text:
https://www.mdanderson.org/publications/conquest2016-10-18T23:16:26.081ZConquestAdobe Experience ManagerBuilding on email@example.com Merville
Working on prostate cancer

One such biopsy study has opened a new door in prostate cancer — a tumor type that so far has stoutly resisted treatment by checkpoint blockade.

Biopsy analyses by Sharma and her colleagues show that a particular combination of immunotherapy drugs might first draw T cells into these tumors, then free them to attack.

A national clinical trial of this concept, led by Sharma, will begin later this year.

"Companies with immunotherapy drugs had largely given up on prostate cancer, yet research has presented another opportunity," Sharma says.

They've also identified a third immune checkpoint that might be hindering immunotherapy for the disease.

There are about 165 clinical trials of various immunotherapies underway at MD Anderson, most of which involve some type of checkpoint blockade or immune-stimulating molecule. These trials generally focus on:

Extending immunotherapy to other types of cancer such as leukemia, colorectal, pancreas, lymphoma, glioblastoma and cancers caused by the human papilloma virus (HPV).

Testing immunotherapy drugs in combinations with each other or with targeted therapies, radiation, and surgery to broaden and deepen patient response and survival.

Comparing these treatments, which are approved for late-stage disease, with standard of care at earlier disease stages to see if immunotherapy might be used earlier.

Pharmaceutical companies are bringing new drugs to trials that seek to stimulate or protect immune response in new ways.

Allison and Sharma, who also are director and co-director of the Parker Institute for Cancer Immunotherapy at MD Anderson, wrote reviews last year in the journals Science and Cell outlining how research can advance the field.

Well-thought-out combinations, they wrote, are the key to "development of new, safe treatments that may prove to be curative for many patients with many types of cancer."

Under an agreement reached this summer with Bristol-Myers Squibb, the developer of both nivolumab and ipilimumab, MD Anderson researchers will test new ways to treat lung cancer at all stages of the disease.

Currently, the standard of care for early-stage lung cancer is surgery. Clinical trials under the agreement will look at:

Treating inoperable early-stage disease with immunotherapy, followed by targeted radiation.

Giving patients whose disease is operable immunotherapy before and after surgery, seeking to cut the recurrence rate of lung cancer down from 50%.

Providing immunotherapy followed by aggressive "consolidation therapy" — either surgery or radiation — for those with metastatic disease.

"These trials will allow us to integrate immunotherapy in innovative ways with other treatments, including surgery and radiation, to improve standard of care and expand treatment options for all patients, including those with early-stage disease," says John Heymach, M.D., Ph.D., chair of Thoracic/Head and Neck Medical Oncology.
 A successful immune attack that began with melanoma is being extended to other cancershttps://www.mdanderson.org/publications/conquest/Summer-2016/broadening-the-immunotherapy-attack2016-08-10T19:22:00.000ZCancer email@example.com Sussman
Costs associated with different breast cancer chemotherapy regimens can vary significantly, regardless of effectiveness, according to new MD Anderson research. Understanding cost differences should help guide informed discussions between patients and physicians when considering chemo options.

Sharon Giordano, M.D., chair of Health Services Research and professor of Breast Medical Oncology, presented the findings at the 2016 American Society of Clinical Oncology Annual Meeting in Chicago.

"The costs of cancer care have been increasing dramatically, both for the health care system and for patients. As physicians, we increasingly are recognizing the financial burden on our patients," says Giordano. "Both physicians and patients need greater access to information about the treatment costs so this critical issue can be discussed during a patient's decision-making process."

The American Cancer Society estimates 246,660 new cases of invasive breast cancer will be diagnosed this year in the United States. At least 35% of patients with breast cancer receive chemotherapy in addition to surgery or radiation.

Therefore, choosing equally effective but less costly regimens could impact costs of breast cancer care nationally by $1 billion every year, Giordano explains.

To calculate cost of care, the researchers analyzed claims from the MarketScan database of 14,643 adult women diagnosed with breast cancer between 2008 and 2012 in the U.S.

To qualify for the study, women must have had full insurance coverage six months prior to 18 months after diagnosis, received chemotherapy within three months of diagnosis, and had no secondary malignancy within one year of diagnosis.

The researchers calculated adjusted average total and out-of-pocket cost using all claims within 18 months of diagnoses, normalized to 2013 dollars, with separate analyses conducted for regimens that did and did not include trastuzumab.

"In this study, we found substantial variation in the costs of breast cancer treatment for different chemotherapy regimens, even when comparing treatments of similar efficacy," says Giordano.

The largest variations were seen when comparing insurer costs. For patients who did not receive trastuzumab, median insurance payments were $82,260, but varied by as much as $20,354 relative to the most common regimen.

Median out-of-pocket costs were $2,727, but the largest variation was just $382.

For those patients receiving trastuzumabbased therapies, median insurance payments were $160,590, with a difference of as much as $46,936 relative to the most common regimen.

Median out-of-pocket costs were $3,381, with relative differences as much as $912.

According to Giordano, this study was limited by its focus on a younger population with private health insurance. Patients lacking private insurance may face significantly higher costs of care. Additionally, researchers were unable to include the costs of newer therapies in the current study. Finally, the study relied on insurance claims, which may include some misclassifications, and was not able to use cancer registry data to analyze cancer stage, patient race or ethnicity, or tumor characteristics.

The researchers plan to continue work with available and future data to better understand the relative value of cancer care options.

Costs associated with different breast cancer chemotherapy regimens can vary significantly, regardless of effectiveness, according to new MD Anderson research. Understanding cost differences should help guide informed&https://www.mdanderson.org/publications/conquest/Summer-2016/Cost-of-chemo-for-breast-cancer2016-08-10T19:02:00.000ZCancer firstname.lastname@example.com Gilmore
Researchers have reported results of the first-ever Phase II clinical trial for treatment with the immunotherapy drug nivolumab on squamous cell carcinoma of the anal canal (SCCA), a rare malignancy that is on the rise.

The Phase II study was designed and led by researchers with MD Anderson's Human Papillomavirus-Related (HPV) Cancers Moon Shot Program. MD Anderson enrolled 18 patients who volunteered to provide both pre- and post- treatment tissue samples. The study revealed encouraging correlations between immunologic biomarkers and responses to treatment.

"There have been no standardized treatment options for metastatic SCCA patients," says Van Morris, M.D., assistant professor of Gastrointestinal Medical Oncology. "This study demonstrated responses in five of 18 patients treated at MD Anderson, and many of the patients had significant reductions in their tumor size."

The findings were presented at the American Association for Cancer Research's annual meeting in New Orleans.

"In this first prospective Phase II trial for refractory metastatic SCCA, our exploratory analysis of preand on-treatment tissue samples revealed potential correlations between immunologic biomarkers and clinical outcomes to nivolumab," says Cathy Eng, M.D., professor of Gastrointestinal Medical Oncology and national study principal investigator.

Metastatic SCCA, a cancer often associated with HPV infection, is normally treated with chemotherapy, although no trials have established a standard of care.

The study employed the monoclonal antibody nivolumab, one of the drugs represented among the growing arsenal of immunotherapies. The drug frees the immune system to attack cancer by disrupting a brake that halts immune response.

"This the first formal clinical trial completed with patients with previously treated metastatic SCCA," says Morris. "In this trial, patients received a biopsy just before being treated with nivolumab and then a second paired biopsy after two doses."

Researchers have reported results of the first-ever Phase II clinical trial for treatment with the immunotherapy drug nivolumab on squamous cell carcinoma of the anal canal (SCCA), a rare malignancy that is on the risehttps://www.mdanderson.org/publications/conquest/Summer-2016/aggressive-anal-cancer-responds-to-immunotherapy-drug2016-08-10T18:59:17.000ZCancer email@example.com Kimmons
Early-stage breast cancer patients who received a shorter course of wholebreast radiation at higher doses reported equivalent cosmetic, functional and pain outcomes over time as those who received standard therapy consisting of a longer, lower-dose course of treatment, according to an MD Anderson study.

Published in the journal Cancer, the study found patient-reported functional status and breast pain improved significantly
 following both radiation schedules, and there were no significant differences in physician-reported cosmetic evaluations.

With equivalent outcomes, the authors suggest the shorter course as the preferred option for patients because of a more convenient treatment schedule.

"In the United States, women historically have been treated with conventionally fractionated whole-breast irradiation (CF-WBI), given in smaller doses over a longer period of time, rather than hypofractionated whole-breast irradiation (HF- WBI), which consists of higher doses for a shorter treatment period," explains Benjamin Smith, associate professor of Radiation Oncology.

Large randomized trials from Canada and the United Kingdom have established HF-WBI as a safe and effective treatment for nearly all patients with early-stage breast cancer. In previously published research, the authors showed patients receiving HF-WBI experienced less acute toxicity and post-radiation fatigue compared to those treated with CF-WBI.

However, the adoption of HF-WBI has been limited in the U.S. In fact, researchers note only one-third of patients for whom HF-WBI is currently recommended by the American Society of Radiation Oncology (ASTRO) actually receive the shorter course of therapy.

"This trial is particularly important because there is still some hesitation among clinicians in the U.S. about adopting the
 hypofractionated schedule," says lead author Cameron Swanick, M.D, a resident in Radiation Oncology. "Because American patients tend to have a higher prevalence of obesity, and because prior trials excluded certain patients with high body mass index, there has been this concern that the shorter radiation treatment course may not be as safe for American patients."

The researchers continue to follow tumor control outcomes, though, to date, no meaningful difference in survival has been found. All outcomes will be reported once all patients have completed three-year follow-up.

The results of this and previous studies further support the use of HF-WBI as the preferred radiation therapy for early- stage breast cancer patients, explained Smith.

"At MD Anderson these shorter courses have become the standard of care."

Early-stage breast cancer patients who received a shorter course of wholebreast radiation at higher doses reported equivalent cosmetic, functional and pain outcomes over time as those who received standard therapy consistinghttps://www.mdanderson.org/publications/conquest/Summer-2016/shorter-radiation-course2016-08-10T18:42:47.000ZA healing email@example.com Wendler
Turning up the heat

The cancer center is one of a select few in the nation using a probe that's specially designed to heat and destroy brain and spinal cord tumors — regardless of their size or location. The treatment is known as laser interstitial thermal therapy, or LITT. Put simply, the name means that laser heat penetrates interstitially — inside tissue — to destroy tumor cells.

"Many types of tumors previously thought to be inoperable can be treated with this technology, including aggressive tumors that originate in the brain or spinal cord, or tumors that have spread to the brain or spine from other areas of the body," says Sujit Prabhu, M.D., a professor of Neurosurgery who works side by side with Rao in the Brain and Spine Center. "We're visited by a lot of patients from around the world who've been told nothing can be done. We offer them LITT."
 How lasers are used to attack 'inoperable' brain and spinal tumorshttps://www.mdanderson.org/publications/conquest/Summer-2016/healing-light2016-08-10T16:09:00.000ZUnraveling the firstname.lastname@example.com Gilmore
Data tsunami

The origin of TCGA may, in part, be traced to John Weinstein, M.D., Ph.D., chair of Bioinformatics and Computational Biology at MD Anderson. But it almost didn't happen.

It began back in 1991 when Weinstein, who was then working at the NCI, was planning to take the day off. Then he remembered his boss was speaking at Grand Rounds that day. Going to work was a fortuitous decision that would lead Weinstein to pursue the development of vital data-related programs that would ultimately influence the creation of TCGA.

"During his talk, I had an idea that led to my laboratory group spearheading a comprehensive molecular profiling of the NCI-60, a set of 60 human cancer cell lines used by the NCI to screen more than 100,000 chemical compounds, plus natural products, for anti-cancer activity," says Weinstein.

He calls the supernova explosion of data resulting from these earlier efforts a "data tsunami," and likens the TCGA to a "12,000-square chess board of patient samples."

"It provides us a context within which to work out the rules of the genomic game and generate useful, potentially significant results, benefiting cancer patients and their families," he says.

Those results can provide researchers with a fresh look at how tumors are developing, and point the way to new therapies. Weinstein often is referred to as a "pioneer of postgenomic biology" in part for another one of his inventions: clustered heat maps. These maps allow researchers to visualize patterns in the huge masses of data and more quickly take advantage of them. Clustered heat maps have appeared in many thousands of publications, and Weinstein's group has now developed "Next-Generation Clustered Heat Maps (NG-CHMs)," which can be zoomed in on and navigated like a Google map. NG-CHMs are routinely used for data from many different cancer types in TCGA.

Today, TCGA is a massive effort that is studying genomic changes in more than 30 different cancer types and, according to Rehan Akbani, Ph.D., assistant professor of Bioinformatics and Computational Biology, MD Anderson is a "heavy hitter and proud participant in every one of TCGA's disease working groups."

"The MD Anderson Genome Data Analysis Center (GDAC) has established itself as the premiere provider of reverse-phase protein array (RPPA)-based TCGA proteomics data and analysis as well as batch effects analysis and data quality control," says Akbani.

Batch effects are the findings and results that occur due to technical artifacts when aggregating data from multiple institutions with varied computer systems, lab procedures and data collection methods. MD Anderson's work with assessing batch effects has helped assure that the data being studied by research institutions worldwide via TCGA are accurate and consistent. RPPAs involve performing protein assays on thousands of samples simultaneously, allowing measurements of protein expression, as well as protein modifications such as phosphorylation, which turn protein enzymes on and off.
 How MD Anderson researchers are working with The Cancer Genome Atlas to unravel the mysteries of the diseasehttps://www.mdanderson.org/publications/conquest/Summer-2016/the-AGGTs-of-cancer2016-08-10T15:45:54.000ZSpace Suit Art Project lifts email@example.com Burton
It's called the Space Suit Art Project, and through it, pediatric patients and their families, as well as the hospital's staff, are hand-painting decorative fabric swatches that are then stitched together to create two replica spacesuits.

So far, the project has produced a spacesuit named "HOPE" from more than 600 swatches painted by patients, families and MD Anderson staff. A second suit, "UNITY," will be assembled from hand-painted swatches provided by the space centers that partnered to build the International Space Station and by children's hospitals around the world, symbolizing the global issues surrounding childhood cancer.

A third suit, "COURAGE," is not a patchwork suit, but a NASA-issue flight suit hand-painted by patients, their families and hospital staff. On July 18, COURAGE flew aboard a cargo vessel to the International Space Station where it will be worn by astronaut Kate Rubins, who is conducting research aboard the space station.
 A unique collaboration spotlights the similar challenges faced by children battling cancer and NASA astronautshttps://www.mdanderson.org/publications/conquest/Summer-2016/space-suit-art-project2016-08-10T15:44:00.000ZThe email@example.com Kimmons
In 2005, Benjamin Chang had just graduated from Stanford University and was eager to start a career in mechanical engineering when he started to lose his vision.

It began slowly. First, his depth perception disappeared, which caused him to misjudge distances between objects and bump into furniture. As his condition worsened, he began tripping over curbs and could no longer go for a run or ride a bike — his two favorite activities — because he felt off-balance.

"I wasn't sure what was happening, but I knew something was wrong," recalls Chang.

After visiting his mother over the winter break, he made the decision to leave California and move back in with his family in Houston.

Chang immediately went to see an ophthalmologist and was diagnosed with a rare brain tumor that was pushing on his optic nerve, causing the vision loss.

After undergoing surgery, his mother's best friend urged him to seek treatment at MD Anderson, where he received 28 days of radiation. He also went through six months of physical therapy and met with a counselor — both helped him cope
 with the physical and emotional stress of his vision loss.

As a young adult with cancer, it wasn't easy for Chang to move back in with his parents and come to grips with the loss of his sight and his independence.

"At first I was angry," he says. "Although it was frustrating, I tried to understand others' viewpoints and remain calm."

He also found it helpful to be upfront with people about his diagnosis, instead of allowing others to make assumptions about him and his abilities.

Though Chang thought everyone at MD Anderson was very kind, what really stood out to him were the volunteers. They came by each morning to offer magazines and conversation, which made him comfortable. They made him feel that he was not alone, and brightened his days in the hospital. This inspired him to become a volunteer himself.

Chang says "that he volunteers not for himself, but to give back." He says it's more rewarding for him than the people he serves.

Chang began volunteering in December 2011 after serving two years as a member of MD Anderson's Adolescent and Young Adult Advisory Council. Made up of former patients and employees, the council meets monthly to find new ways to enhance the experiences of young patients.

Today, he puts on his blue volunteer jacket every Thursday morning before his shift in the Mays Clinic Hospitality Center, where he offers patients and caregivers coffee, tea and refreshments. More importantly, he and his fellow volunteers offer hope, support, laughter and helpful information.

Chang now works for an environmental engineering firm. His condition is stable and he follows up with his MD Anderson team once a year. His outlook is bright and he continues to look ahead to the future.

"I tell patients to keep looking forward and have a positive attitude," he says. "I know that it can be hard, but I tell them
 to take things as they are."

MD Anderson's first Hospitality Center opened in 1987.

Today, its two hospitality centers average more than 114,500 visitors a year. Each weekday from 8 a.m.-3 p.m., myCancerConnection survivor and caregiver volunteers staff the centers and offer free coffee, tea, crackers or cookies to patients and caregivers.

To learn more about volunteering at MD Anderson, call 713-792-JOIN.

 LOCATIONS

 Main Building Floor 2, near The Sundial

 Mays Clinic Floor 2, near Elevator T, ACB 2.1002

In 2005, Benjamin Chang had just graduated from Stanford University and was eager to start a career in mechanical engineering when he started to lose his vision.

It began slowly. First, his depth perception disappeared, whichhttps://www.mdanderson.org/publications/conquest/Summer-2016/brain-cancer-survivor2016-08-10T14:48:48.000ZEnd email@example.com Boldt, Ph.D.
 More than 50 years after the U.S. Surgeon General first warned about the dangers of cigarettes, smoking rates have plummeted.

Yet despite irrefutable evidence that smoking causes cancer and other diseases, 15% of the population still smokes. A number of these smokers are people with what is commonly referred to as a mental health condition, such as schizophrenia or bipolar disorder. Many experts now refer to these conditions as behavioral health disorders — a term that collectively describes mental illness and substance use disorder. People who suffer from these types of conditions make up almost 50% of the U.S. tobacco market.

"The smoking rate for people with behavioral health disorders is about two times higher than for those without such conditions," says Janice Blalock, Ph.D., associate professor of Behavioral Science.

According to the Centers for Disease Control and Prevention, one in five U.S. adults has some form of behavioral health disorder, and 35 to 69% smoke cigarettes. In comparison, 15% of adults without such conditions are cigarette smokers.

"Smokers with behavioral health needs die 25 years younger than the general population, primarily of tobacco-related illnesses," Blalock says. "They smoke more heavily and more intensely, meaning they're getting a lot more of the negative stuff from tobacco."

Helping those diagnosed with such disorders quit smoking hasn't been a priority, until now.

"Because some health care providers and facilities are more focused on treating their patients' psychiatric diseases," Blalock says, "they may not consider treating tobacco addiction."

Some providers have feared that taking tobacco away might worsen patients' conditions, and some facilities have even offered cigarettes as rewards for good behavior, she says.

Blalock and Cho Lam, a senior faculty fellow in Psychology at Rice University, co-lead a program called Project TEACH (Tobacco Education and Cessation in the Health System), which trains community providers to deliver tobacco cessation services to behavioral health patients. Launched in 2015, Project TEACH is conducted in partnership with Rice University, the University of Houston and Austin Travis County Integral Care — Travis County's provider of behavioral health services.

"I've been working in the mental health field 31 years and we operated under the misconception that because a person had a mental illness, they couldn't stop smoking," says Deborah Shedrick, program manager at Spindletop Center, a community behavioral health clinic based in Beaumont, Texas. "We found out they really did want to stop smoking, but nobody had ever asked them."

The Spindletop Center is one of seven community behavioral health centers across the state participating in Project TEACH. They're working with Texas' Local Mental Health Authorities, organizations that are under contract with the Texas Department of State Health Services to deliver treatment in specific geographic areas of the state.

To connect MD Anderson's experts with clinics statewide, Project TEACH uses a videoconferencing program called ECHO, or Extension for Community Healthcare Outcomes.

"The ECHO platform is readily available and used at the convenience of clinicians. This allows us to disseminate information effectively without having to visit and train in person," says Jennifer Cofer, director of EndTobacco, an initiative of the cancer prevention and control platform of MD Anderson's Moon Shots Program. The platform, along with the Lung Cancer Moon Shot, provides support for Project TEACH.

Using ECHO, counselors and physicians from MD Anderson's Tobacco Treatment Program meet one hour each week with community providers. Sessions teach them how to help people with behavioral health needs stop smoking, and offer a forum for providers to discuss their most difficult and challenging cases.

Everyone involved learns something, including MD Anderson experts.

 "The experts listen to our feedback, and we share," says Shedrick. "We're all on the same team."

Shedrick describes a complete cultural shift at Spindletop Center. She's seen a number of clients successfully quit or reduce their tobacco use. Their lives, from health to finances, are transformed.

Project TEACH will soon expand to more clinics and provide more in-depth assistance.

"People with these conditions want to quit smoking and can quit, when given the proper assistance," Blalock says. "The process may take longer and require more intensive interventions, but it can be done."

 People with psychiatric disorders are more likely to be smokers. A new program is training community health providers to deliver tobacco cessation services.https://www.mdanderson.org/publications/conquest/Summer-2016/tobacco-cessation-services2016-08-10T14:38:00.000ZReaching for the email@example.com Wendler
Taste for adventure

Satcher grew up in the coastal town of Hampton, Virginia, where his father was a chemistry professor at Hampton University, a historically black institution, and his mother was an English teacher.

An avid encyclopedia reader who devoured articles about early explorers, young Satcher would stroll along the Virginia coastline and imagine ships from long ago on the horizon, making their way to shore. On board were the British colonials, Spanish conquistadors, French Huguenots and others who would colonize the Americas.

"I wondered what it was like to put your entire life on the line and sail to the other side of the world," he says, "not knowing what you would find. How exhilarating and terrifying that must have been. I wanted to be part of that."

Satcher enjoyed science and math and "tinkering with things to make them work." At age 16 he enrolled in MIT where he majored in chemical engineering and graduated at the top of his class. But halfway through college, his interests began shifting toward medicine.

"A lot of my engineering classwork focused on solving medical problems," he explains.

After graduating, he enrolled at Harvard University and earned his M.D. while simultaneously completing a Ph.D. in chemical engineering at MIT. "I appreciated how engineering interfaced with medicine."

Along the way, he met several physicians and scientists who were also astronauts, including Ronald McNair, who later would die during the launch of the Space Shuttle Challenger in 1986, Leland Melvin, an aeronautics engineer and fellow Virginian, and Scott Parazynski, a veteran of five Space Shuttle flights and seven spacewalks. They shared their tales of adventure with Satcher, and he was hooked.

"I've always been interested in space travel," says Satcher, who grew up watching "Star Trek," "Star Wars" and "2001: A Space Odyssey" "But as I got older, I dismissed it as a childhood fantasy."

But meeting fellow physicians who were astronauts convinced him that, "if they could do it, so could I."

While working as an orthopedic oncologist at Northwestern University in Chicago, he succumbed to space's pull and sent an application to NASA.

"My family and friends thought I was crazy," he says, "but I had to try."

It turns out he wasn't crazy. He was accepted into NASA's astronaut training program.

"I packed up," Satcher says, "and headed to Houston."
 Orthopedic oncologist Robert Satcher has always reached for the starshttps://www.mdanderson.org/publications/conquest/Summer-2016/surgeon-astronaut2016-08-10T14:37:00.000ZProm email@example.com Burton
For most teenagers, prom is one of their best high school memories. Unfortunately, teens being treated for cancer often are forced to miss out on such memorable events.

But on a glitzy and glamorous night in April, MD Anderson Children's Cancer Hospital became a place where not only lives are saved, but lasting memories are made when it hosted a Great Gatsby themed "Prom Party Palooza" for teen cancer patients and their families.

For 18-year old David Olazaba, a two-time Hodgkin's lymphoma survivor, the event was the chance to have the prom he's always envisioned, with plenty of friends, fun, food and dancing. Olazaba, who was first diagnosed at age 9, missed a lot of school when he was going through treatment and eventually had to press pause on high school during his junior year.

Though he finished school, receiving his GED last December, Olazaba hadn't experienced a real prom.

"I was disappointed that I was not able to attend prom with my high school friends, but the prom at MD Anderson made up for that," he says.

Teens were able to choose from more than 300 dresses donated by the local community and businesses. Al's Formal Wear donated the tuxedos and provided alterations and fittings for the dresses and tuxedos. On prom day, patients and their families made jewelry to wear at Kendra Scott's Color Bar, and Pageboy provided hair styling and manicures for the special occasion.
 Prom Party Palooza gave teen cancer patients the chance to put cancer aside and just have a good timehttps://www.mdanderson.org/publications/conquest/Summer-2016/Teens-going-to-prom2016-08-10T14:09:00.000ZWhat's in your firstname.lastname@example.com Boldt, Ph.D.
 When Nonnie Arriola was diagnosed with breast cancer at age 37, her first question was, "Why?" No one in her family had cancer, and Arriola was surprised to be diagnosed with the disease at such a young age.

"I thought it might be genetic," she says. "I worried about my family and my children."

Hereditary cancers are caused by genetic mutations passed down from parents to children. The National Cancer Institute estimates these genetic "mistakes" play a role in about 5 to 10% of all cancers.

More than 50 hereditary cancer syndromes have been identified, and genetic tests have been developed to detect many of these.

"New patients want to know, 'Why did I get this disease and is my daughter at risk?'" says Karen Lu, M.D., chair of Gynecologic Oncology and Reproductive Medicine. "In some cases, we can actually give them that answer."

Knowing that a particular cancer is hereditary is extremely powerful, not only for patients but also for their families, says Banu Arun, M.D., professor of Breast Medical Oncology.

Lu and Arun are co-medical directors of MD Anderson's Clinical Cancer Genetics program. Launched in 2002, the program employs 13 counselors in multiple MD Anderson clinics to advise patients diagnosed with inherited forms of cancer.

"Physicians in those clinics are aware of the importance of genetic testing and champion the program," says Arun. "The process is simple."

Counselors first meet with patients to discuss family history and determine if testing is necessary. Patients who decide to proceed undergo a simple blood draw. Results are back within weeks. Counselors and patients discuss the results and potential next steps.

After undergoing genetic testing, Arriola learned she had a BRCA1 mutation, which significantly increases the risk of developing breast and ovarian cancers.

After completing treatment, she had a double mastectomy to reduce the risk of the cancer recurring. Earlier this year, she completed reconstructive surgery and is doing well.

First-degree relatives — parents, siblings or children — of people with cancer-causing genetic mutations have a 50% chance of inheriting the same mutation, which dramatically raises their own cancer risk.

They're treated in MD Anderson's high-risk clinics, where they may undergo more stringent cancer screenings, take anti-cancer drugs, are encouraged to adopt healthier lifestyles, or even have surgery to remove ovaries, fallopian tubes and/or breasts — an option known as preventive or prophylactic surgery.

"It's a positive ripple effect for the family," says Arun. "We've found when relatives are tested and take preventive measures, they can avoid the devastating cancers that run in their families."

After undergoing genetic testing, Arriola's mother and daughter discovered they carry her same BRCA1 mutation. They're taking action.

"My mother was having yearly mammograms but is now going every six months.

She's also having her ovaries removed this year," Arriola explains. "My daughter is only 20, but she'll start screening early and is considering future options. She wants to have kids one day, and now knows she may need to start earlier than planned."

Arriola also is undergoing regular ovarian cancer screenings.
 Genetic testing can detect many hereditary cancer syndromes, allowing for early preventionhttps://www.mdanderson.org/publications/conquest/Summer-2016/cancer-inheriting-risk2016-08-10T13:52:08.000Z3-D email@example.com Wendler
Jonathan Cope lay sedated on an operating table as Matthew Hanasono, M.D., removed his cancerous lower jawbone. Meanwhile, another doctor extracted the fibula bone from Cope's lower leg.

Using surgical tools resembling those of a sculptor, Hanasono painstakingly whittled away at the fibula, fashioning it into a new jawbone for his patient.

When he was done, he placed the new jaw where Cope's cancer-riddled jaw had been, adjusting it till it "fit like a puzzle piece." The arduous surgery lasted eight hours and challenged Hanasono's skills not only as a doctor, but also an artist.

"Contouring straight leg bone into curved jaw bone is extremely challenging," says Hanasono, a professor of Plastic Surgery. "If the fit isn't precise, patients can become disfigured and have trouble chewing, swallowing or talking."

He and other experts have long realized the need for a way to increase surgical precision and efficiency. Luckily, three-dimensional printing has emerged as a solution.

Eliminating the guesswork

MD Anderson is one of a growing number of cancer centers embracing 3-D printer technology to create exact replicas of body parts damaged by cancer. These replicas, or models, serve as templates to guide doctors like Hanasono as they carve and shape customized, implantable body parts out of patients' own bones or tissues. The fibula is used to form jawbones for patients such as Cope because it's a non-weight-bearing bone and, therefore, not essential to walking.

"Designing and making replacement body parts out of bone or cartilage once involved a lot of trial and error," Hanasono says. "Getting accurate measurements and a good fit wasn't easy, but 3-D printing eliminates the guesswork. Models are printed in three dimensions — length, width and height — and are precise replicas of the patient's original jaw or other body part that needs replacing."

Hanasono uses these models not only to create replacement body parts, but also to plan exactly how a surgery will go.

"I can take precise measurements of the model from different angles before surgery. That helps me strategize my every move," he explains.

This surgical planning cuts down on time spent in the operating room and leads to better outcomes for patients.
 Plastic surgery experts are using the technology to craft customized body parts that replace those damaged by cancerhttps://www.mdanderson.org/publications/conquest/Summer-2016/jaw-with-3-D-printer2016-08-10T13:35:37.000ZCancer email@example.com Merville
They're addressing a challenge posed by the complexity of colon and rectal cancer, which leads to major differences in responses to treatment and patient survival.

"Some cancers have two or three very well-defined biomarkers that, if found in a patient's tumor, can be reliably used to guide treatment," says project co-leader Jeffrey Morris, Ph.D., professor of Biostatistics. "For many cancers, it's not that simple, and colorectal cancer is one of those."

Morris, co-leader Dipen Maru, M.D., professor of Pathology, and colleagues are working to impose some clarity on the problem of heterogeneity — a fancy word for the genetic and molecular diversity found among cancer cells in the same tumor, across tumors in the same patient, and in the results of various genetic tests that seek to characterize cancer.

The team is working with the Moon Shots Program's Cancer Genomics Laboratory platform to apply an integromic approach — an integrated analysis of genetic variations, expression of genes and regulation of genes by nongenetic factors — in 200 tumor samples.

Morris says the researchers have whittled down the 500-gene beginning set to a 100-gene test that accurately places tumors in one of the four categories 94% of the time. They're working to get the number of genes down much lower, which would make a final test much less expensive.

While hints about potential treatment are emerging from the characteristics of the four categories, Morris says much work remains to get to the point of treating patients based on tumor category.

"This information could help us do a better job choosing among standard therapies. We have some preliminary ideas there to pursue," he says. "And we'll try to identify and validate some targeted-therapy strategies."

Preclinical research, in conjunction with the Moon Shots Program Center for Co-Clinical Trials, has developed cell lines and mouse models from patient-derived tumor samples to better understand each category's mechanisms and to apply the gene test to these tumors.

The new categories were described by MD Anderson investigators and five other research groups, which make up the Colorectal Cancer Subtyping Consortium, in a paper that was published in Nature Medicine late in 2015. The investigators folded six independent classification systems into the four consensus subgroups.

 The consensus molecular subtypes of colorectal cancer, which come from their analysis of 18 studies involving more than 4,000 patients, are:

  CMS1 – Genetic/immune, hypermutation with a strong immune response, 14% of tumors

  CMS2 – Canonical, classic tumor of epithelial tissue, the lining of the organ, with specific tumor-promoting pathways activated, 37% of tumors

  CMS3 – Metabolic, epithelial tumors with metabolic defects, 13%

  CMS4 – Mesenchymal, with prominent transforming growth factor-beta activation, invasion of supportive tissue and generation of new blood vessels, 23%

 About 13% of tumors in the study had mixed features, which the authors note could represent a transition from one category to another or major molecular heterogeneity within the tumors.

 Colorectal cancer in general has resisted immunotherapies, but those in CMS1 may be vulnerable to this approach.

 Interestingly, a drug that targets a vital metabolic pathway in some tumors that's under development at the Institute for Applied Cancer Science, the moon shot small-molecule drug development platform, has potential against CMS3.

 And the researchers note that the prime characteristics of CMS2 and CMS4 lend themselves to possible targeted therapy.

 "It won't be as simple as one target per group," Morris says, "These classifications provide a foundation for improved prognostics, and for identifying new targets in well-defined groups of patients that we can move into clinical trials quickly."

 Read about the latest progress in Making Cancer History® at Cancer Frontline.
 Researchers with MD Anderson's Colorectal Cancer Moon Shot are sharpening the focus of a genetic tool designed to classify colorectal cancer into one of four categories — a vital step toward improving treatment.https://www.mdanderson.org/publications/conquest/conquest-spring-2016/categorizing-colorectal-cancer2016-05-25T21:36:19.000ZCancer firstname.lastname@example.com Merville
The Parker Institute for Cancer Immunotherapy, created with a $250 million grant from the Parker Foundation, will focus on accelerating progress in the breakthrough field that helps the immune system attack cancers.

"By bringing institutions with different strengths and expertise together, providing stable funding and access to truly cutting-edge technologies, the Parker Institute empowers us to make big strides in cancer immunotherapy," said Jim Allison, Ph.D., chair of Immunology and executive director of the immunotherapy platform — an essential component of MD Anderson's Moon Shots Program to more rapidly convert scientific discoveries into life-saving advances.

Each of the six centers received initial funding of $10-15 million in the first year to establish the Parker Institute on site. This investment will continue to grow annually via additional project grants, shared resources and central funding.
 Cancer immunotherapy leaders at MD Anderson will work with experts at five other cancer centers in a new alliance funded by the largest single contribution ever made to the field.https://www.mdanderson.org/publications/conquest/conquest-spring-2016/Parker-foundation-immunotherapy-alliance2016-05-25T21:35:56.000ZPrevention, one day at a email@example.com Le
Researchers led by Xifeng Wu, M.D., Ph.D., professor of Epidemiology, discovered that diets with increased meat consumption were associated with increased kidney cancer risk.

The increased risk is primarily the result of ingesting carcinogenic compounds created by certain high-temperature cooking techniques such as grilling or pan-frying. The study was published in the journal CANCER.

 Peiying Yang, Ph.D., assistant professor, and Lorenzo Cohen, Ph.D., professor of Palliative, Rehabilitation & Integrative Medicine, published findings in the online issue of Cancer Research that revealed a connection between dietary sugar intake and breast cancer development.

In laboratory mice, increased sucrose intake fueled breast cancer development and metastasis to the lungs.

Xifeng Wu's team also published a study in Cancer Epidemiology, Biomarkers & Prevention describing an association between dietary glycemic index and lung cancer risk in certain populations, including nonsmokers. The study found that lung cancer patients were more likely than healthy individuals to consume diets with a high glycemic index, a value assigned to carbohydrates to indicate how rapidly they increase blood sugar levels.
 MD Anderson researchers have recently published studies that point to a connection between cancer and our diets and eating habits.https://www.mdanderson.org/publications/conquest/conquest-spring-2016/eating-cancer2016-05-25T21:35:31.000ZPrevention, one day at a firstname.lastname@example.com NorwigCancer prevention experts weigh in on how to decrease your risk for cancer by avoiding carcinogens on a daily basis.https://www.mdanderson.org/publications/conquest/conquest-spring-2016/tips-for-cancer-prevention2016-05-25T21:35:02.000ZNo need for perfect email@example.com Burton
 Travis Arnold is in it to win it. The 17-year-old is a top-rated golfer on Klein High School's Bearkat Golf Team. Academically, he ranks in the top 2% of his class. And two years ago, he kicked cancer to the curb.

At age 12, Arnold was diagnosed with a bone marrow disorder that evolved into acute myeloid leukemia — a fast-growing cancer of the white blood cells.

Doctors hoped a bone marrow transplant rich with stem cells could save his life. Arnold underwent two transplants at another hospital, using marrow from donors who tested genetically as his perfect match. Both transplants failed.

That's when his parents sought help at MD Anderson Children's Cancer Hospital, where doctors decided to try something different. They performed a socalled half-match bone marrow transplant, known medically as a haploidentical transplant, with "haplo" meaning "half."

While half-match donors aren't a perfect match, they're close enough to allow patients to move ahead with a transplant.

To test whether a donor's bone marrow is a suitable match for a recipient, doctors examine genes in the human leukocyte antigen, or HLA System — the part of the immune system that recognizes self and not self.

In a full match, eight to 10 HLA genes need to match between donor and recipient. In a half match, only half of these HLA genes need to match up.

"Parents are always a half-match for their children, and vice versa," says Stefan Ciurea, M.D., associate professor of Stem Cell Transplantation. "Siblings have a 50 percent chance of being a half-match for each other."

In Travis Arnold's case, his father served as his half-match.

Because the matching between donor and recipient is only half, the donor's immune system may generate a stronger attack against the recipient's tissues — a condition known as graft-versus-host disease. Certain therapies given before and after the transplant have been very effective in controlling this reaction.

"With chemotherapy and immunosuppressive treatments, the rates of graft-versus-host disease are surprisingly less than or similar to the rates with matched donors," Ciurea says.

Life begins with second chances

Similar to haploidentical transplants, cord blood transplants are providing effective new treatment options for cancer patients.

At the time of a baby's birth, after the umbilical cord is cut, a needle is inserted into the vein of the cord, and the blood in the cord and placenta is collected and frozen until it is needed for a transplant.

This infant blood is rich in new stem cells that haven't yet been educated against foreign invaders, like bacteria and viruses. So its stem cells are less likely than bone marrow stem cells to attack a recipient's tissues. As a result, the donor and recipient don't need to be as closely matched as those in a bone marrow transplant.

"A match in four of six HLA markers in cord blood is usually considered acceptable," says Elizabeth Shpall, M.D., Ph.D., deputy chair of Stem Cell Transplantation and Cellular Therapy and chair of the Cord Blood Transplant Program at MD Anderson.

Since the first umbilical cord blood transplant performed in France almost 30 years ago, the banking of cord blood has played a significant role in saving lives.

Avoiding delays

With half-matched and cord blood transplants providing new sources of stem cells, patients no longer need to delay transplantation while waiting for a perfect or nearperfect donor match.

"People who need transplants are usually very ill, and rapid access to stem cells can save lives," Shpall says.

Today, practically all patients find a donor, says Dean Lee, M.D., Ph.D., associate professor of Pediatrics and Arnold's doctor. "With new sources of stem cells, we no longer have to turn away someone who needs a transplant for lack of a donor."

A study published in the New England Journal of Medicine in 2014 verified that lack of a donor is no longer a major limitation to transplants. More than 99% of white European-Americans and 95% of African-Americans who need a transplant will have a suitable match, according to the study.

Minority donors needed

This is especially relevant for minorities, who are underrepresented in the National Marrow Donor Program's Be the Match registry — the nation's largest bone marrow registry. More than 10 million people who are willing to donate their bone marrow to a stranger have signed up. If patients cannot find a match within their family, they must attempt to find an unrelated donor from the registry.

"Bone marrow donations must be matched to very specific genetic markers that are overwhelmingly more likely to appear in donors of the same ethnicity," Shpall explains. "Because minorities are under-registered, it's harder for them to find a non-family donor."

 Minorities make up only 25% of donors in the Be the Match registry, according to Cheekswab, an organization dedicated to increasing minority participation. As a result, minorities have a 66 to 73% chance of finding a matching donor through the registry, compared with Caucasians' 93% likelihood of finding a match.

"Additionally, some ethnic groups have a more complicated gene pool that makes it difficult to find a match through traditional methods," Shpall says.

Using half-matched donors now compensates for the lack of donors in Be the Match and other registries, Ciurea adds.

"With half-matched transplants generating improved outcomes that are comparable to full-matched transplants, every patient has a chance," he says.
 Cord blood and half-match options provide patients with a whole lot of hope.https://www.mdanderson.org/publications/conquest/conquest-spring-2016/matching-bone-marrow-transplants2016-05-25T21:34:36.000ZCommon threads of email@example.com Gilmore
A diabetes drug for cancer?

Since the mid-1990s, metformin has been prescribed for Type 2 diabetes. The popular and inexpensive drug works by impacting cell signaling pathways directly or indirectly at several locations in the body. The commonality between diabetes and cancer appears to be obesity.

Scientists at MD Anderson believe metformin may benefit women with breast cancer. A study by Experimental Therapeutics' Enrique Fuentes-Mattei, Ph.D., compared a newly developed obese-mice model with breast cancer and biological changes in breast cancer samples from patients. The results indicated a tie between obesity and a more rapid onset of disease and higher rate of death for women with estrogen-positive (ER+) breast cancer.

"Obesity increases the risk of cancer death among postmenopausal women with ER+ breast cancer, but the direct evidence for how this occurs is lacking," says Fuentes-Mattei, whose study results were published in the Journal of the National Cancer Institute. "Our study reported direct evidence about the breast cancerpromoting impact of obesity, which is like jet fuel for cancer."

Fuentes-Mattei's team found that fat cell proteins known as adipokines change the gene expression profile in breast cancer cells, promoting tumor growth and proliferation. The researchers also revealed that metformin, when combined with the targeted-therapy drug everolimus, suppressed fat cell-induced tumor growth in the obese mice and secretion of adipokines by fat cells.

"We believe that our mouse model will be a useful tool for future research on the development of therapeutic strategies that would block or reverse the effect of obesity on cancer," says Sai-Ching Jim Yeung, M.D., Ph.D., professor of Emergency Medicine and senior co-leader of the study with Mong-Hong Lee, Ph.D., professor of Molecular and Cellular Oncology.

An MD Anderson clinical trial based on the study is being led by Vicente Valero, M.D., professor of Breast Medical Oncology.

 Aung Naing, M.D., associate professor of Investigational Cancer Therapeutics, has also studied metformin and conducted a combination clinical trial that paired metformin with temsirolimus, a chemotherapy drug.

Additional MD Anderson studies are focusing on metformin and other diseases such as lung and endometrial cancer.

Seeking a sickle cell treatment alternative Priti Tewari, M.D., assistant professor of Pediatrics, is an oncologist who specializes in stem cell transplantation for malignant and nonmalignant pediatric diseases. She and her colleagues treat conditions such as anemia, clotting disorders, hemophilia, leukemia, lymphoma and sickle cell disease (SCD).

SCD is a group of inherited disorders in which red blood cells form into a crescent shape, like a sickle, and break apart easily, causing anemia. The damaged cells also clump together and stick to the walls of blood vessels, blocking blood flow. This can cause severe pain and permanent damage to the brain, heart, lungs and other organs. The disorder affects 90,000 to 100,000 people in the United States, primarily African-Americans and Hispanics.

Tewari's interest in sickle cell disease led to a clinical research trial that is studying the safety of giving NiCord® as an alternative therapy to the standard bone marrow transplantation prescribed for many patients with blood disorders. NiCord® is an umbilical cord stem cellbased treatment.

New findings about an ancient disease

The word "leprosy" often conjures up images of Biblical suffering or sanitorium settings. And yet the illness, properly known as Hansen's disease, continues to strike hundreds of thousands of people worldwide each year, primarily in developing countries.

An MD Anderson pathologist, Xiang-Yang Han, M.D., Ph.D., professor of Laboratory Medicine, has studied mycobacterium lepromatosis, a species of bacteria he first reported in 2008 as another cause of the disease. Up to that point, the only known cause of Hansen's disease was mycobacterium leprae.

In studying 20 genes of mycobacterium lepromatosis in comparison with mycobacterium leprae, Han found that the two bacteria came from a common ancestor some 10 million years ago. No one knew how long the disease had existed, but Han's work clearly showed it is, indeed, an ancient disorder, with its genetic beginnings as old as 20 million years.

This discovery offers new insights into disease pathogenesis beyond Hansen's disease, a finding that has implications for cancer microbiologists like Han.
 Physicians and scientists are treating cancer by using their knowledge of the cellular functions shared by it and other diseases.https://www.mdanderson.org/publications/conquest/conquest-spring-2016/connections-between-cancer-and-other-diseases2016-05-25T21:34:12.000Z


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High-fiber psyllium offers an easy way to improve digestive health and lower cholesterol. Psyllium contains about 71g of soluble fiber per 100g and is sold in whole husks or powdered husks. Psyllium is commonly found in laxatives such as Metamucil, but can be used daily in its pure form in small amounts to promote regularity. Psyllium can be added to foods to add fiber and help bind recipes. Because of its mucilage properties, psyllium is a great thickener and binder for raw and cooked foods. Always consult a doctor before taking psyllium in large quantities or as part of a detoxification regime.
Things You'll Need
- Psyllium, powder and/or whole husk form
- Cooking and baking supplies
Thicken and bind dressings, batters, and pie and quiche fillings. Add 1 tsp. to 3 tbs. of psyllium powder slowly to mixtures as a final step in recipe or at indicated place in recipe.
Increase fiber in smoothies and other drinks. Add 1 to 3 tbs. of powder per serving of drink. Blend or mix well.
Bind no-bake crusts. Sprinkle psyllium powder into mixture as it is being processed in food processor.
Add fiber and texture to baked goods. Combine whole psyllium husks with other dry ingredients and follow recipe.
Tips & Warnings
- Use high-fiber and raw food cookbooks to find recipes already containing psyllium before experimenting with psyllium in your own recipes.
- Psyllium is a supplement and should not take the place of naturally high-fiber whole foods in your diet.
- The Complete Idiot's Guide to High Fiber Cooking; Liz Scott; 2008
- Raw Gourmet: Simple Recipes for Living Well; Nomi Shannon; 1999
- The Green Pharmacy: New Discoveries in Herbal Remedies for Common Diseases; James A. Duke; 1997
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What Are Psyllium Seed Husks?. Part of the series: Health Food Facts. ... Cooking Techniques; Food Prep; Grilling Guide; Soups & Sauces;...
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Psyllium husk powder is an ingredient often added to homemade cat food diets and is found in fiber powders like Metamucil. Psyllium......
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Gelatin is made from protein found in the tissues, ligaments and tendons of cows and pigs. The animal tissues are boiled down...
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subset: commoncrawl


text:
THIS IS A DIRECTORY PAGE. Britannica does not currently have an article on this topic.
Learn about this topic in these articles:
accounting principles
The amount of inventory holding gain that is included in net income is usually called the " inventory profit." The implication is that this is a component of net income that is less "real" than other components because it results from the holding of inventories rather than from trading with customers.


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NORMAN, Okla. – What a difference 10 months can make. The Oklahoma defense was torched for 778 yards last year at West Virginia. Toyed with. Humiliated. Embarrassed.
Not this time around. Sparked by the defense, it was the Sooners coming out on top with a 16-7 victory against visiting West Virginia on Saturday night in the Big 12 conference opener for both teams.
It didn't look that good early. West Virginia's Dreamius Smith went 77 yards, breaking one tackle after another to put the Mountaineers (1-1, 0-1) on the board with 8:54 left in the first quarter.
Here we go again. The track meet was on.
Only this time the OU defense was up to the task. As the Sooners' passing offense sputtered, the defense was asked to save the offense this time around.
Each and every single time the defense delivered. "Everyone is buying into the system," senior linebacker Corey Nelson said. "We're selfless. We're a We-Fense instead of a De-Fense. We play like a family."
A family that has seen one of its leaders emerge. Entering the season it was clear Nelson and senior cornerback Aaron Colvin were going to be the go-to guys.
Through two games, though, there is no way anybody can discount the production and the leadership senior safety Gabe Lynn has brought to the team. Lynn recorded his first career interception and recovered a fumble. OU's defense forced four turnovers.
"Gabe was awesome," OU coach Bob Stoops said. "He has really become a leader and is the glue back there for the secondary to go along with Aaron. It has been awesome what he has been doing."
Not to mention what the rest of the defense is doing. OU limited West Virginia to 3-of-13 on third down conversions and 387 yards of total offense, less than half of what the Mountaineers racked up last season.
The defense had to respond to adversity. Colvin left the game midway through the third quarter and didn't return. Stoops said he is not sure how severe the injury is and declined to comment further.
OU defensive coordinator Mike Stoops said his group missed Colvin's leadership and presence but stayed solid and made the necessary adjustments.
"I like this group," Mike Stoops said. "The attitude, the toughness – I like this group a lot. It was controlled chaos."
OU (2-0, 1-0) was clinging to a one-score lead for more than half of the game as the offense couldn't find its way through the air. The Sooners were 1-of-6 for 6 yards and two interceptions in the second half. Early in the fourth quarter, junior Blake Bell replaced redshirt freshman starting quarterback Trevor Knight.
The defense never wilted.
"Especially in this game last year, the offense bailed us out," said Lynn about the defense bailing out the offense. "Coming into this game, we had a lot of motivation after last year. We definitely want to prove everybody wrong. Everybody was counting the defense out earlier, so it definitely felt good to get that win."
Taking out the 77-yard run, West Virginia rushed for 92 yards on its 23 other carries. Kass Everett had a sack and a forced fumble. It was OU's only sack of the game, but Mike Stoops is not worried about that.
"We had one sack, but there was a lot of pressure," Stoops said. "That's just as effective."
And effective is a good word to describe the OU defense. Through two games, the Sooners are allowing a mere 3.5 points per game. The mentality has changed.
"Last year we might have crumbled," said Nelson after Smith's touchdown run. "This year we weren't scared. We were disappointed. We put it behind us and kept playing football."


text:
iHerb 상품평
할인금액: ₩6,716 (39% 할인)
odereviews님께서 May 22, 2013 에 작성하셨습니다.
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It's very cool product
5209565483113286289님께서 Apr 30, 2014 에 작성하셨습니다.
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Taste very good!
Reviewer1324255님께서 May 25, 2014 에 작성하셨습니다.
I have been taking this product for a short time(a few weeks) but have noticed my nails are growing longer as well as my hair. I love the flavor! I think this product is a keeper.
5453927104678640452님께서 Nov 13, 2015 에 작성하셨습니다.
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Taste good :)
5201131921988607178님께서 May 22, 2016 에 작성하셨습니다.
It 's so easy to taking it.
Good taste
khalilbh님께서 Jun 27, 2013 에 작성하셨습니다.
I ordered 2 cherry flavor bottles but I received instead strawberry flavor bottles from Iherb and I don't know why. However; the taste is good enough and the pill dissolves really fast in the mouth (it takes about 3 minutes). I hope this product will cure my hair.
Hidden Costs
5743860784494150025님께서 Apr 08, 2016 에 작성하셨습니다.
The product is fine but I was not happy to find that I had to pay £15 vat which had no mention in your advert.Made the product very expensive and I shall beware of using your site again
5612685559404251352님께서 Apr 10, 2016 에 작성하셨습니다.
I received only 3 cans
see nothing
4847326140558501991님께서 Oct 15, 2015 에 작성하셨습니다.
didn't see results!
Great tasting flavour.
4627625756200978201님께서 Sep 14, 2016 에 작성하셨습니다.
Love the sweet tasting strawberry flavour, haven't taken the product long enough to ascertain the effectiveness of this product but the taste is a big bonus! :) Makes eating supplements a whole lot easier with great flavour such as this one.


text:
Aerys: Charm City Yakyuu
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is milli vanilli in?One big difference between the @rock_hall and the @baseballhall: they do not give a single **** here about performance-enhancing drugs.Beat Writer / Columnist
Just another reason I'm glad the Redskins exist! You can't make this stuff up...Washington coach pulls out dong, pees freely before the masses during game [NSFW] https://t.co/N8lgdvgKZ6 https://t.co/zELqnwLrJ1TV / Radio Personality
Death, vape, hate. Awesome.the first three words you see are how your day will be tomorrow. https://t.co/gyPlcx71LKBlogger / Podcaster
DaaaaaaaaaaamnnBowles on Fitzpatrick: "If pissed off is going to stop the turnovers, I'm more than happy to have him play pissed off." #nyjBeat Writer / Columnist
Woo hoo! Join me at Ed Smith Stadium this spring. ?☀⚾ #Birdland #Sarasota365Start planning your next trip to sunny Sarasota, the #Orioles 2017 Spring Training schedule has been released! More… https://t.co/2enlYB0ZeAMascot
#orioles spring training scheduleStart planning your next trip to sunny Sarasota, the #Orioles 2017 Spring Training schedule has been released! More… https://t.co/2enlYB0ZeABeat Writer / Columnist
Former Orioles PR intern in the early 1990s -- some kid named Theo -- discusses eschewing sports writing for anothe…For Theo Epstein, the writing was on the wall for a career choice. My column on the #Cubs president: #WorldSeries https://t.co/SaAzvUt3txBeat Writer / Columnist
Hey, Joe. It's kind of bad.If you've got a right knee injury keeping you out of the game why are you standing on the sideline the entire 2nd half? How bad can it be?Beat Writer / Columnist
This is exciting#Cubs' Kyle Schwarber to DH in @MLBazFallLeague today, fly to Cleveland after the game.Beat Writer / Columnist
from the pennant-winning night (funny, it seemed more crowded to me)Clark and Addison at play ... https://t.co/tbaN7jQki4Beat Writer / Columnist
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This isn't completely over, either. I've been hearing for some time that more charges are pending related to the scandal, and that now appears to be the case. We also have a similar scandal unfolding with the whole Stanford Financial Group mess. And we all know there are many other instances we never hear about of financial advisors either stealing from or mismanaging the money of their clients.Visit the site: <><<<<<'http://eloquencess.blogspot.com/'><<<<<>
How does this relate to SFI


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I was anticipating these types of numbers and they can only go up from here. This is an incredible opportunity but I am reluctant to even post about it as I am in the red but plan to accumulate many more shares over time. The shorts are playing with fire and since they were given insider info on the audit and went overboard They have dug themselves a grave. Let them short is my philosophy because it is apparent that they are unwilling to surrender. For this reason, I advise a slow accumulation for any shareholder thinking of taking a large position. The shorts need to be squeezed out and not scared out. This is to our benefit and we're the beneficiaries to the games that they already begun. I had to laugh by the ridiculous Enron comment brissbnne made. It seems anytime someone makes a comparison to Enron on any message board, there is a group of shorts stuck short. Last time I checked when Enron was in business, they did not have a third of Latin America or North America or even any single country usung their products or services. Tim is a giant and only will grow. With the world cup and Olympics coming to Brazil and Brazilian equities going out of favor with investors for the first time in a few years, now is the time to begin accumulation. Like I said, I should not even be posting this and I think it is better off keeping Tim a secret to the North American readers and investors.... Most of whom do not know Tim from a whole in the wall. Just look at this message board. it may be we are the only two contributors as of late Poppabear. Of course, brissbone is not a contributor but just an idiot representing the hedge funds. Every time I think of them having gone short on this Audit, I get a good chuckle. Who knows, the whole fiasco may even allow them a few more times to scream boo during the process and that would be the time to double up on the accumulative process for longs. I think the hedgies have already realized, if they tried to cover now, they would be unable to for a profit.
I am certainly going to keep an eye on this one to see when they wise up, cover and cut their losses. The longer I stay in stocks, the more I realize that most hedge funds that have had success were spoiled little rich boys that were in the right place and the right time. Their fortunes were made from sheer luck of being in the right place at the right time and having been born with silver spoons in their mouths or having been able to swindle enough people before hand to take advantage of the world plight.
Good luck poppabear, I believe we are both on the right track whether you are still holding or waiting to jump back in as the shorts start Christmas early for us. I will hold my small investment for now at a loss but continue to slowly...very slowly mutiply my number of shares. This investment requires patience and even the little guys who only want to start with a 100 shares can make out very well over time. In fact, for newbies, I would go as far to say, TIM is an excellent risk/ reward stock to begin a portfolio. Don't worry if your investment goes down before it goes up ( most do). This is a long term hold. Come back in 5 or 10 years and I believe you will be more just happy. I have a good friend who bought a few hundred shares of Apple when it fell out of favor back years ago. It was the only stock he ever bought upon my recommendation. Needless to say, his shares of APPL are now worth 1/4 of a million dollars and he still holds while so many people told him to sell. He sat through the splits and refuses to sell and it is still the only equity he owns. I may give him the second tip I ever gave him now and that is ging to be TSU. TSU is a sleeping giant. Let's just hope we can keep the pumpers out of it and quiet. As for the bashers like the Enron character here, I say, knock your brains out. You are welcomed here and I applaud you and encourage you although I will click on the "ignore" feature myself because I can not stomach your stupidity.
Those of you few normal thinking people out there, search CNN for today's story on Tim. The new Yahoo format does not allow for the posting of outside links. Just remember that Tim now has 1/3 of the Latin American population using their services and this number is almost guaranteed to rise with the Olympics and World Cup coming. I would also consider them a very strong candidate to be bought out but at a very hefty price. Good luck!
Sentiment: Hold
Wow, did anyone see that? Within 9 seconds the shorts hacked my message. This is unbelievable. They hacked it with an alias "false". This is incredible! Apparently, someone is going to an awful lot ofexpense to try and discredit TSU longs. I love it! I am more more encouraged than ever now!


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Pulling Tarantino's strings
Tuesday 26 Feb 2013 10:30 p.m.
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Homeless man accused of taking college student's guitarOctober 26,2013Police: Homeless
man stole a guitar
BENNINGTON — A homeless man who told police he had been living in a tent on the campus of Bennington College for the past three weeks pleaded innocent Friday to stealing a guitar from a student.
Shaun A. Gibbens, 22, was arraigned on the felony grand larceny charge in Bennington criminal court. He was released without bail but banned from the college campus.
Bennington Police Cpl. Christopher Lauzon wrote in an affidavit that a student reported Wednesday that his guitar, worth about $2,000, had been stolen.
The next day, the owner of a Bennington music store told police a man brought in a guitar and was asking about its value. Lauzon said he got to the store while Gibbens was there.
Gibbens said he was given the guitar by a woman at a church in North Bennington, the officer wrote. Gibbens told Lauzon he just wanted to get home to Sacramento, Calif., and had come to Bennington to visit his girlfriend, a Bennington College student who knew the guitar's owner.
"Shaun then stated: 'This doesn't look good for me.' I told him I agreed with his statement and provided him with the opportunity to tell me the truth," Lauzon said.
Gibbens then admitted to taking the guitar, the affidavit said.MORE IN This Just InMerchants Bank will merge with a New York-based bank, according to a statement issued Monday on... Full StoryBRATTLEBORO A Wardsboro man who Vermont State Police say shot his neighbor to death last week... Full StoryREADING A thief has made off with five chain saws belonging to the town of Reading, police said. Full Story
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Broom Hilda by Russell Myers
- April 04, 2013
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Very smart fish.
Good morning, LB.
That fish is at the head of his class in school.
Nerwin will forget that in no time.
MARG! Did you lose your shirt at Vegas?
Nope. We went hiking in Red Rock Park, toured the Mob Museum, checked out the Fairmont Street Experience, went to the pawn shop that's on TV, and ate a lot of good meals, no time for gambling.
Pay attention, Nerwin, and learn from a fish!
(—Which, when you think about, is pretty pathetic.)
Hmm… not a great tutor, if he's just giving Nerwin the answer. He should at least ask the kid to identify numerators and denominators, so that he's putting the information to practical use, that'll reinforce it. (Of course, Nerwin may be about to do some homework questions involving exactly that, but we can't tell.)
Cousin of the Babelfish?
I knew this smelt funny!
It makes sense. After all, Nerwin is being schooled.
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Almighty and loving Father,
I thank you for giving St. Gerard to us
as a most appealing model and powerful friend.
By his example,
he showed us how to love and trust You.
You have showered many blessings
on those who call upon him.
For Your greater glory and my welfare,
please grant me the favours
which I ask in his name.
(Mention your needs here...)
And you, my powerful patron,
intercede for me before the throne of God.
Draw near to that throne
and do not leave it until you have been heard.
O good saint,
to you I address my feverent prayers;
graciously accept them
and let me experience in some way
the effects of your powerful intercession.
Four things to know about your candle on Catholic Online:
Holy Michael, the Archangel, defend us in battle. Be our safeguard against the wickedness and snares of the devil. May God rebuke him, we humbly pray; and do you, O Prince of the heavenly host, by the power of God cast into hell Satan and all the evil spirits who wander through the ... continue readingMore Prayer of the Day
In the centuries old Catholic tradition, holy cards or prayer cards are small, devotional cards for the use of the faithful. Prayer cards have an endless amount of use and make wonderful gifts and keepsakes.


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UPDATE-5-30 16- Max and Ellie continue to do well, very friendly and Ellie has had no seizure activity.
Adoption fee is $300.00 for the two of them.
Adoption fee required.
Thank You!
Your message has been sent to Heart of America Poodle & Friends k9 rsq. inc..
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text: In response to a question about how we can be sure the rabies vaccine protects against the deadly zoonotic disease, veterinarian Jeff Kahler explains the immune system response to an injected vaccine. Dr. Kahler points out that titers in blood tests that measure the circulating antibody level are reliable indicators of an individual's immunity toward rabies. Extensive testing has given veterinarians confidence that the rabies virus provides adequate protection. While vaccine failures do occur, Dr. Kahler adds, the failure rate of the rabies vaccine is almost nonexistent.


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20 Crafts with Mason Jars: Wedding Ideas, Centerpieces, Dcor and More
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Adorable DIY Snowflake Centerpiece
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Christmas centerpiece ideas don't get any cuter than this Adorable DIY Snowflake Centerpiece. Although it may be cold outside, set a warm and welcoming table and invite a few guests over for a holiday dinner. No table is complete without a centerpiece, and the Adorable DIY Snowflake Centerpiece is perfect for any table, whether it be a dining room table, kitchen table, or coffee table. Not to mention, it also makes for a great DIY wedding centerpiece, especially for the winter months.
- Martha Stewart Crafts ® 2oz Gloss Opaque Glass Paint - Pool
- Martha Stewart Crafts ® 2oz Gloss Opaque Glass Paint - Wedding Cake
- Martha Stewart Crafts ® 2oz Pearl Opaque Glass Paint - Aquarium
- Martha Stewart Crafts ® 2oz Frost Translucent Glass Paint - Surf
- Martha Stewart Crafts ® 2oz Liquid Fill Transparent Glass Paint - Bluebonnet
- Martha Stewart Crafts ® Glass Silkscreen - Snowflakes
- Four Glass Ball Ornaments
- Apothecary
- Clean glass with alcohol to remove any soap residue.
- Using a Martha Stewart Crafts™ Foam Pouncer, silkscreen the snowflakes in Wedding Cake.
- Add about a quarter size amount of Gloss Opaque Pool inside one glass ball. Shake vigorously until the entire inside is covered. Add more paint if needed. Hang upside down to allow excess paint to drain out.
- Repeat step 3 with Pearl Opaque Aquarium.
- Using the Liquid fill in Blue Bonnet, cover the entire ball by letting the paint drip from the top of ornament and roll down until it is completely covered. Hang to dry.
- Using the Martha Stewart Crafts™ Foam Pouncer, pounce the Frost Transpartent Surf on the outside of ball. Allow to dry.
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Emily Michelle
Sep 09, 2016
Martha does it again. This is so simple yet it looks stunning.
bdtliv 2315379
Sep 01, 2016
Love the jar and ornaments and snowflake. Just my colors and ocean Christmas theme.
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3232 Olentangy River Road, Columbus 43202, Ohio - OH (Estados Unidos) Ver mapa
From Port Columbus International Airport, travel on International Gateway Drive to I-670 west, then to Route 315 North, then to North Broadway/Olentangy River Road. Exit right on Olentangy River Road and the hotel is on the left after approximately 320 m.
All rooms include upgraded amenities such as complimentary high-speed Internet access and an in-room hospitality centre with a microwave, fridge and coffeemaker. Additional amenities include two phones with voicemail and data ports, a large work desk, ergonomic chairs, and complimentary USA Today delivered each weekday morning. All are en suite with a shower, bath and hairdryer. Further in-room amenities include a double or king-size bed, satellite/cable TV, radio, washing machine and an ironing set. The air conditioning and heating are individually regulated.
During their stay, guests can enjoy the indoor swimming pool, hot tub and gym with state-of-the-art equipment.
Actividades y ocio
Información tasas
La tarifa no incluye tasas locales, suplementos ni otros cargos adicionales que el hotel te pueda cobrar; porque los deberás pagar directamente en el destino. A menos de que el hotel indique lo contrario.
Cómo llegar
American Express, MasterCard and VISA are accepted as payment methods.


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Female robber strikes againStaff Report | February 25,2014Vermont State Police responded to a reported armed robbery at Family Dollar in West Rutland Monday night.
According to broadcasts over police broadband radio, a lone female entered the store at around 8:30 p.m. and displayed a handgun.
Officers with police dogs were at the scene, but the information heard on the scanner could not be confirmed with police by deadline Monday night.
Police have said they suspect a female in two other robberies in Rutland County in the past week.MORE IN This Just InPUTNEY A local women told police someone stole $400 in cash from her car. Full StoryThe Raiders had two goals in a span of about five minutes on Tuesday in upending Middlebury 2-1... Full StoryNORTH CLARENDON Often when a No. 3 seed plays a No. Full Story
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After the close today, Affymetrix (ticker: AFFX) said that, "low instrument sales and delays in completing genotyping processing under a services contract," will cause fourth quarter sales to come in $15 million below previous guidance. In addition, the company guided for 15% top-line growth in 2006, which is below the consensus estimate of 23%.
The fourth quarter miss represents the fifth time out of the past six quarters that Affymetrix has announced a financial shortfall. As of today's close, Affymetrix is trading at a 43x forward P/E despite projected earnings growth of 25%, which will obviously come down given the revised guidance. The question is: will this shortfall be the one that finally deflates the perennial optimism?
AFFX 1-yr chart:


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Brookdale Easley is a premiere senior retirement community located in Easley, South Carolina. Our luxurious campus is set on 46 acres just minutes from downtown Easley. Easley is a charming Southern town nestled in the foothills of the Blue Ridge Mountains near shopping, dining, banks and medical...
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Pendleton Manor is located in the downtown area of Greenville, SC and is owned and operated by Schonberg and Associates. It is the oldest, most established Assisted Living in Greenville. Along with the 35 bed assisted living, Pendleton Manor also has a 30 bed secured memory care unit for those...
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A GP For Me is a joint initiative of the Government of BC and Doctors of BC. The program has been launched across the province, with important work being done at the community level by local Divisions of Family Practice.
The provincial A GP for Me initiative aims to:
Made-in-BC research shows that patients who have an ongoing relationship with their family doctor are likely to experience better care because their doctor knows and understands their background and medical history. A GP for Me won't be an instant solution for everyone who is looking for a doctor now. However, over time it will help make family doctors available to more people.
The Richmond Division of Family Practice is a group of 140 Richmond family physicians whose mission is "a medical community that protects, promotes and expands the role of family physicians in caring for their patients". A GP for Me in Richmond aims to:
The Richmond Divisions' approach to meet the goals of A GP for Me is through five interrelated strategies:
For more information about A GP for Me in Richmond, contact:
Marnie Goldenberg
Project Lead - Richmond A GP for Me
A GP for Me Launches in Richmond
One of the main reasons to live in Richmond is access to modern medicine and continuous health care. And while the former is a reality, unfortunately, the latter often isn't. Many people, even those who have lived here for decades, don't have a regular family doctor/general practitioner (GP).
People of all ages are affected by this situation. By having continuous medical care and a history of medical records, health problems may be detected earlier and before they become serious. When people can speak to their regular GP who they are familiar with and trust, it makes a difference. Having a regular GP is essential to addressing long-term health.
This is why the City of Richmond is so enthusiastic about the A GP for Me initiative currently being rolled out by the Richmond Division of Family Practice.
Click here to download the full Council Update
A GP for Me in Richmond looks to improve access to primary care
Richmond, B.C. – The Richmond Division of Family Practice (RDFP) is addressing the general practitioner (GP) shortage in Richmond with the introduction of specific strategies that help more residents find a family physician, and ensure patients continue to receive quality primary care.
The strategies respond to the results of community surveys and consultations, and will be implemented with $1 million in funding from A GP for Me, a joint initiative of the Government of BC and Doctors of BC.
"The Richmond Division of Family Practice's strategies will help to strengthen physician and patient relationships, recruitment and succession planning for physicians, and increase patient capacity in doctor's offices," said Health Minister Terry Lake. "We know that there is more work to be done but Richmond's work is a reflection of how the A GP for Me program is working to meet the health care needs of specific communities across British Columbia."
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|Job Ref:
|Hire Resolve
|Job Type:
|Post Date:
|27/10/2016 02:11
A Marvelous Surgical Center located in Texas is seeking a Registered Nurse. Duties include Ability to establish and maintain effective working relationships with patients, hospital staff, physicians, vendors and the public. Excellent communication and organizational skills, demonstrates accountability, professionalism, openness, receptive to change, creativity and innovative, excellent communication skills, ability to adapt to change quickly, strong knowledge base relative to surgery procedures and management of the surgical patient, and understands principles of aseptic technique and their implementation. Qualifications include a Nursing Degree from an accredited college, one to two years of experience in a PACU setting, BLS Certification, and a current RN License(TX).
Should you meet the requirements for this position, please email your resume to company website or contact Rebecca, Jennifer or Grace at NA
Correspondence will only be conducted with short listed candidates. Should you not hear from us within 3 days, please consider your application unsuccessful.
or email us: NA(at)NA