FDA panel votes against Aveo's kidney cancer drug

By Toni Clarke

(Reuters) - An advisory panel to the Food and Drug Administration recommended that the agency reject a kidney cancer drug made by Aveo Pharmaceuticals Inc and Astellas Pharma Inc, saying data from the clinical trial were inconsistent.

In a 13-1 vote on Thursday, the panel said Aveo had not shown that the drug's benefits outweighed its risks in a well-controlled study, and said a second trial would be needed before the drug, tivozanib, should be approved.

Aveo's shares fell as much as 57 percent on Thursday.

Aveo and Astellas said that while they were disappointed with the outcome of the meeting, "we remain confident in the efficacy, safety and tolerability of tivozanib," and would work with the FDA to address the issues raised by the panel.

Tivozanib delayed progression of the disease in a 517-patient trial, but patients taking the drug did not live longer than those who took a rival treatment, Nexavar, known generically as sorafenib. Nexavar is made by Bayer AG and Onyx Pharmaceuticals.

The FDA pointed out that while the drug conferred a 20 percent benefit in delaying disease progression, it increased the risk of death by 25 percent. Patients in the tivozanib arm of the trial lived 28.8 months while patients taking sorafenib lived on average 29.3 months.

"If we approve this drug based on this study how would we communicate to patients the potential 25 percent increase in the risk of death?" Jonathan Jarow, Medical Officer at the FDA, asked the panel.

Representatives from Aveo argued that the drug met the main goal of the trial, and they argued that negative overall survival figures were because patients in the Nexavar arm were allowed to cross over into the tivozanib trial. In effect, they said, tivozanib was compared against a two-drug regime.

Jarow countered that there are seven other approved drugs to treat renal cancer on the market, and patients were allowed to cross over in five of those trials, "yet none of these trials demonstrated a negative trend for overall survival," he said.

Panelists expressed concern that most of the patients in the trial were studied in central and eastern Europe and they questioned whether the results would be applicable to the U.S. population.

Why, demanded Dr. Richard Pazdur, director of the FDA's cancer division, did Aveo conduct its clinical trials in central and eastern Europe? If tivozanib was such a promising product, why were clinicians in the United States not clamoring to enter their patients?

Aveo responded that at the time it was enrolling patients, a number of other companies were also enrolling patients in competing trials, forcing Aveo to recruit most of its patients oversees.

One panel member, Lori Dodd, a mathematical statistician with the National Institutes of Health, said she was "angry" at what she perceived to be a sloppy design trial which potentially denied kidney cancer patients access to a new drug.

"I think if the trial had been conducted in a better way we would not be here," she said.

Pazdur also said he was "extremely disappointed" in the information Aveo proposed placing on the drug's label, which he said did not provide patients with the crucial survival data.

Aveo's shares were halted prior to the meeting. They closed on Wednesday at $5.25, having fallen from a year high of $14.08 last July. They fell roughly 27 percent alone on Tuesday after the FDA released its initial impressions of the data.

Aveo's shares fell 47 percent to $2.76 in Thursday afternoon trading on Nasdaq, after briefly slipping as low as $2.25.

(Reporting By Toni Clarke in Washington; Editing by Maureen Bavdek, Sofina Mirza-Reid and Chris Reese)

Source: http://news.yahoo.com/u-fda-panel-votes-against-approval-aveos-kidney-161254012.html

tcu football westminster bonnaroo 2012 lineup twisted metal sea lion si swimsuit 2012 westminster dog show

Drought across the West spurs resurgence of faith

This April 19, 2013 photo shows Our Lady of Sorrows Catholic Church parishioners Albert Lucero, left, and Nick McGovern, center, leading a prayer procession for rain in Bernalillo, N.M. From the heart of New Mexico to West Texas and Oklahoma, the pressures of drought have resulted in a resurgence of faith from Christian preachers and Catholic priests encouraging prayer processions to American Indian tribes using their closely guarded traditions in an effort to coax Mother Nature to deliver some much needed rain. (AP Photo/Susan Montoya Bryan)

This April 19, 2013 photo shows Our Lady of Sorrows Catholic Church parishioners Albert Lucero, left, and Nick McGovern, center, leading a prayer procession for rain in Bernalillo, N.M. From the heart of New Mexico to West Texas and Oklahoma, the pressures of drought have resulted in a resurgence of faith from Christian preachers and Catholic priests encouraging prayer processions to American Indian tribes using their closely guarded traditions in an effort to coax Mother Nature to deliver some much needed rain. (AP Photo/Susan Montoya Bryan)

This April 19, 2013 photo shows Our Lady of Sorrows Catholic Church parishioner Orlando Lucero reciting the rosary during a prayer procession for rain in Bernalillo, N.M. From the heart of New Mexico to West Texas and Oklahoma, the pressures of drought have resulted in a resurgence of faith, from Christian preachers and Catholic priests encouraging prayer processions to American Indian tribes using their closely guarded traditions in an effort to coax Mother Nature to deliver some much needed rain. (AP Photo/Susan Montoya Bryan)

This April 19, 2013 photo shows Our Lady of Sorrows Catholic Church parishioner Nick McGovern holding a rosary during a prayer procession for rain in Bernalillo, N.M. From the heart of New Mexico to West Texas and Oklahoma, the pressures of drought have resulted in a resurgence of faith, from Christian preachers and Catholic priests encouraging prayer processions to American Indian tribes using their closely guarded traditions in an effort to coax Mother Nature to deliver some much needed rain. (AP Photo/Susan Montoya Bryan)

This April 19, 2013 photo shows Our Lady of Sorrows Catholic Church parishioners Nick McGovernor, left, and Orlando Lucero talking about the framed statue of San Ysidro, the patron saint of farmers, after a prayer procession for rain in Bernalillo, N.M. From the heart of New Mexico to West Texas and Oklahoma, the pressures of drought have resulted in a resurgence of faith, from Christian preachers and Catholic priests encouraging prayer processions to American Indian tribes using their closely guarded traditions in an effort to coax Mother Nature to deliver some much needed rain. (AP Photo/Susan Montoya Bryan)

This April 19, 2013 photo shows Our Lady of Sorrows Catholic Church parishioners Nick McGovern, left, and Albert Lucero holding an effigy of San Ysidro, the patron saint of farmers, during a prayer procession for rain in Bernalillo, N.M. From the heart of New Mexico to West Texas and Oklahoma, the pressures of drought have resulted in a resurgence of faith, from Christian preachers and Catholic priests encouraging prayer processions to American Indian tribes using their closely guarded traditions in an effort to coax Mother Nature to deliver some much needed rain. (AP Photo/Susan Montoya Bryan)

BERNALILLO, N.M. (AP) ? Along the irrigation canal that cuts through this centuries-old New Mexico town, a small group of churchgoers gathers to recite the rosary before tossing rose petals into the water.

Remnants of a tradition that stretches back to the days of Spanish explorers, the humble offerings are aimed at blessing this year's meager irrigation season and easing a relentless drought that continues to march across New Mexico and much of the western half of the U.S.

From the heart of New Mexico to West Texas and Oklahoma, the pressures of drought have resulted in a resurgence of faith ? from Christian preachers and Catholic priests encouraging prayer processions to American Indian tribes using their closely guarded traditions in an effort to coax Mother Nature to deliver some much needed rain.

On Sunday, congregations across eastern New Mexico and West Texas are planning a day of prayer for moisture and rain.

"We're worried, but we're maintaining our traditional ways and cultural ways. Together we pray, and individually we pray," said Peter Pino, administrator of Zia Pueblo. "We haven't lost hope in the spiritual world, that they'll be able to provide us resources throughout the year.

"We're not giving up. That's pretty much all we can do at this point."

In its wake, the drought has left farmland idle, herds of cattle have been decimated, the threat of wildfire has intensified and cities are thinking twice about the sustainability of their water supplies.

In New Mexico, the renewed interest in the divine and the tension with Mother Nature stems from nearly three years of hot, dry weather. There are spots around the state that have fallen behind in rainfall by as much as 24 inches, causing rivers to run dry and reservoirs to dip to record low levels.

In neighboring Texas and Oklahoma, the story is no different.

The faithful gathered Wednesday night in Oklahoma City to recite a collection of Christian, Muslim and Jewish prayers for the year's first worship service dedicated to rain.

The Catholic bishop in Lubbock is planning a special Mass at a local farm in two weeks so that farmers can have their seeds and soil blessed. The archbishop of New Mexico's largest diocese has turned to the Internet and social media to urge parishioners to pray.

The prayer is simple: "Look to our dry hills and fields, dear God, and bless them with the living blessing of soft rain. Then the land will rejoice and rivers will sing your praises, and the hearts of all will be made glad. Amen."

In Bernalillo, the parishioners from Our Lady of Sorrows church recited the rosary as they walked a few blocks from the church to the irrigation canal on a recent Friday evening. At the front of the procession, two men carried an effigy of San Isidro, the patron saint of farmers.

"I think people need to pray for rain," said Orlando Lucero, a school teacher and county commissioner who organized the procession. "We used to do it in every community and in every parish. It was a beautiful tradition that disappeared. Now I'm hoping that we can get other parishes involved."

In Clovis, hospital administrator and active church member Hoyt Skabelund hopes thousands join Sunday's prayer day.

"I don't know that moisture comes because we pray," he said. "You're going to have ebbs and flows and not all rainfall is because someone prayed and not all droughts are because someone didn't pray. But I do believe that prayers are answered and faith in God and a higher power unlocks the powers of heaven."

After all, praying can't hurt, he said.

The simple act of digging a new post hole in eastern New Mexico tells the story of how dry it is. Moist dirt used to turn up several inches below the surface. Now, Skabelund said, someone can dig several feet and not run into any moisture.

In dry times, it's natural for farmers and others who depend on the land to turn to God, said Laura Lincoln, executive director of the Texas Conference of Churches. Still, she and others said praying doesn't take away the responsibility of people to do what they can to ease the effects of drought.

Church leaders are urging their parishioners to conserve water and use better land-management practices like rotating crops.

"We have to play our part," said The Rev. William Tabbernee, head of the Oklahoma Conference of Churches. "Prayer puts us in touch with God, but it also helps us to focus on the fact that it is a partnership that we're involved in. We need to cooperate with God and all of humanity to be responsible stewards of the gifts God has given us through nature."

___

Follow Susan Montoya Bryan on Twitter: http://www.twitter.com/susanmbryanNM

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/386c25518f464186bf7a2ac026580ce7/Article_2013-05-03-Drought-Praying%20for%20Rain/id-f7f6bfc8f7a341938f6f2ec4d8e12057

revolution huffington post What is ricin Boston Marathon Explosion Boston Marathon bombing irs new york times

Genomics to reshape endometrial cancer treatment

May 1, 2013 ? The most in-depth look yet at endometrial cancer shows that adding genomics-based testing to the standard diagnostic workup could change the recommended course of treatment for some women.

The new research, involving nearly 400 women with endometrial cancer, is published May 2 in the journal Nature. The endeavor is part of The Cancer Genome Atlas project, funded by the National Institutes of Health (NIH).

The study also indicates that some endometrial tumors are genetically similar to subtypes of ovarian cancer and deadly basal-like breast cancer. Future clinical trials should evaluate whether some endometrial cancers could be treated with drugs typically used for the other cancers, says project co-leader Elaine Mardis, PhD, co-director of The Genome Institute at Washington University School of Medicine in St. Louis. The other co-leader is Douglas A. Levine, MD, of the Memorial Sloan-Kettering Cancer Center.

A second Cancer Genome Atlas paper will be published May 1 in the New England Journal of Medicine. That research, also led by Washington University, describes finding virtually all the major mutations involved in acute myeloid leukemia.

While gynecologic oncologists have long recognized two subtypes of endometrial cancer, one more aggressive than the other, the new data reveal four novel subtypes and also suggest that the frequency of mutations in a tumor could be used to help guide treatment decisions.

"We are entering an era when tumors can be evaluated from a genomics standpoint, not just by looking at cancer cells under a microscope," Mardis says. "This more comprehensive approach provides a clearer picture of the way particular endometrial cancers will behave and will be important to gynecological oncologists who treat this disease."

As part of the new research, a consortium of researchers analyzed tumors from 373 women with endometrial cancer using different technologies to look for defects in DNA, RNA (a close chemical cousin of DNA) and proteins.

Their analysis indicates that about 25 percent of women with endometrial cancer who are thought to have a favorable prognosis based on pathology reports instead have a more formidable form of the disease, based on underlying genetic changes, and should be treated aggressively.

Clinically, endometrial cancers fall into two categories: endometrioid and serous. Endometrioid cancers generally are associated with excess estrogen, obesity and a favorable prognosis. In contrast, serous endometrial cancers are more common in older women and generally have poorer outcomes.

After surgery to remove endometrial cancer, women with the endometrioid subtype typically are treated with radiation therapy to kill remaining cancer cells, while those with serous tumors receive a more aggressive treatment -- chemotherapy.

Doctors distinguish between the two tumor subtypes by evaluating cancer cells under a microscope. But categorizing some tumors is difficult, and pathologists don't always agree.

Looking closely at endometrioid tumors classified as high-grade, meaning they are more likely to grow quickly and spread, the investigators showed that many share genetic features with serous tumors. These include frequent mutations in TP53, a tumor suppressor gene, as well as extensive copy number alterations, which refer to a cell having too many or too few copies of a gene.

"This highlights the benefit of digging deeper to find the genetic drivers of cancer growth," Mardis says. "Even though high-grade endometrioid and serous endometrial cancer are different from a pathological standpoint, they are genetically very similar and may require a similar course of treatment."

With a complete analysis of the tumor samples, the investigators identified four novel genomic-based subtypes of endometrial cancer, which set the stage for developing new ways to diagnose and treat the disease. The subtypes are based, in part, on the frequency of mutations in the tumors.

"The Cancer Genome Atlas' multidimensional approach to collecting genomic data, including clinical and pathology information, have made these findings possible," says Harold Varmus, MD, director on the National Cancer Institute. "Without the integrated characterization of so many tumor samples, correlations between histology and genomic data may not have been observed or potential clinical outcomes identified."

Interestingly, one subtype features an exceedingly high mutation rate in the POLE gene and, in this respect, is similar to an "ultramutated" subtype of colorectal cancer. But, surprisingly, patients with these kinds of tumors generally have good outcomes.

"Having many, many mutations sounds like a bad thing," Mardis explains. "But these patients can't fix the mistakes in their tumor DNA, so their cancer cells mutate themselves into oblivion before they have the opportunity to spread to other locations in the body. The good news for these patients is that their outcomes are excellent, and they don't need aggressive treatment."

Women with serous tumors frequently had mutations in one of two genes that potentially could be targeted with existing targeted therapies. Those with ERBB2 alterations, for example, may be effectively treated with Herceptin, a drug typically used in women with breast cancer who have the same mutation. Additionally, women whose endometrial tumors have PIK3CA mutations may benefit from drugs that inhibit the gene. Those drugs are now in phase II clinical trials.

According to the authors, the new findings provide a roadmap for future clinical trials for endometrial cancer.

"Each tumor subtype may warrant separate clinical trials because of marked genomic differences, which are indicative of different drivers of endometrial cancer," Mardis says. "Developing therapies for each subtype may improve outcomes for many women with endometrial cancer and parallel what has been accomplished in breast cancer."

Endometrial cancer is the fourth most commonly diagnosed cancer among U.S. women. About 50,000 cases will be diagnosed in 2013, and an estimated 8,000 women will die from the disease. For a majority of patients diagnosed with aggressive, high-grade tumors that have spread, the five-year survival rate is about 16 percent, though chemotherapy has been associated with improved survival, and new targeted agents are being tested.

Share this story on Facebook, Twitter, and Google:

Other social bookmarking and sharing tools:

---

Story Source:

The above story is reprinted from materials provided by Washington University School of Medicine. The original article was written by Caroline Arbanas.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

---

Journal Reference:

1. Gad Getz et al. Integrated genomic characterization of endometrial carcinoma. Nature, 2013; 497 (7447): 67 DOI: 10.1038/nature12113

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/health_medicine/genes/~3/eUIp2pdS8hA/130501131938.htm

Tilted Kilt Barbara Palvin Yahoo Fantasy Football Nick Foles Auguste Rodin Breaking Amish Indianapolis explosion

Bizarre bone worms emit acid to feast on whale skeletons: Bone-melting substance drills opening for worms to access nutrients within dead whales

Apr. 30, 2013 ? Only within the past 12 years have marine biologists come to learn about the eye-opening characteristics of mystifying sea worms that live and thrive on the bones of whale carcasses.

With each new study, scientists have developed a better grasp on the biology of Osedax, a genus of mouthless and gutless "bone worms" that make a living on skeletons lying on the seafloor. In the latest finding, scientists at Scripps Institution of Oceanography at UC San Diego describe how the wispy worms are able to carry out their bone-drilling activities. As published in the May 1 online edition of the Proceedings of the Royal Society B (Biological Sciences), Mart?n Tresguerres, Sigrid Katz, and Greg Rouse of Scripps detail how Osedax excrete a bone-melting acid to gain entry to the nutrients within whale bones.

"The acid presumably allows the worms to release and absorb collagen and lipids that are trapped in bone," said Tresguerres. "This model is remarkably similar to how mammals repair and remodel bone, however Osedax secrete acid to dissolve foreign bone and access nutrients."

In their report, the scientists describe a process in which the worms use a "proton pump" to secrete acid onto the bone. Tresguerres says similar acid-secreting enzymes exist in all other organisms, such as in human kidneys to handle blood and urine functions.

Because they lack mouths, bone worms must use an alternative method of consuming nutrients from whale bones. Bacteria that live symbiotically within the worms are involved in this process, however, the exact mechanism is not yet fully understood. Some evidence suggests that the symbiotic bacteria metabolize bone-derived collagen into other diverse organic compounds, and that the worms subsequently digest the bacteria for their own nutrition.

"The Osedax symbiosis shows that nutrition is even more diverse than we imagined and our results are one step closer in untangling the special relationship between the worm and its bacteria," said Katz, a Scripps postdoctoral researcher.

A 2011 study led by Rouse found that bone worms have primarily been found attached to whale skeletons, but they are capable of making a living on other bones as well, including fish. That finding supported a hypothesis that Osedax's bone-eating lifestyle may have evolved millions of years ago, even before the dawn of marine mammals.

To continue learning more about bone worms, the scientists plan to collaborate with colleagues at the Monterey Bay Aquarium Research Institute in the coming months to collect and study additional bone samples with live worm specimens. They also plan to maintain live Osedax in aquaria at Scripps to study their physiology.

"Determining how Osedax gets into bones was the first challenge in understanding the nutrition of these bizarre animals," said Rouse. "Now we'd like to understand how they transport and utilize the nutrients that they have uncovered."

Share this story on Facebook, Twitter, and Google:

Other social bookmarking and sharing tools:

---

Story Source:

The above story is reprinted from materials provided by University of California - San Diego.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

---

Journal Reference:

1. Martin Tresguerres, Sigrid Katz, and Greg W. Rouse. How to get into bones: proton pump and carbonic anhydrase in Osedax boneworms. Proc. R. Soc. B., 2013 DOI: 10.1098/rspb.2013.0625

Note: If no author is given, the source is cited instead.

Disclaimer: Views expressed in this article do not necessarily reflect those of ScienceDaily or its staff.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/~3/HygXOw1sVKc/130501091900.htm

Jaimie Alexander Army Navy Game john lennon leann rimes Jacintha Saldanha pearl harbor japan earthquake

Ontario budget sees 2013-14 deficit of C$11.7 billion

TORONTO (Reuters) - Ontario's minority Liberal government unveiled a budget on Thursday that projected a narrower-than-expected 2013-14 deficit and included measures meant to secure opposition support and prevent an early election for Premier Kathleen Wynne.

Canada's most populous province, which accounts for about 40 percent of the country's economy, will run a budget shortfall of C$11.7 billion ($11.60 billion) in 2013-14 under the budget plan unveiled by Finance Minister Charles Sousa, who succeeded Dwight Duncan in February.

The deficit is below the government's year-ago forecast of C$12.8 billion, but above its 2012-13 shortfall of C$9.8 billion.

New Democratic Party (NDP) leader Andrea Horwath, whose support is needed to pass the budget and prop up Wynne's government, said she would consult with her party members before deciding what to do.

"This budget clearly reflects the budget proposal we put forward ... but what we want to make sure (voters) get those results," she told reporters.

With just 51 seats in the 107-seat Ontario legislature, Wynne's Liberals need NDP support to pass the budget. The right leaning Progressive Conservatives, who hold the second-most seats, will not support the document, leader Tim Hudak said.

Wynne, whose party saw its popularity jump when she took over from longtime Liberal Premier Dalton McGuinty in January, has since watched poll numbers move in favor of the PCs, as her government has struggled with the fallout of a power generation spending scandal.

The PCs currently enjoy 36 percent support, followed by 33 percent for the Liberals and 26 percent for the NDP, according to an aggregation of recent polls published in the Globe & Mail newspaper on Tuesday.

As such, the budget featured more than a little input from NDP leader Horwath in certain areas, most notably a pledge to cut auto insurance premiums by 15 percent, as well as a C$295 million youth job creation program.

"We recognize that we're in a minority situation and we need to work with all sides of the house," Sousa told reporters.

The auto insurance reduction follows a ballooning in premiums in recent years, which insurers have blamed on rising claims and fraud-related costs.

Sousa said he has been in touch with insurance companies - Ontario's largest publicly-traded auto insurer is Intact Financial - and would hope to see rates start to come down within a year.

($1 = $1.0084 Canadian)

(Editing by Jeffrey Hodgson and Nick Zieminski)

Source: http://news.yahoo.com/ontario-budget-sees-2013-14-deficit-c-11-205713416.html

rick ross yahoo finance iOS 6.1 BlackBerry Kwame Harris Vine dr oz

One Reason It?s Hard to Write About the Bangladesh Factory Disaster (Balloon Juice)

Share With Friends: | | Politics - Top Stories Stories, RSS Feeds and Widgets via Feedzilla.

Source: http://news.feedzilla.com/en_us/stories/politics/top-stories/302934029?client_source=feed&format=rss

2012 westminster dog show abe lincoln vampire hunter xi jinping matt bomer westminster kennel club dog show jeremy lin game winner chocolate covered strawberries

Least Restrictive Environment is Different for Each Individual

Closure of two New Jersey developmental centers leaves families with limited placement choices for their relatives with severe disabilities.

by Deborah Smith -

On Feb. 26, Governor Christie announced his plans to increase his commitment to New Jerseyans with disabilities by moving away from a system that has historically focused on institutionalization to one that emphasizes home- and community-based services and support. Christie said his commitment is to provide people with disabilities the ability to live among family, friends and neighbors, as well as comply with the Supreme Court decision requiring that people with developmental disabilities be able to live in the least restrictive environment.

What Christie fails to recognize is that the least restrictive environment does not have the same meaning for everyone in the developmentally disabled community. There are at least two segments of the developmentally disabled community: the profoundly intellectually disabled (IQ level below 20 to 25) and the mild (IQ level 50 to 70) to moderately (IQ level 35 to 55) intellectually disabled.

Two distinct populations

For those with profound intellectual disability, the least restrictive environment for this population is developmental centers where comprehensive medical care is provided to the residents under the Intermediate Care Facility for the Mentally Retarded (ICF/MR) federal-care model for the most vulnerable of our society. Most of these residents have limited or no speech. They are toddlers in adult bodies, and most have a variety of chronic medical conditions. Developmental centers provide healthcare and social services, as well as medical services based on the residents needs determined by a team of professionals in conjunction with input from parent or guardians and family members.

For the mild to moderately intellectually disabled, the least restrictive environment means community-based programs, such as group homes where the objective is to increase the independence of the residents. These facilities do not have medical experts constantly available on-site and need to call local EMTs through 911 for any medical emergency. Group homes focus on increasing the daily living skills of?residents, which include meal preparation, laundry, housecleaning, even money management, and on self-care skills, such as bathing, dressing, toileting, eating, and taking prescribed medications.

Families left with poor choices

The Olmstead U.S. Supreme Court decision, on which the governor says he based his decision, actually recognized that one size does not fit all for care. The court decision states, ?We emphasize that nothing in the Americans with Disabilities Act or its implementing regulations condones termination of institutional settings for persons unable to handle or benefit from community settings ? Nor is there any federal requirement that community-based treatment be imposed on patients who do not desire it.?

Read more at?Opinion: One size doesn?t fit all.

[Via North Jersey]

Source: http://specialedpost.com/2013/05/01/least-restrictive-environment-is-different-for-each-individual/

andy pettitte tyler clementi kevin kolb sarah shahi rutgers dharun ravi george clooney arrested