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ABSTRACT: Squamous cell carcinomas of the head and neck are highly responsive to induction chemotherapy. However, randomized trials have failed to demonstrate a survival advantage with the addition of induction chemotherapy to locoregional therapy consisting of surgery and/or radiation therapy. Currently, concomitant radiation and chemotherapy has emerged as a standard and has optimized locoregional control in head and neck cancer. In this setting, the addition of induction chemotherapy may further improve outcome by enhancing both locoregional and distant control. As interest in induction regimens is renewed, we elected to conduct a systematic review of trials of induction chemotherapy for locoregionally advanced head and neck cancer. The most studied combination— cisplatin(Drug information on cisplatin) plus fluorouracil(Drug information on fluorouracil) (5-FU)—achieves objective response rates of about 80%. In a meta-analysis, induction with platinum/ 5-FU resulted in a small survival advantage over locoregional therapy alone. The introduction of a taxane into induction chemotherapy regimens has produced promising results. Induction chemotherapy should be the subject of further clinical research in head and neck cancer. Randomized clinical trials in which the control arm is concurrent chemoradiotherapy and the experimental arm is induction chemotherapy followed by concurrent chemoradiotherapy are planned. Platinum/taxane combinations are the preferred regimens for further study in the induction setting and a suitable platform with which to investigate the addition of novel targeted agents.
Head and neck cancer affects about 39,000 persons and results in 11,000 deaths annually in the United States.[1] Patients with head and neck cancer commonly have locoregionally advanced disease at presentation, which is associated with a poor long-term outcome: Traditional treatment with surgery and/ or radiation produces a 5-year survival rate of 40% or less.[2] Historically, disease recurrence has been predominantly locoregional, whereas distant failure occurs in 20% to 30% of patients. The use of chemotherapy has been introduced with a binary objective- to achieve organ preservation and improve survival. Indeed, in recent years, chemotherapy has been successfully employed in a variety of clinical settings and has established an integral role in the curative management of locoregionally advanced head and neck squamous cell carcinoma. The timing of chemotherapy in this setting can be either (1) prior to locoregional therapy (ie, induction, neoadjuvant, or preoperative), (2) concurrent with definitive radiation therapy, or (3) after locoregional therapy with or without concomitant radiation therapy (ie, adjuvant or postoperative). Currently, the data strongly support the use of chemotherapy concurrently with radiation therapy either as primary therapy or in the postoperative setting. Concurrent chemoradiotherapy has become the standard nonsurgical treatment for locoregionally advanced head and neck cancer. However, the optimal chemotherapeutics for use concurrently with radiation to treat head and neck cancer have not yet been determined. A favored regimen, supported by results of cooperative group randomized trials in the United States, is cisplatin at 100 mg/m2 every 3 weeks during conventional fractionation radiation. In unresectable disease and nasopharyngeal cancer, a survival advantage was demonstrated with the use of the above regimen over radiotherapy alone,[3,4] whereas in laryngeal cancer, concurrent chemoradiotherapy with cisplatin resulted in a higher rate of organ preservation.[5] Finally, the combination of cisplatin and radiation therapy was superior to radiation therapy alone after a potentially curative surgical resection.[6,7] In addition to single-agent cisplatin, a number of combination chemotherapy regimens, predominantly platinum/fluorouracil (5-FU), have been studied concurrently with radiation and produced superior results over radiation alone in randomized trials.[8]
Induction Chemotherapy: Rationale and Controversy
Squamous cell carcinomas of the head and neck are highly responsive to induction chemotherapy. A complete response (CR) to induction chemotherapy, and especially a pathologic CR, is predictive of improved survival.[9-13] It is reasonable to hypothesize that induction chemotherapy can improve patient outcome by downstaging the primary tumor and eradicating locoregional and distant micrometastases. Nevertheless, with a few notable exceptions, multiple randomized trials conducted in the 1980s and 1990s that used standard locoregional therapy- surgery and/or radiation-as a control failed to demonstrate that the addition of induction chemotherapy to locoregional treatment results in survival benefit.[14,15] In several of these studies, the addition of induction chemotherapy decreased the rate of distant metastasis, which usually did not translate into a survival benefit. Moreover, a deleterious effect on survival from induction chemotherapy was suggested in some studies.[16,17] Domenge et al reported the only positive trial, a study that enrolled 318 patients with locally advanced oropharyngeal cancer.[18] Disease-free survival was improved in the induction chemotherapy arm, but the difference did not reach statistical significance (P = .11); however, overall survival was superior in the induction chemotherapy arm (P < .05).[18] A study by Paccagnella et al, comparing induction chemotherapy with cisplatin/ 5-FU followed by surgery and/ or radiation, showed a survival benefit for induction therapy but only in patients with unresectable tumors.[19] In a meta-analysis by Pignon et al, when all induction chemotherapy studies were examined together, there was no survival benefit with induction chemotherapy.[ 20] However, when the subset of trials with cisplatin (or carboplatin(Drug information on carboplatin)) plus 5-FU was examined, a small (3%) but statistically significant improvement in survival was observed with the addition of induction chemotherapy (hazard ratio [HR] = 0.88, 95% confidence interval [CI] = 0.79-0.97). Nevertheless, the superior treatment was concomitant delivery of chemotherapy and radiation, which resulted in a meaningful survival benefit of 8% at 5 years (HR = 0.81, 95% CI = 0.76-0.88). A number of studies have directly compared induction chemotherapy followed by single-modality radiotherapy to concurrent chemoradiotherapy.[5,21] A study by Taylor et al showed that concurrent therapy on an alternate-week schedule produced better disease control than induction chemotherapy followed by radiation.[21] Furthermore, Forastiere et al reported that locoregional control and laryngeal preservation rates were superior with concurrent vs sequential chemotherapy and radiation.[ 5] Therefore, concurrent chemoradiotherapy has emerged as the preferred treatment strategy for locally advanced head and neck cancer. However, it is unknown whether induction chemotherapy would be of benefit when the primary therapy is concurrent chemoradiotherapy. When the patterns of failure in randomized trials of concurrent chemotherapy and radiation vs radiation alone were analyzed, it was evident that the survival benefit was most likely a result of improved locoregional control.[8] More recently, phase II studies have reported that high rates of local control approaching 90% can be achieved with intensive chemoradiotherapy regimens.[22,23] A reversal of the historical pattern of relapse (ie, local more common than distant) was observed, with a predominance of distant failure.[24] In that context, eradication of distant micrometastasis that is potentially achievable with induction chemotherapy may become critical. In conclusion, the potential role of induction chemotherapy in improving the survival of patients treated with concurrent chemoradiotherapy needs to be revisited. We conducted a review of the activity and toxicity profile of various induction chemotherapy regimens. The review of these clinical trials may assist in the identification of the most efficacious regimens for use in future trials of induction chemotherapy.
We performed a computerized search of Cancerlit, Medline, and American Society of Clinical Oncology website databases in order to identify phase II and III clinical studies of induction chemotherapy for locoregionally advanced head and neck cancer. Trials in the English literature that included previously untreated patients with locoregionally advanced squamous cell cancer of the head and neck were selected and included in this review. We recorded the objective response rates, pathologic response rates (when reported), and toxicities of the regimens. Survival data were primarily reviewed in randomized trials. It should also be noted that most studies included heterogeneous patient populations usually without eligibility restrictions by site or resectability. Moreover, there were significant differences in the methods used to assess and report objective response rates between trials. Although survival end points may be relevant to the efficacy of induction chemotherapy regimens,[ 25] subsequent locoregional therapy is a major confounding factor. Therefore, we elected to use objective response rates as a surrogate of chemotherapy efficacy, acknowledging the limitations of this assumption.
Differences in Response Among Head and Neck Sites
Some reports have suggested differences in chemotherapy responsiveness among squamous cell carcinomas that arise from different head and neck sites. Nasopharyngeal cancer may be different biologically and appears to be the most chemotherapy-responsive head and neck tumor.[26-33] Separate clinical trials of induction chemotherapy for nasopharyngeal cancer are warranted. The oral cavity was shown to be a less responsive site in one study,[34] but contradicting results have also been reported.[35] A recent trial reported an objective response rate of 82% in the primary tumor among patients with resectable oral cavity squamous cell carcinoma.[36] Limited experience has been reported for other less common sites of head and neck cancer[37] such as the paranasal sinuses, but it is likely that squamous cell carcinomas arising from these sites and other more common sites are equally chemotherapy responsive. In this review, the studies examined mainly enrolled patients with tumors affecting four major primary sites: oral cavity, oropharynx, hypopharynx, and larynx.
Optimal Number of Treatment Cycles
Although no randomized trial data have suggested an optimal number of chemotherapy cycles in this setting, it is widely accepted that two to four cycles are optimal as induction therapy.Studies with cisplatin and 5-FU have shown that the response rate is higher with three vs two cycles,[38,39] whereas a plateau may be reached after three cycles.[14] Di Blasio et al observed no further increase in the rate of objective response with the extension of induction chemotherapy to five cycles; however, there the CR rate improved (see Table 1).[14]
Shin et al reported that the rate of complete response to carboplatin/ ifosfamide(Drug information on ifosfamide)/paclitaxel at the primary sites increased from 23% after two cycles to 60% after four cycles.[40] Moreover, the Department of Veterans Affairs (VA) laryngeal cancer study and the European Organization for Research and Treatment of Cancer (EORTC) trial in resectable laryngeal and hypopharyngeal cancers, respectively,[41,42] as well as other randomized trials[36] have employed three cycles of induction chemotherapy with cisplatin and 5-FU. Finally, a recent phase III, randomized EORTC trial in patients with unresectable head and neck cancer incorporated four cycles of induction chemotherapy in both arms-cisplatin/5-FU/docetaxel [Taxotere] or cisplatin/5-FU (Figure 1).[43]
Activity of Combination Regimens
Cisplatin and 5-FU
Cisplatin and 5-FU have been the most commonly used agents in the induction chemotherapy of head and neck cancer.[44] When these agents are combined, standard doses are cisplatin at 100 mg/m2 on day 1 and 5-FU at 1,000 mg/m2/d as a continuous infusion for 5 days, repeated every 3 weeks. This dosing schedule was proven to be superior to cisplatin plus bolus 5-FU in a small randomized study performed at Wayne State University.[ 45] In this study of 42 patients with locally advanced head and neck cancer, both the overall objective response rate (72% vs 20%) and the CR rate (22% vs 10%) were significantly higher for the continuous infusion vs bolus 5-FU treatment arm. Toxicities were also less pronounced in the continuous-infusion arm except for mucositis, which was usually mild in severity and tolerable. Multiple phase II and III trials using PF (cisplatin [Platinol]/5-FU) as induction therapy for locally advanced head and neck cancer have been conducted (Table 2).[5,9,14-17,19,34,36,38,41,43, 46-57] Older studies[54,56,57] utilized clinical/endoscopic evaluation of response only, but more recent studies[ 5,16,48] routinely employed computed tomography (CT) in addition to endoscopy. The OR and CR rates achieved in 24 trials with cisplatin/ 5-FU ranged from 54% to 94% (mean: 80%) and 7% to 66% (mean: 32%), respectively. Pathologic CR rates, which were reported in a minority of studies, ranged between 22% and 33%.[36,46,51,53,54] Toxicities observed in four large trials of induction chemotherapy with the standard cisplatin/5-FU regimen are listed in Table 3.[15,34,38,52-57] The toxic death rate during induction cisplatin/ 5-FU is low, ie, 3% or less.[9,36]
Carboplatin and 5-FU
Carboplatin was introduced as a safer but potentially equally efficacious agent to cisplatin for the treatment of head and neck cancer. However, the combination of carboplatin and 5-FU (CF) was shown to be inferior to PF in the recurrent or metastatic disease setting.[ 61] In the induction setting, a number of phase II trials as well as a phase III trial of CF have been conducted (Table 4).[48,58-60]
CF was compared with PF in a randomized trial conducted in Spain.[48] De Andres et al randomized 96 patients with stage IV squamous cell carcinoma of the head and neck to receive either CF or standard PF. The study was terminated at interim analysis, when superiority of the control arm was demonstrated. The overall response rate (ORR) was higher in the PF arm (92% vs 76%). Moreover, the 5-year disease-specific survival rate (49% vs 25%, P = .03) and 5-year disease-free survival rate (47% vs 24%, P = .02) were significantly better in the PF arm. Differences in the toxicity profile were also noted. Hematologic toxicity predominated in the CF arm, whereas mucositis and nausea/vomiting were more frequently seen with PF. In conclusion, CF should be considered an inferior regimen. However, carboplatin may be substituted for cisplatin in cases of intolerable cisplatin-associated toxicity.
Cisplatin/5-FU Plus Leucovorin
The modulation of 5-FU was a topic of intense research in the 1980s and 1990s. Many phase II clinical studies investigated the efficacy of standard PF when leucovorin was added to the regimen (PFL); leucovorin was administered in various formulations in these studies (Table 5).[62-66] The mean ORR in these five phase II clinical trials of PFL was 78%, with a mean clinical CR rate of 37%. A major downside of PFL was that it results in high rates of severe mucositis (14% to 41%)-higher than what is expected with standard PF-which suggests 5-FU modulation by leucovorin in the normal mucosa.[62-66] Clark et al reported that 27% of patients developed grade 3/4 stomatitis in the first PFL cycle, with a significant percentage of patients requiring hospital admission for severe stomatitis with dehydration,[62] whereas Vokes et al observed that 14% of patients developed grade 3 mucositis, which in some cases was of very early onset, occurring during the first 5 days of the 5-FU infusion.[ 63] Other authors reported that 36% to 41% of patients developed grade 3 or 4 mucositis.[64-66]
Thus, although no randomized trial has compared PFL to PF in the setting of induction chemotherapy for head and neck cancer, the added benefit provided by leucovorin seems to be negligible. Moreover, the toxicities added to the regimen may be considerable. Finally, two phase II trials conducted by groups in Chicago studied the addition of interferon alfa-2b(Drug information on interferon alfa-2b) (Intron-A) to PFL.[67,68] The combination was highly active, resulting in clinical CRs in 51% to 66% of patients. Despite its high activity, PFL/ interferon alfa-2b had an unfavorable toxicity profile, with high rates of severe mucositis (52%-54%) and myelosuppression.[ 67,68]
Cisplatin/Bleomycin-Based Regimens
Cisplatin/bleomycin-based combinations have been extensively studied for the treatment of head and neck cancer. As induction chemotherapy, cisplatin plus bleomycin(Drug information on bleomycin) (PB) demonstrated ORRs of 48% to 70% and CR rates of 0% to 17%.[69,70] The Head and Neck Contracts Program (HNCP) trial randomized patients with stage III/IV resectable head and neck cancer to one of three arms: (1) one cycle of induction chemotherapy with PB followed by standard therapy (surgery and postoperative radiotherapy); (2) induction chemotherapy with PB and standard therapy followed by maintenance chemotherapy, which consisted of six cycles of monthly cisplatin; or (3) standard therapy alone.[71] The ORR observed with one cycle of PB in the HNCP study was low-37%, with a 3% CR rate-and there was no survival advantage with the use of chemotherapy. Toxicities associated with PB included nausea/vomiting (grade 3/4 vomiting in 25%), bleomycin-related rash (grade 3 in 2%), mucositis (grade 3 in 1%), neutropenia, and anemia. Other investigators evaluated the addition of methotrexate(Drug information on methotrexate) to PB with or without leucovorin; we identified four trials in which these regimens yielded ORRs between 58% and 77% (mean: 68%) and CR rates of 9% to 26% (mean: 20%).[12,72-74] In two other studies of PB-containing combinations, the incorporation of vincristine resulted in an ORR of 79% and a CR rate of 29%,[38] whereas the addition of vindesine(Drug information on vindesine) plus mitomycin(Drug information on mitomycin) produced an ORR of 50%, a 10% CR rate in the primary site, 27% ORR, and 9% response rate in the lymph nodes.[75] Weaver et al reported lower rates of CR for two cycles of PB plus vincristine vs three cycles of standard PF (29% vs 54%, P = .04) in a nonrandomized comparison.[38]
Finally, Schuller and colleagues randomized 158 patients with locoregionally advanced head and neck cancer to receive surgery plus radiation with or without induction chemotherapy consisting of three courses of PB plus vincristine and methotrexate.[76] These investigators reported an ORR of 70% and a CR rate of 19%. However, there was no statistically significant difference in survival between the two treatment arms.[76] In conclusion, PB and multiagent PB-based regimens do not optimize antitumor activity in the induction setting. Currently, the use of bleomycin is exceedingly rare for the treatment of patients with head and neck cancer.
Platinum-Plus-Taxane Combination Regimens
The combination of a platinum (carboplatin or cisplatin) and a taxane (paclitaxel or docetaxel(Drug information on docetaxel)) has shown marked antitumor activity in head and neck cancer. A potential advantage of the platinum-plus-taxane combination is that the incidence of stomatitis seen with it is less than what is observed when 5-FU is part of the induction regimen, which may decrease complications of subsequent radiotherapy.
• Platinum and Paclitaxel(Drug information on paclitaxel)—Carboplatin and paclitaxel is well tolerated and active as induction chemotherapy in patients with head and neck cancer. In seven clinical trials (Table 6),[77- 83] the ORR ranged from 66% to 89% (mean: 82%) and CR rates from 13% to 48% (mean: 30%). Although every-3-week administration of carboplatin and paclitaxel is common, weekly regimens with very promising antitumor activity have also been studied by groups at the University of Chicago[78,79] and Brown University.[ 77] Potential severe toxicities with carboplatin and paclitaxel include febrile neutropenia (~5%), thrombocytopenia, neuropathy, hypersensitive reactions, and myalgias/arthralgias. The Minnie Pearl Cancer Research Network conducted a phase II trial that evaluated the addition of continuousinfusion 5-FU to carboplatin/paclitaxel as induction chemotherapy for locally advanced head and neck cancer in a multicenter, community-based setting.[ 84] Induction chemotherapy consisted of paclitaxel at 200 mg/m2 and carboplatin at an area under the concentration- time curve [AUC] of 6, both administered on days 1 and repeated on day 22, and 5-FU at 225 mg/m2/d as a 24-hour continuous intravenous infusion on days 1 to 43. This was fol- lowed 1 to 3 weeks later by radiation to 68.4 Gy plus concurrent paclitaxel at 50 mg/m2 and carboplatin at an AUC of 2, given weekly for six doses. A total of 123 patients were enrolled in the study, the majority of whom had oropharyngeal (41%), laryngeal (18%), or nasopharyngeal (15%) primaries. In 119 evaluable patients, the ORR was 70% (CRs noted in 9%).[84] With a median follow-up of 24 months, the 3-year progression-free and overall survival rates were 53% and 51%, respectively. Toxicities with the induction regimen included mucositis (grade 3/4: 12%) and neutropenia (grade 4: 8%), and 24% of patients required hospitalization for treatmentrelated complications. Subsequent chemoradiotherapy was feasible, but radiation dose omissions and delays were necessary: 58% of patients received the planned radiation dose, and 61% of patients received all six planned doses of weekly carboplatin and paclitaxel with the radiation. During concurrent chemoradiotherapy, 11% of patients experienced grade 3/ 4 radiation dermatitis, and 75% of patients developed grade 3/4 mucositis, whereas 23% required enteral or parenteral alimentation for more than 6 months. Myelosuppression was infrequent; 4% of patients developed grade 3/4 neutropenia. Overall, this study showed that aggressive induction chemotherapy followed by concurrent chemoradiotherapy can be delivered in the community setting. Efficacy results were promising. Surprisingly, there is a paucity of induction trials with cisplatin and paclitaxel. This combination was studied in a phase I/II trial in head and neck cancer by Hitt et al.[85] Twenty-eight patients with locally advanced, unresectable squamous cell head and neck cancer received cisplatin at 75 mg/m2 plus paclitaxel at 175 to 300 mg/m2 for the first cycle with intrapatient dose escalation, repeated every 21 days for three cycles. Patients receiving paclitaxel doses of 200 mg/m2 and above received granulocyte colony-stimulating factor (G-CSF [Neupogen]) support. In 27 evaluable patients, the ORR was 78% and the CR rate was 48%. Despite increased dose intensity, the regimen was relatively well tolerated without dose-limiting hematologic toxicities. Four patients developed grade 3 myalgias.[55]
• Cisplatin/5-FU/Paclitaxel—Hitt et al investigated the triple combination of cisplatin/5-FU/paclitaxel as induction chemotherapy in head and neck cancer.[86] In this phase II trial conducted in Spain, 70 patients with locally advanced squamous cell head and neck cancer, 60% of whom had unresectable disease, were treated with pac-litaxel, 175 mg/m2 as a 3-hour infusion on day 1; cisplatin, 100 mg/m2 on day 2; and 5-FU, 500 to 750 mg/m2/d as a 24-hour continuous infusion on days 2 to 6, repeated every 3 weeks for a total of three cycles, followed by surgery and/or radiation therapy. In 43 patients, weekly paclitaxel was given concurrently with radiation. The 5-FU dose was reduced from 750 to 500 mg/m2/d due to the excessive toxicity, mainly mucositis and neutropenic sepsis, observed in the first 14 patients enrolled. A total of 70 patients were enrolled, 90% of whom received all three cycles of induction. Major toxicities of cisplatin/5-FU/paclitaxel in patients treated at the lower 5-FU dose included grade 3/4 neutropenia in 29% of patients (with one case of neutropenic fever), grade 3/4 mucositis in 5%, and grade 3 peripheral neuropathy in 5%. The ORR in 69 evaluable patients was 87%, including 58% CRs. The 5-year time to progression and overall survival rates of 56% and 44%, respectively, were encouraging. Following this favorable experience, a phase III trial was launched that compared standard PF with PF (using a 5-FU dose of 500 mg/m2/d) plus paclitaxel at 175 mg/m2 for the induction chemotherapy of head and neck cancer.[87] Preliminary results favored the triple combination, and updated results of this study are pending. Finally, a dose-dense cisplatin/5-FU/ paclitaxel regimen, with cycles repeated every 2 weeks, was studied by the same group in patients with recurrent or unresectable head and neck cancer.[ 88] The activity was very promising (ORR of 83% in recurrent patients and 91% in unresectable disease patients), and toxicities were acceptable: grade 4 neutropenia occurred in one patient (3%) but led to sepsis and death; grade 3/4 mucositis in five patients (15%); and grade 3 neuropathy in one patient (3%).
• Platinum/Paclitaxel Plus Ifosfamide—The combination of a platinum (carboplatin or cisplatin), paclitaxel, and ifosfamide showed impressive antitumor activity (ORR: 58%-59%, CR rate: 17%) in patients with recurrent/metastatic head and neck cancer in two consecutive phase II trials at M. D. Anderson Cancer Center.[89,90] Given these promising results, Shin et al conducted a trial of carboplatin/ paclitaxel/ifosfamide as induction therapy in patients with locally advanced head and neck cancer.[40] The induction regimen consisted of paclitaxel at 175 mg/m2 on day 1, ifosfamide at 1,000 mg/m2 as a 2-hour infusion on days 1 to 3 with mesna(Drug information on mesna), and carboplatin at an AUC of 6 on day 1, repeated every 3 to 4 weeks. Patients achieving an objective response after the first two cycles of induction chemotherapy received two additional cycles (ie, a total of four). Of 52 evaluable patients, 31% had a CR and 50%, a partial response (ORR: 81%). Five patients (9%) developed neutropenic fever. Grade 3/4 thrombocytopenia and anemia occurred in three (6%) and four (7%) patients, respectively. Grade 3/4 fatigue developed in four patients (7%), arthralgia/ myalgia in two (4%), peripheral neuropathy in two (4%), and one patient died of an anaphylactic reaction. Khuri et al used paclitaxel/ifosfamide/ cisplatin as sole therapy for selected patients with intermediate-stage (T2-T4, N0/N1) supraglottic or glottic laryngeal cancer that was deemed potentially resectable by conservation laryngeal surgery.[91] The study regimen consisted of paclitaxel at 175 mg/ m2 on day 1, ifosfamide at 1,000 mg/ m2 as a 2-hour infusion on days 1 to 3 with mesna, and cisplatin at 60 mg/m2 on day 1. After three cycles of paclitaxel/ ifosfamide/cisplatin, patients achieving a partial response proceeded to surgery, whereas patients achieving a pathologic CR received an additional three cycles of chemotherapy and no local treatment. Updated results with a median follow- up of 36 months were recently presented.[92] In a total of 29 patients who were treated on study, 11 (38%) achieved a CR, 9 of whom have remained disease-free without locoregional therapy (median followup: 36 months), and 18 (62%) had a partial response. Overall, the results with platinum/paclitaxel/ifosfamide are favorable but represent single-institutional experience. The contribution of ifosfamide in the activity of these regimens is difficult to discern.
• Cisplatin/Docetaxel-Based Combinations—Docetaxel has shown high levels of activity as a single agent and in combination regimens in head and neck cancer. Cisplatin and docetaxel have been combined in phase II trials in recurrent or metastatic head and neck cancer with overall response rates between 33% and 54%.[93-95] This is at least comparable to the activity of cisplatin/ 5-FU and cisplatin/paclitaxel in the recurrent/metastatic disease setting. The combination of cisplatin and docetaxel is well tolerated even in the palliative care setting. The US Food and Drug Administration approved cisplatin/ docetaxel for first-line therapy of metastatic non-small-cell lung cancer. The commonly used doses are 75 mg/m2 for each drug on day 1. This regimen is associated with acceptable toxicities, including about a 5% incidence of febrile neutropenia.[96] There has been limited experience with cisplatin/docetaxel as induction chemotherapy for locoregionally advanced head and neck cancer. The EORTC conducted a phase II trial of docetaxel, 100 mg/m2, followed by cisplatin, 75 mg/m2, both administered on day 1 and repeated every 3 weeks, without prophylactic colony-stimulating factor support.[94] In a subgroup of 18 patients with chemotherapy- naive locally advanced or recurrent head and neck cancer without distant metastasis, the regimen showed substantial activity with an ORR of 89%. Another phase II trial of cisplatin/docetaxel in patients with locally advanced unresectable squamous cell head and neck cancer reported a lower response rate of 55% (30% CR rate) in 37 evaluable patients.[ 97] Finally, preliminary results have been reported from a randomized phase II trial of docetaxel, 85 mg/m2 on day 1, plus cisplatin, 40 mg/m2 on days 1 to 2 vs standard PF in patients with stage III/IV squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx.[98] Both regimens were repeated every 3 weeks to a maximum of four cycles. Objective response rates were comparable between the two treatment arms (ORR/ CR rate: 69%/15% for docetaxel/cisplatin vs 71%/12% for PF). However,the toxicity profile of the two regimens was different. Docetaxel/cisplatin resulted in a higher rate of grade 3/4 neutropenia but less frequent grade 3/4 mucositis and nausea/vomiting.[98]
• Cisplatin/5-FU/Docetaxel—Docetaxel-With the goal of improving the efficacy of PF, many groups have studied the addition of docetaxel to the combination (TPF), and in some cases, the addition of leucovorin (TPFL), in a number of phase I and II trials (Table 7).[99-104] Locoregional therapy varied considerably among these studies. Efficacy results have been very promising. When examined collectively, these trials showed that TPF or TPFL produced 2-year survival rates of 42% to 82% and ORRs that ranged from 71% to 100%.[105] The predominant severe toxicities encountered with TPF are hematologic, with grade 3/4 neutropenia seen in 83% to 95% of patients, resulting in neutropenic fever in 16% to 19%, and grade 3/4 stomatitis in 17% to 30%.[99,101] Treatment-related deaths occurred rarely (0%-4%).[99,101] As expected, toxicities were more pronounced when each drug in the regimen was administered in full doses. On the basis of encouraging efficacy results, two phase III randomized trials comparing TPF with standard PF have been conducted, one of which, conducted by the EORTC, recently re- ported results.[43] This study, presented by Vermorken et al, randomized 358 patients with unresectable head and neck cancer to receive one of two induction regimens: (1) cisplatin at 75 mg/m2 on day 1, 5-FU at 750 mg/ m2 continuous infusion * 5 days, and docetaxel at 75 mg/m2 on day 1, with prophylactic ciprofloxacin(Drug information on ciprofloxacin), or (2) standard PF (cisplatin at 100 mg/m2 on day 1, 5-FU at 1,000 mg/m2 continuous infusion * 5 days). Induction chemotherapy was followed by single-modality radiation therapy (various fractionation schemes allowed) in both arms. TPF proved superior to PF in terms of ORR (68% vs 54%, P = .007), progression- free survival (HR = 0.72; 95% CI = 0.56-0.91), and overall survival (HR = 0.73; 95% CI = 0.57- 0.94).[43] The triplet regimen was generally better tolerated, as it resulted in lower rates of severe nausea/ vomiting and mucositis, apparently due to the use of lower doses of cisplatin and 5-FU in this regimen compared with standard PF. A second randomized trial of TPF (TAX 324) is using somewhat different dosages for cisplatin/5-FU: cisplatin at 100 mg/m2 and 5-FU at 1,000 mg/m2 as a 4-day infusion. Patients in both arms subsequently receive radiation plus weekly carboplatin. Planned randomized trials of chemoradiotherapy with or without induction chemotherapy from the Southwest Oncology Group (SWOG) and the Dana-Farber Cancer Institute will be employing variants of TPF as induction chemotherapy in the experimental arm.
Induction Chemotherapy for Organ Preservation
A major goal of nonsurgical therapy is to achieve organ preservation in patients with resectable head and neck tumors. The avoidance of laryngectomy is the best example of an organpreservation goal. Three randomized trials that included about 600 patients with locally advanced but resectable laryngeal or hypopharyngeal squamous cell carcinoma have compared induction chemotherapy followed by radiation therapy with surgery that included laryngectomy followed by radiation therapy.[41,42,106] A meta-analysis showed a nonsignificant trend toward worse local control (12% vs 25%) and overall survival (39% vs 45% at 5 years) with the nonsurgical approach.[18,107] There was significant heterogeneity among the three trials; moreover, one of them had a small sample size (< 70),[106] which limited the interpretation of meta-analysis results. Induction chemotherapy may decrease the rate of mutilating surgery for other sites, such as the oral cavity, as shown in a randomized trial by Licitra et al.[36] In laryngeal cancer, a subsequent trial to the VA laryngeal study three-arm trial (which contained no surgical arm) showed that optimal laryngeal preservation is achieved with concurrent chemoradiotherapy.[5] Patients with resectable stage III/IV laryngeal cancer were randomly assigned to one of three arms: (1) the laryngealpreservation strategy used in the VA laryngeal study, consisting of induction chemotherapy with three cycles of cisplatin and 5-FU, followed by radiotherapy for responders, (2) radiation plus concurrent cisplatin at 100 mg/m2 administered every 3 weeks, or (3) radiation alone. Locoregional control (78% vs 61%, P = .003) and laryngealpreservation rates were superior with concurrent chemoradiotherapy vs induction chemotherapy (84% vs 72%, P = .005). An advantage in overall survival could not be demonstrated with the use of chemotherapy, despite a decrease in the rate of distant metastasis in the two chemotherapy arms. Based on the results of this study, concurrent chemoradiotherapy emerged as the preferred strategy to achieve organ preservation in laryngeal cancer. This may hold true for other primary sites as well.
Planned Randomized Trials of Induction Chemotherapy
The feasibility of platinum-based induction chemotherapy followed by chemotherapy given concurrently with radiotherapy has been demonstrated in multiple clinical trials (see Table 8), [78,79,81,82,84,87,108] and many groups are launching phase III trials of induction chemotherapy. The general schema of these trials is shown in Figure 2. The control arm consists of concurrent chemoradiotherapy, but regimens and eligibility criteria vary considerably. For example, SWOG is planning a trial in resectable oropharyngeal cancer with cisplatin plus standard radiation as the control arm and cisplatin/ docetaxel/5-FU followed by cisplatin plus standard radiation as the experimental arm. Based on their observations with the T-FHX regimen (paclitaxel, 5-FU, hydroxyurea, and hyperfractionated radiation),[78,79] Vokes et al at the University of Chicago will enroll patients with advanced N-stage disease and will use TPF as the induction regimen; both arms will receive concurrent chemoradiotherapy with docetaxel, 5-FU, hydroxyurea, and hyperfractionated radiation. Finally, Posner and colleagues at the Dana-Farber Cancer Institute designed a phase III trial in which the control arm will be cisplatin at 100 mg/m2 for two cycles plus accelerated boost radiotherapy-based on the phase II Radiation Therapy Oncology Group experience-and the experimental arm will be cisplatin/5-FU/ docetaxel for three cycles, based on the Dana-Farber experience,[109] followed by radiation plus chemotherapy. The concomitant chemoradiotherapy regimen in the experimental arm is determined according to the response to induction chemotherapy: Patients who achieve a CR will receive conventional radiation plus carboplatin, but patients with less than a CR will receive a more aggressive regimen with accelerated concomitant boost radiotherapy plus docetaxel.
Induction chemotherapy remains experimental in head and neck cancer. It is likely that certain patient groups derive benefit from induction chemotherapy, but this has yet to be proven in randomized trials. Concurrent chemoradiotherapy has evolved as a standard primary or postoperative treatment in locoregionally advanced head and neck cancer. With the evolution of standard therapy for locoregionally advanced squamous cell head and neck cancer, the role of induction chemotherapy needs to be revisited. It is postulated that induction chemotherapy may optimize disease control by eradication of locoregional and distant micrometastasis. Distant control is particularly important in the setting of improved locoregional control rates seen with concurrent chemoradiotherapy. Our review identified several active combination regimens in head and neck cancer. Cisplatin/5-FU, which has long been a standard for induction chemotherapy, is being surpassed by platinum/ taxane-based combinations. Carboplatin/paclitaxel appears to be better tolerated than PF and achieves similar response rates, although no randomized study has yet compared the two regimens. On the other hand, carboplatin/ 5-FU has proven inferior to cisplatin/ 5-FU. Docetaxel is another taxane with promising activity in head and neck cancer. The triple combination of taxane/cisplatin/5-FU was shown to be superior to cisplatin/5-FU in two randomized trials; results of a third study are pending. For many authors, docetaxel/cisplatin/5-FU is an emerging standard for induction chemotherapy. With newer, more effective systemic therapies, the rationale for revisiting the role of induction therapy is strengthened. Currently, a number of randomized trials are being designed to define the role of induction chemotherapy in head and neck cancer when the primary treatment is concurrent chemoradiotherapy. These trials are of major importance for the evolution of head and neck cancer therapeutics. Finally, platinum/taxane combinations may be good platform regimens with which to investigate the addition of novel therapeutics in head and neck cancer, including molecular-targeted therapies such as inhibitors of epidermal growth factor receptor. Such clinical studies are expected to attract the interest of investigators in the coming years.
Financial Disclosure: The authors have no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.


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Crystal Lake, Cary Make Headway, Fill Vacant Retail Space
The current vacancy rate in Crystal Lake is at 8 percent while Cary has a vacancy rate of 9 percent.
Follow Crystal Lake-Cary Patch on Facebook - Sign up for the Free Patch Newsletter Slowly but surely, communities have been able to fill vacant retail space in the area. Crystal Lake added about 50 new businesses and 500 new jobs over the past two years, filling nearly 1 million square feet of empty retail space Michelle Rentzsch, the city's director of planning and economic development, told the Northwest Herald. The Northwest Herald reports the following vacancy rates for area communities: When the economy was booming, vacancy rates were between 5 to 7 percent. Crystal Lake offers a variety of incentives to attract new businesses, including grant programs that "provide financial assistance to new Crystal Lake retailers who occupy …
In this Article:
1:42 pm on Tuesday, February 19, 2013
And I agree, great news, but it also makes me question, based on what I see, how many have closed up and lost jobs probably outweighs the good.   more ›

subset: commoncrawl


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Pall Advanta ALT Liquid Filter Housings
Source: Pall Life Sciences - BioPharmaceuticalsDatasheet: Pall Advanta ALT Liquid Filter Housings
The Pall Advanta™ range of filter housings has been specifically designed and engineered for today's manufacturing processes. These advanced housings are manufactured from 316L stainless steel and are engineered to meet the requirements of the BioPharmaceutical industry. State-of-the-art manufacturing technologies are used to construct a housing ideal for the most critical of applications.
Fine filtration of liquids is a key part of many production processes. These Pall Advanta housings have been specifically designed to meet the many requirements of this demanding application. During the design process critical features were optimized to ensure trouble-free use and low installation and maintenance costs. Areas such as surface finish, suitability for CIP and SIP, integrity testing and incorporation into automated production processes are included.
Features and Benefits
- Aseptic design
- Crevice-free electropolished surfaces with an internal
- Ra value of = 0.4 µm (= 15 µin.)
- Fully self draining
- No dead legs
- Low hold-up volumes for maximum product recovery
- Quick fit Stäubli*-type connections for easy filter integrity testing
- Easy to use low point sanitary drain valve
- Range of options to aid use in automated production systems
- CE marking shows design review to European Pressure Directive 97/9/EC
- Every housing supplied with a quality certificate and manufactured to ATEX Directive 94/9/EC (Group ll Category 2)
- Variety of connection styles, vents and drains offer choice and convenience
- Filter cartridge accepts single open-ended Pall Code 7 and Code 2 AB style 5 in. (127 mm), 10 in. (254 mm), 20 in. (508 mm), and 30 in. (762 mm) height filter cartridges
Datasheet: Pall Advanta ALT Liquid Filter Housings


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Classroom Of The Month
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Every Wednesday | FM 105.1 "Winesday" at Radisson Lobby Bar
Join FM 105.1 every Wednesday from 5pm to 7pm for "Winesday" at the new Lobby Bar at the Radisson in downtown Fargo! $2 off glasses of wine and prize giveaways.
for more info.
Saturday, May 11th | Taste Of Home Cooking School
Join Us For The 3rd Annual Taste Of Home Cooking School on Saturday, May 11th at the Holiday Inn presented by Happy Harry's Bottle Shops. Doors open from at Noon and until 4pm you can shop and sample a variety of wine & food from local vendors. The national Taste Of Home Cooking School takes place from 4-6pm.
Tickets available now at Happy Harry's Bottle Shop (seating is limited). $20 General Admission or $40 VIP Seating: includes VIP seat and Taste Of Home Cooking School Cookbook ($35 value)
All attendees will receive a gift bag full of free products and coupons. All attendees will also have their choice of: Taste of Home print magazine (6 months/3 issues), Taste of Home digital edition (1 year/7 issues), or The Family Handyman print magazine (1 year/11 issues)
July 9th-14th | Red River Valley Fair
Join the fun and excitement of the Red River Valley Fair, July 9th through the 14th at the Red River Valley Fairgrounds on Main Avenue in West Fargo. This year's grandstand lineup includes: Randy Houser, Hairball, Hinder, Hunter Hayes, The Band Perry and Sevendust. The Midway opens at 1pm daily.
Click here
for more information and ticket prices.
Saturday, June 15th | Hard Charge
FM 105.1 welcomes the "Hard Charge Televised Obstabcle Mission" to the Red RIver Valley Fairgrounds Saturday, June 15th! Hard Charge is a 4 to 6 mile course of obstacles, mud and mayhem! Whatever your current fitness level Hard Charge will push you to the max. They are also filming the event and you could end up on TV!
for more info on Hard Charge!
Fargo Parks Daily Events
The Fargo Park District provides a variety of activities all year long. The events are always family friendly and most of them are free!
Click here to see what's going on in the parks today!
Racing at Brainerd Interational Raceway | All Summer Long
Check out exciting race action all summer long at Brainerd International Racway!
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Yankees begin to sell Groupon discounts for home games
They don't have Derek Jeter, Alex Rodriguez, Curtis Granderson or Mark Texiera in the lineup, so the Yankees have called upon Groupon to go to bat for them.
As of Tuesday, the popular coupon site was listing tickets for weekday home games against the Indians and Mariners for $22, down from their $48 face value.
After 19 home games this season, the Yankees have an average attendance of... » more
City unveils All-Star week plan ahead of July game at Citi Field
The MLB All-Star Game is coming to Citi Field July 16, along with a five-day fan festival featuring Mets captain David Wright and more.
Mayor Michael Bloomberg Wednesday welcomed Wright and Mets legends Mookie Wilson, Edgardo Alfonzo and John Franco to City Hall to announce the All Star FanFest. The game will be in Queens for the first time since 1964.
"It's a validation that... » more
Bloomberg set to attend Yankees and Mets opening day games
Don't expect Mayor Michael Bloomberg to play favorites on Opening Day.
Bloomberg will attend the Yankees and Mets' first games of the season Monday, even though they start at the same time.
Hizzoner will start off with the Yanks and then head over to Queens.... » more


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Mario Badescu Vitamin C Serum
Improve skin's radiance and hydration levels with Mario Badescu's potent, 7.5% ascorbic acid formula. Skin tone will become more even from the brightening effects of the antioxidant vitamin C, while skin's texture is left soft and smooth from the anti-aging powers of collagen and hyaluronic acid. How to use: Apply 3-4 drops on clean skin every other evening. May be used under moisturizer or alone. Brand: Mario Badescu. Style Name: Mario Badescu Vitamin C Serum. Style Number: 253610. Available In Stores.. Price: $45.00
This item is available from NORDSTROM.com


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MOUNT VERNON, Wash. (AP) — Officials in Washington state performed a special inspection six months ago on the Interstate 5 bridge that collapsed because there were indications it had been struck by a different vehicle.
ST. LOUIS (AP) — Longtime Kentucky pals Russ Cochran and Kenny Perry have shared a massive gallery the first two rounds of the Senior PGA Championship. Now, they also share the lead.


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(June 25, 2007)
Skate Canada – Manitoba will be celebrating the 25th anniversary of their Grassroots Bursary on April 12, 2008, and are looking for all former bursary recipients to attend the reunion dinner and to participate in the reunion ice show.
The Skate Canada Manitoba Grassroots Bursary Fund was initiated in 1984 by a group of dedicated volunteers to support the training and development of elite skaters in Manitoba. Since its inception, the bursary fund has distributed scholarships to over 400 skaters who have earned a berth to compete at Western Canadian, Canadian and International Championships.
If you received a Grassroots Bursary of know anyone who did contact Skate Canada – Manitoba www.mbskates.ca.


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Hurricane Center Console Cover
Sale price:
Clearance price:
Starting at:
Sale starting at:
Clearance starting at:
Reg. price:
Keep your boat's center console in great shape with this Center Console Cover from Hurricane. Made from heavy-duty Hurricane 300 denier fabric, this Hurricane Center Console Cover will protect the console from harsh UV rays, mildew, salt and other marine elements that can spell doom to a console that's left unprotected. An elastic cord in the bottom hem provides a secure fit. Imported.
Rated 4.2 out of 5 by 9
Rated 5 out of 5 by jgbh 2nd time buyer
Just purchased my 2nd cover. Boat sits in salt water in the south Georgia for 365 days per year in direct sun. You won't find a better cover for the money. This cover has a toggle at the bottom for a tight fit. This cover stayed on for two separate storms with 50 plus MPH winds. Cover will last two years under these conditions. I used duct tape to extend the life for a few months before re-ordering a new one. No self respecting southerner would throw away any item before attempting to repair it with duct tape first.
March 11, 2013
Rated 1 out of 5 by WVBoater Junk
This is junk. Mine ripped within a year. I would not buy this
July 30, 2012
Rated 5 out of 5 by alkatrazlake works better than expected
This cover works great. All I need to protect is my electronics so I don`t have to mess with my big cover between uses. Bob
May 23, 2012
Rated 3 out of 5 by toonaman Console cover
This is second cover I have purchased from this MFG. While it is priced well and it fits console great, I expect it to last 1 year at best in an outdoor full sun environment. My boat sits on a lift in a coastal environment. The first cover was installed on Oct 2010 ...by Aug 1022 , (9 mo) it was rotten and you could pull it apart by hand. However I have not found a product that last any longer.
September 5, 2011
3 Questions | 4 Answers
Outdoor Answers
Get help about this item from fellow customers.
Ask your questions. Share your answers.
looking at picture,the width looks smaller than the depth-front left side across is width and left to right depth?Answers
This is the information from the manufacturer web site: Center consoles up to 40"W 30"L 44"H. Web Site: http://classicaccessories.com/hurri.... ThanksDetails:
Do you have different size console covers? The size listed for this product is not big enough.Answers
We carry Small, Medium, and Large:S: Center consoles up to 36"W 24"L 42"H item number 1645264
M: Center consoles up to 40"W 30"L 44"H item number 1645265
L: Center consoles up to 46"W 40"L 45"H item number 1645266
I have a 21 foot SunTracker that I would like to cover the console when we don't put the boat cover on.Answers
Depends on measurementA:
THIS WILL COVER A LARGE CONSOLE HAVE PLENTY ROOM FOR CONSOLE ON MY MONACK PONTOON1 of 1
1 of 1


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Read reviews (2)
Rate recipe
A delightful combination of herbs and reduced-fat cheese make this simple tuna sandwich stand out. Marie Connor of Virginia Beach, Virginia shares the recipe.
This recipe is:
Diabetic Friendly
Nutritional Facts 1 sandwich equals 332 calories, 9 g fat (4 g saturated fat), 144 mg cholesterol, 864 mg sodium, 30 g carbohydrate, 4 g fiber, 34 g protein. Diabetic Exchanges: 4 lean meat, 2 starch.
Originally published as Herbed Tuna Sandwiches in Light & Tasty June/July 2007, p6
Light-Bodied White Wine
Enjoy this recipe with a light-bodied white wine such as Sauvignon Blanc or Pinot Grigio.
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Reviewed on Aug. 01, 2012 by mcclearyamy
My 16 year old daughter followed this recipe for the first time last year. This sandwich quickly became a weekly must in our home. Easy and EXCELLENT!!!
Reviewed on Jun. 18, 2011 by Perticus
Delicious. I did modify it a little. I added some garlic powder. I think everything is better with a little garlic. I used my own home made white bread and grilled it on the stove top. Not as healthy but mmm, mmmm, good.
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Pruning the forum database.
Booting linux from GPT currently has its share of issues, http://www.rodsbooks.com/gdisk/booting.html (and follow the appropriate links)Mostly you will only be stuck with GPT if you are installing to a MAC, that's not the case here. Can you tell us about your hardware? Did you choose to setup a GUID partition table, or did the system come with windows installed on GPT?
Only if your definition of better varies from that found in all the dictionaries I'm aware of.
Fedora is likely to be the easiest for now, but you could help to get PCLinuxOS working well with GPT by giving details and trying suggestions that may be offered, (with PCLOS as a test distro).
I got it to work. I am posting this using PCLinuxOS.I shrank the main partition on the SSD, leaving 12GB free. Then using the PCLinixOS live USB, I set a mount point of / for that 12GB, formatted as ext4.I set the partition on the GPT hard disk to have a mount point of /usr. The other small partition there is still setup as Linux swap.Then when I set Grub to install on the SSD, it worked


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Under state law, beer and wine can't be sold in the same store. But Mary R. Miles, owner of Arsenal Street Wine & Liquor Depot, found a solution to that problem.
Cases of cold beer will be sold by Bottle Caps Beverage Center, a convenience store being built in the basement of the building occupied by the wine store at 940 Arsenal St. An array of brews will be showcased in a large walk-in cooler at the business, a 2,400-square-foot retail space separated from Arsenal Street Wine that's set to open at the end of May. [Read more...]


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LWN.net Weekly Edition for May 23, 2013
An "enum" for Python 3
An unexpected perf feature
LWN.net Weekly Edition for May 16, 2013
A look at the PyPy 2.0 release
This series is a follow on to the series posted earlier (archived at [1]). Patches 01/22 .. 09/22 of this series have been pretty intensively reviewed; thanks to all who helped. We've modified per feedback, and these should be in reasonable shape. Patches 10/22 .. 19/22 of this series have not been very widely reviewed. We'd very much appreciate eyeballs here. Patches 20/22 .. 22/22 of this series are specific to the TI Keystone platform. These are not ready to be merged in. These are being provided here for the sake of completeness, and to better illustrate the other patches in this series. These are dependent on the smpops patches (see [2]). These patches are also available on the following git repository: git://arago-project.org/git/projects/linux-keystone.git keystone-v2 [1] - http://thread.gmane.org/gmane.linux.kernel/1336081 [2] - http://permalink.gmane.org/gmane.linux.ports.arm.kernel/1... Series changelog: (01/22) ARM: add mechanism for late code patching (v2) pulled runtime patching code into separate source files (v2) reordered arguments to patch macros for consistency with assembly "Rd, Rt, imm" ordering (v2) added support for mov immediate patching (v2) cache flush patched instructions instead of entire kernel code (v2) pack patch table to reduce table volume (v2) add to module vermagic to reflect abi change (v2) misc. cleanups in naming and structure (02/22) ARM: add self test for runtime patch mechanism (v2) added init-time tests to verify instruction encoding (03/22) ARM: use late patch framework for phys-virt patching (v2) move __pv_offset and __pv_phys_offset to C code (v2) restore conditional init of __pv_offset and __pv_phys_offset (04/22) ARM: LPAE: use phys_addr_t on virt <--> phys conversion (v2) fix patched __phys_to_virt() to use 32-bit operand (v2) convert non-patch __phys_to_virt and __virt_to_phys to inlines to retain type checking (05/22) ARM: LPAE: support 64-bit virt_to_phys patching (v2) use phys_addr_t instead of split high/low phys_offsets (v2) use mov immediate instead of add to zero when patching in high order physical address bits (v2) fix __pv_phys_offset handling for big-endian (v2) remove set_phys_offset() (06/22) ARM: LPAE: use signed arithmetic for mask definitions (07/22) ARM: LPAE: use phys_addr_t in alloc_init_pud() (08/22) ARM: LPAE: use phys_addr_t in free_memmap() (v2) unchanged from v1 (09/22) ARM: LPAE: use phys_addr_t for initrd location and size (v2) revert to unsigned long for initrd size (10/22) ARM: LPAE: use phys_addr_t in switch_mm() (v2) use phys_addr_t instead of u64 in switch_mm() (v2) revert on changes to v6 and v7-2level (v2) fix register mapping for big-endian in v7-3level (11/22) ARM: LPAE: use 64-bit accessors for TTBR registers (v2) restore comment in cpu_set_reserved_ttbr0() (12/22) ARM: LPAE: define ARCH_LOW_ADDRESS_LIMIT for bootmem (13/22) ARM: LPAE: factor out T1SZ and TTBR1 computations (v2) unchanged from v1 (14/22) ARM: LPAE: accomodate >32-bit addresses for page table base (v2) apply arch_pgd_shift only on lpae (v2) move arch_pgd_shift definition to asm/memory.h (v2) revert on changes to non-lpae procs (v2) add check to ensure that the pgd physical address is aligned at an ARCH_PGD_SHIFT boundary (15/22) ARM: mm: use physical addresses in highmem sanity checks (16/22) ARM: mm: cleanup checks for membank overlap with vmalloc area (17/22) ARM: mm: clean up membank size limit checks (18/22) ARM: add virt_to_idmap for interconnect aliasing (v2) unchanged from v1 (19/22) ARM: recreate kernel mappings in early_paging_init() (v2) disable on !lpae at compile time arch/arm/Kconfig | 36 ++++ arch/arm/Makefile | 1 + arch/arm/boot/dts/keystone-sim.dts | 77 +++++++ arch/arm/configs/keystone_defconfig | 23 +++ arch/arm/include/asm/mach/arch.h | 1 + arch/arm/include/asm/memory.h | 94 ++++++--- arch/arm/include/asm/module.h | 7 + arch/arm/include/asm/page.h | 2 +- arch/arm/include/asm/pgtable-3level-hwdef.h | 10 + arch/arm/include/asm/pgtable-3level.h | 6 +- arch/arm/include/asm/proc-fns.h | 28 ++- arch/arm/include/asm/runtime-patch.h | 175 ++++++++++++++++ arch/arm/kernel/Makefile | 1 + arch/arm/kernel/armksyms.c | 4 - arch/arm/kernel/head.S | 107 +++------- arch/arm/kernel/module.c | 7 +- arch/arm/kernel/runtime-patch.c | 230 +++++++++++++++++++++ arch/arm/kernel/setup.c | 18 ++ arch/arm/kernel/smp.c | 11 +- arch/arm/kernel/vmlinux.lds.S | 13 +- arch/arm/mach-keystone/Makefile | 2 + arch/arm/mach-keystone/Makefile.boot | 1 + arch/arm/mach-keystone/include/mach/debug-macro.S | 44 ++++ arch/arm/mach-keystone/include/mach/memory.h | 47 +++++ arch/arm/mach-keystone/include/mach/timex.h | 21 ++ arch/arm/mach-keystone/include/mach/uncompress.h | 24 +++ arch/arm/mach-keystone/keystone.c | 124 +++++++++++ arch/arm/mach-keystone/keystone.h | 23 +++ arch/arm/mach-keystone/platsmp.c | 84 ++++++++ arch/arm/mm/context.c | 9 +- arch/arm/mm/idmap.c | 4 +- arch/arm/mm/init.c | 19 +- arch/arm/mm/mmu.c | 114 +++++++--- arch/arm/mm/proc-v7-3level.S | 50 +++-- 34 files changed, 1214 insertions(+), 203 deletions(-) create mode 100644 arch/arm/boot/dts/keystone-sim.dts create mode 100644 arch/arm/configs/keystone_defconfig create mode 100644 arch/arm/include/asm/runtime-patch.h create mode 100644 arch/arm/kernel/runtime-patch.c create mode 100644 arch/arm/mach-keystone/Makefile create mode 100644 arch/arm/mach-keystone/Makefile.boot create mode 100644 arch/arm/mach-keystone/include/mach/debug-macro.S create mode 100644 arch/arm/mach-keystone/include/mach/memory.h create mode 100644 arch/arm/mach-keystone/include/mach/timex.h create mode 100644 arch/arm/mach-keystone/include/mach/uncompress.h create mode 100644 arch/arm/mach-keystone/keystone.c create mode 100644 arch/arm/mach-keystone/keystone.h create mode 100644 arch/arm/mach-keystone/platsmp.c -- 188.8.131.52 -- To unsubscribe from this list: send the line "unsubscribe linux-kernel" in the body of a message to firstname.lastname@example.com More majordomo info at http://vger.kernel.org/majordomo-info.html Please read the FAQ at http://www.tux.org/lkml/
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pool and hottub where not available,ice machine did not work,breakfast was below par,but price was acceptable
- Also Known As:
- Super 8 Keystone/Mt. Rushmore Hotel
- Super 8 Keystone/Mt. Rushmore Hotel Keystone
- Keystone Super Eight
- Keystone Super 8
- Super 8 Keystone
- Super Eight Keystone
- Reservation Options:
- TripAdvisor is proud to partner with Expedia, Wyndham and Hotels.com so you can book your Super 8 Keystone/Mt. Rushmore reservations with confidence. We help millions of travelers each month to find the perfect hotel for both vacation and business trips, always with the best discounts and special offers.


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Update: To add more fuel to the fire, http://scrawlfx.com/2010/04/ubisoft-support-lists-splinter-cell-conviction-for-ps3 has now uncovered a http://ubisoft-en.custhelp.com/cgi-bin/ubisoft_en.cfg/php/enduser/std_alp.php?p_sid=owW6FNZj&p_lva=&p_li=&p_accessibility=0&p_redirect=&p_page=1&p_cv=&p_pv=2.1861&p_prods=1483%2C1861&p_cats=0&p_hidden_prods=&prod_lvl1=1483&prod_lvl2=1861&cat_lvl1=0&p_search_text=&srch_btn_submit=%C2%A0%C2%A0%C2%A0Search%C2%A0%C2%A0%C2%A0&p_new_search=1&p_search_type=answers.search_nl for Splinter Cell: Conviction in the Ubisoft Support center.
Since last year Ubisoft has been stating that they have no plans for a PS3 version of Tom Clancy's Splinter Cell: Conviction, but now contradictory images are turning up in a Blockbuster Video ad and from Swedish retailer Game giving fans hope the XBox 360 exclusive is no more.
To quote: "Look at the scan below, although could be a typo, it shows a number of games and movies with the dates and times they'll be available, but what caught my attention was the Splinter Cell: Conviction listing that also lists PS3 as one of the platforms.
It's also listed as available on February 23rd, the date it was supposed to be released before Ubisoft abruptly postponed it to a later date. Does Blockbuster know something we don't?"
Additionally, Kroogah from http://www.ps3info.pl/forum/index.php?/topic/25539-splinter-cell-conviction-jednak-na-ps3/ and Chrisma from http://polygamia.pl/Polygamia/1,96455,7586591,Nadchodzace_premiery__22_02___28_02__w_deszczu_strugach.html stated the following, to quote roughly translated:
"In the Swedish retail chain Game is officially ordered Splinter Cell Conviction for PS3. Here (below) is the photo shop of the exhibition. Employees reportedly swear that is the official info and take orders."
Finally, the title is currently slated for release in North America on April 13, Europe and Australia on April 15, and Japan on April 28, 2010.
More PlayStation 3 News...
13250 HeyManHRU
13207 PS3 News
11287 elser1
11119 oVERSoLDiER
9248 GrandpaHomer
8578 Tidusnake666
7968 saviour07
7340 condorstrike
7258 deank
6858 OGroteKoning
24993 PS3 News
5279 Starlight
2965 HeyManHRU
2129 elser1
1818 cfwprophet
1756 her0
1572 oVERSoLDiER
1291 GrandpaHomer
1080 barrybarryk


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Home / Alumni / Economics Leadership Council (ELC) /
Andrew W. Marcus, CFA
AB '83 Econ Sugarloaf Rock Capital, LLC |
Andrew (Drew) Marcus launched Sugarloaf Rock Capital, LLC in 2009, which manages SLRC Media Opportunities Fund, LP. He departed Deutsche Bank after 16 years in December 2008. He was Vice Chairman of Global Banking at Deutsche Bank Securities, Inc., focusing on media and telecommunications from 2005-2008. He was previously Managing Director, Global Head of Media Research at Deutsche Bank and Senior Media Analyst. Marcus joined Alex. Brown Inc. in 1992 as a founder of its Media Group, which was subsequently acquired by Deutsche Bank. Prior to that, he was a Vice President, focused on media M&A, at Henry Ansbacher Inc. From 1983-1990, he was in the Media and Technology Research Group at Kidder, Peabody.
During his 23 years as an analyst, Marcus covered radio and TV broadcasting, outdoor, publishing and entertainment stocks and published strategic overviews on the Media group. He has ranked as the number one Broadcasting Analyst in surveys conducted by Institutional Investor, the Wall Street Journal, Greenwich Associates, Reuters and Red Herring Magazine. In addition, he is an eight-time Institutional Investor "All American" and a six-time Wall Street Journal "Master Stock Picker." He is credited with being the first analyst on Wall Street to publish research on the radio and outdoor.
Marcus has been involved in nearly 200 banking transactions in the broadcasting, outdoor and entertainment sectors valued at over $100 billion. His deals include lead advisory and financing roles in the $24.5 billion acquisition of Clear Channel, $13.7 billion acquisition of Univision and the $1.2 billion acquisition of Susquehanna by Cumulus Media Partners.
Marcus is on the Endowment Committee at the Greenwich Country Day School and the Advisory Board at the Boys and Girls Club of Greenwich. He is the former Chairman of the Media Corporate Information Subcommittee of the Association for Investment Management and Research (AIMR). Marcus is a Chartered Financial Analyst.


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There is no special at this time.
Do I qualify for the special?
Please view this table and compare your annual income and number of family members with the county you live in. If your income is below the number shown, you qualify! If your county is not listed on this table, please contact us to see if you qualify. Be sure to review the details of the special to see if it is only being offered for residents of specific counties. If you do not live in the areas indicated, please contact us for information about other assistance programs that may be available.
Project Catnip
For feral and free-roaming cats we offer a special program titled "Project Catnip", which is a package of services including: spaying or neutering, rabies vaccine, a tattoo, ear tip and ear mite treatment (if needed). The cost for the package is only $20. Cats must be in a humane trap.
For more information about feral/free-roaming cats and the services we offer, please visit the Feral/Free-Roaming Cat section of our website.
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We are currently offering a Pit Bull specific spay/neuter special called the Fix-a-Bull program. If you are a low-income Pierce County resident, we can spay or neuter your Pit Bull for a copay of only $25! To schedule an appointment please call (253) 627-7729 Monday–Thursday from 10:00am–4:00pm or fill out our online appointment form and mention Fix-a-Bull.
The Responsi-Bull Project Pit-Fix
Have your pit bull spayed or neutered for FREE under the Responsi-Bull program at Northwest Spay & Neuter Center. Pit bull mixes are accepted, as long as we can tell they are part pit bull by their photo. The first 40 applicants who qualify will be accepted into the program. You MUST follow these instructions carefully to participate:
* * * Go to bullseyerescue.org/RESPONSIBULL.htm and scroll down to "Part I: Pit-Fix". Follow the instructions there.* * *
For a direct link to the appointment request form mentioned in the instructions, go to our online Dog Reservation Request form. You MUST fill in "RAB" where the form asks if you are using an assistance program. You MUST follow the instructions for e-mailing a photo of your dog. Put YOUR NAME and "RAB" in the SUBJECT LINE so we can match the photo with the appointment request. Use the SAME OWNER NAME you used on the appointment request form. PLEASE DO NOT CALL regarding this program. The above steps MUST be completed online, as required by the organizations funding the program. Limited to one per household (in a lifetime).
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Christopher Maloney
Latest News
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Reports Suggest That The BGT Winner Is Planning A Las Vegas Residency... More » Will Susan Boyle Follow Britney Spears To Las Vegas?
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The Band Surprised Fans With A Stripped Back Version Of The Indie Hit More » LISTEN: Union J Perform An Accousic Version Of Bastille's Smash Hit Pompeii
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The Singer Admits His New Material Will Surprise Fans More » He's Back! X Factor Finalist Christopher Maloney Signs Record Deal With Tristar
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Scousers Left Furious As Plymouth Is Lined Up As Possible Replacement Town More » X Factor Bosses Axe Liverpool Auditions Due To Chris Maloney And 'Lack Of Talent'
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Insists He 'never Denied It' More » X Factor's Christopher Maloney Confirms He's Gay
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They Took To Twitter Following Sell Out Shows At Wembley And The O2 More » 'Thank You So Much!': One Direction And X Factor Stars Show Fans Some Love After Rocking London
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The X Factor Blubberer Angrily Denied That He Was Heckled And Laughed At More » 'Lies Again!' Christopher Maloney Slams Reports He Was Booed At London Gig
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Star And Fans Insist He Was Not Booed More » 'Wot An Absolute Crock Of S*@t' Christopher Maloney Blasts The X Factor Tour Heckler Claims
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Audience Members Did Not Sympathise More » Christopher Maloney Heckled While Crying On X Factor Tour Stage
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The Saturdays, The Wanted and those involved with The Big Reunion may have proven that there's a lot to be said for popstars who venture into reality TV, but does the … More » Top 10 reality TV stars who've attempted pop careers
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Former X Factor Star Still Bullied After Appearing On Show More » Christopher Maloney: 'My Nan Was Called A S**g And A S**t And I Still Get Death Threats'


text: Pink polka dots make our 1st Birthday Girl Bag Tag a pretty way to commemorate your little girl's special day. Personalize tags with her name or with guests' names to create custom keepsakes everyone will love. Laminated 2.5 inch by 3.9 inch tags hang from plastic lanyards, safe for kids 3+.


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Bovada Sportsbook (SBR rating A) betting odds have been added to the NCAA Tournament Betting Futures grid released by Sportsbook Review.com Monday morning. Following Selection Sunday, betting odds will also be posted by online sportsbooks for the 2013 NCAA Men's Championship. Make sure to get the best available odds for your prospective tournament wager!
Bovada Sportsbook (SBR rating A) users report website downtime from 9PM-11:45PM ET. A representative of Bovada commented on SBR Forum that users still having difficulty accessing their accounts or with general inquiries should write to firstname.lastname@example.com. Players may also reach Bovada via telephone at 1-888-263-0000.
Bovada Sportsbook has returned to its original rating of A. On May 23rd, SBR downgraded Bovada to B+ after its payout time-frame increased to an average of 30 days in some cases. Bovada worked through its backlog, clearing all outstanding payments and shortened the payout window to 5-10 business days. Users with feedback can write to firstname.lastname@example.com.
Bovada Sportsbook upgraded from A- to A
Bovada Sportsbook upgraded from B+ to A-
SBR newswoman Natalie delivers a sportsbook industry news update. Natalie is joined later in the program by seasoned dispute expert and legal mind Justin7. Covered in today's program are updates on BetUS, Bet770, BetAtHome, Bovada, as well as a peek into Justin's sportsbook dispute case-load. | Read more
Bovada Sportsbook downgraded from A to B+
Bovada Sportsbook (SBR rating A) processing time has been extended to an average of 30 business days in some cases. Management tells SBR it expects processing time to be shortened and back to the regular time-frame soon. SBR will update this report once the average payout time-frame has returned to normal.
Bovada (SBR rating A) has closed the accounts of players residing in Maryland. Players will be paid their balances in full. Bovada management tells SBR that they are communicating through email and telephone to impacted players. On February 27th, SBR reported that Bodog was the latest sportsbook to have a ".com" domain confiscated. A federal indictment was unsealed by the U.S. attorney's office in Baltimore, naming alleged Bodog executives on charges of unlawful gambling.Before year's end, SBR reported that the Morris Mohawk Gaming Group's brand licensing agreement expired with the Bodog Brand. As a result, MMGG rebranded their sportsbook as Bovada. No Bodog brand licensee currently serves the US market.Maryland players with feedback are asked to write to SBR.
Bovada (SBR rating A) will close their Costa Rica office and consolidate wagering services with their Antigua operation. Some of the staff will be moving to the second and now primary wagering center. With the change, Bovada will offer betting online-only which was already planned to change following March basketball. The customer service center will remain the same and players are expected to be able to call for account inquiries and receive the same level of customer service during the migration. Bodog Brand managers tell SBR that the Costa Rican office was only a third party service provider company but there was concern that Costa Rica would wrongly interpret the indictment against its former sportsbook website domain, Bodog.com. We are also told that all former employees from the Costa Rica service company will be paid full severance.
Bodog (SBR rating A) is changing their domain name for US players. Bodog.eu players will be able to access their accounts at www.Bovada.lv. Bodog is in the process of migrating all affected player accounts to the new website. Though the domain itself is changing, Bodog's US players will have the same software, platform, customer service and betting options to choose from. Bodog released a statement to all .eu players this morning addressing the change. | Full Bodog statementBodog statement: [quote]Bodog.eu is changing - New Name, New Look, Same Great Service
The Morris Mohawk Gaming Group's ("MMGG") brand licensing agreement with the Bodog Brand is expiring at the end of this year and as a result MMGG will no longer be offering its services using the bodog name or from the website, bodog.eu.
From today, December 14th, MMGG will continue to operate as it has for over 4 years, just under its new name, BOVADA, at www.bovada.lv.[/quote]
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(based on 1 review)
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(1 of 2 customers found this review helpful)
Not what I thought it would be
By curlylocks
from Upstate NY
Comments about Personalized Pill Box with Mirror:
This is a pill box, not a medication. I don't get the Pros & Cons selections above. The compartments are small, so larger pills take up a whole compartment without room for other pills. It's a nice box, however, I do not think it's worth $15.00


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los hooligans - agujetas de color de rosa, from a ritmo de twist (1962) CLASSIC CLIP, CLASSIC SONG, now that i've...
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CurvyDolls , I reposted this vid like I know what they heck they are singing. But I do adore the CurvyGirls with STYLE !...
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Mitch Hilligoss didn't have to wait until his final at-bat to extend his hitting streak to a South Atlantic League record 36 games, but he did wait long enough to provide some drama for the Charleston fans.
Hilligoss laid down a bunt down the third base line for a single in the seventh for his only hit in five at-bats. That was enough to give him the South Atlantic record all by himself. His eighth-inning double on Tuesday had tied Scott Seabol's mark set in 1999.
The third baseman also stole his seventh base of the season. With a hit against Columbus at home on Thursday Hilligoss' would equal Joey Cora's 37-game hitting streak for the longest mark of the past 20 years. The minor league record is Joe Wilhoit's 69-game streak set with Wichita in 1919.
Hilligoss was the Yankees' sixth-round pick out of Purdue in 2006. While he hasn't hit for much power, he does have some pedigree as a hitter. He was the Big 10′s batting leader in 2005 and a scout told John Manuel before last year's draft that Hilligoss was one of the best college bats he'd ever seen. Last year he made Baseball America's short-season Postseason All-Star Team and was named the 17th best prospect in the New York-Penn League.
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In the news
- PINC Solutions recognized as 2013 Top 100 Logistics IT Provider by Inbound Logistics Magazine
- Logistics Management Magazine: RFID streamlines yard management, enhances visibility.
- Jean Murphy, Editor Emeritus of SupplyChainBrain, interviews Dr. Aleks Gollu at RILA Logistics 2013
- PINC Solutions Appoints Matt Yearling Chief Executive Officer
Pinc blog
PINC Solutions Named 2012 Supply & Demand Chain Executive 100
PINC Solutions and one of its customers selected as "100 Great Supply Chain Projects" in 2012 by Leading Business Magazine
Alameda, CA — June 12, 2012— PINC Solutions, North America's leading provider of supply chain visibility and advanced yard management solutions (YMS), today announced the editors of Supply & Demand Chain Executive Magazine named PINC Solutions and one of its customers to its 11th annual listing of the Supply & Demand Chain Executive 100. The 2012 award highlights the "100 Great Supply Chain Projects."
"Our readers count on Supply & Demand Chain Executive for intelligence and decision-making information on solutions and best practices for supply chain transformation," said Barry Hochfelder, Editor of Supply & Demand Chain Executive. "With this year's Supply & Demand Chain Executive 100, we are featuring '100 Great Supply Chain Projects' that demonstrate the broad spectrum of opportunities for enabling excellence in the supply chain."
The PINC customer selected by the magazine as one of the great supply chain projects in 2012 is a leading third-party logistics (3PL) company. The company achieved savings by increasing the yard-goat drivers' productivity, reducing average travel distance within the yard, streamlining communication between drivers and the shipping office and eliminating the manual yard-check process. It also provided operators the ability to share data with freight carriers and customers; and utilized the system to resolve detention claims from their carriers.
"Our goal with this year's '100' is to put the spotlight on successful and innovative transformation projects that are delivering bottom-line value to small, medium and large enterprises across the different functions that comprise the supply chain," Hochfelder added. "The projects featured in the '100' article can serve as a roadmap for supply chain executives looking for new opportunities to drive improvement in their own operations."
"Helping our customers to overcome their supply chain and logistics challenges and operate more efficiently is at the forefront of our strategy," Said Ken Colby, PINC Solutions' CEO. "As our customers increasingly view their supply chain as a complex and dynamic network of trading partners, PINC continues to focus on leveraging real-time visibility as the key enabler for management and practitioners to make informed decisions. We strive to provide solutions that not only meet our customers' needs for quick ROI, but also function as a catalyst for business process improvement and redesign for sustainable logistics excellence."
About PINC Solutions
PINC Solutions is North America's leading supplier of supply chain visibility and advanced yard management solutions with Fortune-500 customers in the manufacturing, retail, logistics, and transportation sectors. PINC has pioneered the development of cost-effective real-time location systems (RTLS) using passive RFID technology that minimizes capital investment required in the infrastructure. PINC's award-winning products are designed with a scalable architecture for businesses of any size, and are expandable with modular components as customers needs grow. Available as turnkey solutions and delivered through a Software-as-a-Service (SaaS) model, these systems have proven their value through immediate efficiency improvements in customers daily operations, typically generating positive ROI in less than a year. To learn more about PINC Solutions, please visit www.pincsolutions.com.
About Supply & Demand Chain Executive
Supply & Demand Chain Executive is the executive's user manual for successful supply and demand chain transformation, utilizing hard-hitting analysis, viewpoints and unbiased case studies to steer executives and supply management professionals through the complicated, yet critical, world of supply and demand chain enablement to gain competitive advantage. Visit us on the Web at www.SDCExec.com.
Media Contact
Rafael Granato
PINC Solutions - Marketing Communications Manager – firstname.lastname@example.com


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My Recipe Box
March 11, 2008 - 12:32pm
My Recipe Box
March 11, 2008 - 12:32pm
How about a quick link to our recipe box's? Instead of having to go 'My Profile'.
March 12, 2008 - 4:20am
I second that!!
March 16, 2008 - 1:09pm
Good idea. I'll add it to my list!
March 22, 2008 - 4:10pm
I wouldn't mind having a way to organize my recipe box into categories like smoothies, breakfast, et cetera. thanks for all your hard work!!


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Flood Damaged Cars
By: Julie Musgrave
Updated: September 16, 2008
Many folks are now facing serious mechanical problems on their vehicles from all the flooding. Some tow truck companies are almost 7 hours behind trying to gather up all the cars, and local businesses -- already seeing to the damage.
Prock automotive opened it's doors at , and already had cars coming in for some work due to flood damage.
Owner Joel Prock says the most common type of damage is water ingested into the engine itself, prohibiting your car from starting.
Even worse, if water gets in the motor, it could rust.
Repair costs range anywhere from $200 to thousands if you end up having to replace your engine.
One major telltale sign is the smell of mildew, but Prock also says if any water came up over your hood, don't start the car. Just bring it in as soon as possible.
Also -- check your insurance before you get repairs. Lots of times flood damage is covered and could save you a lot of money.
The most important thing to remember here though is don't wait for the damage to get worse.
Joel Prock, Prock Automotive: "Most of the damage will be seen immediately, especially engine wise. If you actually get water on the interior, and it actually fills the interior, some of that damage comes slowly."
If you suspect your car has any damage, don't wait to bring it in.
You should have it checked out before you drive on it and cause any unnecessary harm.


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Plant Certification
PCI's Plant Certification Program ensures that each plant has developed and documented an in-depth, in-house quality system based on time-tested, national industry standards. Each plant undergoes two thorough, unannounced audits each year. They are conducted by third-party engineers who inspect the plant according to requirements specifically targeted to the products being manufactured at that location.
Precasting plants can be certified in as many as four product groups: Group A—Architectural Products; Group B and BA—Bridge Products; Group C and CA—Commercial (Structural) Products; and Group G—Glass-Fiber-Reinforced Concrete (GFRC) Products.
PCI Certified plants are audited in accordance with standards published in three PCI quality-control manuals (MNL-116, MNL-117, and MNL-130).
PCI's plant certification program as compared to those offered by the National Precast Concrete Association (NPCA) and the Architectural Precast Association (APA):
Structural products (prestressed)—established 5 years or more
Precast concrete product (conventional reinforcement)
Architectural precast concrete
P.E. inspection/oversight
All inspections unannounced
Minimum 2 inspections per year
Clearly defined product certification categories
Approval of plant QC manual
Mandatory for PCI Producer Members
Personnel certification
Field certification
Technical manuals
Quality-control (QC) manuals
© 2008 Precast/Prestressed Concrete Institute


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Publishing house Bird Publisher was established in september 2008. I loved books for almost all of my life. Also an area of personal development and spirituality was quite commom to me, because for more than 12 years it fulfilled my life with different kinds of experiences and wonders. At that time I was acquainted with old scripts and other literature and was wondering how to make it accesible all over the world, at any time and place on the Earth. Thanks to God, we have the world wide web! Ebooks, eMeditations and eLectures ... that was it(!). Because at that time my personal web page was my own creation, I knew a few things also about this subject. Also one translatition, meditation and lekture were finished. I had at that time one finished translation, one PC, a few finished meditations and lectures, but that was not something that worried me much, so I`d rather start.
For some of projects friends joined me and somehow helped to complete them. They are authors (wants to publisher their work), publishers (wants to publisher books as eBooks), translators (wants to translate texts), lectors, etc. That was how entirely new eBooks and other editions came into existence.
Now it is up to you, dear visitor, to search this web site, look at eBooks, eMeditations and eLectures, and choose the one you are looking for.
Bird Publisher
Avgust, 2012.
You would like to share a common path? In work.
Would you like to be a part? Contact.
Are you looking for yourself or your friends literature, meditations or lectures? See more.
Sharing experiences and wisdom - Bird Publisher.


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It's Hatched!42 Bought
Deal Over
Awake to the melody of bird's chirping when you book a 1-night stay at the James River Cabins in Galena. Each cabin offers a private bedroom with a queen-sized bed, living room with satellite TV, queen-sized pull out sofa, eat-in kitchen, bathroom, washer and dryer and central heat and air. You'll also enjoy a large deck overlooking the James River, which is one of Missouri's top canoe rivers. Plus, there's a fire pit, private covered picnic area with charcoal grill and reserved covered parking. You can enjoy your stay without busting your budget: Save 50% off the regular price.
Located at 314 Elm Street, James River Cabins provides an ideal base to enjoy many of the area's attractions. Open seven days a week.
$50 for 1 night stay at James River Cabins
The Merchant, not DealChicken, is solely responsible for this Deal. This Deal is subject to the Terms of Service and HOW DEALCHICKEN WORKS.
The state mineral of Missouri is galena. It was given this honor on July 21, 1967. Galena is dark gray in color and breaks into small blocks.
James River Cabins
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New app can identify human emotions?
Posted at: 12/05/2012 8:36 PM | Updated at: 12/05/2012 8:44 PM
Smart phones can do a ton of things to make a user's life easier and soon they might be able to tell how your feeling.
The University of Rochester says they are working on a new app for smartphones that could identify your mood.
The new technology identifies aspects of your voice and uses that to tell what mood you are in. Researchers say the new app could be a big help in studies and situations where emotions are recorded.
Wendi Heinzelman, a professor working on the app, talked with Lia Lando about how it works and why they are developing it. You can watch that interview by hitting play on the video player.
Have a story you want our news team to investigate? Call us at 585-232-1010, click here to send us an e-mail or leave us a Facebook post or tweet.
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The Longboat Key Police Department has linked two suspected burglars that were apprehended breaking into the Waterfront Restaurant in Anna Maria early Tuesday, May 19 to the Centre Shops of Longboat Key burglaries May 11.
Longboat Key Police Detective Kristina Roberts said John O'Keefe, 18, of Sarasota, and Patrick Samuel Banker, 18, of Sarasota, will be charged with two counts of burglary and two counts of grand theft for burglaries at Longboat Key businesses.
A third grand-theft charge is also likely, Roberts said, because the Exit Art merchandise found in the bushes by the Centre Shops adds up to $300 or more worth of merchandise stolen from the business.
Just like in the Centre Shops burglary, a sheriff report depicts a routine check of the area uncovered the suspects running from the Waterfront Restaurant Tuesday.
A Holmes Beach police officer found one of the suspects, and a sheriff's K-9 caught up to the other suspect. Manatee County Sheriff spokesman Dave Bristow believes the two suspects could be responsible for as many as 15 to 20 recent burglary cases from Longboat Key to Anna Maria Island.
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20 Cafe L'Europe UnCorked!
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22 Dog Days of Summer - Adoption Event
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Dance teams show off skills
Children from Imagine School and Gullett Elementary School showed off their hard work and dancing talents recently, during a special end-of-year dance team recital. -
John Saputo: Undercover boss?
Look closely: Who is that stock boy? -
Turtles head home after rehab at Mote
Tyler the turtle is back at sea.


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The story feels like a work of fiction because we are trained to see these kinds of monsters and evil forces within the framework of fictional films already. But when you acknowledge that Jesus actually spoke to demons, you have to ask the bigger question. Is the Bible real?
The story we care about is connecting in a world of disconnect. Whether that is connecting with family or just with friends, we inherently need more than a text or a tweet. Interestingly, we need the same thing from God.
The story doesn't show us a better world with a benevolent Rainmaker, so we are left holding the question in our own hands. Does the active presence of a parent make a difference in a child's life?
Promised Land explores how surfing connects the lives of Jews, Muslims, and Christians in Israel. Beware of Christians is the story of four college guys who travel across Europe to discover what it means to truly follow Christ.
These two films did exactly what shorts ought to do. Rather than simply telling a good story, shorts should strive to make a lasting impact. Like a quick punch, they should provide an instant awakening.
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