The CUSBA Linkedin Group had these terrific quotes posted this morning. They were compiled by mycomeup.com I hope you enjoy them as much as I did.
# 1 ? IKEA founder Ingvar Kamprad ?Only those who are asleep make no mistakes.?
# 2 ? Warren Buffett, CEO of Berkshire Hathaway ?Rule no. 1: Never lose money. Rule no. 2: Never forget rule No. 1.?
# 3 ? Steven Jobs, Apple Co-Founder ?You can?t just ask customers what they want and then try to give that to them. By the time you get it built, they?ll want something new.?
# 4 ? Andrew Carnegie, Carnegie Steel Company Founder ?As I grow older, I pay less attention to what men say. I just watch what they do.?
# 5 ? Ingvar Kamprad, IKEA Founder ?Only those who are asleep make no mistakes.?
# 6 ? Aristotle Onassis, Greek Shipping Magnate ?The secret to business is to know something that nobody else knows.?
# 7 ? Carlos Slim Helu, CEO of Telmex, America Movil, Grupo Carso ?When you live for others? opinions, you are dead.?
# 8 ? Sam Walton, Walmart Founder ?We?re all working together; that?s the secret.?
# 9 ? Richard Branson, Chairman of Virgin Group ?We?re going where no one has gone before. There?s no model to follow, nothing to copy. That is what makes this so exciting.?
# 10 ? Oprah Winfrey, CEO of Oprah Winfrey Network ?You become what you believe. You are where you are today in your life based on everything you have believed.?
# 11 ? Ted Turner, CNN Founder ?I just love it when people say I can?t do it, there?s nothing that makes me feel better because all my life, people have said that I wasn?t going to make it.?
# 12 ? J. Paul Getty, Getty Oil Company Founder ?If you can count your money, you don?t have a billion dollars.?
The factors that might have been problems for Canada in its game against the United States at the 2013 World Junior Championship didn?t materialize.
Instead, goalie Malcolm Subban, who had allowed six goals in Canada?s first two games of the tournament, was nearly perfect in a 2-1 victory.
Canada played the game without a pair of suspended forwards. JC Lipon served his one-game suspension, while Boone Jenner?s three-gamer is done as well. Both will be in the lineup when Canada and Russia meet on New Year?s Eve in the final preliminary-round game for both teams. The winner will earn a bye the semifinals on Thursday.
But there was not much off the pace of the Canadian forwards, who didn?t perform like they were one man short.
Captain Ryan Nugent-Hopkins and Ryan Strome scored for Canada.
With Strome in the penalty box, Jacob Trouba scored for the U.S. in the third period on a power play.
Nugent-Hopkins, who leads the tournament with eight points, scored on a wrist shot in the first period after Mark Scheifele won a faceoff in the U.S. end. Canada gained control and Jonathan Huberdeau made a pass off the side boards to Nugent-Hopkins, whose wrist shot cleanly beat American goalie John Gibson to the stick side.
Strome made it 2-0 at 14:44 when he flipped a pass from Niagara IceDogs linemate Brett Ritchie behind Gibson. U.S. defenceman Seth Jones, a potential No. 1 pick in the 2013 NHL entry draft, had no idea Strome was in front of the net when Ritchie made the pass.
Subban?s biggest save came on a breakaway by U.S. forward John Gaudreau in the first period with Canada up 1-0. Gaudreau deked to his backhand and tried to slip the puck between Subban?s legs, but the netminder simultaneously slid across the crease and closed the five hole.
But Subban was sharp throughout the game. He settled into a groove with a pair of tough stops on Vince Trocheck in the first few minutes, demonstrating to fans at the rink and across Canada that he was capable of taking his game to a higher level.
In the second period, Subban stopped a close-range chance by J.T. Miller and then saved an Alex Galchenyuk shot from the slot.
And there was Subban lunging across the crease to deny Ryan Hartman not long after Trouba scored to preserve the one-goal lead.
Canada had to kill off its share of penalties ? Mark McNeill and Phillip Danault were excellent ? but nothing came close to being a suspension. The pair was instrumental in killing off a four-minute minor to Griffin Reinhart in the second period.
Nugent-Hopkins was sent off for boarding with just under two minutes to play, but the U.S. could not score. Subban stopped Galchenyuk, among other saves.
Subban and Gibson were named the MVPs of the game for their respective teams.
Multiple sources say the National Hockey League and its union will hold the first face-to-face negotiating session in almost a month on Monday, as the clock ticks towards virtual midnight for a resolution to the 106-day lockout.
The sides spent the weekend exchanging phone calls to clarify points made in a major proposal from the NHL on Thursday night that ran to 288 pages.
At the same time, lawyers and business experts representing Commissioner Gary Bettman and NHLPA head Donald Fehr also held meetings to go over points.
Time is short as NHL sources indicate anything less than a 48-game schedule would not be acceptable, and that must begin by Jan. 19. Work in a week of training camp, with no exhibition games, and a day for organization, and that seems to leave Jan. 11 as a drop-dead date for a final deal.
This would not preclude the union from telling players to head for their teams in the days before that, if negotiations indicated success was at hand, according to sources.
Also, there are more than 100 free agents left to be signed by teams who won?t know the salary cap for this season until a deal is signed.
The NHL breathed new life into negotiations Thursday night by presenting their proposal to the NHLPA, one that included a summary of key points, a Memorandum of Understanding with more detail, and a lengthy legal document that details the offer in proper language.
After spending Friday going over the package, the union held informational discussions by phone with the NHL on Saturday to ensure they were clear on each point. Sunday morning saw more of the same.
Under the league?s new proposal, term limits of the deal would be 10 years, with a mutual opt-out at eight, maximum contract length would be six years, or seven if re-signing your own player, and a $300-million fund to guarantee much of the existing contracts is included.
A key point seems to be variance, with the NHL not wanting any contract year paying more than 10 per cent more than it did in the first year, while the players are reportedly seeking a 25 per cent level.
This is important because of the league?s resistance to the long-term, back-ended contracts some general managers have used as a way around salary caps.
Also, reports each team would be able to buy out a contract (likely a large one for a player no longer producing well) without it counting against the salary cap now seem to point to a start date of this summer, so it would not affect the stub season this winter and spring.
Escrow terms are also still under discussion. Under this provision, players would continue to have some of their salary held back until the end of each season when league-wide profits are counted up.
If the players have earned less than a 50-50 split of overall revenues, they would receive monies from escrow to bring it back up. If they have earned more, the escrow goes to the league.
More than 50 per cent of the schedule (625 games), has been lost to the lockout.
Rescuers work at the site where a plane careered off the runwaw at Vnukovo Airport in Moscow, Saturday, Dec. 29, 2012. A Tu-204 aircraft belonging to Russian airline Red Wings careered off the runway at Russia's third-busiest airport on Saturday, broke into pieces and caught fire, killing several people. (AP Photo/Alexander Usoltsev)
Rescuers work at the site where a plane careered off the runwaw at Vnukovo Airport in Moscow, Saturday, Dec. 29, 2012. A Tu-204 aircraft belonging to Russian airline Red Wings careered off the runway at Russia's third-busiest airport on Saturday, broke into pieces and caught fire, killing several people. (AP Photo/Alexander Usoltsev)
Rescuers work at the site where a plane careered off the runway at Vnukovo Airport in Moscow, Saturday, Dec. 29, 2012. A Tu-204 aircraft belonging to Russian airline Red Wings careered off the runway at Russia's third-busiest airport on Saturday, broke into pieces and caught fire, killing several people. (AP Photo/Alexander Usoltsev)
Rescuers work at the site where a plane careered off the runway at Vnukovo Airport in Moscow, Saturday, Dec. 29, 2012. A Tu-204 aircraft belonging to Russian airline Red Wings careered off the runway at Russia's third-busiest airport on Saturday, broke into pieces and caught fire, killing several people. (AP Photo/Ivan Sekretarev)
Cars travel past the wreckage of a plane that careered off the runway at Vnukovo Airport in Moscow, Saturday, Dec. 29, 2012. A Tu-204 aircraft belonging to Russian airline Red Wings careered off the runway at Russia's third-busiest airport on Saturday, broke into pieces and caught fire, killing several people. (AP Photo/Ivan Sekretarev)
Rescuers work at the site where a plane careered off the runway at Vnukovo Airport in Moscow, Saturday, Dec. 29, 2012. A Tu-204 aircraft belonging to Russian airline Red Wings careered off the runway at Russia's third-busiest airport on Saturday, broke into pieces and caught fire, killing several people. (AP Photo/Ivan Sekretarev)
MOSCOW (AP) ? Investigators on Sunday examined flight recorders and other evidence to try to determine the cause of the airliner crash in Moscow that killed five people, an official said.
The Tu-204 belonging to Russian airline Red Wings was carrying eight people, all of them crew members, when it careered off the runway Saturday while landing at Moscow's Vnukovo Airport. It went partly into an adjacent highway, broke into pieces and caught fire.
Four people were pronounced dead soon after the crash and the airline said on its Twitter account that a fifth, a flight attendant, died Sunday. Those who died Saturday were the pilot, co-pilot, flight engineer and another attendant, Red Wings said.
The survivors were reported in critical or serious condition in Moscow hospitals.
Vladimir Markin, a spokesman for Russia's main investigative agency, was quoted by Russian news agencies saying the data recorders were being examined, along with fuel samples. In addition, he said flight documents for the plane have been taken from the airline for examination.
Pakistani volunteers carry a wounded bus passenger following a blast in Karachi, Pakistan on Saturday, Dec. 29, 2012. The blast that ripped through the bus set the vehicle on fire and reduced it to little more than a charred skeleton, killing scores of people and left many injured. Police were trying to determine whether the explosion was caused by a bomb or a gas cylinder, said police spokesman. Many buses in Pakistan run on natural gas. (AP Photo/Fareed Khan)
Pakistani volunteers carry a wounded bus passenger following a blast in Karachi, Pakistan on Saturday, Dec. 29, 2012. The blast that ripped through the bus set the vehicle on fire and reduced it to little more than a charred skeleton, killing scores of people and left many injured. Police were trying to determine whether the explosion was caused by a bomb or a gas cylinder, said police spokesman. Many buses in Pakistan run on natural gas. (AP Photo/Fareed Khan)
Pakistani volunteers carry a wounded passenger following a blast in Karachi, Pakistan on Saturday, Dec. 29, 2012. The blast that ripped through the bus set the vehicle on fire and reduced it to little more than a charred skeleton, killing scores of people and left many injured. Police were trying to determine whether the explosion was caused by a bomb or a gas cylinder, said police spokesman. Many buses in Pakistan run on natural gas. (AP Photo/Fareed Khan)
EDS NOTE: GRAPHIC CONTENT - Pakistani volunteers help a critically injured passenger on his way to a hospital following a blast in Karachi, Pakistan on Saturday, Dec. 29, 2012. The blast that ripped through the bus set the vehicle on fire and reduced it to little more than a charred skeleton, killing scores of people and left many injured. Police were trying to determine whether the explosion was caused by a bomb or a gas cylinder, said police spokesman. Many buses in Pakistan run on natural gas. (AP Photo/Fareed Khan)
PESHAWAR, Pakistan (AP) ? Twenty-one tribal policemen believed to have been kidnapped by the Taliban were found shot dead in Pakistan's troubled northwest tribal region early Sunday, government officials said.
Officials found the bodies shortly after midnight in the Jabai area of Frontier Region Peshawar after being notified by one policeman who escaped, said Naveed Akbar Khan, a top political official in the area. Another policeman was found seriously wounded, said Khan.
The 23 policemen went missing before dawn Thursday when militants armed with rocket-propelled grenades and automatic weapons attacked two posts in Frontier Region Peshawar. Two policemen were also killed in the attacks.
Militants lined the policemen up on a cricket pitch late Saturday night and gunned them down, said another local official who spoke on condition of anonymity because he was not authorized to talk to the media.
No group has claimed responsibility for the attack, but suspicion fell on the Pakistani Taliban, who have been waging a bloody insurgency against the government for the past few years. The tribal region is the main sanctuary for the Taliban in Pakistan.
On Saturday, an explosion ripped through a passenger bus at a terminal in the southern city of Karachi, killing six people and wounding 52 others, some of whom were in critical condition, said Seemi Jamali, a doctor at the hospital where the victims were being treated.
Police were trying to determine whether the blast, which reduced the bus to a charred skeleton, was caused by a bomb or a gas canister that exploded, said police spokesman Imran Shaukat. Many buses in Pakistan run on natural gas.
Karachi has a long history of political, ethnic and sectarian violence. It is also believed to be home to many Taliban militants who have fled U.S. drone attacks and Pakistani army operations in the country's northwest.
Also Saturday, a government official said authorities are investigating allegations that cough syrup has killed 33 people over the past three days in eastern Pakistan, the second time in recent months medicine is suspected of causing multiple deaths.
The deaths occurred in the city of Gujranwala and nearby villages, said local official Abdul Jabbar Shaheen. Another 54 people thought to have consumed the syrup are also being treated at city hospitals. Officials believe the victims drank the syrup to get high, he added.
Tests show the victims' stomachs contained dextromethorphan, a synthetic morphine derivative used in cough syrup that can have mind-altering effects if consumed in large quantities, said Shaheen. Investigators are trying to determine if the victims drank too much syrup, or whether there was a problem with the medicine itself, he said.
Twenty-three people died in the nearby city of Lahore in November after drinking bad cough syrup sold under the brand name Tyno. They were also described at the time as people who consumed the drug to get high.
Shaheen said the cough syrup involved in the incidents in and around Gujranwala was not sold under a single brand. He said some people in the city make cough syrup to sell specifically to drug addicts, and officials are trying to arrest them.
Officials temporarily closed one Lahore-based pharmaceutical company whose cough syrup was found in the possession of some affected in Gujranwala. They are investigating whether it caused any of the deaths, said Shaheen.
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Associated Press writers Adil Jawad in Karachi, Pakistan, and Zaheer Babar in Lahore, Pakistan, contributed to this report.
Self improvement is incredibly personal. You will need to find ideas and methods of advancing yourself that will work with your unique life. Teach yourself as much as you can to enrich your personal development. The following article will likely help you find the assistance that you need, as it contains several tips that you are able to use for your benefit.
If you are going to be a champion, then you need a great coach. All champions have awesome coaches or mentors behind them, and this is very important. Everyone should help one another. This is an important strategy for ensuring that everyone is able to achieve their goals. Behind every successful story, there?s a great mentor.
TIP! Make an honest effort to become more organized. An uncluttered home promotes a sense of calm and gives you a feeling of accomplishment.
Find your personal values so you can create your self improvement strategy. It?s counterproductive to focus on things that you don?t value. Instead, focus on all that is important in your life, and work to improve those things. By spending your time in these specific areas, you can make the changes in the areas that matter and have these changes stick with you.
Learn to recognize which obstacles are keeping you away from your goals. Doing this is extremely hard for a lot of people. Even so, identifying personal weak points is a critical initial step in order for them to be dealt with. By eliminating things that stand in your way, you can walk on the path to your future with less stumbling blocks on the way.
Ego and self esteem can suffer as a result of failure when one is striving to make strides in the area of self improvement. However, failure is really an opportunity to grow as a person. Failure helps you learn about weaknesses and strengths. So, in a way, each failure can be viewed as an opportunity to gather important information of use in your personal development efforts.
TIP! Determine which aspect of yourself needs the most improvement, and concentrate solely on that quality. If you focus all your efforts on that one thing, then the change will come faster and easier.
Knowing that you deserve only the best is incredibly important in personal development. Commit to taking good care of yourself by providing yourself with only the best. When you complete your journey you?ll be secure in the knowledge that you did the best you could and no regrets are necessary.
Research the methods other people have applied to be successful. Pay special attention to their mistakes, as well as their overall strategies, so that you don?t have to learn the hard way. Think of reading about their stories as an important step in your own development.
With any good personal development goal, you should be able to see the distance between your current state and the one you want to achieve. This is the best way to be able to set a course of direction to get there. By living in denial of these facts, you will sabotage your efforts of reaching your true potential.
TIP! In order to be properly motivated toward personal development goals, it is important to admit how much you do not know. You will want to learn all you can, once you realize that you have only scratched the surface of all there is to be known.
Do away with unneeded aggravation in your life. Avoid over-reacting when something doesn?t turn out the way you want, because it can cause you stress. Work on remembering that sometimes, things just go wrong no matter how well you plan. You need to put your focus on overcoming these obstacles, rather than becoming discouraged or giving up.
Never force yourself to work beyond your physical limitations as you pursue your goals. Take your best shot, but know when you have reached your limit. Don?t neglect your body when your are striving to meet your goal. Short-changing your body in order to meet self improvement goals is a terribly counter-productive form of self-improvement.
Prepare for emergency expenses. Even the slightest unforeseen event can send a person?s finances spiraling into free fall. If you put back just a few dollars every week you will quickly build up an emergency fund. This fund can be crucial in both your immediate and distant future as you work toward decreasing debt, rather than accumulating it.
TIP! Overreacting in any situation will cause your anxiety levels to raise. Dealing with your stress in a healthy, constructive manner will improve your overall mental wellbeing.
Do not be afraid to take risks in the pursuit of happiness. Being a little too risk-averse carries its own dangers, because someone who avoids failure or rejection at all costs can wind up feeling safe, but unsatisfied. If you take risks, chances are you will be happier.
The most effective way to increase your success for self improvement is to start using the powerful advice above, beginning today. You can only succeed if you try. If you apply what you?ve just read, you?ll see changes in yourself before you know it.
China has kicked off commercial and public services of its Beidou satellite navigation system across the Asia-Pacific rim in earnest, after finishing trials it started last year. Civilians in the region as far away as Australia are now able to navigate using the satellites to a distance of 30 feet and speeds as low as 0.5 mph -- comparable to (WAAS-less) GPS, according to officials. Currently the nation has 16 navigation satellites aloft along with four experimental models, and expects to provide worldwide coverage by 2020 when it'll have as many as 40 additional units in orbit, according to China Daily. China launched the project in 2000 to avoid reliance on the US GPS system, and joins that service, Russia's GLONASS and eventually Galileo in the EU at the sat nav soirée. Check the source for the party line.
Powerful winter storms have suspended thousands of flights across the country, wreaking havoc on post-holiday travel plans. Those who purchased travel insurance and planned ahead are reaping the benefits, while others are left with limited options for reaching their final destinations. Squaremouth, America?s fastest growing travel insurance agency, is reminding travelers stranded by a backlog of cancellations and delays to lean on travel insurance for relief.
?Travelers who have planned for the worse are benefiting from insurance coverage, while other travelers are at the mercy of the airlines,? says Chris Harvey, CEO of Squaremouth. ?This week is a prime example of just how beneficial travel insurance can be.?
From three-hour delays to cancelling a trip altogether, travelers can take advantage of the following benefits to keep holiday travel frustration at a minimum.
Travel Delay Travel delay typically covers minor expenses, but is among the most frequently used benefits during times of high travel and mass delays. The benefit can pay for meals, accommodations and local transportation.
Some policies may even provide coverage for a traveler involved in a weather related traffic accident while on their way to the airport. It?s important however, to know the details of a policy to ensure this specific type of coverage is included.
Travelers should also be aware of the time restrictions and limitations related to the benefit. Most providers require travelers to be delayed for a specific amount of time before the benefit kicks in. Travel delay benefits can become available in as little as three hours.
Trip Interruption Trip interruption can reimburse travelers up to 200% of the trip cost if a reason listed on the policy prevents them from continuing on their trip. For example, a traveler who makes it through the first leg of their trip but is unable to continue on due to the weather can return home early. The benefit can provide reimbursement for the unused days of a trip and the charges incurred for additional transportation expenses to either get home or rejoin the trip.
Trip Cancellation When all else fails and a trip must be cancelled, those who have trip cancellation coverage can rest easy knowing they can be reimbursed for costly nonrefundable expenses. Trip cancellation protection provides up to 100% in reimbursement if a traveler needs to cancel a trip. Travelers who have weather coverage under this benefit, and are stranded by this week?s mass travel disruptions, are in the most favorable position in terms of travel and recouping their costs.
?Trip cancellation is one of the most popular reasons people buy travel insurance this time of year,? says Harvey. ?With so many cancellations this week, travelers who have purchased this benefit have the comfort of knowing they won?t go home at a complete loss.?
As scores of stranded airport travelers try to make it to their final destinations through a series of powerful storms, those with travel insurance are far better off. Whether it?s waiting out a rebooked flight, booking an overnight hotel or incurring costs for canceling a trip, travel insurance is often the best way to minimize the negative impacts being felt at airports across the country.
About Squaremouth Squaremouth is America?s fastest-growing travel insurance comparison site, providing the tools to instantly quote, compare and buy policies from every major provider. The company is headquartered in St. Petersburg, FL, with offices in Fort Wayne, IN. For more information on Squaremouth or its extensive network of partner sites worldwide, visit www.squaremouth.com.
About our Zero Complaint Guarantee The cornerstone of Squaremouth?s commitment to customers is the guarantee to remove any provider with a customer complaint that cannot be resolved to Squaremouth?s satisfaction. Squaremouth offers the broadest selection of insurance, with an emphasis on quality, follow-up care, and independent evaluations from insurance industry watchdog, AM Best.
Squaremouth offers products from the following travel insurance providers: Air Ambulance Card, AMEX Assurance Company, Azimuth Risk Solutions, LLC, CSA Travel Protection, Global Alert Administrators, HCC Medical Insurance Services, HTH Worldwide, IMG, ?iTravelInsured, John Hancock Insurance Agency, Inc., MedjetAssist, MH Ross Travel Insurance Services, RoamRight, Seven Corners Inc, Travel Guard, Travel Insurance Services, Travel Insured International, Travelex Insurance Services, TravelSafe, Trawick International, USA-ASSIST Worldwide Protection, and VacationGuard.
AVAILABLE TOPIC EXPERTS: Chris Harvey charvey@squaremouth.com Toll-free (800) 240-0369 x 6103 Direct (727) 490-5802 Chrisharvey.com LinkedIn Google+
Jenna Gravino jgravino@squaremouth.com Direct (727) 502-6849 LinkedIn Google+
[unable to retrieve full-text content]HOME :: Shopping and Product Reviews :: Electronics ... The under counter ice machine is a convenience for even the smallest shop or business since the hassle of obtaining ice is virtually non-existent. Installing an under ...
The iPhone 5 has launched in several new countries recently, predominantly in Africa. The phone launched on December 21 in Botswana, Camaroon, Central African Republic, Egypt, Guinea, Ivory Coast, Kenya, Madagascar, Mali, Mauritius, Morocco, Niger, Senegal, St. Lucia, St.Vincent & the Grenadines, Tunisia, and Uganda, along with the islands of Barbados, St. Lucia, and St. Kitts. The iPhone 5 also went on sale in Vietnam.
The team of physicians and engineers at the University of California-Los Angeles (UCLA) has now brought forward a new tool dubbed Artemis to diagnose prostate cancer.
Till now, doctors used an old technique to diagnose the disease by which it was quite difficult to test the cancer. They relied on biopsy which began 25 years ago and was not a good method to do the diagnosis.
The new technique used Magnetic Resonance Imaging (MRI) along with real time ultrasound system to fix the problem with the old technique. This new technology will help the doctors by letting them figuring out the cancer from high resolution 3-D images instead of inspecting the disease visually during biopsy.
The groundbreaking procedure will help to diagnose the prostate cancer earlier in men with serious cancers and those who have comparatively less serious disease can be helped to avoid unnecessary treatments. As expected by the health authorities, some 240,000 prostates cancers will be diagnosed in the United States this year; however, they affirmed that not every cancer is deadly.
"Artemis has delivered very dramatic results, and the rate of cancer detection in these targeted biopsies is very high. We're finding a lot of tumors", said Leonard Marks, MD, University of California-Los Angeles (UCLA) professor of urology and the Director of the UCLA Active Surveillance Program.
Drug shortage linked to greater risk of relapse in young Hodgkin lymphoma patientsPublic release date: 26-Dec-2012 [ | E-mail | Share ]
Contact: Summer Freeman media@stjude.org 901-297-9861 St. Jude Children's Research Hospital
National study connects higher rates of relapse in pediatric cancer patients to drug shortage, offering first example of patients hurt by shortages and renewing calls to protect patient access to lifesaving treatments
A national drug shortage has been linked to a higher rate of relapse among children, teenagers and young adults with Hodgkin lymphoma enrolled in a national clinical trial, according to research led by St. Jude Children's Research Hospital.
Estimated two-year cancer-free survival for patients enrolled in the study fell from 88 to 75 percent after the drug cyclophosphamide was substituted for mechlorethamine for treatment of patients with intermediate- or high-risk Hodgkin lymphoma. The study was launched before the drug shortages began. The change occurred after a mechlorethamine shortage that began in 2009. No study patients have died, but those who relapsed received additional intensive therapy that is associated with higher odds for infertility and other health problems later.
An analysis comparing how patients in each group were faring two years after their cancer diagnoses appears in the December 27 edition of the New England Journal of Medicine. The report provides the first evidence of a drug shortage adversely impacting treatment outcomes in specific patients. St. Jude led the study for a national group that includes the Stanford University School of Medicine and Lucile Packard Children's Hospital at Stanford; Dana-Farber Cancer Institute and Boston Children's Hospital; Massachusetts General Hospital; and Maine Medical Center.
In recent years, many patients and caregivers have had their medical care complicated by drug shortages, primarily of generic injectable drugs like mechlorethamine. Mechlorethamine, which has been used in cancer treatment since the 1960s, has only recently become available again.
Cyclophosphamide has been widely used in treatment of both adults and children with Hodgkin lymphoma. Based on earlier studies, the drug was considered a safe and effective alternative to mechlorethamine.
"This is a devastating example of how drug shortages affect patients and why these shortages must be prevented," said Monika Metzger, M.D., an associate member of the St. Jude Department of Oncology and the study's principal investigator. "Our results demonstrate that, for many chemotherapy drugs, there are no adequate substitute drugs available."
Past shortages have been resolved in a variety of ways and always before a drug substitution became necessary, said Michael Link, M.D., the senior author of the new report. Link is a professor of pediatrics in hematology-oncology at Stanford and a member of the pediatric hematology-oncology service at Packard Children's Hospital. He is also immediate past president of the American Society of Clinical Oncology. "This puts a face on the problem of drug shortages and shows that the problem is real, not theoretical. This is about a curative therapy that we were unable to administer because the drug we needed was not available," Link said. "Despite heroic efforts by the drug shortage office of the Food and Drug Administration to solve the shortages of a number of medically necessary drugs, it is clear that patients are still suffering from the unavailability of life-saving drugs. A more systematic solution to the problem is needed."
Amy Billett, M.D., a pediatric oncologist at Dana-Farber/Children's Hospital Cancer Center in Boston is the paper's other author.
Hodgkin lymphoma is a cancer of the lymph system and accounts for about 6 percent of childhood cancers. In the United States, about 90 percent of patients will become long-term survivors. Working as the Pediatric Hodgkin Consortium, in 2002 the five institutions involved in this study adopted a seven-drug chemotherapy regimen that included mechlorethamine for the treatment of high-risk pediatric patients. The goal was to preserve high cure rates, but to reduce the risk of second cancers, infertility and other problems associated with the earlier treatments. In 2006, a parallel study was opened for patients with intermediate-risk disease. The risk categories reflect the extent to which cancer has spread, particularly the number and location of lymph nodes involved, plus the presence of unfavorable symptoms of fever, night sweats and unexplained weight loss.
The strategy involved 12 weeks of the seven-drug chemotherapy regimen. Patients also received radiotherapy with the dose based on their response to chemotherapy. When mechlorethamine became unavailable, the protocol was revised to allow the cyclophosphamide substitution.
Outcomes for cancer patients are often measured in terms of cancer-free survival, which is the number of years patients remain free of the disease. When researchers assessed the substitution's impact, they found that estimated disease-free survival was 88 percent for the 181 patients whose treatment included mechlorethamine. It was 75 percent for the 40 patients who received cyclophosphamide instead. The difference led researchers to stop enrolling new patients in the trials.
"We can think of no credible explanation for this dramatic difference in event-free survival other than the drug substitution," the researchers noted. The analysis found that, as a group, patients who received cyclophosphamide had fewer unfavorable symptoms and were more likely to have intermediate-risk, rather than high-risk Hodgkin lymphoma. The patients ranged in age from 3 to 21. Half were age 14 or younger.
Patients who relapsed received additional therapy. Researchers said it is too soon to know if these patients will have the same long-term survival rates as those whose did not relapse. The additional treatment included intensive chemotherapy followed by a stem cell transplant using the patient's own blood-producing stem cells.
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St. Jude Children's Research Hospital
Since opening 50 years ago, St. Jude Children's Research Hospital has played a pivotal role in pushing overall U.S. pediatric cancer survival rates from 20 to 80 percent. Founded by the late entertainer Danny Thomas, St. Jude is the first and only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children. St. Jude is also a leader in research and treatment of life-threatening blood disorders and infectious diseases in children. No family ever pays St. Jude for the care their child receives. To learn more, visit www.stjude.org. Follow us on Twitter @StJudeResearch.
The Stanford University School of Medicine
The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu.
Lucile Packard Children's Hospital
Lucile Packard Children's Hospital at Stanford is an internationally recognized 311-bed hospital, research center and leading regional medical network providing the full complement of services for the health of children and expectant mothers. In partnership with the Stanford University School of Medicine, our world-class doctors and nurses deliver innovative, family-centered care in every pediatric and obstetric specialty, tailored to every patient. Packard Children's is annually ranked as one of the nation's best pediatric hospitals by U.S. News & World Report and is the only Northern California children's hospital with specialty programs ranked in the U.S. News Top 10. Learn more about us at www.lpch.org and about our continuing growth at growing.lpch.org. Like us on Facebook, watch us on YouTube and follow us on Twitter.
Dana-Farber/Children's Hospital Cancer Center
Since 1947, Boston Children's Hospital and Dana-Farber Cancer Institute have provided comprehensive care for children and adolescents with cancer through Dana-Farber/Children's Hospital Cancer Center. The two Harvard Medical School affiliates share a clinical staff that delivers inpatient care at Boston Children's and outpatient therapies at Dana-Farber's Jimmy Fund Clinic. The Boston Children's inpatient pediatric cancer service has 33 beds, including 13 designated for stem cell transplant patients.
Stanford/Packard Children's Media Relations Contacts:
Stanford University School of Medicine news pager
(650) 723-8222, pager ID #25314
Robert Dicks
(650) 497-8364
rdicks@lpch.org
Dana-Farber/Children's Hospital Cancer Center Media Relations Contact:
Bill Schaller
(617) 632-5357
william_schaller@dfci.harvard.edu
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Drug shortage linked to greater risk of relapse in young Hodgkin lymphoma patientsPublic release date: 26-Dec-2012 [ | E-mail | Share ]
Contact: Summer Freeman media@stjude.org 901-297-9861 St. Jude Children's Research Hospital
National study connects higher rates of relapse in pediatric cancer patients to drug shortage, offering first example of patients hurt by shortages and renewing calls to protect patient access to lifesaving treatments
A national drug shortage has been linked to a higher rate of relapse among children, teenagers and young adults with Hodgkin lymphoma enrolled in a national clinical trial, according to research led by St. Jude Children's Research Hospital.
Estimated two-year cancer-free survival for patients enrolled in the study fell from 88 to 75 percent after the drug cyclophosphamide was substituted for mechlorethamine for treatment of patients with intermediate- or high-risk Hodgkin lymphoma. The study was launched before the drug shortages began. The change occurred after a mechlorethamine shortage that began in 2009. No study patients have died, but those who relapsed received additional intensive therapy that is associated with higher odds for infertility and other health problems later.
An analysis comparing how patients in each group were faring two years after their cancer diagnoses appears in the December 27 edition of the New England Journal of Medicine. The report provides the first evidence of a drug shortage adversely impacting treatment outcomes in specific patients. St. Jude led the study for a national group that includes the Stanford University School of Medicine and Lucile Packard Children's Hospital at Stanford; Dana-Farber Cancer Institute and Boston Children's Hospital; Massachusetts General Hospital; and Maine Medical Center.
In recent years, many patients and caregivers have had their medical care complicated by drug shortages, primarily of generic injectable drugs like mechlorethamine. Mechlorethamine, which has been used in cancer treatment since the 1960s, has only recently become available again.
Cyclophosphamide has been widely used in treatment of both adults and children with Hodgkin lymphoma. Based on earlier studies, the drug was considered a safe and effective alternative to mechlorethamine.
"This is a devastating example of how drug shortages affect patients and why these shortages must be prevented," said Monika Metzger, M.D., an associate member of the St. Jude Department of Oncology and the study's principal investigator. "Our results demonstrate that, for many chemotherapy drugs, there are no adequate substitute drugs available."
Past shortages have been resolved in a variety of ways and always before a drug substitution became necessary, said Michael Link, M.D., the senior author of the new report. Link is a professor of pediatrics in hematology-oncology at Stanford and a member of the pediatric hematology-oncology service at Packard Children's Hospital. He is also immediate past president of the American Society of Clinical Oncology. "This puts a face on the problem of drug shortages and shows that the problem is real, not theoretical. This is about a curative therapy that we were unable to administer because the drug we needed was not available," Link said. "Despite heroic efforts by the drug shortage office of the Food and Drug Administration to solve the shortages of a number of medically necessary drugs, it is clear that patients are still suffering from the unavailability of life-saving drugs. A more systematic solution to the problem is needed."
Amy Billett, M.D., a pediatric oncologist at Dana-Farber/Children's Hospital Cancer Center in Boston is the paper's other author.
Hodgkin lymphoma is a cancer of the lymph system and accounts for about 6 percent of childhood cancers. In the United States, about 90 percent of patients will become long-term survivors. Working as the Pediatric Hodgkin Consortium, in 2002 the five institutions involved in this study adopted a seven-drug chemotherapy regimen that included mechlorethamine for the treatment of high-risk pediatric patients. The goal was to preserve high cure rates, but to reduce the risk of second cancers, infertility and other problems associated with the earlier treatments. In 2006, a parallel study was opened for patients with intermediate-risk disease. The risk categories reflect the extent to which cancer has spread, particularly the number and location of lymph nodes involved, plus the presence of unfavorable symptoms of fever, night sweats and unexplained weight loss.
The strategy involved 12 weeks of the seven-drug chemotherapy regimen. Patients also received radiotherapy with the dose based on their response to chemotherapy. When mechlorethamine became unavailable, the protocol was revised to allow the cyclophosphamide substitution.
Outcomes for cancer patients are often measured in terms of cancer-free survival, which is the number of years patients remain free of the disease. When researchers assessed the substitution's impact, they found that estimated disease-free survival was 88 percent for the 181 patients whose treatment included mechlorethamine. It was 75 percent for the 40 patients who received cyclophosphamide instead. The difference led researchers to stop enrolling new patients in the trials.
"We can think of no credible explanation for this dramatic difference in event-free survival other than the drug substitution," the researchers noted. The analysis found that, as a group, patients who received cyclophosphamide had fewer unfavorable symptoms and were more likely to have intermediate-risk, rather than high-risk Hodgkin lymphoma. The patients ranged in age from 3 to 21. Half were age 14 or younger.
Patients who relapsed received additional therapy. Researchers said it is too soon to know if these patients will have the same long-term survival rates as those whose did not relapse. The additional treatment included intensive chemotherapy followed by a stem cell transplant using the patient's own blood-producing stem cells.
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St. Jude Children's Research Hospital
Since opening 50 years ago, St. Jude Children's Research Hospital has played a pivotal role in pushing overall U.S. pediatric cancer survival rates from 20 to 80 percent. Founded by the late entertainer Danny Thomas, St. Jude is the first and only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children. St. Jude is also a leader in research and treatment of life-threatening blood disorders and infectious diseases in children. No family ever pays St. Jude for the care their child receives. To learn more, visit www.stjude.org. Follow us on Twitter @StJudeResearch.
The Stanford University School of Medicine
The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu.
Lucile Packard Children's Hospital
Lucile Packard Children's Hospital at Stanford is an internationally recognized 311-bed hospital, research center and leading regional medical network providing the full complement of services for the health of children and expectant mothers. In partnership with the Stanford University School of Medicine, our world-class doctors and nurses deliver innovative, family-centered care in every pediatric and obstetric specialty, tailored to every patient. Packard Children's is annually ranked as one of the nation's best pediatric hospitals by U.S. News & World Report and is the only Northern California children's hospital with specialty programs ranked in the U.S. News Top 10. Learn more about us at www.lpch.org and about our continuing growth at growing.lpch.org. Like us on Facebook, watch us on YouTube and follow us on Twitter.
Dana-Farber/Children's Hospital Cancer Center
Since 1947, Boston Children's Hospital and Dana-Farber Cancer Institute have provided comprehensive care for children and adolescents with cancer through Dana-Farber/Children's Hospital Cancer Center. The two Harvard Medical School affiliates share a clinical staff that delivers inpatient care at Boston Children's and outpatient therapies at Dana-Farber's Jimmy Fund Clinic. The Boston Children's inpatient pediatric cancer service has 33 beds, including 13 designated for stem cell transplant patients.
Stanford/Packard Children's Media Relations Contacts:
Stanford University School of Medicine news pager
(650) 723-8222, pager ID #25314
Robert Dicks
(650) 497-8364
rdicks@lpch.org
Dana-Farber/Children's Hospital Cancer Center Media Relations Contact:
Bill Schaller
(617) 632-5357
william_schaller@dfci.harvard.edu
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
In this photo released by China's Xinhua news agency, a bullet train G80 leaves for Beijing from the Guangzhou South Railway Station in Guangzhou, capital of south China's Guangdong Province, Wednesday, Dec. 26, 2012. China has opened the world's longest high-speed rail line, which runs 2,298 kilometers (1,428 miles) from the country's capital in the north to Guangzhou, an economic hub in the Pearl River delta in southern China. (AP Photo/Xinhua, Chen Yehua) NO SALES
In this photo released by China's Xinhua news agency, a bullet train G80 leaves for Beijing from the Guangzhou South Railway Station in Guangzhou, capital of south China's Guangdong Province, Wednesday, Dec. 26, 2012. China has opened the world's longest high-speed rail line, which runs 2,298 kilometers (1,428 miles) from the country's capital in the north to Guangzhou, an economic hub in the Pearl River delta in southern China. (AP Photo/Xinhua, Chen Yehua) NO SALES
In this photo released by China's Xinhua news agency, a high-speed train G802 leaves for Beijing from Shijiazhuang, capital of north China's Hebei Province, Wednesday, Dec. 26, 2012. China has opened the world's longest high-speed rail line, which runs 2,298 kilometers (1,428 miles) from the country's capital in the north to Guangzhou, an economic hub in the Pearl River delta in southern China. (AP Photo/Xinhua, Wang Xiao) NO SALES
In this photo released by China's Xinhua news agency, a high-speed train G90 leaves for Beijing from the Zhengzhou East Railway Station in Zhengzhou, capital of central China's Henan Province, Wednesday, Dec. 26, 2012. China has opened the world's longest high-speed rail line, which runs 2,298 kilometers (1,428 miles) from the country's capital in the north to Guangzhou, an economic hub in the Pearl River delta in southern China. (AP Photo/Xinhu, Zhao Peng) NO SALES
Map shows China???s high-speed rail line from Beijing to Guangzhou;
BEIJING (AP) ? China on Wednesday opened the world's longest high-speed rail line that more than halves the time required to travel from the country's capital in the north to Guangzhou, an economic hub in southern China.
The opening of the 2,298 kilometer (1,428 mile)-line was commemorated by the 9 a.m. departure of a train from Beijing for Guangzhou. Another train left Guangzhou for Beijing an hour later.
China has massive resources and considerable prestige invested in its showcase high-speed railways program.
But it has in recent months faced high-profile problems: part of a line collapsed in central China after heavy rains in March, while a bullet train crash in the summer of 2011 killed 40 people. The former railway minister, who spearheaded the bullet train's construction, and the ministry's chief engineer, were detained in an unrelated corruption investigation months before the crash.
Trains on the latest high-speed line will initially run at 300 kph (186 mph) with a total travel time of about eight hours. Before, the fastest time between the two cities by train was more than 20 hours.
The line also makes stops in major cities along the way, including provincial capitals Shijiazhuang, Wuhan and Changsha.
More than 150 pairs of high-speed trains will run on the new line every day, the official Xinhua News Agency said, citing the Ministry of Railways.
Railway is an essential part in China's transportation system, and the government plans to build a grid of high-speed railways with four east-west lines and four north-south lines by 2020.
The opening of the new line brings the total distance covered by China's high-speed railway system to more than 9,300 km (5,800 miles) ? about half its 2015 target of 18,000 km.
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