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Clinical Commissioning Policy: Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma
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1 Clinical Commissioning Policy: Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma Reference: NHS England B03/P/a 1
2 Information Reader Box (IRB) to be inserted on inside front cover for documents of 6 pages and over, with Publications Gateway Reference number assigned after it has been cleared by the Publications Gateway Team. Publications Gateway guidance and the IRB can be found on the Intranet. 2
3 Standard Operating Procedure: NHS England Clinical Commissioning Policy: Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma First published: January 2015 Prepared by NHS England Specialised Services Clinical Reference Group for Specialised Cancer Published by NHS England, in electronic format only. 3
4 Contents Policy Statement... 5 Equality Statement... 5 Plain Language Summary Introduction Definitions Aim and objectives Epidemiology and needs assessment Evidence base Rationale behind the policy statement Criteria for commissioning Patient pathway Governance arrangements Mechanism for funding Audit requirements Documents which have informed this policy Links to other policies Date of review References Version Control Sheet
5 Policy Statement NHS England will not routinely commission cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy for peritoneal mesothelioma because there is inadequate evidence for its clinical and cost-effectiveness. In creating this policy NHS England has reviewed this clinical condition and the options for its treatment. It has considered the place of this treatment in current clinical practice, whether scientific research has shown the treatment to be of benefit to patients, (including how any benefit is balanced against possible risks) and whether its use represents the best use of NHS resources. This policy document outlines the arrangements for funding of this treatment for the population in England. Equality Statement Throughout the production of this document, due regard has been given to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited in under the Equality Act 2010) and those who do not share it. Plain Language Summary Peritoneal mesothelioma is a form of cancer affecting the lining of the stomach (the peritoneum). It is caused by the ingestion of asbestos fibers and has a rapid and fatal course. This is because the early symptoms of peritoneal mesothelioma are similar to those of other gastrointestinal illnesses. As a result, diagnosis is often delayed and occurs at an advanced stage of disease (when it has spread throughout the stomach). If left untreated, survival rarely exceeds a year. Cytoreduction surgery (CRS), also referred to as de-bulking surgery, aims to remove as much of the tumour as possible. When the technique is used in patients with peritoneal mesothelioma, the surgery involves many surgical procedures and treatment can take a long time. The surgery can also be carried out along with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) treatment. HIPEC is used in patients who have cancers of the abdomen. This involves using a high dose of chemotherapy which aims to kill any remaining cancer cells left after a cytoreduction surgery. HIPEC is a heated and sterilized chemotherapy treatment. 5
6 1. Introduction Background Mesothelioma is a rare, usually aggressive, form of cancer that principally affects the serosal surfaces of the pleura (70%), peritoneum (30%) and, in a small proportion of cases, the tunica vaginalis of the testis or pericardium (1-2%). It is strongly associated with exposure to asbestos. Peritoneal mesothelioma (also referred to as malignant peritoneal mesothelioma, peritoneal malignant mesothelioma, malignant primary peritoneal mesothelioma and abdominal mesothelioma) usually has a rapidly fatal course. Because the early symptoms may mimic those of a benign ailment of the gastrointestinal tract, diagnosis is often delayed, occurring at an advanced stage of disease when it has spread throughout the peritoneal cavity. If left untreated, survival rarely exceeds a year. There are three main histological types of malignant peritoneal mesothelioma: epitheliod, sarcomatoid and biphasic (or mixed). Epitheliod mesothelioma is the most common type seen in around 75-80% of patients; the biphasic subtype shows a mixture of both epitheloid and sarcomatoid features and is seen in about 20-25% of patients. The pure sarcomatoid subtype is rare. Distinction between these morphologic subtypes is important because patients with pure epithelial mesotheliomas have a better prognosis than do those with sarcomatous or mixed/biphasic tumours (Levy et al. 2008). Tumours can also be classified according to whether they are diffuse or localized, which gives rise to different clinical presentations. Patients with diffuse peritoneal malignant mesotheliomas commonly experience abdominal pain, abdominal distension or ascites, nausea, anorexia, and weight loss. Gastrointestinal complications such as bowel and renal obstruction may occur with advanced disease. Patients with localized peritoneal malignant mesotheliomas may complain of localized abdominal pain or a palpable abdominal or pelvic mass. Symptoms can be very severe and difficult to manage clinically. Prognosis is generally better with localised than with diffuse tumours (Levy et al. 2008). Other rarer varieties of mesothelial neoplasm affecting the peritoneum include benign adenomatoid tumour and tumours on the borderline between benign and malignant such as well-differentiated papillary mesothelioma and multicystic mesothelioma, both of which commonly arise from the pelvic surfaces of the peritoneum and mostly occur in women. Well-differentiated papillary mesothelioma is rare and has no reported link with exposure to asbestos. The tumour is often discovered incidentally during pelvic examination or surgery. It has a good prognosis and is either cured with complete surgical resection or follows an indolent course with long survival. Multicystic mesothelioma (also referred to as peritoneal inclusion cyst, multilocular inclusion cyst, and benign multicystic mesothelioma) is an unusual, multilocular cystic tumour. It is thought to develop as a result of peritoneal reactive proliferation secondary to previous intra-abdominal surgery, infection, trauma or endometriosis (Chua, et al. 2011). It follows a benign or indolent course in most patients, but can recur locally and, in rare cases, may show malignant transformation (Levy et al. 2008). The clinical presentation and radiological findings (CT, US and MRI) of peritoneal 6
7 mesothelioma can often mimic those of psuedomyxoma peritonei, and histological analysis may not be available until after surgery, or may be equivocal Treatment Treatment options for peritoneal mesothelioma were previously limited to systemic chemotherapy, palliative (de-bulking) surgery, and palliative/supportive care including repeated paracentesis and drainage of ascites and, in a few patients, abdominal radiation. In practice relatively few patients undergo palliative surgical treatments, due to the nature and extent of the tumour and the technical expertise required in de-bulking. More recently, treatment of peritoneal surface malignancies has evolved to include the more aggressive combination of cytoreductive surgery and peri-operative intraperitoneal chemotherapy. This combined technique was first developed in the 1980s by Paul Sugarbaker at the Washington Cancer Institute, USA, with the intention of providing a curative treatment for peritoneal surface malignancies. In most cases this radical procedure is not appropriate, and careful patient selection is important. Cytoreduction surgery (CRS) (also referred to as cytoreductive surgery) is performed under general anaesthetic via laparotomy. The aim of CRS is to remove all visible (macroscopic) tumour. The scope of surgery will depend on the spread of visible tumour in each case. When used in patients with peritoneal mesothelioma, the surgery involves up to six peritonectomy procedures (greater and lesser omentectomies, right and left upper quadrant peritonectomies, and anterior parietal and pelvic peritonectomies) together with resection of involved non-essential organs as required. Whilst the aim of CRS is to remove all macroscopic tumour, microscopic and residual macroscopic tumour may be left behind. To treat any residual tumour, on completion of the CRS, the abdomen is perfused with chemotherapy solution, heated to between 40 and 43 C for 60 to 120 minutes, which is then drained from the abdomen prior to closure. Intraoperative intraperitoneal administration of chemotherapy (usually referred to as hyperthermic intraperitoneal chemotherapy or HIPEC) allows the drug to be distributed uniformly to all surfaces of the abdomen and pelvis. Heating the perfusion fluid is thought to increase its therapeutic effect by increasing drug penetration and the cytotoxic effect of the drugs used. A further course of systemic or intraperitoneal chemotherapy, referred to as early postoperative intraperitoneal chemotherapy (EPIC), may be administered at normal temperature, for up to five days following surgery. Different centres vary in the surgical technique they use (whether closed, open or semi-closed) and in the chemotherapy protocols (in terms of technique, drugs used, carriers, timing and temperature). 2. Definitions Peritoneum or peritoneal membrane is the continuous connective tissue membrane that covers the walls of the abdominal cavity, and the organs within it. Peritoneal cavity is the space within the continuous membrane (peritoneum) that covers the walls of the abdominal cavity and the organs within it. 7
8 Peritoneal Mesothelioma (also referred to as malignant peritoneal mesothelioma, peritoneal malignant mesothelioma, malignant primary peritoneal mesothelioma and abdominal mesothelioma is a rare, usually aggressive, form of cancer affecting the serosal (inner) surface of the peritoneum Peritonectomy is the surgical removal of areas of the peritoneum. Cytoreduction surgery (CRS) involves removal of the maximum amount of the visible (macroscopic) tumour through a series of peritonectomy procedures, and removal or resection of involved non-essential organs as required. The exact scope of the surgery is dependent on the spread of the visible tumour in each patient. Hyperthermic intraperitoneal chemotherapy involves flushing the abdominal cavity with a chemotherapy agent. This can be performed either as an open (intraoperative) or closed procedure. The therapeutic aim is to achieve a high local concentration of chemotherapy in the peritoneal cavity in order to kill any residual tumour cells. Heating the chemotherapy agent increases its therapeutic effect by improving penetration of the tissue. 3. Aim and objectives The aim of this policy is to set out the commissioning policy of NHS England with respect to cytoreductive surgery and hyperthermic peritoneal chemotherapy. The objectives are to: Summarise the published evidence pertaining to the clinical and costeffectiveness of CRS in peritoneal mesothelioma and its clinical sub-groups. Explain the rationale for the NHS England commissioning position. 4. Epidemiology and needs assessment Mesothelioma has a strong association with exposure to asbestos. In men, asbestos exposure has been shown to be the cause in 90% of pleural malignant mesotheliomas and 60% of peritoneal malignant mesotheliomas (Chua et al. 2009). Peritoneal malignant mesothelioma usually develops in individuals exposed to higher levels of asbestos. In women, asbestos exposure plays a smaller role in the development of malignant mesothelioma; less than a quarter of women who develop peritoneal malignant mesothelioma have been exposed to asbestos (Levy et al. 2008). Other aetiological factors implicated in the development of malignant mesothelioma include exposure to therapeutic irradiation, erionite (a mineral fibre found in Turkey), simian virus 40 and, rarely, chronic pleural or peritoneal irritation. Malignant mesothelioma occasionally occurs in young patients with no exposure history. Most malignant mesotheliomas occur in men, with a median age at presentation of 60 years. In women, peritoneal malignant mesothelioma occurs in a slightly younger age group (mean age, 50 years) and, in general, has a better prognosis. Incidence 8
9 Peritoneal mesothelioma was once extremely rare but has shown an increasing incidence worldwide following the vast mining of asbestos, which peaked in the 1970s (Chua et al. 2009). In 2009, the number of reported new diagnoses of peritoneal mesothelioma in England, based on cancer registry data, was 2209 (1832 men, 377 women), equivalent to an age-standardised annual incidence of 9.29 per 100,000 population for men and 1.54 per 100,000 population for women (Public Health England, 2014). Mortality In 2011, there were almost 2,300 deaths from mesothelioma (including peritoneal mesothelioma) of which around 85% were in men, and 15% in women. Based on the latest projections, the annual number of deaths from mesothelioma in the UK is expected to continue to rise in future years before peaking at around 2,500 per year towards the end of this decade. Most deaths occurring now are a consequence of the long latency period (i.e. the time between initial exposure to asbestos and symptom onset) which is typically between 20 and 30 years for peritoneal mesothelioma, and somewhat shorter than the latency period for pleural mesothelioma of years (Boffetta, 2007). Survival The median survival of untreated malignant peritoneal mesothelioma is reported to be around 6 months (Turner et al. 2012). Treatment with palliative surgery and/or systemic/intraperitoneal chemotherapy is associated with a median survival of around 12 months to two years (Baratti et al. 2013, Baratti et al. 2011). Biphasic/sarcomatoid histology, lymph-node involvement, and diffuse tumours, as opposed to localized, are reported to be associated with a poorer prognosis (Baratti et al. 2013). Women appear to have a more favourable prognosis than men. Suggested reasons for this difference include differing aetiology and causative factors, differing histology, and earlier presentation of the disease amongst women (Yan et al. 2007). Activity and cost Between 1998 and October 2013, 44 patients with peritoneal mesothelioma underwent the procedure, with approximate average referrals of 5 cases per year. The rate of referrals to the service is reported to have increased recently, and this has resulted in an increase of surgical intervention to around 6-8 cases per year. This activity is currently funded through Individual Funding Requests (IFR), and based on an expected average of 8 cases per year, the total cost of CRS plus HIPEC for patients with peritoneal mesothelioma in England, at a cost per case of 57k, is estimated as 456k per year. 5. Evidence base Clinical effectiveness The review found one well-conducted systematic review of prospective nonrandomised uncontrolled observational studies, two more recently published retrospective uncontrolled observational studies, and one ongoing study of CRS plus HIPEC in patients with malignant peritoneal mesothelioma. Median overall 9
10 survival in the systematic review studies ranged from 29.5 to 92 months; median survival in the two more recently published studies was within the same range (38.4 and 63.2 months). In one small retrospective uncontrolled observational study of 26 patients with multicystic peritoneal mesothelioma receiving the intervention, median follow up was 54 months; all patients were still alive at the time of the study. A NICE overview of studies investigating the use of CRS and HIPEC in peritoneal carcinomatosis included one uncontrolled case series for which median survival was reported as 27.1 months for the 27 patients with peritoneal mesothelioma as the primary tumour of origin. A second more recently published retrospective uncontrolled cohort study was found which reported median survival of 41 months for 88 patients with peritoneal carcinomatosis arising from peritoneal mesothelioma. Since all of the studies identified in this report were uncontrolled case series, their findings are of very limited value in determining the clinical effectiveness of the intervention in the treatment of either localized or diffuse peritoneal mesothelioma. The patients included in these studies were those deemed clinical suitable for radical surgery, and therefore not representative of all patients with the condition. These limitations mean that no clear conclusions can be drawn as to the magnitude of any survival advantage associated with the procedure. Cost-effectiveness The review identified one cost-effectiveness study of CRS plus HIPEC in the treatment of 136 patients with peritoneal carcinomatosis, 15 of whom had peritoneal mesothelioma as the primary tumour. For patients with peritoneal mesothelioma as the primary tumour of origin, median survival was 49 months, average health care costs per patient were 55,062 Australian dollars (range 23,261 to 94,104), equivalent to around 30k (range 13k to 53k) and average cost per life year gained was 20,521 Australian dollars, equivalent to around 11.5k. Although the study considered key health care costs associated with the intervention, its findings were based on a very small sample of patients with peritoneal mesothelioma with advanced disease in the form of peritoneal carcinomatosis. There was no comparator group receiving standard treatment against which costs and survival outcomes of the intervention could be compared, there was no sensitivity analysis around the estimated cost per life year gained, and transferability of results to the NHS is difficult to assess. Safety In the systematic review of CRS plus HIPEC in patients with all-type or diffuse malignant peritoneal mesothelioma, overall operative mortality was 3.1% (ranging from 0 to 10.5% in individual case series). Morbidity ranged from 20 to 41% and reoperation rates from 4 to 42%. Median and mean lengths of hospital stay ranged from 7 to 33 days and 24 to 41.5 days respectively. 6. Rationale behind the policy statement There is insufficient evidence to support routine commissioning of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for peritoneal mesothelioma, based on the current published research. 10
11 7. Criteria for commissioning Not applicable. 8. Patient pathway Not applicable. 9. Governance arrangements Not applicable. 10. Mechanism for funding CRS will not routinely be funded for peritoneal mesothelioma. 11. Audit requirements Not applicable. 12. Documents which have informed this policy Cytoreductive surgery in the treatment of peritoneal mesothelioma. 2014: Solutions for Public Health (Greater East Midlands Commissioning Support Unit) Links to other policies This policy follows the principles set out in the ethical framework that govern the commissioning of NHS healthcare and those policies dealing with the approach to experimental treatments and processes for the management of individual funding requests (IFR). 14. Date of review This policy will be reviewed in 2016/17, unless information is received which indicates that the proposed review date should be brought forward or delayed. 11
12 References Cytoreductive surgery in the treatment of peritoneal mesothelioma. 2014: Solutions for Public Health (Greater East Midlands Commissioning Support Unit). Levy AD, Arnaiz J, Shaw JC et al. From the archives of the AFIP: primary peritoneal tumours:imaging features with pathologic correlation. Radiographics 2008; 28(2): Chua TC, Yan TD, Deraco M et al. Multi-institutional experience of diffuse intra-abdominal multicystic peritoneal mesothelioma. Brit J Surg 2011; 98(1): NICE Interventional Procedures Guidance IPG 331. Cytoreduction surgery followed by hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis. NICE Feb 2010, London. Chua TC, Yan TD, Morris DL. Surgical biology for the clinician: peritoneal mesothelioma: current understanding and management. Can J Surg 2009; 52: Health and Safety executive. Mesothelioma in Great Britain 2013: Mesothelioma mortality in Great Britain HSE Accessed at Boffetta P. Epidemiology of peritoneal mesothelioma: a review. Annals of Oncology 2007; 18: Turner K, Varghese S, Alexander HR Jr. Current concepts in the evaluation and treatment of patients with diffuse malignant peritoneal mesothelioma. J Natl Compr Canc Netw. 2012; 10: Baratti D, Kusamura S, Cabras AD et al. Diffuse malignant peritoneal mesothelioma: Long-term survival with complete cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC). Eur J Cancer 2013; 49: Baratti D, Kusamura S, Deraco M. Diffuse malignant peritoneal mesothelioma: systematic review of clinical management and biological research. J Surg Oncol 2011; 103: Yan TD, Welch L, Black D et al. A systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for diffuse malignancy peritoneal mesothelioma. Annals of oncology: official journal of the European Society for Medical Oncology/ESMO. 2007; 18(5): Alexander HR Jr, Bartlett DL, Pingpank JF et al. Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma. Surgery 2013; 153(6): Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 1996; 82:
13 NICE Interventional Procedures Programme IP 256/2. Interventional procedure overview of cytoreduction surgery followed by hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis. NICE May 2009, London. Levine EA, Stewart JH, Russell GB et al. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: experience with 501 procedures [erratum appears in J Am Coll Surg Oct;205(4):630]. J Am Coll Surg 2007; 204: Glehen O, Gilly FN, Boutitie F et al. Toward curative treatment of peritoneal carcinomatosis from non-ovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional stufy of 1,290 patients. Cancer 2010; 116(24): Chua TC, Martin S, Saxena A et al. Evaluation of the cost effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (peritonectomy) at the St George Hospital peritoneal surface malignancy programme. Annals of surgery 2010; 251(2): Tentes AAK, Pallas N, Korakianitis O et al. The cost of cytoreductive surgery and perioperative intraperitoneal chemotherapy in the treatment of peritoneal malignancy in one Greek institute. Journal of BUON. 2012; 17(4): Version Control Sheet Version Section/Para/Appendix Version/Description of Amendments Date Author/Amended by 1 Whole document First draft June 2014 SN 2 Whole document Placed in new template Sept 2014 NMc 3 Plain Language Summary Addition of text / final edit Sept 2014 NMc
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Guest post by Dave McClow.Fatherlessness has become an epidemic in our society: 43% of our kids grow up without fathers (US Census), approaching a catastrophe rivaling the 1918 flu pandemic when an estimated 56% of the world was infected. Fatherlessness is devastating—legally, morally, psychologically, and spiritually. A shocking snapshot of our fatherless youth shows they comprise 63% of youth suicides (US Dept. Of Health/Census)–5 times the average; 90% of all homeless and runaway child … [Read more...]
St. Joseph: Our Father? – Part 1
Kids on My Mind: Parenting Changes Dad's Brain!
We've known for quite a while that parenthood facilitates changes in mom's brain that help her be more nurturing. It turns out that being a hands-on parent changes dad's brain too!"Our findings add to the evidence that fathers, and not just mothers, undergo hormonal changes that are likely to facilitate increased empathy and motivation to care for their children," said lead author Dr. James Rilling, an Emory University anthropologist and director of the Laboratory for Darwinian Neur … [Read more...]
A Different Kind of Fatherhood for All Men?
A guest blog by Pastoral Solutions Institute pastoral counseling associate, Dave McClow, M.Div., LISW, LMFT.The Ultimate Challenge, at least in this column, is about men and faith. But today I will use an example of a fictional female character to illustrate a different kind of fatherhood.C.S. Lewis' The Great Divorce tells the story of a man from hell who takes a bus tour of Heaven. He sees some "bright Spirits." Amongst them is a lady surrounded by musicians, and boys and girls singin … [Read more...]
Soccer and the Sacred Heart: The Rhythm of Spiritual Fatherhood
A guest post by Pastoral Solutions Institute Associate Pastoral Counselor, Dave McClow, M.Div., LMFT.June is the month of the Sacred Heart of Jesus. Father's day also falls within the month, and spiritual fatherhood ties these two together.The human heart always operates in two directions—the muscle contracts and then relaxes. If this rhythm is disrupted, you have earned a trip to either the ER or the undertaker. There is also a rhythm of Catholic fatherhood—the rhythm of loving, then … [Read more...]
A Crisis In Catholic Fatherhood
A recent caller to my radio program said that she and her husband weren't on the same spiritual level. He didn't go to mass or pray with her. He zoned out when she talked about the faith. As a result, her children were starting to buck her efforts to form them in the faith. The problem, as she saw it, was that "he's a convert so it just isn't reasonable for me to expect him to be in the same place that I am." Thinking that he might be a recent convert, I was hopeful that there might be some p … [Read more...]
Pope Francis: The Heart of Spiritual Fathers
A guest post by Pastoral Solutions Institute Clinical Pastoral Counselor, Dave McClow, M.Div, LMFT.Cardinal Kasper thinks that "heroism is not for the average Christian." Can you hear Jesus say, "Be mediocre, as your heavenly Father is mediocre"? Or, "If it is hard to do, don't bother picking up your cross"? Or, "Lay down your life if it's convenient"? I don't think sooo…. Men need to be challenged! They need to be loved, but they definitely need to be challenged to live a heroic lif … [Read more...]
On St. Joseph's Feast Day, 15 Reasons Dads Matter (#15 Will Shock You!)
St. Joseph is the Patron of Fathers and in honor St Joseph's Feast Day today (March 19th), I thought it would be good to take some time to remind us all how important dads are. Check out these great dad facts! (Teaser: I saved the most surprising fact for last!)1. Fathers' interaction with babies (engaging in cognitively stimulating activities, emotional warmth, physical care) reduced their infants' chances of experiencing cognitive delay2. Children whose fathers are involved in rear … [Read more...]
The Prodigal Father: Benedict XVI on Fathering
Check out this great post on Catholic fatherhood by Dave McClow. Dave works for me as a clinical pastoral counseling associate with the Pastoral Solutions Institute's Tele-Counseling Practice. He has some great insights. I hope you enjoy!The "prodigal father" is the story of our time. It is the story of fatherlessness in our families. Pope Emeritus Benedict XVI is and has always been highly aware of the crisis of fatherhood and its implications for society (see my previous blog). He know … [Read more...]

subset: commoncrawl


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Download The Way:Card Drinking Game apk 1.1 free for Android smartphone
Posted by Neo064 in Card | Feb. 25, 2013 | 0 Comments
Apk file size: 935.0 KB
The Dixit is a perfect card drinking game when partying with some friends.
The principle is simple : the game is made of 4 rows of cards. You start by picking a card from the top or bottom row, then you pick one from the next row, etc. until you pick a card from the last row.
If one picked card is a jack, a queen, a king or an ace you have to drink and start over otherwise you let the next player play.
Jack = 1 sip
Queen = 2 sips
King = 3 sips
Ace = Bottoms up
Enjoy responsibly.
To report a bug or suggest a new functionality, contact me at : [email protected]
Whats new
Rules modification (Ace rule "easier")
New screen describing the rules
Neo064 part of our Card and have average installs from 100 to 500. Last Update Feb. 25, 2013. Google play rating is 88.0. Current verison is 1.1. Actual size 935.0 KB.
Similar applications
550+ Card Games Solitaire Pack2633 Comments


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Arunagiri Hotel, Tirunelveli
59B, Madurai Road Junction, Near Old Bus Stand,
Ranked 39 amongst 55 hotels in Tirunelveli
Arunagiri Hotel Reviews (6)
"Good location but not so good hotel"
This hotel is located close to the Tirunelveli railway station, but otherwise it is just average compared to other good hotels nearby. Looks old and definitely needs lot of maintenance and renovation. The room service was also just average. The management can try to improve the hotel given that its location is an advantage.
"Stay was good but I am not satisfied "
The stay in Arunagiri hotel was good and trip was in the month of December 2014 for relaxation purpose with my family. It is located in the city so it was easy to locate. Staff behavior in the hotel was good. There was no restaurant facility in the hotel. However, I was not satisfied in the hotel. I will not recommend the hotel for other travelers.
"Excellent location with good accommodation "
I once went to this hotel with my family for a vacation and party. This is an excellent location for family stay. It is provided with good service and accommodation. It is also a good friend of your wallet. I am also satisfied with the location for easy travel.
"Average quality hotel; not recommeded"
This hotel is located near Tirunelveli junction, on the busy Madhurai road. This is just an average quality hotel, more suited for solo travellers. Not suitable for family travellers. The maintenance and room service needs lot of improvement. The rooms look very old and dirty. Not a recommended option.
"Good food and location; Average front office"
Front office need improvement, room service is not standard but the destination is very beautiful, city upon the mounted valley and sea distance is about 1 hour. Journey by road and the location of the hotel is in prime location of the city and the food provided by the hotel is very nice.
"Location of hotel is very very good near bus stand"
Front office need improvement, room service not standard, but the Destination is very beautiful, city upon the mounted valley and sea distance also near about 1 hrs. journey by road, "Trichandur", location of hotel is very very good near bus stand and railways junctions,
Are you the business owner of Arunagiri Hotel, Tirunelveli ?
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Hurry up and claim your property now!Manage your listing > Get more reviews for your property >


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"To have another language is to posses a second soul."
– Charlemagne
We offer numerous foreign language and art classes that are taught by a highly educated faculty.
Classes are designed to meet the needs of various age groups.
The unique learning materials we use are highly equipped tools that are aimed toward improving the language skills of diverse groups.
We offer high standard educational classes for major business employees
Our Business Purpose classes are designed to accommodate the needs of participating companies by providing lessons at the existing company location(s).
One-on-one conversation classes are offered.
Private tutoring classes are available upon request.
Our classrooms are immaculately designed to provide a calm, yet enjoyable atmosphere.
Why study a foreign language?
Learning a foreign language at any age enriches a child's mental and social development.
Foreign language programs have managed to demonstrate greater cognitive development, creativity, and divergent thinking in their students.
Likewise, the study of foreign languages increases one's ability to communicate and develop a deeper understanding of their own and of other cultures.
Knowing a foreign language is beneficial, as it offers a wide pool of employment opportunities for numerous careers including: writer, translator, teacher, foreign correspondent, court interpreter, international police officer, receptionist, secretary, sales personnel, airport personnel, airline flight attendant, tourist guide, travel agent, interviewer, and in all international businesses.


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As usual, Rosie O'Donnell has been getting her ass handed to her on The View. Most recently, it was over the notorious "torture report." She butted heads with the show's resident conservative, Nicole Wallace, formerly of the Bush White House.
Wallace was working in the White House on September 11, 2001. She described the horrific events which followed the terrorist attacks and defended the CIA's response. "The last three days I've been asked about this a lot in this job and in my other job at MSNBC and I have never had more people call me and thank me for defending the men and women of the CIA who were simply doing their jobs," Wallace remarked.
Her opinion was admirable, well-informed and shared by the majority of Americans, as the CIA was trying to prevent further attacks on the American people, which were likely planned in the coming days after the World Trade Center was taken down.
O'Donnell, instead of keeping her big mouth shut, decided to add her unsolicited two cents. "And I've never had so many people call me to say thank you for saying the other point," vomited the overweight liberal.
"But I have never been more proud to defend the people who walk the line for this country and this city and the city in which I worked, the city where my mom and dad lived," Wallace concluded. She called the release of the controversial report "traumatic" for "the men and women who were simply doing their jobs."
Reports indicate that O'Donnell will soon be canned from The View, thanks to her own idiocy and the general fact that most viewers can't stand her. As Wounded American Warrior points out, perhaps she'd fit in better as a production assistant for Al Sharpton's MSNBC gig.
Share this report if you think Rosie O'Donnell has outstayed her welcome on network TV!
(Read More: Rosie O'Donnell Will Be Fired For Radical Liberal Views)


text: Renovated in 2004, this hotel features 6 floors in the main building and 4 in the neighbouring building with a total of 32 rooms. An inviting lobby awaits guests with a lift and a reception. Furthermore, there is a public Internet terminal on offer, as well as room, laundry and medical services. Those arriving by car may make use of the hotel car park.The rooms are designed in a Mexican style and include a private bathroom, a hairdryer, a direct dial telephone, satellite/ cable TV, Internet access and a kitchenette with a fridge. There is also heating and a balcony or terrace in each room.


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Welcome to AmeriPay
Thank you for visiting the home page of AmeriPay. Our comprehensive services for the distressed debt industry are available at competitive rates. Please contact your account executive directly to add services to your existing client account.
AmeriPay's services are generally provided to our existing client base and via existing client referrals. If you are not a client of AmeriPay you may use the Contact Us form to obtain more information regarding our services.
AmeriPay is your one-stop center for services for the debt-purchasing, sales and recovery industry. Our mission is to assist debt buyers and sellers with support services to simplify your company's operations and allow you to do what you do best: RECOVER MONEY!
AmeriPay's primary business is the purchase and compliant outsourcing of distressed debt for our own account. We require that every agency be licensed in every US State and Territory. Our in-house compliance team verifies every license, bond and insurance policy of our network agencies as they come up for renewal, conducts scheduled and unscheduled site visits at our agencies annually and we remotely monitor their agent's recovery efforts to ensure that every account we purchase is serviced to the highest industry ethical standards. AmeriPay does not resell debt once purchased. Since 2011 AmeriPay Corporation's portfolio has grown to over $1.75 billion unpaid principal outstanding across nearly a million individual consumer accounts.
Our comprehensive list of services includes:
Corporate Headquarters:1621 Central AvenueCheyenne, Wyoming 82001Telephone: (307) 509-0689Administrative Offices:5300 Westview Drive, Suite 108Frederick, Maryland 21703Telephone: (301) 898-2377


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Blue Mountain Hickory Collection
Made for Big and Wide People! Are you looking for a porch rocker that is built with plenty of room for an up-sized body? No more squeezing into small porch rockers – we have the Big and Wide Hickory Porch Rocker that you've been looking for!
Our Amish made hickory wood porch rockers are handcrafted in the USA.
This sturdy, durable and comfortable Big and Wide Hickory Porch Rocker will make an excellent addition to your home.
Relax in style and comfort in this beautiful Amish Hickory Rocker. It will be an heirloom rocking chair in your family, passed on from generation to generation.
The Big and Wide Hickory Porch Rocker usually ships in 5-7 weeks.
Questions? Call DutchCrafters at 866-272-6773 to speak with a friendly furniture specialist who will be happy to help you.
© Copyrights 2003 - 2017 DutchCrafters All rights reserved.


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Tumka Flint J – DJ Shadow MP3 Song, Video | Lyrics
Complete Music Information :
Song Name: Tumka
Singers: Flint J,Kay T
Song Cast: Flint J,Kay T, DJ Shadow
Track Duration: 3:12
Music Director: Atif Ali, DJ Shadow
Lyricist: K Khan
Movie/Album: Tumka – Single
Complete Lyrics,MP3 Video – Given Below
Tumka – Flint J – DJ Shadow Video
About Tumka Video : Flint J – DJ Shadow is Back with New Song Named "Tumka" Flint J,Kay T are the singers for Tumka Single. Video of Tumka is Live Now. Tumka From Flint J – DJ Shadow MP3 Full Song is Here. Complete Video detail is Given Above. Download the Complete Mp3 Song ITunes Rip and Lyrics here. Music is Given by Atif Ali, DJ Shadow.
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Tumka Flint J – DJ Shadow : Complete Song Lyrics
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white caker song download now xkuk full file
Publisher's Description
Title: white caker song
Languages: Multiple languages
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03/18/2015 00:33:12
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User rating:
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4/12/2006 · Average White Band - Cut The Cake (Live At Sinbad'S Summer Jam)Cake is a form of bread or bread-like food. In its modern forms, it is typically a sweet baked dessert. In its oldest forms, cakes were normally fried breads or ...Cake Shop is one of New York City's premier independent music venues for breaking talent. It's all done seven nights a week, features cafe comforts and a well-curated ...4/23/2007 · cover and songThis white chocolate wedding cake is a chocoholic's dream! For this recipe you'll need a 23cm/9in round cake tin and board and a 15cm/6in round cake tin and board.Cake Shop is one of New York City's premier independent music venues for breaking talent. It's all done seven nights a week, features cafe comforts and a well-curated ...White Mehron StarBlend cake makeup; 2 oz in size; Fade and perspiration resistant; Non-streaking; Highly pigmented makeup is best applied with a dry smoothie blenderAmazon.com: CakeSupplyShop Packaged Elegant White Tiered Wedding Cake Step Decoration Stair: Industrial & ScientificBuy Verbatim DataLifePlus 4.7GB 8X DVD+R White Inkjet Printable, Hub Printable 50 Packs Cake Box Disc at Walmart.comA white wedding is a traditional formal or semi-formal wedding originating in Britain. The term originates from the white colour of the wedding dress, which first ...
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Rugby Shirt Drogue
79.95€ VAT included
- very soft cotton
- print and embroidery on the chest
- large vintage print on the back
Color : Navy
This product is currently not available.
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Sporty rugby shirt made of comfortable, soft cotton. Perfect for creating casual nautical looks in the warmer months.


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Middlebury Furniture Collection
Gather around your TV for a movie marathon, a super-charged video game tournament or your favorite TV program with our Amish Centennial TV Stand with Four Doors and Two Drawers to help host the evening!
This superior piece of solid wood furniture offers a spacious display surface for your TV, roomy cabinets for storage and lengthy drawers to help keep your DVDs, CDs, video games, remotes, game controls, books, puzzles and photo albums organized and at your fingertips.
Keep your coffee table free from clutter and avoid drilling into smooth walls for TV mounts. The Amish Centennial combines style and function, resulting in a piece that is gorgeous to look at and serves many purposes to store and display your collections.
Consider our Amish Misson Style Corner TV Stand for another option.
© Copyrights 2003 - 2017 DutchCrafters All rights reserved.


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January 6th, 2016
Alster Magazin presents Marcia:Bloom in an article, No. 12/ 2015, page 32!
January 2nd, 2016
Thank you Kobi Zarco for presenting Marcia:Bloom on Radio Lev Hamedina 91 FM, Israel!
October 18th, 2015
We are honoured to perform at Grindelhof 30 in Hamburg, Germany
August 19th, 2014
Marcia:Bloom on Galil Radio 105,3 FM, Israel
July 25th, 2015
We are honoured to perform at the Workers' Music Festival in Valkeakoski, Finland. Venue: Valkeakoski, Puu-Sali Stage, 8:30 pm
November 20th, 2014
Marcia:Bloom's production partner "AUDIX" microphones has put one of our pictures showing Petra Schechter in their product catalogue for 2015! We are flattered and proud to be in the company of "TOWER OF POWER", "Alanis Morissette", and others...!!! Thanx to Matthias Höbeler @ TRIUS-Vertrieb Germany
June 23rd, 2014
Our Video "Los Bilbilikos" is out now!!!
June 19th, 2014
Zeit Online concert announcement/article for cd release
June 13th, 2014
Our EPK is out now!!!
June 10th, 2014
Check out our new videos here, or on youtube.
June 8th, 2014
The CD is now for sale in our neighborhood: rad-core, Brüsseler Str. 46, 13353 Berlin
Thank you guys!
June 4th, 2014
Our new CD has just arrived and is now for sale - you can order via eMail: firstname.lastname@example.com
June 19th, 2014
Live premiere of our new production 'ladino soul', Venue: Mojo Club - Jazz Café, Reeperbahn 1, 20359 Hamburg, St. Pauli
April 2014
Listen to Marcia:Bloom on Soundcloud: www.soundcloud.com/marciabloom
April 2nd & 3rd, 2014
CD mix in Hanover
March 2014
Additional recording in Hamburg and Berlin
February 10th - 14th, 2014
CD Recording in Hanover
February 3rd - 6th, 2014
Marcia:Bloom in Toledo


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Question: Selected accounts for Heather s Salon are presented below All June
Selected accounts for Heather's Salon are presented below. All June 30 postings are from closing entries.
(a) Prepare the closing entries that were made.
(b) Post the closing entries to IncomeSummary.
View Solution:
(a) Prepare the closing entries that were made.
(b) Post the closing entries to IncomeSummary.
View Solution:
Answer to relevant QuestionsAndrew Clark Company discovered the following errors made in January 2014.1. A payment of Salaries and Wages Expense of $700 was debited to Equipment and credited to Cash, both for $700.2. A collection of $1,000 from a ...Reblin Company pays salaries of $12,000 every Monday for the preceding 5-day week (Monday through Friday). Assume December 31 falls on a Tuesday, so Reblin's employees have worked 2 days without being paid.Instructions(a) ...Dao Vang, CPA, was retained by Universal Cable to prepare financial statements for April 2014. Vang accumulated all the ledger balances per Universal's records and found the following.Dao Vang reviewed the records and ...Kristin Malone opened Kristin's Maids Cleaning Service on July 1, 2014. During July, the company completed the following transactions.July 1 Invested $14,000 cash in the business.1 Purchased a used truck for $10,000, ...J. Brownlee Company purchased equipment for $18,000. By the current balance sheet date, $6,000 had been depreciated. Indicate the balance sheet presentation of the data.
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Once the village is handed over the process of fitting out the new apartments, which involves the installation of 16,000 beds, 64,000 sheets and 21,000 pillows, begins.
The village will be able to house up to 16,000 athletes and team officials during the Games and 6,200 athletes and team officials during the Paralympics, all from 200 countries around the world.
After the Games are over it is hoped the village will create a legacy of 2,818 new homes across 11 individual plots in a new community dubbed the 'East Village'.
Over one thousand of the homes have been purchased by Triathlon Homes who intend to provide affordable housing. The remaining properties will become private housing after being purchased by a consortium that includes the Qatar Diar real estate investment company.
Locog chair Seb Coe said Games bosses are hoping to make the village feel like a "home from home" for the visiting athletes. "Athletes are at the heart of the London 2012 Games and our plans for the Olympic Village will provide them with a home-from-home as they prepare for one of the biggest sporting moments of their lives," he said.
"With the Village now handed over we are starting the huge process to install essential facilities and services ready to welcome competitors from around the world in 6 months' time."
The work still to be done on the village includes:
- • Installation of 9,000 wardrobes and more than 170,000 coat hangers
• Installation of 1,000 sofas, 5,000 bins and 5,000 toilet brushes
• Equipping each apartment with a television and Wi-Fi services
• Constructing the temporary 24-hour main dining facility with 5,000 seats
• Building the Olympic Village Plaza – the main 'social hub' of the Village with essential shops and services for athletes and guests
• Constructing the Welcome Centre, the initial arrival point for athletes and officials to be officially accredited for the London 2012 Games
• Installing exercise equipment to create a state-of-the art athlete gym in Chobham Academy
Locog will reveal details about the scale of delivering the London 2012 opening and closing ceremonies today. However, artistic director Danny Boyle and executive producer Stephen Daldry are unlikely to give too much away in a bid to ensure the multi-million pound ceremonies remain a surprise.
Individuals who passed their auditions for places in the ceremonies have been informed this week, with organisers taking costume measurements and telling them whether they are dancing or drumming.
The deadline to accept conditional offers of places has now passed but 900 East End youngsters have been given the chance to get involved.
The 7-13-year-olds, who all hail from schools in six east London Olympic host boroughs, will be part of large-scale choreography, as well as dance routines.
Meanwhile, it was announced that a two-day cycling festival will be the first large scale event at the Olympic Park when it reopens after London 2012.
The August 2013 London Cycling Festival will begin with up to 70,000 cyclists taking part in a family fun ride on an eight-mile loop of closed roads.
The next day 35,000 riders will tackle a 100-mile course from Stratford to Surrey. Mayor of London Boris Johnson hailed the initiative and said: "This spectacular event will help ensure that the 2012 Games are just the start, not the end of the benefits of hosting the Olympics."


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The proportion of people needing lung cancer treatment is likely to fall by nearly a fifth over the next 20 years, scientists have claimed.
Experts at Cancer Research UK believe that anti-smoking measures have played an important role in reducing the rate of lung cancer.
Smoking causes around nine in ten cases of lung cancer, so as smoking rates continue to fall, so should rates of the disease.
However, the overall number of people diagnosed with lung cancer is likely to continue to rise as people are living for longer and the disease can take years to develop.
Report co-author Professor Max Parkin said: "These predictions are based on what we know to date about the current figures and trends for lung cancer. We can see that lung cancer rates should continue to drop but the number of cases will increase."
The expert noted that the increase will mostly affect women, reflecting the high rates of female smokers in the 1970s.
At present, around 38,500 people are diagnosed with lung cancer every year in the UK, making the disease the second most common cancer.


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Yevgeny Plushchenko, the silver medalist at the world championships, landed a quadruple and seven triples today to win his second consecutive Russian figure skating championship. He beat the world champion, Aleksei Yagudin, who failed on a quadruple toe loop.
Plushchenko performed a quadruple-triple-double, the only skater in the world to do such a combination.
''I landed it first in Japan during practice preparations for the triple-triple,'' Plushchenko said. ''I liked it, and I decided to keep it.''
He received straight 5.9's for presentation and had six technical 5.9's.
Yagudin performed seven triples but had several rough landings, along with doubling his quad attempt.Continue reading the main story


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Program includes Beethoven, Mozart and Bartok
During the past nine years, the Cypress String Quartet
has gained a reputation for its bold programming,
educational outreach and dedication to performing both
contemporary and traditional classical music. Hailed as a
Generation X Ensemble to Watch by Chamber
Music Magazine, the San Francisco-based quartet has
performed all over the country, collaborating with
contemporary composers and participating in public
seminars with Isaac Stern and the Amadeus Quartet.
The quartet has also been praised for its educational
contributions as a Quartet-in-Residence at the Banff
Centre for the Arts and San Jose University and outreach
programs for high school students in New Mexico, Los
Angeles, Philadelphia and Chicago. In 2004, the ensemble
was awarded the McGraw-Hill Companies Robert
Sherman Award for Music Education and Community Outreach.
Tickets for the April 1 concert, part of the Silver
Series, are $20 for adults, $19 for seniors, $10 for
youth and $5 for PSU students. Tickets can be purchased
at the Silver Cultural Arts Center Box Office by
calling (603) 535-ARTS or visiting www.plymouth.edu/cac.


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I love shooting roadside attractions and things that make you laugh or go "WTF" lol. I also like moody, dramatic, almost horror like images. I guess that makes me kind of a retro/rockabilly/goth kind of lomo girl I don't know. Then there's the architecture, the landscapes, the travel images. I feel the need to shoot every hotel in Vegas and the insides so it can be brochure-like. I'll be at a roadside oddity and want to capture the same image in b/w, cross process and with different cameras.
I'm interested in doing portrait work but afraid to ask people to do it for me. I feel like I'm intruding when I get in their faces with a camera. How does one go about this "shooting shyness" as I call it?
Candid street photography is something I feel I could be good at, but when people stare at me with a camera and ask me to go away or not take pictures it's pretty depressing. Anyone else have this experience? Discuss.
written by sthomas68 on 2011-07-04


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Sep 8 - 14, 2008
Balochistan is endowed with a large number of metallic and non-metallic minerals. The rising prices of minerals like coal, chromite, copper, lead and zinc in the world metal market has brought the mineral rich province in the radar screen of foreign investors. The province's near term growth potential exists with commercial exploitation of Saindak copper and gold deposits and the possible future exploitation of Reko Diq copper deposits in Chagai and Duddar zinc-lead deposit in Lasbela district.
Balochistan's strategic copper and gold assets have attracted interests of foreign investors who have purchased stakes in copper projects during the last five-year period. The Chagai district is expected to become a hub for the metallic mineral mining industry in the next five years. Saindak and Reko Diq projects can make Pakistan one of the major producer and exporter of copper in the world. The country can save a huge amount, which is spent on the import of minerals each year. It can earn a large foreign exchange by exporting minerals, and its products. The key issues related to the development of mineral sector in the province include the policy issue, lack of infrastructure and law and order problem.
Balochistan mineral sector needs to be developed for attracting international investment particularly in metallic minerals and coal related energy projects in the province. The federal government has mainly been responsible for mineral sector promotion and co-ordination across federal, provincial, and local governments. However, the results are still below expectations mostly due to relatively slow implementation of the National Mineral Policy (NMP). What is really needed is to implement the NMP that was formulated in 1995 with an aim to bring reforms in the sector. The NMP decentralized licensing, regulatory, oversight functions, and taxation to provincial governments to achieve efficiencies and promote local economic development.
As per revised mineral policy, the basic geological data would be generated and disseminated through print and electronic media and project profiles of world class mineral resources would be published in well-reputed mining magazines. Accelerated geological mapping and geo-chemical exploration of high mineral potential areas in Balochistan would assist understanding the genesis and geometry of these deposits for the subsequent development. Last year, the government had earmarked Rs 326 million for mineral sector. Major projects to be carried out r included the ground follow-up aero-magnetic anomalies in Chagai district at a cost Rs 35 million, upgradation of geo-science advance research laboratories of Geological Survey of Pakistan (GSP) in Islamabad at a cost of Rs 70.180 million.
Government should first collect maximum valid resource data on minerals in the province. This resource data can be collected by carrying out a detailed exploration of the minerals, which will quantify the reserves. It is deplorable that even mineral reserves of many ores have not yet been categorized. The mineral reserves of all the ores found in the province must duly be categorized as 'measured', 'indicated' and 'inferred'. The funds should be allocated the purpose. The provincial mining concession rules, which fail to meet international standards, must be abolished. The inadequacies of these rules created uncertainty decelerating the pace of development in the sector. Another reason for negligible growth in the sector has been the lack of knowledge of the mineral potential of the province
The mining districts in the province essentially lack the facilities like electricity, gas and water, which have plagued timely development and commissioning of mines. The exploration of underground water potential of the area is essential for carrying out any mining project. Chagai is faced with acute shortage of water. Like the Saindak project, the expected mining operations in Reko Diq will depend on sub-surface water. To overcome the shortage of water, there is a dire need to explore and develop underground water potential of the mining areas in Balochistan.
The government may establish Export Processing Zones (EPZs) in different districts of Balochistan where mining and production activities are underway. The utilization of EPZ facilities by foreign companies would bring foreign investment in mineral sector. There are other indirect benefits of establishing EPZ such as income from taxation, development of rural areas, infrastructure and support industries and poverty alleviation.
What has happened to the export-oriented mining projects in Balochistan is a shocking story. The Saindak copper project was abruptly closed after trial production in 1995. The latest example of the cancellation of the Gulf Minerals' licence may be cited in this regard. Gulf Minerals, a Dubai-based company is set to wind up its mining operations at Sonmiani in Lasbela district. The company had started the project of the minerals sand with an investment of $199 million. This particular project is 100 percent export-oriented with minimum export of Rs 500 million per year. US$200 million mineral sands project around Sonmiani was aimed at exploring zircon, garnet, hematite, rutile and other iron-associated minerals. The company had been engaged in setting up export-oriented mineral exploration and allied facilities in the proximity of Sonmiani area. Former Balochistan government had issued a notification to the company in which the official exploration lease had been withdrawn due to the strategic importance of the area. The initiative had not only created uncertainty among foreign companies interested in the exploration of minerals in the province but it also sent a discouraging signal to the potential investors.
No foreign investment can be allured as long as the province remains in the state of turmoil. Many foreign mining firms have closed their operations due to the security reasons in the province. Though discovered some 35 years back, the Chamalang coal mines could not be exploited due to security reasons. The Luni and Marri tribes had been at war over the ownership of the mines during the last three decades. This tribal rivalry had not only hampered mining activities in the area but also caused human casualties. Resultantly, the coal reserves remain untapped. As result of peace moves on both sides under official patronage, the two tribes entered into an agreement to revive the mining operations in the area. The government must try to resolve the security problem amicably through a peace truce with the tribal jirga and stop military operation in the province.


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NEWS FROM THE FRONT is your daily wrap-up of conservative and Tea Party news. ConservativeHQ.com is a community of principled, constitutional conservatives. For media inquiries, contact Bob Sturm or Ryan Rogge at (703) 392-7676.
click this link.
Quin Hillyer: Let's Try a Better Response (to the Arizona Tragedy)
American Spectator - Quin Hillyer wonders why Americans couldn't react to the Arizona shootings more like we did after 9/11, and says we should "reboot" our attitudes in order to rediscover the better angels of our nature.
Brent Bozell: Left Exploiting Arizona Rampage to 'Criminalize' Conservatives
Newsmax - Conservative media watcher Brent Bozell says the Left is exploiting the Arizona tragedy to score political points. Bozell thinks it's an active campaign on behalf of the Left to stifle and ultimately criminalize conservative speech.
Pat Buchanan: Arizona Shooting is Just the Latest Attempt to Blame Conservatives for the World's Problems - Human Events
Poll of Conservatives Shows Support for Broad Cuts to Spending, Including Military Spending - Daily Caller
GOP Appropriations Cardinals Hint Earmarks May Return - The Hill
Texas Tea Party Leader Takes Her Fight to the Capitol - Dallas Morning News
GOP is Looking Strong as States Begin Redistricting Process - Washington Times
Joseph Farah on the Prospect of a Michele Bachmann Presidential Run - World Net Daily
Feulner: GOP Must Fight for the Filibuster - Washington Times
Rep. Peter King (R-NY) Joins NYC Mayor Bloomberg in Call for More Gun Control - Daily Caller
Tim Pawlenty Clarifies his Remark on Sarah Palin and Arizona - Hot Air
Rep. Clyburn Uses Shooting to Push Fairness Doctrine - Outside the Beltway
Budget Crisis Opens Door for Conservative School Reform - Wall Street Journal
U.S. Chamber Vows War Against Government's "Regulatory Tsunami" - Daily Caller
CHQ Poll Results: Majority of Conservative Activists Disagree with DeLay Prison Sentence
Adam Cassandra - Poll finds that only 26% of respondents think DeLay "got what he deserved."
CHQ POLLS (Please join the CHQ community to vote ):
The Daily Debate: Do you agree with Rep. Peter King (R-NY) that government should restrict handgun possession within 1,000 feet of "certain high-profile government officials?"
Recurring Monthly Poll: Who will win the 2012 GOP presidential nomination? Vote in the monthly CHQ Straw Poll ( Cast a new vote each month!)
CHQ January Poll: Which do you think should be the major focus of the new Congress?
To read these and other articles, and to vote in the CHQ polls, click this link.
Richard Viguerie


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SEAN BELGRADE NAMED VICE PRESIDENT OF MARKETING SPEEDWAY ANNOUNCES ADDITIONAL ORGANIZATIONAL CHANGES DAYTONA BEACH, Fla. -- Daytona International Speedway President Joie Chitwood III today announced the following organizational ...
DAYTONA BEACH, Fla. -- Daytona International Speedway President Joie Chitwood III today announced the following organizational changes effective immediately:
* Sean Belgrade was named Vice President of Marketing. Belgrade is the former Managing Director of Consumer Marketing for International Speedway Corporation ("ISC"), parent company of Daytona International Speedway. In his new role, Belgrade will oversee all aspects of marketing, ticketing, public relations and guest services for The World Center of Racing. He will report to Chitwood.
* Lenny Santiago was named Director of Public Relations for the speedway. Formerly the Director of Marketing Communications for ISC, Santiago will lead Daytona's public relations team which includes Manager of Media Relations Andrew Booth, as well as the speedway's credential department led by Director of Media Services Donna Freismuth. In addition, Santiago will continue to manage select corporate communications initiatives for ISC.
* Julie Giese, Daytona's former Director of Communications, has been named Director of Marketing. Giese will be responsible for developing and executing the speedway's marketing initiatives, leading a team that includes Joann Mantovani, Manager of Advertising and Promotion, and Jason Lucas, Manager of Consumer Marketing.
* Mike Scheer was named Senior Financial Analyst for Daytona International Speedway. Sheer was formerly a Senior Financial Analyst with ISC. In his new role, Sheer will be responsible for various financial analyses including return on investment, cash flow, multi-year financial modeling, budgeting, and other financial functions.
"I'm thrilled to have an executive of Sean's caliber to lead our marketing efforts heading into the 53rd DAYTONA 500 and beyond," stated Chitwood. "In addition, our new structure better aligns the key elements of our organization to ensure we provide our fans the best possible experience both during events and all year round. I believe we have an outstanding team of professionals and look forward to their immediate contributions to the continued success of Daytona International Speedway."
-source: dis