantly, a BIOS simulator. The Boot Camp BIOS simulator is written into the EFI, and it allows the EFI to act like a BIOS and boot up Windows for installation on Intel-based Macintosh hardware.
You can access Boot Camp by going to Applications->Utilities->Boot Camp Assistant. It will take you step-by-step through the process necessary to run Windows natively on your Macintosh hardware.


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Shawnee County Judge Matthew Dowd will not hear anymore cases involving sex offenses. Dowd, who plans to retire in September, has come under public scrutiny after granting light sentences for sex crimes.
Chief Judge Nancy Parrish said in a statement that Dowd acted
because of ``the appearance that his impartiality might be
questioned'' after intense public reaction to some of his prior
Any cases involving sex offenders that were on Judge Dowd's agenda will be reassigned to other judges in the criminal division.
The decision comes on the same day that more than 60 people gathered on the steps of the courthouse to protest the Judge (see below).
Topeka, KS (WIBW) - Signs reading Dowd with a large "x" marked through them were held by more than 60 people on the steps of the Shawnee County Courthouse Monday.
Those who came out said they believe Judge Matthew Dowd is not providing justice to the victims in several cases he is overseeing. They say they are fed up with him and this protest was meant to gain the attention of voters in Shawnee County to make a change.
"They have to have a good reason to deviate from sentencing guidelines. Well, I haven't seen one yet," said Sue Lyon. "The victims have a life sentence. It will come up off and on throughout their whole life."
"I have a 5 year-old daughter and I think it's ridiculous that someone is being given 3 years probation for what he did to a young girl," said Olivia Kemp.
"I just want the punishment to fit the crime," said Brian Renfro.
Not everyone feels the same way. Ashlee Spencer's daughter was the victim of abuse from her grandfather Harold Spencer. Spencer says her daughter is fine and that probation was all he needed. "I think he's a great judge," said Spencer of Judge Dowd.
To hear more from Spencer and others you can click on the video icon at the top of the story.


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Michael Meurer
Innovative software companies start each work day knowing that, no matter how careful and how ethical they are, they face a meaningful risk of being sued for patent infringement. It's like a tooth ache – painful and distracting, even when not debilitating. A major source of this pain is non-... Read more


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GENESEO, N.Y. - The executive committee of the SUNY Geneseo Undergraduate Student Association (UGA) has unanimously passed a resolution calling for an end to the massive budget cuts the state has made to SUNY. The committee has sent the resolution to Governor-elect Andrew Cuomo and the leadership of the state Assembly and Senate.
The resolution is in response to recent academic program deactivations Geneseo implemented to close a $7.2 million structural deficit. The UGA resolution calls for five actions:
1) An immediate cessation on future cuts to SUNY
2) Restoration of the hundreds of millions of dollars cut from SUNY over the past few years
3) Imposition of a rational tuition policy and an end to the raising of SUNY tuition as a tradeoff for lowering state support
4) The passage of legislation including a "maintenance of effort" provision to ensure consistent state funding for SUNY
5) Suspension of Bundy Aid with those funds being diverted to SUNY instead of private universities
"It is the duty of our state politicians to stop undue harm from happening to the state of New York," the resolution reads. "That is exactly what will happen it these provisions are not met and our schools continue to slide towards insolvency. Effective action has not been taken by the current legislature and governor, which is unacceptable."
The UGA executive committee passed the resolution by an 8-0-0 vote.
Media Contact:
David Irwin
Media Relations Manager
(585) 245-5516


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I was just curious what the most complex kanji—in terms of number of strokes—is, whether or not it's actually used often.
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That really depends what you mean by "kanji". Remember that kanji are derived from Chinese characters of which there are not a defined number.
The 常用 (general use) kanji set is the one prescribed for education in schools and treated as a "safe" list to use in newspapers and other publications. The 常用 kanji with the most strokes is currently 鬱 (as noted by atlantiza), with 29 strokes. However according to the usage stats given by KanjiDic2 it is not one of the 2500 most used kanji in newspapers, so while it's taught in school it would be likely be considered as a "tricky" kanji.
The 常用 kanji that does feature in the 2500 most-used by newspapers is 鑑, which KanjiDic2 places at the 1391st most commonly used kanji in newspapers, basically meaning all literate Japanese will know it.
Outside of general use it's a lot less difficult to define, as there are many classical kanji that very few people would know today, so the "one with the most strokes" really just depends on how much you want to search. For example, in KanjiDic2 it appears to be 䯂, with 34 strokes. This is not a widely-used kanji and much less likely to be recognised by the average person.
For common (常用) kanji, I think 鬱 has the most strokes - 29. It is probably not as common as 鑑, but it's not exactly rare either. It's used in 憂鬱【ゆううつ】 (depression, the way you feel after writing that kanji) and a lot of other emotion-filled words.
And for archaic ones, I've also heard that 䯂 has the most strokes - 34. It's so uncommon these days though that it's not even in my online dictionary.
鸞 ラン. That's a character with 30 strokes, but I think there's bigger...


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- Scottsdale
- Washington, D.C.
Fash Bash
Hip Houstonians dressed in haute spring attire hit the Wortham for the annual Passion for Fashion Luncheon, a trendy event benefiting the Design Society at Houston Community College. Saks Fifth Avenue Executive Vice President Terron Schaefer, currently participating on NBC's reality show Fashion Star, spoke to guests about his inspiration, and HCC honored Sheridan Williams with the Fashion Icon Award. Glam guests joined chairs Paula Fyhr and Liz Glanville for a Champagne reception in the Grand Foryer following the presentation. Photos by Kim Coffman


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Low-Calorie Dinner Recipes (Slide 9)
(Slide 9 of 26) Start at the beginning | View recipes as list
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Poached Cod & Asparagus
In this recipe, we poach the cod right on top of the asparagus. The result is perfectly cooked cod a…View slide
Seared Strip Steaks with Ho…
Steaks are often served with hearty accompaniments like mashed potatoes, which can make the whole me…View slide
Apricot-Espresso Glazed Roa…
A little espresso gives a robust edge to the sweet-tart apricot glaze for this roasted pork loin. Th…View slide
Grilled Chicken Tostadas wi…
These grilled chicken tostadas are topped with rich mole sauce and sweet-and-sour summer vegetables …View slide
Scallop Piccata on Angel Hair
Superfine angel hair and delicate scallops are coated with a light lemon, white wine and caper sauce…View slide
Indian-Spiced Chicken & Asp…
This easy chicken-and-asparagus sauté is boldly seasoned with aromatic cumin and fennel; the seeds …View slide
Tuna, Artichoke & Basil Stu…
These baked potatoes topped with canned tuna, artichoke hearts, provolone cheese and basil may seem …View slide
Rice Pilaf with Shrimp
Don't be surprised if you start humming the jingle about the San Francisco treat while you're ea…View slide
Chicken Breasts Stuffed wit…
Stuffing boneless, skinless chicken breasts with pimientos, scallions and cheese gives them great fl…View slide
Asparagus-Goat Cheese Souff…
Puffy and warm, these asparagus-goat cheese soufflés are the essence of spring. Serve them alongsid…View slide
Chard Dumplings in Chive Broth
Sweet, tender leaves of early-season chard, caramelized onion and a salty bit of capicola fill these…View slide
Jamaican Curried Shrimp & M…
Transport yourself to the islands with this Jamaican-inspired soup, full of fresh shrimp and sweet m…View slide
Lemon-Rosemary Turkey Meatb…
Lemon and rosemary flavor both these turkey meatballs and their velvety-rich sauce. Thyme can be use…View slide
Green Pizza
Why not use cooler-weather vegetables like broccoli and arugula as an unconventional pizza topping? …View slide
Creamy Hungarian Mushroom Soup
Mushroom-soup lovers, this soup is for you! Russet potatoes make it hearty, and dill and paprika add…View slide
Salmon with Red Wine-Morel …
Dried mushrooms give this rich red-wine sauce an almost meaty flavor. Look for them in the produce d…View slide
Fettuccine with Creamy Mush…
Any variety of mushroom will work in this creamy vegetarian pasta sauce, but we particularly like a …View slide
Chicken, Mushroom & Wild Ri…
In Minnesota, chicken, mushrooms and wild rice are often bound together in a casserole with cream of…View slide
Tomato-Corn Pie
Tomatoes and corn have a natural affinity for one another: the slight acidity of tomatoes balances t…View slide
Spinach & Frisée Salad wit…
The flavors of coriander and tangerine complement the sweet scallops in this easy-to-make dinner sal…View slide
Grilled Fish Tacos
Instead of deep-frying the fish for these fish tacos, we coat the fish with a flavor-packed chile ru…View slide
Thai-Style Melon & Beef Salad
We give this Thai-style beef salad a sweet twist by adding thin matchsticks of melon to the mix. Fir…View slide
Easy Salmon Cakes
If you are trying to boost your intake of omega-3s, try this simple favorite. It is a great way to u…View slide
Fish Fillets with Pineapple…
Serve simple sautéed fish fillets with jalapeno-spiked pineapple salsa for a Caribbean-inspired mea…View slide
Herb-Crusted Chicken with F…
This roasted chicken recipe with fresh strawberry relish couldn't be any simpler to make. The chic…View slide


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| HP News Services
[Persian Gulf]
[South Korea]
By ERIC YEP
SINGAPORE -- Asia's oil refining sector is getting too
crowded for comfort.
Persian Gulf oil producers are building strings of big
refineries both at home and across Asia challenging
long-established Asian refiners in local and global fuel
markets thanks to their guaranteed and relatively cheap
crude-oil supplies and to geographical advantage.
Among the first of these new refining behemoths to start
pumping out gasoline, diesel and other products will be a
400,000 barrel-a-day joint venture project at Jubail in Saudi Arabia
owned by Saudi Arabian Oil Co., or Saudi Aramco, and Total.
Output will start within three months.
Companies in the firing
line include India's Reliance Industries,
Taiwan's Formosa Petrochemical, South Korea's SK
Innovation Co. and S-Oil Corp. and those in Singapore's oil refining and trading hub where
ExxonMobil, Shell and Chevron have major investments.
"Intense competition is expected between India, Singapore,
South Korea and Taiwan refiners to retain their existing
markets and capture new ones," Sushant Gupta, Wood Mackenzie's
senior downstream analyst, says.
Australia, Latin America and East Africa may absorb some of
the surplus, and so can India, China and Southeast Asia if
economic growth there accelerates further, but even so the risk
of oversupply, and eroding margins, is very real for Asian
Three more supersized 400,000 bpd refineries are being
readied in the Gulf region alone -- one at Ruwais in the United
Arab Emirates by 2015, a Saudi Aramco-Sinopec Group joint
venture one at Yanbu on the Red Sea by 2017, and another Aramco
one at Jazan, also on the Red Sea.
"Countries in the Middle East now have a strategy to
diversify from exporting only crude oil to exporting
value-added oil products," said London-based Salar Moradi, oil
market analyst at FGE. Saudi Arabia's imports of gasoline,
diesel and fuel oil averaged around 315,000 bpd in 2012, worth
$35 million-$40 million a day at current prices.
This key market will slip away from refiners like Reliance
Industries, which operates the world's largest refining complex, at Jamnagar in
northwest India.
Saudi Aramco, Kuwait Petroleum Corp., Qatar Petroleum
International and Russia's Rosneft and Venezuela's PdVSA are
all building new joint-venture refineries in China which will
displace imports and allow greater volumes of exports. Kuwait
Petroleum International, PetroVietnam and Idemitsu Kosan Co.
have agreed to build a relatively modest 200,000-bpd unit in
Vietnam, which will trim that country's needs for imports.
Further capacity will come from other refineries planned by
Indonesia, India and China, among others, with
many of these due to be producing only a few years out. China
alone is expected to add around 750,000 bpd of refinery capacity both this year and
next, JP Morgan said.
Asia's diesel exports to Africa, the Middle East and Latin
America in 2011 totaled 308,000 bpd, while gasoline exports to
Middle East alone amounted to 90,000 bpd, Wood Mackenzie's Mr.
Gupta said, in a reference to possible lost sales and market
share due to new Gulf and Asian refiners.
Reliance Industries, SK Energy, Formosa and other Asian
companies have enjoyed strong refining margins -- the price
difference between crude-oil and refined products -- as demand
has exceeded supply for three consecutive years, but the
outlook isn't rosy.
"Asian Singapore complex FCC margins are likely to drop from
around $10/bbl currently to $8-$8.5/bbl by 2015," Mr. Gupta
A spokesman for SK Energy, South Korea's largest refiner by
volume, agreed that margins will be pressured lower by new
Middle East units, but he declined to elaborate.
Chevron's investments to improve reliability, efficiency and
flexibility at its joint venture refineries in Korea, Thailand
and Singapore will ensure that they "continue to remain
competitive in the longer term," spokesman for the company
It is not alone in spending to head off competitors.
Reliance Industries plans to trim operating costs to levels
that can compete with the Middle East, and it is building to
convert a refining byproduct to gas, which
will boost margins by $2-$3/bbl, Macquarie Bank said in a
research report.
Reliance, Formosa, and Shell and ExxonMobil didn't respond
to questions about the implications of the refinery construction boom.
"Nervousness about Saudi Arabia's increased self-sufficiency
has driven traditional supplying refineries in Asia to seek
sanctuary in longer-term contracts," said Priya Narain
Balchandani, an analyst at Standard Chartered. Asian refinery margins will hold up in the
near- to medium-term but downside risks loom if refineries
don't adjust their volumes, she said.
Dow Jones Newswires
All comments are subject to editorial review.
All fields are compulsory.
Isaias Grinberg- ChE consultant
It is evident that ME oil exporters are nowadays seriously contemplating the erection of oil refineries to diversify and increase their income. These expanded capabilities are generally meant to produce large volumes of high quality distillates.We feel now is the time to analyse the feasibilities of erecting the following producing venues:• Groups II and III base oils and finished lubricants• FDA- quality paraffin waxes• Tertiary recycling of waste thermo-plastics An optimum slate of products should include all of these processing schemes based on emerging latest technologies compatible with green chemistry.
Hirak Dutta
GRM of India refineries can be further improved by reducing F&L and energy index numbers. Focus should also be on improving product slate rather than operating beyond 100% capacity. It must be true elsewhere also.
I feel that Indian Refineries can further improve its GRM by reducing the fuel & loss and looking closely at its Energy Index besides the product slate. The same would be true elsewhere also.
Stiff competetion cuts corners to suatain profitability. It results in maintenance, inspection and testing. It cuts the service to the coustomers.Politics plays greater roles. It is like uncontrolled behaviour of community resulted in allowing gay marraiges.
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Engineers and designers are highly skilled individuals. Forcing them to enter design changes using tables, forms and spreadsheets is unproductive and uneconomical, and it increases the likelihood of human error—this is the way that most instrumentation software systems currently work. For too long, software vendors have denied engineers and designers the simple practicality of a graphical visual engineering interface with "drag and drop" capability and inbuilt intelligence, ensuring changes are automatically replicated into all the associated data and databases.
Is 2016 the peak for US gasoline demand?
Too soon to tell
July 2016