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This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
Fortunately, cancer in children and adolescents is rare, although the overall incidence of childhood cancer has been slowly increasing since 1975.[1] Children and adolescents with cancer should be referred to medical centers that have a multidisciplinary team of cancer specialists with experience treating the cancers that occur during childhood and adolescence. This multidisciplinary team incorporates the skills of the primary care physician, pediatric surgical subspecialists, radiation therapists, pediatric oncologists/hematologists, rehabilitation specialists, pediatric nurse specialists, social workers, and others to ensure that children receive treatment, supportive care, and rehabilitation that will achieve optimal survival and quality of life. Specific information about supportive care for children and adolescents with cancer can be found in the PDQ Supportive and Palliative Care summaries.
Guidelines for pediatric cancer centers and their role in the treatment of pediatric patients with cancer have been outlined by the American Academy of Pediatrics.[2] At these pediatric cancer centers, clinical trials are available for most of the types of cancer that occur in children and adolescents, and the opportunity to participate in these trials is offered to most patients/families. Clinical trials for children and adolescents with cancer are generally designed to compare potentially better therapy with therapy that is currently accepted as standard. The majority of the progress made in identifying curative therapies for childhood cancers has been achieved through clinical trials. Information about ongoing clinical trials is available from the NCI Web site.
Dramatic improvements in survival have been achieved for children and adolescents with cancer.[1] Between 1975 and 2002, childhood cancer mortality decreased by more than 50%. For gonadal extracranial germ cell tumor (GCT), the 5-year survival rate has increased over the same time from 89% to 98% for children younger than 15 years and from 70% to 95% for adolescents aged 15 to 19 years. For extragonadal GCT, the 5-year survival rate from 1979 to 2002 increased from 42% to 83% for children younger than 15 years.[1] Childhood and adolescent cancer survivors require close follow-up since cancer therapy side effects may persist or develop months or years after treatment. (Refer to the PDQ summary on Late Effects of Treatment for Childhood Cancer for specific information about the incidence, type, and monitoring of late effects in childhood and adolescent cancer survivors.)
Childhood GCTs are rare in children younger than 15 years, accounting for approximately 3% of cancer cases in this age group.[3,4,5] In the fetal/neonatal age group, the majority of extracranial GCTs that occur are benign teratomas occurring at midline locations including sacrococcygeal, retroperitoneal, mediastinal, and cervical regions. Despite the small percentage of malignant teratomas that occur in this age group, perinatal tumors have a high morbidity rate due to hydrops fetalis and premature delivery.[6,7] Extracranial GCTs (particularly testicular GCTs) are much more common among adolescents aged 15 to 19 years, representing approximately 14% of cancer diagnoses in this age group. The distribution of extracranial GCTs by 5-year age group and by gender is shown in Table 1 below.
GCTs develop from primordial germ cells, which migrate during embryogenesis from the yolk sac through the mesentery to the gonads.[8,9] Childhood extracranial GCTs can be divided into gonadal and extragonadal types. Most childhood extragonadal GCTs arise in midline sites (i.e., sacrococcygeal, mediastinal, and retroperitoneal); the midline location may represent aberrant embryonic migration of the primordial germ cells.
The histologic and genetic properties of these tumors are heterogeneous and vary by primary tumor site and the gender and age of the patient.[10,11] Histologically identical GCTs that arise in younger children have different biological characteristics from those that arise in adolescents and young adults.[12]
Childhood extracranial germ cell tumors (GCTs) comprise a variety of histologic diagnoses and can be broadly classified into mature or immature teratomas and malignant GCTs.
Mature Teratomas
Mature teratomas usually occur in the ovary or at extragonadal locations and are the most common histological subtype of childhood GCT.[1,2,3] These teratomas usually contain well-differentiated tissues from the ectodermal, mesodermal, and endodermal germ cell layers, and any tissue type may be found within the tumor. Mature teratomas are benign, though some mature and immature teratomas may secrete enzymes or hormones, including insulin, growth hormone, androgens, prolactin, and vasopressin.[4,5,6]
Immature Teratomas
Immature teratomas contain tissues from all three germ cell layers, but immature tissues, primarily neuroepithelial, are also present. Immature teratomas are graded from 0 to 3 based on the amount of immature neural tissue found in the tumor specimen.[7] Tumors of higher grade are more likely to have foci of yolk sac tumor.[8] Immature teratomas occur primarily in young children at extragonadal sites and in the ovaries of girls near the age of puberty, but there is no correlation between tumor grade and patient age.[8,9]
Malignant GCTs
GCTs contain frankly malignant tissues of germ cell origin, and rarely, tissues of somatic origin. Isolated malignant elements may constitute a small fraction of a predominantly mature or immature teratoma.[9,10] Malignant germ cell elements of children, adolescents, and young adults can broadly be classified by location (see Tables 2 and 3).
Yolk sac tumors produce alpha-fetoprotein (AFP), while germinomas (seminomas and dysgerminomas), and especially choriocarcinomas, produce beta-human chorionic gonadotropin, resulting in elevated serum levels of these substances. Most children with malignant GCTs will have a component of yolk sac tumor and have elevations of AFP,[12,13] which is serially monitored during treatment to help assess response to therapy.[9,10,12]
Adolescents and young adults present with more germinomas (testicular and mediastinal seminomas in males and ovarian dysgerminomas in females). These tumors are usually treated with chemotherapy. They are also sensitive to radiation therapy, but radiation is rarely recommended. Radiation therapy and surgery for the patient with brain metastases may provide palliation and occasionally, long-term survival.[14][Level of evidence: 3iiiA]
The following paragraphs describe the biologically distinct subtypes of GCTs found in children and adolescents. It should be emphasized that very few pediatric GCT specimens have been analyzed to date. Biologic distinctions between GCTs in children versus adults may not be absolute.[1,2]
Testicular GCTs
Ovarian GCTs
Ovarian GCTs occur primarily in adolescent and young adult females. While the majority of ovarian GCTs are benign mature teratomas, a heterogeneous group of malignant GCTs occur in females, including immature teratomas, dysgerminomas, yolk sac tumors, and mixed GCTs. Patients with pediatric ovarian GCTs have an excellent prognosis. One series of 66 patients followed over 44 years reported recurrence and mortality rates of 4.5% and 3%, respectively.[12] The malignant ovarian GCT commonly shows increased copies of the short arm of chromosome 12.[13] (Refer to the PDQ summary on Ovarian Germ Cell Tumors Treatment for more information.)
Extragonadal Extracranial GCTs
There is very little data about the potential genetic or environmental factors associated with childhood extracranial GCTs. Patients with Klinefelter syndrome [21,22,23] are at increased risk for mediastinal GCTs, while patients with Swyer syndrome [24,25] are at increased risk for gonadoblastomas and germinomas.
As with other childhood solid tumors, stage directly impacts the outcome of patients with malignant germ cell tumors (GCTs).[1,2,3] The most commonly used staging system in the United States is described below.[4] Retroperitoneal lymph node dissection has not been required in pediatric germ cell trials to stage males younger than 15 years. Data on adolescent males with testicular GCTs are limited. Retroperitoneal lymph node dissection is used for both staging and treatment in adult testicular GCT trials.[5] (Refer to the PDQ summary on Testicular Cancer Treatment for more information about the staging of adult testicular GCTs.)
Nonseminoma Testicular GCT Staging From Children's Oncology Group
Ovarian GCT Staging From Children's Oncology Group
Ovarian GCT Staging From FIGO
Another staging system used frequently by gynecologic oncologists is the International Federation of Gynecologic Oncologists (FIGO) staging system, which is based on an adequate staging operation at the time of diagnosis.[6] (Refer to the PDQ summary on Ovarian Germ Cell Tumors Treatment for more information.) This system has also been used by some pediatric centers,[2] and is as follows:
Stage I: Tumor limited to the ovaries
Stage II: Ovarian tumor with pelvic extension
Stage III: Tumor outside the pelvis, or positive nodes
Stage IV: Distant organ involvement, including liver parenchyma or pleural space
Extragonadal Extracranial GCT Staging From Children's Oncology Group
Prior to effective chemotherapy, children with extracranial malignant germ cell tumors (GCTs) had 3-year survival rates of 15% to 20% with surgery and radiation therapy,[1,2,3] though young boys with localized testicular tumors did well with surgical resection.[4,5] The outcome for most children and adolescents with extracranial GCT is now favorable when appropriate treatment is provided. Prognosis and appropriate treatment depend on factors such as histology (e.g., seminomatous vs. nonseminomatous), age (young children vs. adolescents), stage of disease, and primary site.[6,7,8,9] To maximize the likelihood of long-term survival while minimizing the likelihood of treatment-related long-term sequelae (e.g., secondary leukemias, infertility, hearing loss, and renal dysfunction), it is important that children with extracranial malignant GCTs be cared for at pediatric cancer centers with experience treating these rare tumors. Based on clinical factors, appropriate treatment may involve: surgical resection followed by careful monitoring for disease recurrence; diagnostic tumor biopsy and preoperative platinum-based chemotherapy followed by definitive tumor resection; or initial surgical resection followed by platinum-based chemotherapy.[10] For patients with completely resected immature teratomas at any location (even those with malignant elements) and patients with localized, completely resected (stage I) gonadal tumors, additional therapy may not be necessary; however, close follow-up is important.[11,12] The watch-and-wait approach requires scheduled serial physical examination, tumor marker determination, and primary tumor imaging to ensure that a recurrent tumor is detected without delay.
Cisplatin-based chemotherapy has dramatically improved the outcome for children with extracranial GCTs, with 5-year survival rates of more than 90%.[6,7,8,9] The standard chemotherapy regimen for both adults and children with malignant nonseminomatous GCTs includes cisplatin, etoposide, and bleomycin (PEB), though children receive fewer doses of bleomycin than adults.[6,7,13,14] The combination of carboplatin, etoposide, and bleomycin (JEB) has undergone clinical investigation in the United Kingdom in children younger than 16 years and is reported to have a similar event-free survival (EFS) by site and stage as PEB.[8,15] The use of JEB appears to be associated with less ototoxicity and nephrotoxicity than PEB.[8] Adult studies have substituted standard-dose carboplatin for cisplatin in combination with etoposide alone and in combination with etoposide and low-dose bleomycin,[16] but the carboplatin regimens demonstrated inferior EFS and overall survival (OS) compared with cisplatin-containing therapy among patients with malignant GCTs. No randomized comparison of PEB versus JEB has been conducted in children. See Table 4 for pediatric PEB and JEB chemotherapy dosing schedules.
The approach to the management of extracranial GCTs has been informed by the results of two intergroup studies conducted by the Children's Cancer Group (CCG) and the Pediatric Oncology Group (POG).[6,7,11] These studies explored the use of PEB for the treatment of localized gonadal GCT [6] and the benefit of increasing the dose of cisplatin (high-dose [HD]-PEB: 200 mg/m2 vs. PEB: 100 mg/m2 of cisplatin) in a randomized manner in patients with extragonadal and advanced gonadal GCTs.[7]
The intensification of cisplatin in the HD-PEB regimen provided some improvement in EFS but no difference in OS; however, the use of HD-PEB was associated with a significantly higher incidence and severity of ototoxicity and nephrotoxicity. In a subsequent study, amifostine was not effective in preventing hearing loss in patients who received HD-PEB.[17]
Table 5 provides an overview of standard treatment options for children with extracranial GCTs. Treatment requires a multidisciplinary approach with various surgical subspecialties and pediatric oncologists. Specific details of treatment by primary site and clinical condition are described in subsequent sections.
Non-GCT Malignant Elements
The treatment of GCTs with other non-GCT elements is complex and scant data exist to inform treatment. Specific treatment for both the malignant GCT and non-GCT elements may be required.[18] However, the optimal treatment strategy for other malignant elements found in GCT has not been determined.
Mature and immature teratomas arise primarily in the sacrococcygeal region of neonates and young children and in the ovaries of pubescent girls. These tumors are also less commonly found in the testicular region of boys younger than 4 years, the mediastinum of adolescents, and other sites.[1,2,3]
Sacrococcygeal Tumors in Children
Standard treatment options
The sacrococcygeal region is the primary tumor site for the majority of benign and malignant germ cell tumors (GCTs) diagnosed in neonates, infants, and children younger than 4 years. These tumors occur more often in girls than in boys; ratios of 3:1 to 4:1 have been reported.[4] Sacrococcygeal tumors present in two clinical patterns related to the child's age, tumor location, and likelihood of tumor malignancy. Neonatal tumors present at birth protruding from the sacral site are usually mature or immature teratomas. Among infants and young children, the tumor presents as a palpable mass in the sacropelvic region compressing the bladder or rectum.[1] These pelvic tumors have a greater likelihood of being malignant. An early survey found that the rate of tumor malignancy was 48% for girls and 67% for boys older than 2 months at the time of sacrococcygeal tumor diagnosis, compared with a malignant tumor incidence of 7% for girls and 10% for boys younger than 2 months at the time of diagnosis.[5] The pelvic site of the primary tumor has been reported to be an adverse prognostic factor, which may be due to either delayed diagnosis because it was unappreciated at birth or incomplete resection at the time of original surgery.[5,6,7,8]
After successful resection, neonates diagnosed with benign mature and immature teratomas are observed with close follow-up exams and serial serum alpha-fetoprotein (AFP) determinations for several years to ensure that the expected physiological normalization of AFP levels occurs and to facilitate early detection of tumor relapse.[9] A significant rate of recurrence among these benign tumors has been reported by several groups, ranging from 10% to 21%, with most relapses occurring within 3 years of resection.[4,9,10,11] While there is no standard follow-up schedule, follow-up should include scans and tumor markers for 3 years. Importantly, 43% to 50% of these recurrent tumors will be malignant and require adjuvant chemotherapy. With early detection, these malignant GCTs can be treated successfully with surgery and chemotherapy (overall survival, 92%).[12] Complete resection of the coccyx is vital to minimize the likelihood of tumor recurrence;[2] however, one study reported that 11 out of 12 patients with microscopic residual benign immature teratoma had no recurrence.[13] Long-term survivors should be monitored for complications of extensive surgery, which include constipation, fecal and urinary incontinence, and psychologically unacceptable cosmetic scars.[14]
Nonsacrococcygeal Teratomas in Children
Mature teratoma and epidermoid cyst in the prepubertal testis are relatively common benign lesions and may be amenable to testis-sparing surgery.[15] Children with mature teratomas, including mature teratomas of the mediastinum, can be treated with surgery and observation with an excellent prognosis.[1,16] In a review of 153 children with nontesticular mature teratoma, the 6-year relapse-free survival for completely resected disease was 96% versus 55% for incomplete resection.[2] Head and neck GCTs in neonates should be cared for by a multidisciplinary team. While most are benign, they do present significant challenges to surgeons. Some tumors develop malignant elements, which may change the treatment strategy.[17]
In infants and young children, immature teratomas have benign clinical behavior if they can be resected.[10,18,19] In a single institution retrospective study, immature teratomas had a mortality rate (16.2%) twice that of yolk sac tumors (7.4%) and reflects the few patients with immature teratomas (unfavorable sites) that could not be resected. Immature teratomas generally do not respond to chemotherapy.[20] In adults, immature teratomas (primarily ovarian) reportedly have an aggressive clinical behavior [21] requiring surgery and chemotherapy. The benefit of adjuvant chemotherapy for children was questioned in a study by the Pediatric Oncology Group and Children's Cancer Group that evaluated the use of surgical resection followed by careful observation for patients with immature teratomas. Surgery alone was curative for most children and adolescents with resected ovarian immature teratoma of any grade, even when elevated levels of serum AFP or microscopic foci of yolk sac tumor were present. The study demonstrated a 3-year event-free survival of 97.8%, 100%, and 80% for patients with ovarian, testicular, and extragonadal tumors, respectively.[22] It is important to emphasize that the number of pediatric patients with residual teratomas and immature teratomas is very small. There may be a role for surgical removal of residual benign lesions.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood teratoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Childhood Malignant Testicular GCTs
Testicular GCTs in young boys
Testicular germ cell tumors (GCTs) in children occur almost exclusively in boys younger than 4 years.[1,2] The initial approach to evaluate a testicular mass in a young boy is important because a transscrotal biopsy can risk inguinal node metastasis.[3,4] Radical inguinal orchiectomy with initial high ligation of the spermatic cord is the procedure of choice.[5] Retroperitoneal dissection of lymph nodes is not beneficial in the staging of testicular GCTs in young boys. Computed tomography or magnetic resonance imaging evaluation, with the additional information provided by elevated tumor markers, appears adequate for staging.[3,4] Therefore, there is no reason to risk the potential morbidity (e.g., impotence and retrograde ejaculation) related to lymph node dissection.[6,7]
A Children's Cancer Group (CCG)/Pediatric Oncology Group (POG) clinical trial evaluated surgery followed by observation for boys aged 10 years or younger with stage I testicular tumors. This treatment strategy resulted in a 6-year event-free survival (EFS) of 82%; those boys who developed recurrent disease were salvaged with four cycles of standard-dose cisplatin, etoposide, and bleomycin (PEB), with a 6-year survival of 100%.[3,4] Boys younger than 10 years with stage II tumors were treated after diagnosis with four cycles of PEB.[8] Boys and adolescents (age not limited to 10 years or younger) with stage III and IV testicular tumors were treated with surgical resection followed by four cycles of standard or high-dose (HD)-PEB therapy. The 6-year survival outcome for males younger than 15 years with stage III and IV tumors was 100%, with 6-year EFS of 100% and 94%, respectively.[9] The use of HD-PEB therapy did not improve the outcome for these boys but did cause increased incidence of ototoxicity. Excellent outcomes for boys with testicular GCTs using surgery and observation for stage I tumors and carboplatin, etoposide, and bleomycin (JEB) and other cisplatin-containing chemotherapy regimens for stage II, III, and IV tumors have also been reported by European investigators.[6,10] Thus, surgery followed by standard-dose platinum-based chemotherapy is the recommended approach for stages II, III, and IV testicular GCTs in children younger than 15 years.
Surgery: The role of surgery at diagnosis for GCTs is age- and site-dependent and must be individualized. Primary resection is appropriate when feasible without undue risk of damage to adjacent structures; otherwise, an appropriate strategy is biopsy for diagnosis followed by subsequent excision in selected patients who have residual masses following chemotherapy.
Stage I
Stages II through IV
Treatment options under clinical evaluation for stages I through IV in patients younger than 15 years
The following is an example of a national and/or institutional clinical trial that is currently being conducted. Information about ongoing clinical trials is available from the NCI Web site.
Testicular GCTs in adolescents and young adult males
Because the biology of testicular GCTs among adolescents and young adult males is different from that of testicular tumors arising in infants and young boys, the treatment guidelines described above for young boys may not be strictly applicable to adolescent males. In particular, the use of retroperitoneal lymph node dissection may play a crucial role both in early stage testicular GCT [11] and for residual disease after chemotherapy for the treatment of metastatic GCT.[12,13] In this age group, the presence of a sarcomatous component in the primary testis GCT does not alter the prognosis, but if a sarcomatous component is found in a metastatic lesion, survival is likely to be compromised.[14]
(Refer to the PDQ summary on Testicular Cancer Treatment for more information.)
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood malignant testicular germ cell tumor and childhood malignant ovarian germ cell tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Childhood Malignant Ovarian GCT
Most ovarian neoplasms in children and adolescents are of germ cell origin.[1] Ovarian GCTs are very rare in young girls, but the incidence begins to increase in children aged approximately 8 or 9 years, and continues to rise throughout adulthood.[1] Childhood malignant ovarian GCTs can be divided into dysgerminomas (seminomatous) and nonseminomatous malignant GCTs (i.e., immature teratomas, yolk sac carcinomas, mixed GCTs, choriocarcinoma, and embryonal carcinomas). (For information on childhood mature and immature teratomas arising in the ovary, see the Nonsacrococcygeal Teratomas in Children section of this summary. Refer to the PDQ summary on Ovarian Germ Cell Tumors Treatment for more information.)
For stage I ovarian dysgerminomas and immature teratomas, cure can usually be achieved by unilateral salpingo-oophorectomy, conserving the uterus and opposite ovary, and close follow-up observation.[10,15,16,17,18] Chemotherapy can be given if tumor markers do not normalize or if tumors recur.
While advanced-stage ovarian dysgerminomas similar to testicular seminomas are highly curable with surgery and radiation therapy, the effects on growth, fertility, and risk of treatment-induced second malignancy in these young patients [19,20] make chemotherapy a more attractive adjunct to surgery.[21,22] Complete tumor resection is the goal for advanced dysgerminomas; platinum-based chemotherapy can be given preoperatively to facilitate resection or postoperatively (after debulking surgery) to avoid mutilating surgical procedures.[18] This approach results in a high rate of cure and the maintenance of menstrual function and fertility in most patients with dysgerminomas.[21,23]
For ovarian malignant GCTs other than dysgerminomas or immature teratomas, treatment generally involves surgical resection and adjuvant chemotherapy.[24,25] Platinum-based chemotherapy regimens such as PEB or JEB have been used successfully in children,[8,9,10,15] and PEB is a common regimen in young women with ovarian GCTs.[26,27] This approach results in a high rate of cure and the maintenance of menstrual function and fertility in most patients with nondysgerminomas.[25,28] A few small studies have suggested that observation after surgery may be an option, but only as part of a clinical trial with strict adherence to surgical guidelines.[10,28]
A multidisciplinary approach is essential for treatment of ovarian GCTs. Various surgical subspecialties and the pediatric oncologist must be involved in clinical decisions. The reproductive surgical approach for pediatric GCTs is often guided by the hope that function can be preserved. In a completed pediatric intergroup trial, pediatric patients with ovarian GCTs (stages I-IV) had excellent survival with PEB and conservative surgery, rather than the strict guidelines proposed originally in the study.[29] The role of laparoscopy in children with ovarian GCTs has not been well studied.
Surgery: The role for surgery at diagnosis is age- and site-dependent and must be individualized. Primary resection is appropriate when feasible without undue risk of damage to adjacent structures; otherwise, an appropriate strategy is biopsy for diagnosis followed by subsequent surgery in selected patients who have residual masses following chemotherapy.
Stages I through IV
Treatment options under clinical evaluation for stages I through III
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood malignant ovarian germ cell tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Extragonadal germ cell tumors (GCTs) (i.e., sacrococcygeal, mediastinal, and retroperitoneal) are more common in children than adults.[1] Children with extragonadal malignant GCTs, particularly those with advanced stage, have the highest risk of treatment failure for any GCT presentation.[2,3] In a study of prognostic factors in pediatric extragonadal malignant GCTs, age older than 12 years was the most important prognostic factor. In a multivariate analysis, children aged 12 years or older with thoracic tumors had six times the risk of death compared with children younger than 12 years with primary nonthoracic tumors.[4] Outcome has improved remarkably, however, since the advent of platinum-based chemotherapy and the use of a multidisciplinary treatment approach.[2,5] Complete resection prior to chemotherapy may be possible in some patients without major morbidity, but for patients with locally advanced sacrococcygeal tumors, mediastinal tumors, or large pelvic tumors, tumor biopsy followed by preoperative chemotherapy can facilitate subsequent complete tumor resection and improve ultimate patient outcome.[5,6,7,8]
Sacrococcygeal GCTs are very common extragonadal tumors that occur in very young children, predominately young females.[9] They are usually diagnosed at birth, when large external lesions predominate (usually benign or immature teratomas), or later in the first years of life, when presacral lesions with higher malignancy rates predominate.[9] Malignant sacrococcygeal tumors are usually very advanced at diagnosis; two-thirds of patients have locoregional disease and metastases are present in 50% of the patients.[7,10,11] Because of advanced presentation, the management of sacrococcygeal tumors requires a multimodal approach with chemotherapy followed by delayed tumor resection. Platinum-based therapies, with either cisplatin or carboplatin, are the cornerstone of treatment. The cisplatin, etoposide, and bleomycin (PEB) regimen or the carboplatin, etoposide, and bleomycin (JEB) regimen produces event-free survival (EFS) rates of 75% to 85%; overall survival (OS) rates of 80% to 90% can be achieved.[7,8] Surgery is usually facilitated by preoperative chemotherapy, and completeness of surgical resection is a very important prognostic factor. Patients with resected tumors with negative microscopic margins have EFS rates greater than 90%; patients with microscopic margins have EFS rates of 75% to 85%; and patients with macroscopic residual disease after surgery have EFS rates less than 40%. In any patient with a sacrococcygeal GCT, resection of the coccyx is mandatory.[7,8]
Mediastinal GCTs account for 15% to 20% of malignant nongonadal, extracranial GCTs in children.[5] The histology of mediastinal GCT is dependent on age, with teratomas predominating among infants and with yolk sac tumor histology predominating among children aged 1 to 4 years.[6] Children with mediastinal teratomas are treated with tumor resection, which is curative in almost all patients.[6] Children with malignant, nonmetastatic mediastinal GCTs who receive cisplatin-based chemotherapy have 5-year EFS and OS rates of 90%, but an EFS closer to 70% occurs with metastatic mediastinal tumors.[5,6] Most mediastinal GCTs in adolescents and young adults occur in males and 50% have cytogenetic changes consistent with Klinefelter syndrome. The age of presentation is younger in patients with Klinefelter syndrome.[12,13] As with sacrococcygeal tumors, primary chemotherapy is usually necessary to facilitate surgical resection of mediastinal GCTs, and the completeness of resection is a very important prognostic indicator.[6,14] Survival rates for the older adolescent and young adult population with mediastinal tumors are generally less than 60%.[4,15,16,17]; [18]Level of evidence: 3iiA (Refer to the PDQ summary on Extragonadal Germ Cell Tumors Treatment for more information.)
Malignant GCTs located in the retroperitoneum or abdomen usually present in children before age 5 years; most tumors are of advanced stage and locally unresectable at diagnosis.[19] A limited biopsy followed by platinum-based chemotherapy to shrink tumor bulk can lead to complete tumor resection in most patients. Despite advanced-stage disease in most patients, the 6-year EFS using PEB was 83% in the Pediatric Oncology Group/Children's Cancer Group intergroup study.[19]
Though rare, benign and malignant GCTs can occur in the head and neck region, especially in infants. Often the airway is threatened. Surgery for nonmalignant tumors plus chemotherapy for malignant tumors can be curative.[20][Level of evidence: 3iiiDii]
Standard Treatment Options
Surgery: The role for surgery at diagnosis for extragonadal tumors is age- and site-dependent and must be individualized. Depending on the clinical setting, the appropriate surgical approach may range from no surgery (e.g., mediastinal primary tumor in a patient with a compromised airway and elevated tumor markers), to biopsy, to primary resection. In some cases, an appropriate strategy is biopsy at diagnosis followed by subsequent surgery in selected patients who have residual masses following chemotherapy.
Stages I and II
Stages III and IV
Treatment Options Under Clinical Evaluation
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood extragonadal germ cell tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Only a small number of children and adolescents with extracranial germ cell tumors (GCTs) relapse.[1,2] However, the approach to recurrent disease and its success depend on the initial treatment regimen and on the response of the tumor to treatment.
Boys with stage I testicular disease originally treated with surgical resection and observation can usually be salvaged, if relapse occurs, by further surgical excision and standard cisplatin, etoposide, and bleomycin (PEB) or carboplatin, etoposide, and bleomycin (JEB) chemotherapy.[3,4] Several European studies also have reported encouraging salvage rates for stage I ovarian GCT patients originally treated with surgery and observation.[5,6]
Most children with recurrent sacrococcygeal tumors will recur locally at the primary tumor site. For these children, complete surgical resection of the recurrent tumor and the coccyx is the basis of salvage treatment; preoperative chemotherapy may assist the surgical resection. In patients in whom a complete salvage resection is not achieved, postoperative local irradiation should be considered.[7]
Despite overall cure rates greater than 80%, children with extracranial GCTs who have disease recurrence after surgery and three-agent platinum-based combination chemotherapy (PEB or JEB) have an unfavorable prognosis. Reports regarding the treatment and outcome of these children include small patient samples.[7] Reports of salvage treatment strategies used in adult recurrent GCTs include larger numbers of patients, but the differences between children and adults regarding the location of the primary GCT site, pattern of relapse, and the biology of childhood GCTs may limit the applicability of adult salvage approaches to children.
In adults with recurrent GCTs, several chemotherapy combinations have achieved relatively good disease-free status.[8,9,10,11,12,13] A combination of paclitaxel and gemcitabine has demonstrated activity in adults with testicular GCTs who relapsed after high-dose (HD) chemotherapy and hematopoietic stem cell transplant (SCT).[14]
HD chemotherapy with autologous stem cell rescue has been explored in adults with recurrent testicular GCTs. HD chemotherapy plus hematopoietic stem cell rescue has been reported to cure adult patients with relapsed testicular GCTs, even as third-line therapy and in cisplatin-refractory patients.[15] While several other studies support this approach,[16,17,14,18,19] others do not.[20,21] Salvage attempts using HD-chemotherapy regimens may be of little benefit if the patient is not clinically disease free at the time of hematopoietic SCT.[15,22]
The role of HD chemotherapy and hematopoietic stem cell rescue for recurrent pediatric GCTs is not established, despite anecdotal reports. In one European series, 10 of 23 children with relapsed extragonadal GCTs achieved long-term (median follow-up 66 months) disease-free survival by using HD chemotherapy with stem cell support.[23] Further study is needed in children and adolescents.
There are no standard treatment options for recurrent pediatric GCTs. The role for surgery in selected patients who have recurrent GCTs has not been established but should be considered. Information about ongoing clinical trials is available from the NCI Web site.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent childhood malignant germ cell tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Treatment of Mature and Immature Teratomas in Children
Added text to state that with early detection, these malignant germ cell tumors can be treated successfully with surgery and chemotherapy (cited De Corti et al. as reference 12).
This summary is written and maintained by the PDQ Pediatric Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of childhood extracranial germ cell tumors. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Pediatric Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Childhood Extracranial Germ Cell Tumors Treatment are:
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Levels of Evidence
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Chaos Code (June 2010)
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Topic: Chaos Code (June 2010)
Posted: June 04 2010 at 12:50
Chaos Code from USA is one of the many symphonic prog bands who has been bubbling around just under the surface for some time. They have been suffering from a lack of magazines dedicated to this genre in their efforts to promote their albums. But their music is still deserving a broader audience. I got in touch with Cliff Phelps from Chaos Code.
He patiently answered my questions with some help from the fellow band member Patrick Gaffney.
When and by whom was Chaos Code formed and do you have any background from other bands ? Why did you choose that name ?
Chaos Code formed in 1997 by Mike Potter, (owner of Orion Studios), Phil Rous, myself and others. i had just left a bar band called "Second Nature" and wanted to join/form a band writing experimental rock. the other guys had been playing Genesis covers as "The Web" but lost their guitarist when they transitioned to an original band. when i arrived they had 3 very long and interesting (but unfinished) compositions. we worked these for a while, lost and added members and finally secured a line up and album (tapestry) in 1999. Mike Potter had to leave becuase of other obligations at the studio but remained close to the group and recorded sax and flute on our second album. the name Chaos Code refers to the relationship between chaos and order in the natural world. also there is an actual code called Chaos Code which is said to be oneof the hardest codes to break, that was fitting for us as we were still trying to figure ourselves out.
Whose bands were you influenced by ?
Early on the band was influenced by
groups like Pink Floyd, King Crimson, Genesis, you know all the rest,
Pat Gaffney brought some fusion influences like Jeff Beck, Universe
Zero etc and everyone else who has contributed has come from a slightly
different musical background so the influences are very diverse.
Please give us your (long or brief) thoughts and lowdowns on.....
A Tapestry Of Afterthoughts from 1999
This was very much of an experiment. we spent many hours crafting the songs and the result was very honest and reflected where we were musically at the time. looking back each song has strengths and weeknesses. the highlights for me are "The Cave", "Days Of Reflection", "Silence" and "the Devil's Trombone" the last of which was sort of a crowd favoraite, i barrowed the name (and some lyrical references) from a scenes from the movie "A Clockwork Orange".
The Tragedy Of Leaps And Bounds from 2002
With a new line-up, we attempted to bring all of our different voices into focus musically. our best performances of many of these songs came after the recording sessions along with a couple tracks that were left over from the album.
Propaganda from 2005
After the "tragedy" sessions we thinned down to a 3 piece and took time to arrange the new material. every detail was worked out and the album seemed to be cohesive. we got help from some other musicians on the recording and are very happy with the result.
There has been no new studio album since 2005. What have you been up to all these years, what is the latest update on your band and what is your plans for this year ?
It hardly seems like 5 years has gone by. Patrick has been busy with Cerebus Effect and Turbomatic and i have been recording much new material with The New Eleven. scheduling had become very difficult for us and it was time to do something else for a while. i think in the future things will come back around and maybe there will be another album, but these things must happen in their own time.
You are referred to as a mix of King Crimson, VDGG, Salem Hill and Jethro Tull. But how would you describe your music ?
There is no shame in that i guess but i really don't think it's accurate. i think it's too easy to hear a flute and say "that sounds like Tull" for example. the music is made with the same instruments and in a similar spirit, but there's a lot more to it. the lyrics can be easily overlooked and i think maybe that is where we stand apart somewhat. also the contrasts and dynamic changes have always been a constant in our music.
What is your experiences with the music industry and how do you take care of your three albums at the moment ?
Well, we are musicians and really not managers or promotors. progressive music being a relatively small market keeps us honest. there are no large financial pay-offs for making a great album or world tours to follow, just the satisfaction of creating something artistic that stands the test of time. we distribute the album independantly to retailers such as Syn-phonic, Musea, Kenesis etc. and they let us know when they need more copies, it's really that simple.
What is your five favourite albums of all time ?
We could fill this page with all the obvious choices, and i'm sure it would look similar to your list, but here are a few classic albums that maybe are not as common.
Rare Bird "Epic Forest"
Gyspy "gypsy" (2lp)
Arti + Mistieri "Tilt"
Jeff Beck "Blow by Blow"
Discipline "Unfolded Like Staircase"
Anything you want to add to this interview ?
It is good to see that publications like yours and others are keeping this music alive. there are plenty of great bands out there that push the boundries of popular music, but without some clues it's hard to know where to start. We hope that some of your readers who are not familiar with us can take some time to "check us out".
A big thank you to Chaos Code for this interview
Chaos Code's PA profile is here and their homepage is here
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|Posted: June 05 2010 at 17:38
Great pick Torodd!!
Chaos Code are one of my favorite lesser-known prog bands. Great stuff Cliff, I do hope you come back with a fourth work someday!!
"nobody else could ever know
the part of me that can't let go..."
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|Posted: June 16 2010 at 03:38
Yep, good work again torodd... nice review of A Tapestry Of Afterthoughts as well
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Everybody Loves To Laugh
Ray Romano loves his wife. He reiterates this publicly in his stand up act in order to "get points." He scored big points Saturday night at the Broad Theatre when he put on "Everybody Loves to Laugh" – a night of comedy with Ray Romano, Jason Alexander, Cheryl Hines and Wendy Liebman. Evidently Ray's wife is involved in Harvest Home. So while he and his friends were delighting the crowd, he raised a considerable amount of funds for the cause.
Harvest House is a large family home in Venice, which provides a warm environment where women facing a crisis pregnancy can seek refuge. In addition to food, shelter and clothing, Harvest Home provides a comprehensive program aimed at helping homeless pregnant women regain their independence, both emotionally and financially. The program aims to increase employability through education, develop life skills and find spiritual wholeness.
The evening was made magical with the aid and assistance of volunteers. Besides the wonderful performers, there was a silent auction. A volunteer was stationed at each table, who was dressed in the style of that which was being auctioned. So at the artwork table was a volunteer with a beret. At the Las Vegas table was a young woman in an evening gown and a cohort dressed like Harpo Marx. Other prizes of note included a private yacht cruise, a two night stay at Hotel Casa del Mar, an in-home cooking lesson with a or personal sommelier.
Tasty Mediterranean hors d'oervres and wine were provided. The hummus, grape leaves and other treats were completely demolished by hungry audient members before the show started. Delicious desserts were artfully displayed from Cookielicious of Huntington Beach. I had never had a cake treat presented as a lollypop (a cake pop) before and enjoyed two!
Needless to say most people came to see some of their favorite stars in person and performing. Cheryl Hines was the host of the show. She is looking ultra glamorous and told us a couple of anecdotes about her friendship with Ray.
Jason Alexander started his performance at a grand piano, which he played beautifully and sang comedy lyrics to a medley of familiar tunes. He then thrilled the audience with a well-developed comedy routine, filled mostly with self deprecation. He revealed that although he looks different than when he was playing the famous George Costanza character on Seinfeld, (he now has more hair and does not wear glasses) - no one ever mentions the change to him as though he may not be aware of it. Yes it is a wig and it does change his look. He and his family were his own best target. Some people come from money… "I come from coupons…" Imagine wearing full metal braces for 9 years starting at age 8. Then at age 17, braces-less and ready to go on his first big date, he discovers he has a bald spot!
Wendy Liebman, the charming pixieish comic who is well known and well traveled on the comedy circuit was next. She has an endearing self deprecation style of making statements and then uttering almost beneath her breath of what she really means. She delighted the audience with some of her classics: " I ran a business…into the ground. I love my parents. I'm really close with them…genetically."
A beautiful and talented17 year old singer/songwriter named Ceej performed her version of Leonard Cohen's "Hallejulah."
Then it was time for the big guy, Ray Romano. He is indeed a comic genius as his multiple emmys attest to. His megahit show Everybody Loves Raymond was based on his stand up act. And he has followed that up with continued stand up, voice over animation in Ice Age: Continental Drift and his other series Men of a Certain Age.
He has such a likeable and easy persona an everyman. His comedy is a great example of Shakespeare's Hamlet's advice to the players to have their pronouncements be "trippingly on the tongue."
Parts of his act are many years old….he has many jokes about his twins as two year olds and now he admitted, his youngest is already 14. Any yet it is delivered in such an easy way, in an improvisational casual style as though he had just thought of it. And yet you know he has spoken those same words hundreds of times. He starts a bit with something that seems spontaneous and ends up taking it into a hugely worked out comic piece that you know must have taken him six months to put together. He had the audience eating out of his hand when he talked about staying alert when driving by removing his pants. He likes vacation sex because if it isn't good, you can still have fun on your vacation. And there were many other zingers and hilarious bits wildly enjoyed during the evening.
Jessica Pham, Interim Executive Director of Harvest Home was also introduced to the audience. She is lovely and charismatic. Evidently, many of the friendly volunteers who where helping out are her friends. She does a great job of recruiting. We wish her and her helpers continued big success with their good work at the Harvest Home. The event should help a lot. I understand Everybody Loves To Laugh raised $45,000 for the Home!
Georja Umano is an actress/comedienne and animal advocate.


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AMC Hialeah 12
780 W. 49th Street,
No one has favorited this theater yet
United Artists opened this 14-screen site in 1989. In 1996 Muvico took it over.
It was downsized to 12-screens in 2011.
Recent comments (view all 5 comments)
This theater was remodeled and now has 12 screens. All digital, stadium seating, DBOX seats, beer and wine, and a giant arcade. Reopened for Tron Legacy.
Was this multiplex opened in the former Zayre's store?
In 1967-72 I worked at Palm Springs Music which was located next to Ekert Drug Store in the original 1960's Palm Springs Shopping Center.
The huge Palm Springs Theater, operated by Wometco, a division of CBS-TV ch4) was next to Shell Liquor, then another multiplex opened way down 49th Street by the Palmetto Expressway.
Many thanks Al…
I bet myself $100, and won… so now I'm ordering some old classics from TCM. Standby in projection and roll the film… and don't forget to open the curtains!!!
@simon- actually it was opened a little further west of where the old zayre's/ames dept. store stood about ½ block up. where zayres stood is now a mini-shopping center of sorts.
This Cinema is now under the Carmike Banner website
Just login to your account and subscribe to this theater


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Honoring the brotherhood of specialized police agencies
It is important to understand that anyone who pins on the badge, straps on a gun, and enforces the law with statutory authority is a law enforcement officer
The LEO who was murdered after the Boston Marathon bombing — Officer Sean Collier — and a second officer who was injured in direct engagement with the terrorists — Officer Richard Donohue Jr. — both came from non-traditional or specialized law enforcement agencies.
Individuals working for specialized agencies need to understand that they can be harmed just like any other officer, and traditional officers need to start understanding that a police officer is a police officer, no matter what agency they work for.
Having worked in specialized law enforcement, I can tell you firsthand that I was viewed as a lesser officer — a "park police officer" doing picnic basket searches with Yogi and Boo Boo.
Some officers feel that officers/agents working for specialized (nontraditional) agencies are working for a lesser agency. This discussion takes many forms — troopers will say "the troopers are the best" while the city police and/or the sheriff's department will claim the same. Most of the time these discussions occur in jest — just good-natured ribbing — but sometimes, some officers/deputies view LEOs working at non-traditional agencies as lesser officers.
What are some examples of non-traditional law enforcement agencies? Well, how about the Texas and Southwestern Cattle Raiser Association, the Levee District Police in Louisiana, the ASPCA Law Enforcement Division, or the New York Sanitation Police Department?
What about nontraditional law enforcement agencies such as (but not limited to) transit police, park police, museum police, park rangers, Veteran Affairs Police, DOD Police, Federal Reserve Police, airport police, harbor police, hospital police, railroad police, college and university police, and K-12 school district police?
The title might be different but when looking at the job duties, they are all duly sworn, and licensed to enforce the law.
Redefining Law Enforcement
It is important to understand that anyone who pins on the badge, straps on a gun, and enforces the law with statutory authority is a law enforcement officer. The dangers, challenges, and rewards are the same. The only notable difference is the mission of the agency.
Officers who like more consistently positive interaction with citizens tend to gravitate towards a specialized agency, as they tend to have more positive interactions with the public.
Specialized law enforcement agencies also tend to draw individuals who are looking for an entry level career, and/or officers that are truly engaged in service-order law enforcement.
James Q. Wilson — who has written extensively on public safety and public administration — has noted that there are officers who are particularly grounded in a service-style of law enforcement.
Officers working for nontraditional agencies have the ability to focus their time on community building, and customer service based law enforcement. Yes, they also get to arrest people, conduct investigations, but the mission of their organization is different than traditional law enforcement agencies.
Let's spend a moment and reflect on Robert Peel's original nine principles:
1.) The basic mission for which the police exist is to prevent crime and disorder.
2.) The ability of the police to perform their duties is dependent upon the public approval of police actions.
3.) Police must secure the willing co-operation of the public in voluntary observation of the law to be able to secure and maintain the respect of the public.
4.) The degree of co-operation of the public that can be secured diminishes proportionately to the necessity of the use of physical force.
5.) Police seek and preserve public favor not by catering to public opinion, but by constantly demonstrating absolute impartial service to the law.
6.) Police use physical force to the extent necessary to secure observance of the law or to restore order only when the exercise of persuasion, advice, and warning is found to be insufficient.
7.) Police, at all times, should maintain a relationship with the public that gives reality to the historic tradition that the police are the public and the public are the police; the police being only members of the public who are paid to give full-time attention to duties which are incumbent upon every citizen in the interests of community welfare and existence.
8.) Police should always direct their action strictly towards their functions, and never appear to usurp the powers of the judiciary.
9.) The test of police efficiency is the absence of crime and disorder, not the visible evidence of police action in dealing with it
We find that everyone that follows these basic principles, and are duly sworn, are police officers.
Law enforcement is a rewarding career but it is also a difficult and dangerous job. All officers stand to protect citizens from evildoers. Let's try to put an end to the "infighting" among law enforcement professionals that there are lesser law enforcement agencies.
As a profession, we need to keep in mind that we are all brothers and sisters, regardless of shield, star, or patch. Whether an officer is working for a traditional agency or nontraditional agency, officers are hired to serve and protect — to defend against enemies foreign and domestic.


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Mona Lisa's Revenge, was watched by 1.0 million viewers, with an audience share of 7.4%.
Again the rating is incredibly good for 4.35pm on BBC One where the average audience is around 0.4 million.
Final ratings are now available for episodes three and four of the series, The Mad Woman in the Attic. Part one was watched by 0.75 million, with part two having an audience of 0.84 million. Final figures are more accurate than the initial overnights and include those who record the programme and watch it within one week. They do not include iPlayer figures.
Follow the Doctor Who News Page on


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The beef is here. I mean: The beef is here! Ten pounds of rouladen-cut top round. Wah-wow! (That's the sound in Tetris when you get a super-slam {it's not called that, but it should be}). I'm cooking some tonight and freezing the rest for the next rouladen occasion. And I'm in love with Crown Foods (the butcher's), serving Spokane since 1956. The son, Scott, cut my beef and sharpened my knives. The mother ( I don't know her name but she's in her eighties) rang me up on an ancient cash register with a crank handle she pulled to open the drawer. It was so excellent. I need to develop a keener taste for flesh, so I can go back again.
|Right inside this bag. I can only assume the D stands for delectable.
|With this receipt.
|Investigated by this kitty.
|Five knives have been sharped and are ready to go. Not that this dish
requires five knives-it's just that I had them all sharpened at once.
Smart move on my part.
|Sunset in Browne's Addition. Walking home from the Museum tonight
was nowhere near as frosty as this morning...when it was 1 degree.
|Patsy Clark's mansion. On the way home, so why not take a picture?
|Walking and freezing and ducking under branches.


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Amitabh Chandra is an economist, a Professor of Public Policy and Director of Health Policy Research at the Harvard Kennedy School of Government, where he also Director of PhD Admissions and Area Chair for Social and Urban Policy. He is a member of the Congressional Budget Office's (CBO) Panel of Health Advisors, and a Research Associate at the IZA Institute in Bonn, Germany and at the National Bureau of Economic Research (NBER). His research focuses on productivity and cost-growth, medical malpractice, and racial disparities in healthcare. His research has been supported by the National Institute of Aging, the National Institute of Child Health and Development, the Robert Wood Johnson Foundation, and has been published in the American Economic Review, the Journal of Political Economy, the New England Journal of Medicine, the Journal of the American Medical Association, and Health Affairs. He is an editor of the Review of Economics and Statistics, a former editor of the Journal of Human Resources, and serves on the editorial boards of Economics Letters and the American Economic Journal.
Chandra has testified to the United States Senate and the United States Commission on Civil Rights. His research has been featured in the New York Times, the Washington Post, CNN, Newsweek, and on National Public Radio. He has been a consultant to the RAND Corporation, Microsoft Research, the Institute of Medicine and the Blue Cross Blue Shield Foundation of Massachusetts. In 2011 he served as Massachusetts' Special Commissioner on Provider Price Reform.
Professor Chandra is an elected member of the Institute of Medicine, the first-prize recipient of the Upjohn Institute's Dissertation Award, the Kenneth Arrow Award for best paper in health economics, and the Eugene Garfield Award for the impact of medical research. In 2012, he was awarded American Society of Health Economists (ASHE) medal. The ASHE Medal is awarded biennially to the economist age 40 or under who has made the most significant contributions to the field of health economics.


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We have recently launched our new range of heavy, medium, light & flexi plans.
To change your current plan -:
Speak to our Tikona care executive on 18002094276
Write to us at firstname.lastname@example.com
Our executive will call on your registered number within 24 hours.
Read more on our blog post <http://bit.ly/1iAdiQp> and spare yourself the frustration of a mismatched internet connection.


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0 Members and 3 Barbarians in a Horde are spying on this topic.
"Is that a whip me'boy? Did ya come to challenge Vallace or buy him a drink?"--After a long moment of silence, the strange, olive-skinned man turned to look at Talia and parted his thin lips slightly, as if ready to finally speak, or so Talia assumed. She would not find out for the moment.
(OOC: Um, is the Harpy's Kettle still around? I thought the xaren had pretty well busted it up, and killed the owner to boot.)
Page created in 0.582 seconds with 32 queries.


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Earlier today Twitter released an update for its app across Android and iOS for both phones and tablets. Although everything looks pretty much the same, there are a few slight changes. Most notably, the "My Profile" Page has been altered to include background images and 'photo streams'.
The Blog post concerning the update published by Twitter explains:
New profiles now feature header photos so you can express who you are more meaningfully on Twitter. Upload an image from your mobile device and see the same beautiful profile design on your phone, tablet or computer.
The second part of the blog post addresses photo stream specifically:
Photo streams for profiles display the images people have shared on Twitter. Whenever you see a photo stream, swipe left or right through the thumbnails or tap to view photos in fullscreen mode. Android users can also get closer to photos with pinch-to-zoom.
Here are some photos of the apparent visual changes. They certainly make the mobile Twitter experience that much nicer when you view peoples profiles. Other than that I'm guessing this update contained plenty of bug fixes.


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Oracle has just announced a new microprocessor, and the servers and engineered system that are powered by it. The SPARC M8 processor fits in the palm of your hand, but it contains the result of years of co-engineering of hardware and software together to run enterprise applications with unprecedented speed and security.
The SPARC M8 chip contains 32 of today's most powerful cores for running Oracle Database and Java applications. Benchmarking data shows that the performance of these cores reaches twice the performance of Intel's x86 cores. This is the result of exhaustive work on designing smart execution units and threading architecture, and on balancing metrics such as core count, memory and IO bandwidth. It also required millions of hours in testing chip design and operating system software on real workloads for database and Java. Having faster cores means increasing application capability while keeping the core count and software investment under control. In other words, a boost in efficiency.Download this whitepaper to completely understand the value of the fastest speed, highest security with the new Oracle M8 systems.
* Please enter your email address and click the Download Now button to download the white paper.
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Inquiry Question
Floyd Bennett Field: Naval Aviation's Home in Brooklyn--Supplemental Resources
By completing the lesson, Floyd Bennett Field: Naval Aviation's Home in Brooklyn, students will learn about the vital role played by naval aviators defending the Atlantic sea lanes and delivering tested aircraft to combat-bound units in the Pacific during World War II. They will also discover the crucial role played by women workers on the home front who helped in one of the greatest industrial feats in history, U.S. wartime aircraft production. Those interested in learning more will find that the Internet offers a variety of interesting materials.
Floyd Bennett Field Resources:
Floyd Bennett Field Task Force
World War II History Resources:
Department of the Navy, Naval Historical Center
The National Archives, A People At War
Aviation: From Sand Dunes to Sonic Booms


text: Home » Drizzling Words Competition » Galeri Foto » Video Drizzling Words Competition Tweet On January 6, Jogja English held an interesting EPS which took place at the living room of Jogja English office. That competition was held in the evening. Not only members but also all of the instructors joined that event so the room was crowded at that time. We gathered happily because we could meet and know one another. The EPS was named "Drizzling Competition". FOTO (31) VIDEO (3)


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Rensselaer Polytechnic Institute ViewsAcademic & Administration Buildings
The Approach
Aerial Views
Student & Alumni Buildings
Troy ViewsBusinesses
Public Buildings
Educational Institutions
A Brief History of Picture Postcards
Picture postcards were first introduced in the United States in the late 19th century. Their size and format derives from earlier "postal cards" - blank cards with preprinted postage - which the U.S. Post Office began issuing in 1873. According to John McClintock, head of the Postcard History Society, an early form known as "souvenir cards" had a picture on the front and a space on the back for the address, but there was no space allocated for a message (CNN article, 1997).
The years 1900 to 1920 are widely regarded as the golden age of postcards, when they began to be used both as souvenirs and as an inexpensive means of communication. The majority of the postcards in this exhibit date from that period, and depict a variety of buildings and public spaces in and around Troy, New York and the Rensselaer Polytechnic Institute.
The images included here are a small fraction of the Postcard Collection (accession number AC 15) held by the Rensselaer Polytechnic Institute Archives and Special Collections Department. Originals can be seen by visiting the department during our regular business hours.
View Eric Larson's extensive collection of RPI Postcards:www.rpiviews.com
Visit a postcard collectors web site for more information on this topic:www.atozee.com/web/postcards/
Descriptions of postcards on display in the Krause Lounge of RPI's Folsom Library:
Lance O. Spallholz's Union College postcard collection:
Research & design: Tammy Gobert
Each of the archives' online exhibits has been created from a selection of original documents in our collections. In general, many more documents relating to a particular topic can be found in the archives, and viewers are welcome to visit the department to use these materials. Anyone interested in pursuing archival research at Rensselaer, should consult additional online information about the department and its holdings.
People occasionally wonder why we don't scan ALL of our holdings for easy access via the Web. The answer is simple: with Rensselaer's 175 year history, it would take a long time (and considerable resources) to convert the millions of photographs, letters, diaries, minutes, reports, and other items that make up the Institute's documentary past. We will continue to add to our online collections, so visit us often to see what's new in the online gallery.
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U.S. Equal Employment
Opportunity Commission
EEOC Says Statesville Supermarket Fired Employee for Being Non-Latino
CHARLOTTE, N.C. – West Front Street Foods, LLC, doing business as Compare Foods, will pay $30,000 and provide other relief to settle a national origin and race discrimination lawsuit brought by the U.S. Equal Employment Opportunity Commission (EEOC), the agency announced today. The EEOC had charged that West Front Street Foods fired Robert Bruce, a white, non-Hispanic meat cutter, from a Compare Foods supermarket it operated in Statesville, N.C., based on his race and national origin. The lawsuit also charged that Bruce was replaced by a Hispanic worker as a racially motivated maneuver.
Race and national origin discrimination violate Title VII of the Civil Rights Act of 1964. The EEOC filed the litigation on September 8, 2008 in U.S. District Court for the Western District of North Carolina (EEOC v. West Front Street Foods, LLC d/b/a Compare Foods, Civil Action No 5:08-cv-102).
In addition to the monetary payment, the consent decree resolving the case also requires West Front Street Foods to distribute a formal, written anti-discrimination policy; provide periodic training to all its employees on the policy and on Title VII's prohibition against national origin and race discrimination; send periodic reports to the EEOC concerning employees who are fired or resign; and post a "Notice to Employees" concerning this lawsuit.
Last year the EEOC settled a lawsuit against another Compare Foods supermarket in Charlotte (EEOC v. E & T Foods, LLC d/b/a Compare Foods, Civil Action No 3:06-cv-318, W.D.N.C). In that case, the EEOC also charged that the employer fired three non-Hispanic employees in the store's meat department because of their race or national origin and replaced them with Hispanic workers.
"Federal law clearly prohibits employers from making employment decisions based on an employee's race or nationality," said the regional attorney of EEOC's Charlotte District Office, Lynette A. Barnes. "Everyone deserves the freedom to compete in the workplace on a fair and level playing field."
The EEOC enforces federal laws prohibiting employment discrimination. Further information about the Commission is available on the agency's web site at www.eeoc.gov.


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October 6, 2011
Monthly letter to campus from President Schulz
Dear Faculty and Staff:
Welcome to October! It has been a busy year already, with everything on campus in full swing. In order to facilitate communications on campus, we will frequently post various updates of interest to the Kansas State family in K-State Today. In addition to my monthly letters, you will see periodic updates on research, our financial situation, initiatives out of the provost's office, and information on other aspects of Kansas State University. I scan through K-State Today each morning, and I encourage you to start your day by taking a few minutes to keep up with all that is Kansas State University.
We continue to make plans to celebrate Kansas State University's 150th birthday. The steering committee has been working for a year and more than 100 people have been involved to date. Four classes, graduate and undergraduate, are also involved in the planning. We will kick off the celebration Feb. 14, 2013, with a weekend of events and close our celebration with homecoming weekend 2013. Mark your calendars now! The nine months will be packed full of events recognizing K-State's history and accomplishments and the accomplishments of our alumni and friends. We will also take a look at K-State's future endeavors. As we have more information on our 150th celebration, I will include updates in my monthly letters.
This month, I want to describe our new Premier Student Scholarship program at Kansas State.
Scholarship support for our students is absolutely critical to ensuring that Kansas students have access to a K-State educational experience. Our program is designed to consider both need and ability and acknowledges the fact that approximately 70% of Kansas State students receive some form of financial aid. To illustrate, the percentage of total federal Pell Grant recipients among the state's four year public institutions for 2008-2009 was: 25% K-State, 21% KU, 19% Wichita State, 14% Pittsburg State, 12% Fort Hays State, and 9% Emporia State (National Center for Educational Statistics). Presently, we provide $206 million in student financial aid to current K-State students, which has increased from $168 million five years ago. Given the significant financial need of our students, increasing the funds for student financial aid is more important than ever before.
The granting of scholarship aid to our students is part art and part science. Ideally, we want to provide appropriate aid to our students to ensure that they can continue to progress through their degree programs in a timely fashion with a minimum amount of debt. We also want to be able to provide scholarship support based on merit and academic prowess so that we are attracting the best and brightest students to Kansas State. The bottom line is that we need to continue to grow the financial resources available for our students in a way which is sustainable and balanced.
I have continued to place a high priority on philanthropy as we move K-State toward our goal of becoming a Top 50 Public Research University. As part of this, we need to continue to build our privately-funded scholarship resources including donor-designated scholarships and premier scholarships.
Donor-designated scholarships have been the primary philanthropic scholarship program at Kansas State. These funds may be endowed or given annually, with the donor deciding on the scholarship amounts and frequency of awards. This program has worked well for Kansas State for many years, and will continue to be a key part of our scholarship fundraising strategy.
As we examined this program, it was clear that we needed to design additional scholarship opportunities that will be significant enough to help us recruit the best and brightest high school graduates, and will provide the complete cost of attendance for the academically elite students in Kansas who could attend virtually any university of their choice. With these attributes in mind, we designed the Premier Scholarship program.
Our Premier Scholarship program is built around four key scholarships: Presidential, Bluemont, Leadership and Wildcat. These scholarships are all renewable for up to four years (or five years for programs that require five years) if the student maintains a 3.5 GPA while at Kansas State. The Presidential Scholarship is a $20,000 annual award, with a one-time $2,000 study abroad stipend. These are our highest scholarships, given to our most academically gifted students at Kansas State University. The Bluemont Scholarship award is $10,000 per year, and designated for students with a minimum of 32 on the ACT and a 3.8 or higher GPA. The Leadership Scholarship awards $5,000 per year, and is designated for students with a minimum of 26 on the ACT and a 3.8 or higher GPA. The Wildcat Scholarship award is $2,500 per year, and is designated for students with a minimum of 23 on the ACT and a 3.8 or higher GPA. Leadership and Wildcat scholars have demonstrated leadership in their high school or community.
These scholarships can be funded through either an endowment or an expendable gift. As we enter our next comprehensive campaign, we will be placing a high priority on endowing as many of these scholarships as possible. However, some alumni and friends will make annual cash gifts to support scholarships. For the Premier Scholarships, this means making a commitment for a minimum of four or five years to fund the scholarship on a renewable basis.
As we make substantive progress towards securing more privately-funded Premier Scholarships, does this mean that we will redirect existing scholarship funds? No. It is vital to continue increasing scholarship support to keep K-State accessible.
So, as we celebrate another record enrollment, please also know that all of us are working to ensure that we are attracting outstanding students to Kansas State, in addition to putting together financial packages to keep K-State affordable for Kansas families.
Go Cats!


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|The vinyl E.P. collection boxed set.
Many countries released Beatles E.P.s, and for the Beatles themselves, the E.P.s were important products. It was a product for those who wanted more than singles, but who couldn't afford forking out the cost of an album (L.P. - "long playing" record). Still, most of The Beatles' UK E.P.s were put together from two different singles, or from songs extracted from a contemporary album. Only two E.P.s were especially made to be individual products: the "Long Tall Sally" E.P. (re-released in 2014 as a "black Friday" release in conjunction with Record Store Day) and the "Magical Mystery Tour" double-E.P. These were both standalone products, not derived from singles or album cuts. But another E.P. was manufactured by EMI in 1981, and it was also a special release.
|On this 1966 E.P., all the tracks were from 1965, only the front cover photo was from 1966.
GEP 8880 "The Beatles Hits"
GEP 8882 "Twist and Shout"
GEP 8883 "The Beatles No.1"
GEP 8891 "All My Loving"
GEP 8913 "Long Tall Sally"
GEP 8920 "A Hard Day's Night (extracts from the film)"
GEP 8924 "A Hard Day's Night (extracts from the film) Vol.2"
GEP 8931 "Beatles For Sale"
GEP 8938 "Beatles For Sale No.2"
GEP 8946 "The Beatles Million Sellers"
GEP 8948 "Yesterday"
GEP 8952 "Nowhere Man"
MMT1/SMMT1 Magical Mystery Tour"
After that, people had more money and could afford to buy L.P.s, so E.P.s stopped being important.
|The "Long Tall Sally" EP.
In 1981, after having had success with the 1978 so called "blue box", a boxed set containing all The Beatles' regular U.K. albums, plus an additional L.P. with "Rarities", EMI decided to put all the EPs together in a similarly designed blue box as well. For this release, an extra E.P. of "rarities" was also made.
This nameless E.P. contained the following: "The Inner Light" (the stereo mix, all previous releases had used a mono mix of the song), "Baby You're A Rich Man" (the true stereo mix, previously only available on the World Records Beatles albums boxed set), "She's a Woman" (stereo mix, with Paul's count-in of the song available nowhere else) and "This Boy" (reprocessed stereo, previously only available on the "Love Songs" album).
The E.P. had no title (or perhaps it was just called "The Beatles"), and had a unique catalogue number: SGE1.
|The U.K. single sleeve for "Penny Lane"/"Strawberry Fields Forever".
|The sleeve of the extra E.P. in the boxed set was laminated.
|The extra E.P.: back cover and record.
Eleven years after the vinyl E.P. boxed set was released, a CD version was released on 15th June 1992, also containing that extra E.P., now on a compact disc.
|The Compact Disc EP. Collection of 1992.
On March 20, 1995, The Beatles released a single which was dressed up as an E.P., "Baby It's You".
|"Baby It's You" with radio versions of four songs. Single or E.P.?
The vinyl version of it totally looks the part: it has four songs, it is presented in a cardboard cover with a laminated front and the flips on the back, and the layout with the song titles written on a white stripe at the top shouts E.P. However, the catalogue number gives it away: R6406. The famous Parlophone R-series singles. And it's CD counterpart looks nothing like an E.P., it looks like a modern day (1995) CD maxi single.
|The back of "Baby It's You".


text: Share: Comments Print October 14, 2013 at 12:12 PM Review: Samsung Galaxy Gear watch tries dialing the future Posted by Brier Dudley It took decades to figure out, but we finally know how Dick Tracy and Star Trek's Captain Kirk were able to place calls with their amazing wristwatch-communicator devices. Samsung Galaxy Gear watch calling out via Samsung Note 3 phone. Photo by Ellen M. Banner, Seattle Times staff photographer Apparently our fictional heroes also had enormous smartphones in their pockets. Their watches connected to the phone via Bluetooth radios, and calls went out on a wireless-phone network that costs perhaps $70 per month to access. At least, that's how the new Samsung Galaxy Gear "smart" watch works. The Gear is an exciting new gadget that will help popularize wearable-computing devices, a category that's expected to soar over the next five years. It works better than I expected and does plenty of tricks to impress your friends and co-workers, like placing calls, displaying email and taking pictures and videos with a camera in the wristband. But the Gear also feels a bit like a prototype — a work in progress that Samsung released early to build interest among app developers and beat its nemesis, Apple, to the punch. The Gear also fails to live up to the promise of Samsung's terrific TV ads, which show Dick Tracy, Captain Kirk and other characters using their super-duper watches. The ads suggest that we can finally buy something similar for everyday use. The Gear is close, but not quite there yet. It looks the part. Its case is about the size of a matchbook, with a 1.6-inch touch screen, and overall the watch weighs just under 3 ounces. This is pretty big but reasonably sized for a watch packing the computing power of a circa-2010 smartphone or the PC your children may be using in school. I've been testing one loaned by AT&T, which began selling the Gear last week for $299. The price is a little misleading because you'll probably need to buy a new, high-end phone to make it work. Samsung plans to make the Gear work with multiple Android-based devices, but for now it only works with Samsung's new Note 3 phone. The Note 3, with a 5.7-inch display and a stylus that slips into its leatherette case, is a nice option if you're looking for a jumbo phone. But it also starts at $299, plus a service plan. Once you've paired the Gear and the Note 3, they connect automatically when they're within about 5 feet of each other. Then you can receive calender and message notifications on the watch, though emails and even tweets are difficult to read because you have to scroll through them on the tiny screen. You can also use the Gear as a remote control for the phone's music player and record voice memos. Photos and videos taken with a 1.9-megapixel camera in the wristband can be saved in the Gear's 4 gigabytes of memory, stored on the phone and shared wirelessly over the phone network. Battery life is better than a smartphone but far worse than a normal watch. My Gear ran for several days without needing a charge. To maximize battery life, the display goes to sleep frequently, at which point you can't see the watch face. Wireless charging or a simple USB plug would have been nice ways to juice up the Gear. Instead you clamp a plastic charging case around the watch and plug the contraption into a power source to recharge. This make the Gear less appealing to road warriors who don't want to carry extra bits and pieces. The watch has a single button, for power, but the button can be programmed to also launch apps with a double press. You can control the Gear with voice commands such as saying "cheese" to take a picture, though I couldn't get them to work. Mostly the Gear is controlled with screen taps or gestures, such as a downward swipe to close apps and a sideways swipe to scroll through its menu. This takes two hands — one holding steady, the other tapping the watch — for things that often take a single hand on a phone. Gear apps can be loaded through a control panel on the phone. For now there's a limited selection of mostly social apps — including the location-notification service from Seattle-based Glympse — and exercise programs that take advantage of the Gear's pedometer capabilities. You can access contact lists and dial calls from the Gear, then use it like a speakerphone. The call is placed by the phone, which remains in your purse or pocket. Having this sort of auxiliary display starts to make sense if you're carrying a jumbo phone and just want to place a quick call or check something, without having to extract and wake the beast. Perhaps our phones will eventually become servers that store and stream data to and from our watches, glasses and other gizmos we're carrying around. Wearable-computing devices now entering the mainstream range from health and activity tracking bracelets such as Nike's FuelBand and FitBit devices to watches that sync with phones or even connect directly to wireless networks. Streaming digital information onto watches isn't new. Microsoft dabbled in the category a decade ago. But recent advances are igniting the category, including the latest version of Bluetooth radio technology that dramatically reduces energy usage and miniaturized sensors and mechanical components. Curved and flexible displays are next, but perhaps even more remarkable are the shrinking processors. The actual processor used in a wearable device may be smaller than the eye of President Lincoln on a penny, according to Charlene Marini, vice president of marketing for ARM, which designs and licenses the tiny microprocessors widely used in mobile devices. These processors sit in a package that may be as small as a third of an inch by a quarter of an inch. Which explains why we're starting to see computing in watches, glasses and other accessories for the fashionable geek. What makes them "smart"? Basically the term applies to devices with a processor that can run applications and a full operating system, according to Marini. Smart-watch sales are likely to be slow at first but climb rapidly, according to research firm IHS. It's expecting fewer than 300,000 to sell this year, but millions to be sold next year. By 2018 annual sales should reach nearly 39 million units. Over that same time period we're likely to see other wearable devices emerge. Marini envisions computerized bandages or patches that monitor and transmit EKG and blood-pressure information, and perhaps industrial outfits embedded with sensors that monitor environmental conditions such as heat and gases. Researchers at the University of Washington and elsewhere are looking into devices embedded into the body such as "smart" contact lenses and prosthetic devices. Meanwhile, early adopters who can't wait for the category and devices to mature will be surreptitiously checking their email and taking your picture by tapping on their wrist. Almost like on TV. Samsung photo Here are specs for the Gear, as provided by Samsung: Processor 800 MHz processor Display 1.63 inch (41.4mm) Super AMOLED (320 x 320) Camera 1.9 Megapixel BSI Sensor, Auto Focus Camera / Sound & Shot Video Codec: H.264 Format: MP4 HD(720p) Playback & Recording Audio Codec: AAC Format : M4A Featured Apps Atooma is a contextually aware horizontal intelligence platform. Banjo to see what's happening right now, anywhere in the world Evernote watch app to remember things by quickly capturing images and memories and bringing important reminders to GALAXY Gear. Glympse allows people to easily share their location temporarily and in real-time, letting recipients see their movements on a dynamic map. eBay app allows you to complete all your transactions on eBay. Line is a global messaging service available in over 230 countries worldwide. MyFitnessPal tracks your nutrition and exercise Path is the personal network designed to bring you closer to your friends and family. Pocket brings text-to-speech article playback to GALAXY Gear. RunKeeper is a personal trainer in your pocket, helping you track your runs, set your goals, and stay motivated. TripIt from Concur to organize travel plans in one place. Vivino Wine Scanner allows you to take a photo of any wine and get to know about it instantly. Samsung Services Samsung Apps ChatON: mobile communication service Additional Features Smart Relay, S Voice, Memographer, Voice Memo Auto Lock, Find My Device, Media Controller, Pedometer, Stopwatch, Timer Safety assistance: In case of emergency, press a power button 3 times continuously, and then user's location information is transferred to the saved contacts with message. 2 Microphones (Noise Cancellation), 1 Speaker Connectivity Bluetooth v 4.0 + BLE Sensor Accelerometer, Gyroscope Memory 4GB Internal memory + 512 MB (RAM) Dimension 36.8 x 56.6 x 11.1 mm, 73.8g Battery Standard battery, Li-ion 315mAh Comments | Topics: Apple, apps, ARM


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ComicLife in Education - 2 views
shared by David L. Brooks on 21 Sep 09 - Cached
David L. Brooks on 21 Sep 09The Benefits of Comic Life in Education Making comics is fun for everyone, and Comic Life makes it easy. Teachers and students will find Comic Life a very useful software tool, and now it's available for both Mac and Windows platforms. Technology not only changes how we write, but it also changes what writing is. Education will need to re-evaluate which writing skills teachers should pass to their students. Digital graphic writing is one genre students need to be fluent. Comic Life is the "word processor" of digital graphic writing. Easy to Learn Students and teachers need only a short time to learn the basics of Comic Life. It's easy to add images from digital cameras, computer web-cameras, clip art from CD's and the web, stills from QuickTime movies, scanned photos and drawings -- just about any on-screen image can be used in Comic Life. Adding captions and word balloons is as easy as drag and drop.