text:
Dr. Len's Cancer Blog
Today is the beginning of Memorial Day weekend and the summer holiday season. It's a day to remember to enjoy your fried chicken, while not frying your skin. (OK, fried chicken isn't exactly healthy for you, but it is fun once in a while. Frying your skin is never healthy nor fun).
It is also Don't Fry Day, an annual reminder of the need to be sun safe while we enjoy the outdoors during the summer months. More...
Filed Under:
Other cancers | Prevention | Vitamins
OK. So Groundhog Day was on Saturday this year, and unlike the furry little beast what I have to say each year around this time is just as good today as him looking for his shadow on Saturday.
What is all this about, you are probably asking yourself?
It is about an annual update that I started a couple of years ago on my blog to remind myself and those who are interested that losing weight and staying healthy is a tough slog and a major commitment which too often is not successful. Like many of you out there I am not immune to all the problems surrounding diet and trying to get weight under control. Try, try, try again and again, and hopefully one day we can all get it "right." That's why I dubbed this the Groundhog Day Diet, after the Bill Murray movie of a similar name where he strikes out to relive the same day again and again until he gets it "right."
And, let's face it: I am not alone in this dilemma. Many of us are in the same boat: we keep trying, but nothing seems to work. There are temptations and messages all around us that are leading us to eat ourselves into oblivion. We as a nation are becoming larger and larger, and now there are concerns that overweight and obesity-if left unchecked, and on their current trajectory-will result in reversal of the gains we have made in extending and improving life. But maybe--just maybe--with the new techologies offered by apps and smarphones we will be able to actually take control of our lives and our eating habits and make some real progress through more awareness and information in realtime at the moment we are making our choices about our diets. More...
Diet | Environment | Prevention | Vitamins
Yesterday I wrote a blog discussing how meetings like the current annual gathering of the American Society of Clinical Oncology (ASCO) gives me a chance to think about big picture questions.
Well, there is another side to the experience that is also interesting and important, such as getting information that helps put together pieces of a larger puzzle, and perhaps even gives closure to a nagging question. When you have one of those "Aha!!!" moments, it can truly solidify your thoughts and maybe even save a few lives in the process. In this case, the same presentation that led to yesterday's comments about the emerging complexities of the diagnosis of cancer also produced another enlightening moment.
Dr. Levi Garraway is a highly regarded genomics researcher from Dana Farber Cancer Institute in Boston who presented a lecture on the topic of how genome sequencing is bringing new insights to the biology and treatment of cancer. As part of his presentation, Dr. Garraway offered information on areas where genomics has already offered us definitive information that has direct implications in understanding cancer.
The #1 item on Dr. Garraway's list was a topic of intense interest to me and several of my skin cancer colleagues.
According to Dr. Garraway, genetic analysis of cancers from patients with melanoma show an overwhelming number (my words) have a signature genetic marker proving their melanomas were caused by ultraviolet (UV) radiation. He elaborated that there have been questions in the scientific literature as to whether or not this was the case, and acknowledged that we have had to rely on relatively indirect research to prove the case that melanoma is caused by UV light. However, he continued, because of genomics it is now essentially "case closed" and essentially proven: melanoma is caused by exposure to UV light. More...
Environment | Other cancers | Prevention | Research | Vitamins
Oh, vitamin D, where have ye gone? We miss ya!!
That might be the refrain of many who have labored so long to promote awareness of vitamin D as a possible cancer prevention agent for the past number of years.
Not that the advocates have lost their faith-a recent article from Dr. Cedric Garland, who is an expert on vitamin D as a case in point-but a report from the Institute of Medicine (IOM) has thrown a bit of a damper on the unbridled enthusiasm that vitamin D was the answer to cancer prevention that many have been seeking for some time.
No, the IOM did not endorse vitamin D as a cancer prevention agent. And based on what they could say from the literature, the panel did endorse the concept that vitamin D is important for bone health, while blood tests that reportedly showed substantial deficiencies throughout the United States were in fact not being appropriately interpreted.
Now, in a "Perspective" piece in this week's New England Journal of Medicine, three of the IOM panel members share their thoughts with the public as to why the panel did not reach the conclusion that vitamin D decreases cancer risk. And, while they support that conclusion, they also don't lose sight of the possibility that there may just be some truth behind the claims-bit it hasn't been proven just yet. More...
Breast Cancer | Cancer Care | Colon Cancer | Diet | Lung Cancer | Medications | Other cancers | Prevention | Prostate Cancer | Vitamins
Now that the tanning industry has had its nosed bloodied by the Federal Trade Commission, maybe it's time for the Food and Drug Administration to step up to the plate.
That's the question that is looming large for many interested in the issue of tanning bed risk, and the upcoming FDA meeting on March 25 where further restrictions on tanning beds are going to be considered.
From my point of view, and based on my personal/family experience, action can't come soon enough.
This is clearly not a new topic.
Several years ago, the World Health Organization published a detailed, comprehensive report on the risks of tanning beds. They concluded they were bad for your health, and recommended that youth under the age of 18 should be banned from using them.
Fast forward to this past July, and you have the International Agency for Research in Cancer—better known as IARC—issuing a statement that tanning beds are in fact a Class I carcinogen, on the same page and same line as tobacco.
In other words, just like tobacco, here is a product that when used as intended has a considerable chance of causing you harm. And, at the same time, it is unclear except in the most limited of circumstances how tanning beds can possibly offer any benefit that can't be achieved using approaches that are much less risky at substantially less cost.
In very condensed terms, what happened this past Tuesday was that the FTC charged the Indoor Tanning Association (ITA)—a trade industry that is supported by the tanning industry—of "making false health and safety claims about indoor tanning." According to the FTC press release, the association simultaneously "agreed to a settlement that bars it from any further deception."
So what did they "decept" you might ask?
In a March 2008 advertising campaign—one that raised great concern among those aware of the risks of indoor tanning—the Association claimed:
· Indoor tanning is approved by the government
· Indoor tanning is safer than tanning outdoors because the amount of ultraviolet light received when tanning indoors is monitored and controlled
· Research shows that vitamin D supplements may harm the body's ability to fight disease, and
· A national Academy of Sciences study determined that "the risks of not getting enough ultraviolet light far outweigh the hypothetical risk of skin cancer."
As part of the settlement, the industry has to let people know that they don't have to become tan to get vitamin D and that doing so "may increase the likelihood of developing skin cancer and can cause serious eye injury."
When you look at a more detailed report of the FTC investigation, you find that the industry actually claimed—according to the FTC—that indoor tanning does not increase the risk of skin cancer. The FTC countered that "tanning, including indoor tanning, increases the risk of skin cancer, including squamous cell and melanoma skin cancers."
I distinctly remember the advertisements in question.
Some of us were so concerned that—through the National Council on Skin Cancer Prevention—we actually wrote a letter to the ombudsman of a major national newspaper that ran the ads, taking them to task for running an advertisement that was clearly full of dangerous misinformation. To the best of my knowledge, we never received a response.
And then there was the article that appeared in the New England Journal of Medicine that provided an excellent review of vitamin D but also included tanning beds as a means of supplementing vitamin D. We complained about that as well, but the editor declined to run our letter.
Shortly thereafter, there were published reports and an article on this blog discussing the fact that the researcher who wrote the article indicated that his research was supported by the Ultraviolet Foundation, which is a "foundation" wholly supported by the ITA.
So the battle goes on an on.
This past November, I had the privilege of testifying on behalf of the American Cancer Society at a hearing in Howard County MD that resulted in a county-wide ban on the use of tanning beds by minors under the age of 18. This was an outright ban, not one of those "if your parents give you permission it's OK" types of restrictions.
The room was filled with people in favor and opposed to the ban, and to be certain there were a number of tanning salon owners there who said they don't want to harm children, and feel that tanning is safe (there were also a number of people there who had a strange looking tan, but that's not a topic for this blog. They just looked really out of place.)
There were also experts there who testified on behalf of the tanning salon owners. One of those was a recently retired FDA official who just happened to be intimately involved with tanning bed regulation at the FDA prior to his retirement.
We are going to have a replay of that hearing on March 25th at an FDA advisory committee meeting just outside of Washington DC, when the FDA is going to consider whether they should reclassify tanning lamps from their "essentially safe" list to one that has a bit more teeth.
That, at least, would reflect current thinking on the question that these lamps are not safe when used as intended, and in fact can cause serious harm.
Like many things in life, this all comes down to one's personal experiences. And my family has had one of those experiences.
When my daughter was in high school, she succumbed to the lure of the tanning industry and wanted to get tan for her prom.
As you might imagine, she never told me or consulted with me about this. After all, dear old Dad may have some knowledge about these things, but what does he really know?
Well, Dad may not know anything but my daughter soon discovered the problem with tanning beds.
You see, she has what is called "type I" skin. That means she is very fair, and can't tan. She burns.
And that's how I found out that my daughter was going to the "tanning" salon. She returned home one Saturday, red as a lobster from head to toe, burned by one of those salons that allegedly always follows the rules. And now she is at a lifetime increased risk of skin cancer and melanoma as a direct result of her sessions under the "safe" UV light in a local tanning salon.
I guess I shouldn't be surprised.
Researchers have documented the dangers of tanning devices. They have also documented the lack of controls on the tanning industry.
So I ask you, why? Why continue this charade? Why let this go on?
Tanning isn't something we need. It's something we want—for all the wrong reasons. It can even be addicting like cigarettes. And, like cigarettes, when used as intended it does bad things—even causing cancer that can result in death—and doesn't do anything good that can't be done otherwise more safely, more effectively and less expensively.
I say it's time for the FDA to follow the lead of the FTC and get on with the job that has to be done.
And, as reflected in a number of bills and proposed regulations currently pending in state and local legislative and regulatory bodies around the country, it's time to ban the tan—especially for those under the age of 18.
Finally, we have the results of a large scale randomized, placebo-controlled clinical trial to tell us whether or not vitamin D can reduce the risk of breast cancer.
The study, reported in today's issue of the Journal of the National Cancer Institute, concludes that there is no evidence that vitamin D decreases breast cancer incidence in post-menopausal women.
But I will bet you dollars-to-doughnuts (well, maybe not doughnuts—they are fattening) that this study isn't going to provide closure to the hotly-debated question of whether or not vitamin D reduces breast cancer risk.
The study was part of the larger Women's Health Initiative which was designed to look at the impact of hormone therapy on the health of post-menopausal women. As part of that study, close to 18000 post-menopausal women were randomly assigned to take 1000 mg of calcium and 400 IU (international units—the recommended daily allowance for vitamin D) daily. The other 18,000 women took placebos.
The problem is that both groups of women were allowed to take extra vitamin D and calcium, and a good number of them did just that—although the number of women who did so was basically the same in both groups. By year 6 of the trial, about half of the women in both groups were taking extra vitamin D.
The end result was that over the seven years of this study, there was no difference in the frequency of breast cancer between the two groups. The vitamin D did not make a difference in how often women developed breast cancer.
An editorial that accompanied the report pointed out some of the problems with the study, and which I would also consider important:
In the same editorial, the authors wrote:
"Because preclinical, epidemiological, and clinical trial results of vitamin D supplementation are conflicting, additional studies will be needed to determine whether vitamin D plus calcium will prevent breast cancer…Future clinical trials should address the above questions to help determine whether higher does of vitamin D supplements will be cancer preventive. The potential health benefits of vitamin D and calcium may yet have a bright future."
Another interesting finding pointed out by the authors of the research report was that vitamin D blood levels measured at the beginning of the study didn't necessarily relate that closely to the amount of vitamin D that the women had been taking in the past. High vitamin D intake did not necessarily mean high vitamin D levels in the blood. That raises the question of how much vitamin D our bodies absorb when we take supplements. Those amounts may be different in different people, and may be controlled by other factors such as our genetic makeup.
The authors concluded:
"Such results suggest that factors other than dietary and supplement intake of vitamin D likely influence (blood levels of vitamin D)…Before future clinical trials of high-dose vitamin D regimens to reduce breast cancer risk are implemented, it will be important to demonstrate that the selected vitamin D dose can definitively increase (blood vitamin D) levels to the projected target level. Definitive assessment of factors that influence the relationship between vitamin D supplement use and subsequent changes in circulating (vitamin) D levels are therefore a research priority."
The bottom line?
When it comes to vitamin D there are a lot of questions and not many answers.
For now, we would be hard-pressed to conclude that vitamin D reduces the risk of breast cancer in post-menopausal women.
There is still a lot we don't know: we don't know how much vitamin D is healthy in our bodies, and if in fact there are risks associated with too much vitamin D (see prior blog). We don't know whether or not we should be routinely measuring vitamin D in our bodies with blood tests. We don't know how much vitamin D we should be taking every day, and whether each person responds the same way to the same dose of vitamin D. We don't know whether vitamin D reduces cancer risk or influences outcome after cancer is diagnosed and for which cancers, if any.
Unfortunately, when it comes to vitamin D, confusion reigns supreme. We deserve better.
Breast Cancer | Prevention | Vitamins
Are we looking for cancer prevention clues in all the wrong places? That is the question I am asking myself as another vitamin theory bites the dust.
A report in this week's Journal of the American Medical Association (and supported in part by research funding from the American Cancer Society) examined the relationship between folic acid, vitamin B6 and vitamin B12 and breast cancer.
The bad news? A combination vitamin pill did not reduce the risk of breast cancer.
The good news? A combination vitamin pill did not increase the risk of breast cancer, or any other cancer.
In the study, the researchers examined the effect of giving a daily dose of the three vitamins in a single pill to a group of women who were at high risk of heart disease. Half the participants received the vitamins, and the other half took a placebo (or dummy pill) that did not contain the vitamins.
After a little over 7 years of treatment, there was no difference between the two groups of women with respect to the incidence of breast cancer or any other cancer. There was also no difference in the frequency of cancer deaths between the two groups
The theory behind this research was that these particular vitamins play an important role in orderly cell growth, and therefore may prevent cancer.
The reason the theory is so attractive is the same as it is for every vitamin claim: vitamins are easy to take, inexpensive, and thought to be harmless. For many of us, they are a part of our daily routine. What could be easier than popping a vitamin pill in the morning to prevent cancer and a host of other diseases?
The problem is—as it has been for many years—that when the vitamin claims are subjected to the magnifying glass of a well-done clinical trial, the claims simply don't hold up.
Trust me, I know. Years ago, vitamin C and vitamin E were the rage. I took them until the research didn't support the claims that they reduced the risk of cancer and heart disease, respectively.
Then there was folate, which many of us take that as part of our daily multivitamin tablets.
First folate was reported to reduce the risk of colorectal cancer. More recently, some research suggests that folate may promote polyp growth for people who already have colon polyps possibly resulting in an increased risk of colon cancer.
To be honest, the research on the risks and benefits of folate in colorectal cancer is conflicting and confusing to medical experts, let alone people who are trying to make the right decisions about their health.
This is important, since beginning in 1998 folate was added to our food in an effort to reduce the incidence of a certain birth defect in the spinal cord. The food fortification program has been successful, and blood levels of folate in our bodies have increased over the past decade.
But now there is concern—in part because of the research results noted above—that too much folate may actually cause harm, and increase the risk of some cancers.
That's why this study's negative outcome is so important: folate did not increase the incidence of colorectal cancer or any other cancer.
Do you find yourself asking the question how something so simple—and so "natural"--as a vitamin can hurt people?
If we hadn't done the research, we would all be taking large doses of vitamin C to prevent cancer (it doesn't). We would never have found out that beta carotene leads to an increased risk of lung cancer in heavy smokers. We wouldn't know that vitamin E and selenium—alone or in combination—did nothing to reduce prostate cancer in men.
Next on my list is vitamin D. But we won't have definitive answers to questions about the cancer-related benefits and risks of the "sunshine vitamin" for years.
Maybe we are looking for cancer prevention in all the wrong places, and maybe not.
It would be great if something as simple as a vitamin pill would ward off the risk of cancer. Right now, however, the vitamins aren't scoring any home runs in the cancer prevention arena.
For now, we are just going to have to do things the old fashioned way: eat your five fruits and vegetables a day, maintain a healthy weight, eat a balanced diet, and exercise, exercise, exercise.
I know. That's much more complicated than taking a vitamin pill once a day. But at least we know those are strategies that work for reducing your risk of cancer.
Broccoli, anyone?
Just because it's "natural" and looks like it might work to prevent cancer doesn't mean it will work to prevent cancer.
That's the message of today's announcement from the National Cancer Institute and the Southwest Oncology Group (which is a national research group that does clinical trials in cancer) that they are telling the over 35,000 men participating in a prostate cancer prevention trial to stop taking their pills.
The study, called "SELECT" and which was started in 2001, was based on two earlier trials that found pretty much by accident that it appeared selenium and vitamin E decreased the incidence of prostate cancer.
Both of those studies were designed to primarily look at cancers other than prostate cancer. One, in Finland, was done to see if vitamin E reduced lung cancer incidence and the other examined the impact of selenium on the incidence of skin cancer. In both of the studies, there was tempting data that selenium or vitamin E unexpectedly reduced the risk of prostate cancer.
But those "accidental findings" didn't hold up in a well-designed clinical trial. Life is not always simple in medical research.
After 7 years, the results are in: An independent review board which monitored the SELECT trial found selenium and vitamin E—either alone or in combination—did not reduce the risk of developing prostate cancer. In fact, there was a small but not significant increase in the incidence of prostate cancer in the men taking only vitamin E and diabetes in the men taking only selenium.
The result: men are being instructed to stop their pills, but will continue to be monitored for several years.
The theories that vitamin E or selenium can reduce the risk of prostate cancer have been around for awhile. There were many men who already believed that vitamin E and selenium could reduce the risk of prostate cancer. But, once subjected to critical study through a randomized clinical trial—the gold standard of medical research—we find the evidence didn't support the theories.
We have been here before with various vitamins and minerals. And, there are those out there who have been suggesting that other vitamins and minerals can reduce cancer risk.
This blog is no stranger to evidence based medicine. No matter how tempting the reports of success may be, until the right trial is done you simply can't authoritatively support an unproven theory that a vitamin or anything else can prevent cancer.
Let's always keep that principle in mind before we start advocating that "this thing" or "that thing" prevents cancer.
Until the evidence is in, the evidence isn't in.
Prostate Cancer | Prevention | Vitamins
A study in the current issue of the Archives of Internal Medicine addresses a question that has interested me for some time: does vitamin D really reduce the risk of death for the general population?
The study, from Johns Hopkins in Baltimore and the Albert Einstein College of Medicine in New York, examined data from a national health survey performed in the United States from 1988 through 1994.
The studies did back up the claim that vitamin D deficiency is associated with an increased risk of death in the general population, but did not show that it reduced deaths from all types of cancer.
Perhaps even more important to me was an observation in the report that suggested there may indeed be an increase in death rates for women who have higher levels of vitamin D in their blood.
The authors noted that approximately 41% of men and 53% of women in the United States are deficient in vitamin D based on prior studies.
The researchers examined data from a nationwide health survey that was performed in the United States from 1988 through 1994. They evaluated health-related surveys, physical examinations and blood samples that were obtained from 13,331 people representative of the United States population who were 20 years or older. They then examined the causes of death in this group through December 31, 2000.
In this study, the profile of people who had the lowest levels of vitamin D was older age, female, and non-Hispanic black. People with low vitamin D levels in this study also tended to include those with higher blood pressures, higher body mass index or BMI (reflecting a greater incidence of overweight and obesity), diabetes, lower socioeconomic status and less physical activity when compared to people with higher levels of vitamin D.
When the researchers looked carefully at the rates of death from any cause, the 20% of the people studied with the lowest level of vitamin D in their blood had a 26% increased chance of death. Many of the people in this group also were smokers and had other medical illnesses, but the authors were able to discount those factors as contributing to the increased death rate they observed
Unlike heart disease, the investigators found no evidence that vitamin D levels had any influence on the risk of dying from cancers of all types.
When looking only at death rates for cancers which had previously been associated with vitamin D—including colorectal, breast and prostate cancer—there was no association seen in those who were most vitamin D deficient. There was a suggestion of lower death rates for those specific cancers at a slightly higher vitamin level—which was still deficient, but not the most seriously deficient group.
And then there was the graph I came across when looking at the paper.
You may recall back in June I reported on a study presented at ASCO which demonstrated that higher vitamin D levels in post-menopausal women diagnosed with breast cancer were associated with a better prognosis.
In the same study—reported at the meeting but not included in the abstract—there was a slide showing death rates from all causes in women who participated in the study.
In that study, as expected based on the conclusions of the research, the slide showed that women who presented with primary breast cancer and were deficient in vitamin D had a higher death rate compared to women with the middle range of vitamin D levels.
But it was the other end of the curve that gave me cause for concern, namely that the researchers in that study also observed an increased death rate from "other causes" at the higher vitamin D levels found in some of the women. Those deaths were not from breast cancer, and the research did not point to any specific reason.
The researcher who presented the paper noted the finding, but also indicated that it had to be confirmed by other studies.
That was the first time that I had heard that people from an otherwise "normal" population (except for their breast cancer, of course) had an increased risk of death related to higher—but still acceptable--vitamin D levels.
We must always bear in mind that there may be many explanations for that observation, since the study wasn't designed to measure that specific outcome. It could be related to some other factor, or may have occurred just by chance.
Then there was the graph in the current study, and that graph showed a similar curve. I can't explain all the statistical considerations, but the graph showed that the women in this study who had higher levels of vitamin D in their blood also had what appears to be either a significant or a borderline significantly increased risk of death from all causes.
They really didn't say much about the increased mortality rates seen in the 20% of the women in the study with the highest levels of vitamin D in their blood.
"This is the first study, to our knowledge, to explore the association between (vitamin D) levels and mortality in the general population…
"As shown, in women, having both low (<20 ng/ml) and high (>50 ng/ml) (vitamin levels) was associated with an increased rate of mortality. (Emphasis mine)
"Several authors have commented that the optimal levels of (vitamin D) should be greater than 30 ng/ml. In our observational study, we found that there was a lower risk of mortality at levels of 30-49 ng/ml, but that at levels greater than 50 ng/ml, there was again a higher risk of mortality in women. (Emphasis mine) This is similar to findings about antioxidant vitamins and vitamin E, which show that too much may be harmful."
I have to say that seeing this information in two separate studies certainly raises a concern as to whether or not this observation is real. When you start to see a pattern like this in studies of this size, then one's instinct is to start to pay attention to the finding.
If it is real, then the statement that there is no risk to having high levels of vitamin D—or trying to raise vitamin D levels beyond a "normal" or "middle" range—may not be correct. Seeing two independent studies point in the same direction is suggestive that this is something worthy of further investigation. It is not conclusive of evidence of harm.
As I have written previously, there is much yet that we need to learn about this vitamin and its role in health. But before we can start making recommendations that people take large quantities of vitamin D, we need to know whether there in fact may be a serious mortality risk involved, especially for women.
Vitamin D deficiency is a cause for real concern in this country. There is no doubt that many people in this country are vitamin D deficient, and that deficiency impacts their bone health, and may impact their overall health as well.
What we need to do now is look at a total strategy regarding vitamin D, beginning with a review of dietary guidelines and how all of this information plays into the everyday practice of medicine. We need better understanding of the precise role of vitamin D in relationship to health and to cancer specifically. We need to know if there is benefit from routinely measuring vitamin D levels as part of our general medical care, and what the best advice is regarding replacement and follow-up measurement. We need to educate the public and the profession alike about vitamin D, but at the same time we need to understand the limitations of our knowledge.
This study did suggest that vitamin D deficiency is associated with an increased death rate from all causes, and supported in some cancers that there may be a relationship between vitamin D levels and the risk of cancer death.
But we also need to know if there is a downside, and the magnitude of risk from that downside.
As the authors clearly pointed out, we have been down this path before.
Vitamins are assumed to be "safe" because they are "natural." But when studied carefully in some situations where there were claims of health benefits, they have been shown not only to not have a health benefit, but have actually caused harm.
As has been said, those that forget the past are condemned to repeat it. On the other hand, for the sake of our physical well-being, we also need evidence-based answers for the questions related to the relationship between vitamin D and our health.
Diet | Prevention | Vitamins
A couple of weeks ago, I wrote a blog about vitamin D deficiency and its impact on breast cancer recurrence. The information was based on an abstract that had been released in advance of the American Society of Clinical Oncology's annual meeting, currently underway in Chicago.
In that blog, I reported on the conclusions of the researchers from the University of Toronto, Canada, that outcomes for women with breast cancer were worse if they were vitamin D deficient at the time of diagnosis, compared to women who had sufficient amounts of vitamin D in their blood.
Yesterday, the researchers presented their paper at the ASCO meeting. And that presentation emphasized the fact that what appears in an abstract is not always the whole story.
The basic results reported at the meeting were essentially the same as those in the abstract. Adequate levels of vitamin D in the blood of newly diagnosed breast cancer patients were associated with a less aggressive cancer and a better prognosis.
But there were two important points that were made that were in fact different from what was in the abstract or weren't in the abstract at all.
First, during her presentation, Dr. P.J. Goodwin, who was the lead author on the study, commented that unlike what was printed in the abstract about the vitamin D relationship only pertaining to women with hormonally sensitive (estrogen receptor (ER) positive) breast cancers, in fact the study data showed that higher vitamin D levels were associated with an improved prognosis of all women with breast cancer—whether or not their cancers were hormonally sensitive.
That is an important point, since ER negative breast cancers—although representing a minority of breast cancers—are known to be more aggressive. If vitamin D levels didn't influence their prognosis, then that would represent one more negative differentiating factor for women diagnosed with these tumors.
Another interesting corollary—although not addressed specifically in this abstract presentation—is the fact that recent research has shown that African American women have a greater proportion of ER negative breast cancers. They also have more aggressive disease, with presentation at younger ages and with higher mortality compared to white women. (It remains unclear how much of this difference is related to biology vs. lack of access to affordable, adequate health care.)
African Americans are also known to have a greater prevalence and degree of vitamin D deficiency.
If that is the case, then there is an intriguing question of whether or not there is a link here. If we addressed vitamin D deficiency in African American women, could we reduce their risk of developing ER negative breast cancers, and improve their prognosis once diagnosed?
The second point that was presented in yesterday's session was not addressed in the printed abstract. Yet, in my opinion, it is possibly one of the most important observations regarding vitamin D being used to decrease the risk of cancer. It is critical to assessing the claims of many researchers and others that vitamin D supplementation is not toxic, and that we should be routinely recommending large doses of vitamin D through supplements or UV exposure to prevent cancer.
Dr. Goodwin showed a slide which looked at mortality in the women who participated in this study, based solely on their measured vitamin D levels. (Unfortunately, I have not been able to get hold of a copy of this slide.)
The finding as reported, from my point of view, was unexpected and certainly should provide us with a sense of caution as we pursue to question of vitamin D as a cancer prevention agent.
The slide showed death rates over time as a function of vitamin D levels in these women with newly diagnosed breast cancer.
As would be expected, increased deaths were seen with low levels of vitamin D. That in large part was due to increased deaths from breast cancer.
As vitamin D levels in the blood at the time of diagnosis increased, there was a fall-off in deaths, again probably due to fewer deaths from breast cancer.
But then there was the unexpected finding that as vitamin D levels increased, death rates increased as well. That should not have happened from breast cancer, since the data was clear that higher levels of vitamin D were associated with better prognosis. So something else was leading to more deaths than expected. (For the scientists among you, this is what we call a "U" shaped mortality curve—increased deaths at the upper and lower limits of the measured variable, with a low level in the middle.)
What Dr. Goodwin reported was that there essentially was a "sweet spot" for blood levels of vitamin D that maximized its benefit with respect to breast cancer, while minimizing harm. But the data also suggests that increased levels of vitamin D were in fact potentially harmful.
Dr. Goodwin mentioned that she did not know why this happened, and that it merits further research as to the cause as well as careful evaluation in upcoming studies. She cited prior research that has suggested higher blood vitamin D levels may be associated with an increased number of cardiac events.
In any event, this is the first time I have heard of a potentially harmful relationship of this type, implying that we should be cautious before we recommend megadoses of vitamin D for women for the prevention of breast cancer, or as part of their treatment.
So what are the lessons?
First, what we see in print in an abstract is frequently never the whole story, and we don't have the "final word" until a study is actually published in a peer review journal. Even then, research studies are always subject to further discussion and scrutiny.
In this situation, the abstract said the benefits of higher vitamin D levels were limited to women with ER positive cancers. In the presentation yesterday, we heard that women with both ER positive and ER negative breast cancers who had higher levels of vitamin D in their blood had better prognoses.
Second, there may be harm with having too much vitamin D in the blood. This is very much a preliminary observation, and clearly needs more study to help us understand if this is a consistent, real finding.
As I have noted before, we must always approach new ideas with caution. We need to do the appropriate research to demonstrate both the benefits and the risks of vitamin D before we make recommendations for millions of people.
Only then can we have the confidence that the recommendations we are making are backed by the strongest and best scientific studies, and won't result in more harm than good.
J. Leonard Lichtenfeld, MD, MACP - Dr. Lichtenfeld is Deputy Chief Medical Officer for the national office of the American Cancer Society.


text:
Welcome to the Oz Broadband Speed Test. This site is an Internet speed test, where you can test both the download speed and the upload speed of your Internet connection, whether it be Dialup, ADSL, ADSL2, ADSL2+, Cable, Wireless or Satellite.
Optus Speed Test Mirror
We recommend you use the Optus mirror.→ Start Speed Test
Search Broadband Plans
Find and compare broadband plans the easy way. It could even help you find a better deal.
Site Stats
Total Users: 6,055
Tests Run: 30,788,693
Broadband News
|Subscribe to Oz Broadband Speed Test News Feed
|Follow Oz Broadband Speed Test on Twitter
Monday, 28th July 2014
NBN Co sets September FTTP service date for TPG areas
NBN Co's fibre-to-the-premise product will be ready for service in areas where internet service provider TPG is seen as posing a competitive threat from late September this year.
Source: iTnews Australia
NBN Co examines 'connected home' opportunities for RSPs
NBN Co, in conjunction with Ovum, has released a report highlighting opportunities for service providers to innovate and profit from the rise of the 'connected home'.
Source: ARN
Beware the spin behind Australia's copyright law discussion paper
Another week, another propaganda-driven proposal from the mind of Australian Attorney-General Brandis. This one assumes that ISPs need to fix other people's broken product distribution models.
Source: ZDNet Australia
Friday, 25th July 2014
Govt proposes crackdown on ISPs over piracy
The Australian government has proposed amending the country's Copyright Act to make internet service providers legally responsible when their users infringe on copyrighted material, and to allow the copyright industry to force ISPs through the courts to censor specific websites.
Source: iTnews Australia
Brandis proposes website blocking and piracy crackdown
A leaked discussion paper from the Australian Attorney-General's Department reveals proposals to implement new legislation to undo the High Court's judgement in the 2012 iiNet copyright infringement case against Hollywood film studios, and force ISPs to block websites containing copyright infringing material.
Source: ZDNet Australia
Thursday, 24th July 2014
Turnbull urges ACCC to avoid NBN migration 'price shock'
Federal communication minister, Malcolm Turnbull, is urging the Australian competition watchdog to avoid making any decisions that could result in an NBN migration "price shock".
Source: ZDNet Australia
Turnbull warns ACCC against undermining Telstra NBN agreement
Communications minister Malcolm Turnbull and finance minister Mathias Cormann have warned the Australian Competition and Consumer Commission that cutting wholesale pricing for services over Telstra's copper network could negatively affect the National Broadband Network rollout.
Source: Computerworld
Telstra sends more jobs to Asia
When Telstra boss David Thodey said the company's future is in Asia, he was right. That's where many of the company's jobs are headed.
Source: iTWire
Australia a wireless leader and wired laggard
Australia has the second highest rate of broadband mobile in the world but ranks a lowly 21st place in fixed broadband. Australia has 114.4 wireless broadband subscriptions per 100 population but just 26.1 fixed connections per 100, according to the latest figures from the OECD.
Source: iTWire
Wednesday, 23rd July 2014
Australia drops in OECD broadband rankings
Australia has dropped from 18th to 21st in the OECD rankings for fixed broadband penetration for the last six months of 2013.
Source: ZDNet Australia
Telstra to shutter 2G network by the end of 2016
Telstra has sounded the death knell for its legacy 2G network, announcing plans to close it down at the end of 2016.
Source: ZDNet Australia
More mobile gadgets than people? Seven countries - including Australia - now qualify
Wireless broadband subscriptions now outnumber people in seven countries as consumers continue to snap up smartphones and tablets, according to a new report.
Source: Computerworld
Vodafone relying on high-value subscribers amid 137,000 customer loss
Vodafone Hutchison Australia (VHA)'s former boss, Bill Morrow, expected the telecommunications provider's subscriber loss to halt by mid-2014, but the company continues to feel the aftermath of its 2010 outages.
Source: ARN
Vodafone still bleeding mobile customers
Vodafone Australia has not yet been able to stem the tide of mobile user losses despite a dedicated turnaround effort, losing a further 137,000 mobile subscribers in the six months to June 30.
Source: iTnews Australia
Tuesday, 22nd July 2014
NBN: Nothing, But Nothing is happening
You know the NBN is dead when not even the FttN haters bother to shellac Malcolm Turnbull's blogs. As Telstra reasserts control over the NBN and the Coalition government flounders, can we actually expect anything from the NBN anymore?
Source: ZDNet Australia

subset: commoncrawl


text:
Sort: publication date | titles A - Z
Page: | 1 |
Practitioners in social care are often required to work with clients who do not want to work with them, and these 'reluctant' clients can often be the most challenging, but most rewarding, to work with. This practical, jargon-free book covers all the issues that practitioners are likely to encounter in the course of working with reluctant clients. more »2010, Paperback: £16.99/ $26.95
Keywords: adults, advocacy, anger management, carers, challenging behaviour, child protection, children, communication, community care, domestic abuse, early intervention, emotions, families, fostering, health care, looked after children, mental health, mental illness, nursing, offenders, older people, parenting, pastoral care, probation, psychotherapy, race, relationships, safeguarding children, social care, social skills, social work, supported living, teenagers
For children growing up in foster care, the role of their birth parents is an important factor in the success of their long-term placements. Understanding the experiences of parents is therefore essential for social workers. This book set out a model of good practice, based on the experiences of these parents and social workers. more »2010, Paperback: £22.99/ $36.95
Keywords: adolescence, adoption, adults, attachment, child development, child protection, children, communication, domestic abuse, drugs, emotions, families, fostering, looked after children, mental health, parenting, relationships, residential care, resilience, safeguarding children, self esteem, social care, social policy, social work, teenagers, transitions, trauma
Page: | 1 |
(2 titles match the current selection)


text:
Commissioner Bob Ott can tell you what political weakness looks like whether it is in East Cobb or South Cobb.
On Tuesday, there was a rare, open to the public, meet and greet of local politicians at the Parc at Piedmont retirement community off Roswell Road. Of the 50 or so in attendance, about half were elected officials and their primary opponents. A few of the highlights.
Rep. Don Parsons was sighted for the first time in a decade. Without a DNA test we can't be sure but it looked like a much older version of the Don Parsons picture we see in the MDJ. His smiling opponent, JoEllen Smith, chatted up the crowd, and had a pleasant productive evening.
Still no Rep. Matt Dollar but one of his opponents, Cynthia Rozzo, was the most talked to person at the event. People stood in line to have the opportunity to say hello.
If David Banks had supported quality public education, instead of his extremist agenda on the school board, he wouldn't have two primary opponents.
Democrat Kevin "Big Kev" Westphal is running for Bobby "Dr. No" Franklin's old seat in HD46. "Big Kev" was comfortable talking to all comers. Think the folks in HD46 will vote for another representative with a nickname?
Tom Price, another phantom elected official, as usual, wasn't there. Some of his defenders said that he gets out in public, like addressing the Chamber of Commerce or a fundraiser at an Atlanta Country Club home.
The last reported town hall meeting was reported to be in front of some East Cobb seniors a few years ago when he tried to sell the privatization of Social Security. The knowledgeable seniors left him hurrying for the door. Tom Price's most likely Democratic opponent, Jeff Kazanow, was present, shaking hands, answering questions, and having a fun time with East Cobb Republicans.
Commissioner Ott came in a little late but it probably took just one look for him to know who politically was on the way out and who was moving forward. The next night, the commissioner was in Powder Springs, so he dropped in on a local candidate's forum hosted by popular representative David Wilkerson. It was similar to the Parc event, short on introductions and long on mix and mingle with about 100 in attendance.
School Board member David Morgan has worn out his welcome in South Cobb and has two formidable primary opponents, Bobby J. Allen and Karyn A. Harrison. Both opponents are well-qualified and supporters of strong public education with no personal financial or political agenda.
Outstanding school board member Alison Bartlett was present. For those who wanted a quality school board representative, they didn't have to look far for a model. Republicans can't beat her, so they are redistricting her district to try to improve their chances of maintaining control of the biggest pot of money in Cobb County, the school board budget.
The other invited candidates were running for Commissioner Woody Thompson's job. I would not guess who the front runners are since most had signs all over the district. They were all well connected to local organizations, and seemed more qualified than the folks currently on the commission. They were Lisa Cupid, Monica Delaney, Ruth Negron, Michael Rhett, and Connie Taylor.


text:
It's Hatched!
Relax your feathers and indulge your senses when you book a two-night getaway for two people at the Charleston Harbor Resort and Marina at half off. You'll enjoy a hot breakfast each morning during your stay in one of 125 nautically themed rooms in this waterfront sanctuary. The largest marina in the Carolinas, it's close to all the history and nightlife in downtown Charleston.
The Charleston Harbor Resort and Marina offers a private beach, pool, Jacuzzi, two restaurants, bike rentals, sailing lessons and more. The resort has received the Gold Property Certification from Elite Meetings and a Certificate of Excellence from TripAdvisor.
$219 for a two-night arrival Sunday through Wednesday
Charleston Harbor Resort & Marina
Calling All Shoppers...
Calling All Merchants...
Stay Connected!
© 2010-2014
DealChicken.com. All Rights Reserved. Users of this site agree to the
Terms of Service
Privacy Policy / Your California Privacy Rights
Ad Choices
Subscribe below and we'll send you a daily deal alert for Binghamton.
MontgomeryPhoenixPhoenix - East Valley Phoenix - West ValleyScottsdale/Paradise ValleyTucsonLittle RockMountain HomePalm SpringsSacramentoSalinasVisaliaDenverNorthern ColoradoDelawareWashingtonFort Myers/Cape CoralFSUJacksonvillePensacolaSpace CoastTallahasseeTampa BayUCF / East Seminole CountyAtlantaAtlanta NorthAtlanta SouthMaconGuamChicagoEast Central Indiana / RichmondIndianapolisLafayetteMuncieDes MoinesIowa CityLouisvilleAcadianaCentral LouisianaMonroe/West MonroeOpelousasShreveportBangorPortlandMontgomery CountySalisbury/Ocean CityBattle Creek / KalamazooDetroitGrand RapidsLansingLivingston CountyPort HuronCentral MinnesotaTwin CitiesHattiesburgJacksonOzarksSt. LouisGreat FallsRenoCentral JerseyCumberland CountyMonmouth CountyNorth JerseyOcean CountySouth JerseyBinghamtonBuffaloElmiraIthacaPoughkeepsieRochesterRockland-GreaterWestchesterWestchester-Shore TownsAshevilleThe TriadCincinnatiClevelandCoshocton / Holmes CountyFairfield CountyGreater CincinnatiLicking CountyMarion CountyMuskingum ValleyNorth Central OhioNorth CoastScioto ValleySalemBucks/MontgomeryPittsburghColumbiaGreenvilleSioux FallsClarksvilleJacksonKnoxvilleMurfreesboroNashvilleSouthern UtahNorthern VermontNorthern VirginiaStauntonCentral WisconsinFond du Lac / OshkoshFox CitiesGreen BaySheboygan / Manitowoc
There's one last thing we need from you to create your account.


text:
After enjoying a session of the Steel City Ukuleles musical gathering, founder Marlene Parrish said if you don't walk away smiling, you don't have a pulse.
"We are so glad to see each other and just hate to leave, and usually by the end, people are sitting there jamming," Parrish said.
The group formed last June and meets from 7 to 9 p.m. every first and third Wednesday of the month at the . While the core group has about 15 members, Parrish said they are looking for new people interested in this miniature musical instrument.
"It's just a bunch of people committed to playing the ukulele and singing for fun," Parrish said. "We have a template for teaching and a whole list of songs. We take three or four easier songs for people in the room who may be fairly new and try to get a proper intro to it, decide the verses and a proper ending."
The sessions also are comprised of playing other songs together, one of which included a parody of Petula Clark's "Downtown," reworked into a more Pittsburgh-friendly version called, "Dahntahn."
The group finds new songs to play in a book called "The Daily Ukulele," which has 365 different tunes for the year, and also consults websites for various options.
"We have beginners, intermediate and really good players," Parrish said. "It's a whole continuum and we try to meet everybody's needs one at a time."
After its first six months, the group is ready to play for group homes for the elderly and other audiences. of the WSCC said the Steel City Ukuleles were a big hit at the holiday party in Regent Square.
"And that was their first gig, which you would have never guessed, since they had style and panache," Doody said. "The group enjoys playing, so you enjoy listening. Plus, many of the tunes they play are tunes that you know, and they encourage a singing along."
Parrish, who has written for the Pittsburgh Post-Gazette for many years, said the ukulele has given her a new outlet for fun. It's also one of the few instruments that can be thrown in the back of the car and easily taken just about anywhere.
"Personally, I can amuse myself, I can grow and learn new things," she said. "I was looking for something to invest considerable energy in and this is different. It works a different part of the brain."
In addition to the music, the people in the group add another element to the enriching aspect of the playing the ukulele.
"It's the community—it's about being with other people and it's helpful," she said. "We start laughing from the time we walk in the room to the time we leave. It's just a whole new way to be."
For more information, e-mail Parrish at firstname.lastname@example.com.


text:
August 2, 2014
MILWAUKEE (AP) -- The Brewers open a series at home against Cincinnati tonight.
The series comes after they were swept in three games at Miller Park by the charging St. Louis Cardinals.
Adam Wainwright gave up two hits in seven scoreless innings and Yadier Molina put on a rare power display with two homers to lead the Cardinals to yesteday's 8-0 victory.
The win closed the Cardinals to within two and a half games of the Central Division lead for the first time since April 20.
The Brewers were swept at home for the first time since Florida took three games at Miller Park last September.
Milwaukee has been swept on the road twice this year, at San Diego in May and at Colorado last week.
The Cardinals outscored the Brewers 28-7 in the series.
The Brewers have lost 13 of their last 18 games.


text:
Last week, we confirmed the big details: Neal Adams is returning to the Dark Knight for a 12-issue mini-series, BATMAN: ODYSSEY. We even had a cool piece of art to debut. But why stop there?
The latest arc by the creative team of writer Chris Yost and artist Marcus To races to its conclusion as Ra's al Ghul's endgame for Time Drake begins. The Men of Death are on the move in Gotham, and Red Robin, Batgirl and Prudence are out to stop them from killing everyone close to Bruce Wayne. But before our hero can face off against Ra's, he has to throw down against a few familiar faces.
Grant Morrison and artist Andy Clarke continue to roll in the second part of the "Batman vs. Robin" arc, as the Dynamic Duo fight it out in the ultimate death duel. But what happens when Damian's mother Talia sends out an old enemy to finish the job her young son couldn't stomach?
BATMAN AND ROBIN #11 hits 4/7.
Been a great show so far, eh? For those reading along from home, our very own Ian Sattler promised on the DC Editorial panel at WonderCon today that we'd be talking about some major creators contributing to upcoming issues of DCU: LEGACIES, the era-spanning series touching on the various heroes and villains of the DC Universe.
With BLACKEST NIGHT #8 out and in the world and WonderCon upon us, why not remove some of those pesky shadows from the first cover of BIRDS OF PREY #1? Enjoy.
Writer Matthew Sturges and artist Freddie Williams II present a tale of the Injustice Society, as the villains find the All-Stars new headquarters. But Cyclone, of all people, has found a way to turn their own allies against them. Meanwhile, Stargirl shares a moment with a teammate -- which might not be the wisest decision.
TIME MAGAZINE has posted 200, count 'em, 200 nominees for their list of the Top 100 Most Influential People of 2010. Included on that list? DC Entertainment President Diane Nelson and Neil Gaiman, author of the Hugo Award nominated WHATEVER HAPPENED TO THE CAPED CRUSADER? and, of course, SANDMAN.
Just woke up and yeesh, it's early here on the west coast. Just so you guys know, I'll be up in the air with a few of my DC colleagues heading back to NY. But don't fret. We've got a preview of the next issue of BATMAN AND ROBIN coming first thing tomorrow, though. See you then.
Greetings DC Nation! Are you ready for WonderCon? We're so ready to go that I took a practice run to the airport this morning and then I held a rehearsal DC Universe panel on the street in front of our offices. We are THAT ready. From April 2-4 we will be at the Moscone Center South in San Francisco and we will be the best prepared comics publisher you have ever seen!


text:
May is National Smile Month! Fittingly, here are ten ways that you can improve your oral health this month:
1. Brush your teeth for two minutes twice a day with fluoride toothpaste. This one sounds simple, but are you actually brushing for the full two minutes? Make sure that you are giving your teeth a good, thorough brush twice a day. Additionally, use a toothpaste that has fluoride; all toothpastes that have the ADA seal of approval contain fluoride.
2. Floss at least once a day. Ideally you should floss even twice a day. Flossing is so important because it is the only way to remove the plaque that is left in between your teeth that brushing cannot reach. This plaque can cause cavities, gingivitis, and bad breath, and if left on your teeth plaque can calcify into tartar.
3. Add mouthwash to your daily routine. When used in conjunction with brushing and flossing, mouthwash can further improve your oral health by killing the bacterial plaque that causes cavities, bad breath, and gingivitis. The ADA seal of approval is on many antiseptic mouthwashes such as Listerine and ACT.
4. Replace your toothbrush. The ADA recommends that you replace your toothbrush every 3-4 months. Toothbrushes lose their efficiency over time and can even start to house bacteria.
5. Eat your vegetables! Pumpkins, carrots, sweet potatoes, and broccoli all contain Vitamin A which is necessary for the formation of tooth enamel. Crunchy vegetables such as carrots and celery help clean the gums and produce saliva.
6. Chew sugar-free gum after meals. Chewing gum increases the flow of saliva which in turn rinses your teeth and protects them from decay. Choose a sugar-free gum like Orbit or one with xylitol like Trident.
7. Clean your tongue. This is essential to good oral hygiene. Cleaning your tongue removes bacteria that causes bad breath, tooth decay and gum problems. Use your toothbrush to brush your tongue or buy a tongue scraper.
8. Avoid tooth stainers. If you want to keep your smile bright avoid black tea, coffee, smoking, and dark foods (like spaghetti sauce).
9. Say no to sugary drinks. This means soda, sweet tea and many juices, and if you must drink it then use a straw. Sugar is so bad for your teeth because when dental plaque is mixed with sugar the bacteria that live in the plaque start the process of tooth decay and cause cavities. Cutting down on sugary drinks is the easiest way to prevent cavities- and it's healthier for you overall!
10. See your dentist regularly! It's so important to see your dentist for regular cleanings in order to maintain good oral health. You should get your teeth cleaned at a dental office twice a year or every 6 months. This can prevent problems, like gum disease, and fix ones, like small cavities, before they get out of control.


text:
You've seen the covers. You've watched the video. You've shopped the River Island collection. Now, at long last, you can get your hands on it.
ELLE's April issue, starring Rihanna on its special, double-cover release, hits newsstands today.
Shot by Mariano Vivanco in Paris, Rihanna models pieces from her River Island line paired with spring hero looks from Prada and Louis Vuitton. ELLE writer Mark Ellen spent seven days and one night with the tireless star for the issue and, trust us, you do not want to miss the resulting feature.
Spring has finally sprung and, needless to say, we've got all your shopping needs covered - not least with our special Style For Less supplement. You won't want to buy anything until you've seen it.
This is the issue you've been waiting for to go inside this year's starrier-than-ever ELLE Style Awards, with exclusive, behind-the scenes pictures of all the stars you won't find anywhere else. Yes, that's Bradley Cooper, Kate Hudson, Stella McCartney and too many more to mention as you've never seen them before.
A must-see for beauty addicts is make-up artist Val Garland's exclusive take on the neutral look. You'll also get first look at the new, limited Charlotte Stockdale edition of Jo Malone London's Rose Cologne – and the chance to win a spot on the waiting list for it.
Nick Grimshaw takes the Snapshot stage and New York fashion writer Jillian Mercado writes about how being in a wheelchair won't halt her career. We'll also introduce you to the PAs of some of the fashion industry's most successful names (think Vivienne Westwood and Thandie Newton), and – haven't you heard? Life begins at 20. Find out why.
As if that weren't enough, we're unveiling the results of our ELLE Chic Shack Awards 2013 – our favourite, simple and unique places to stay around the globe, be that a £20-a-night beach hut or luxurious villa.
Enough to see you through the month? We think so.
The April issue of ELLE is on sale from today, Wednesday, 6 March 2013, from all good news stockists.
Or why not subscribe and never miss an issue?


text:
Ray Beltran beat Arash Usmanee to likely earn a world title shot against Terence Crawford this summer.
Manny Pacquiao remains the betting favorite on fight day, as we're now just hours away from his rematch with Timothy Bradley.
Manny Pacquiao faces Timothy Bradley in the welterweight main event tonight on HBO pay-per-view, with three undercard fights airing before the highly-anticipated rematch.
Manny Pacquiao and Timothy Bradley headline tonight's big card in Las Vegas. Here's info on how you can watch around the world, including live stream options.
Manny Pacquiao and Timothy Bradley are set for tomorrow night's HBO pay-per-view rematch in Las Vegas.
The winner of tomorrow night's HBO PPV undercard bout between Ray Beltran and Arash Usmanee will secure a shot at WBO lightweight titlist Terence Crawford.
Manny Pacquiao and Timothy Bradley hit the scales today in Las Vegas for tomorrow night's HBO pay-per-view rematch.
Manny Pacquiao will make a guarantee of $20 million for Saturday's rematch with Timothy Bradley, who will pull in a career-high $6 million.
Manny Pacquiao is the favorite this Saturday against Timothy Bradley, just as he was in 2012. But unlike that fight, this one isn't seen as any foregone conclusion, with close odds that haven't...
Arash Usmanee will replace an ill Rocky Martinez on the Pacquiao-Bradley II undercard.
We'll email you a reset link.
If you signed up using a 3rd party account like Facebook or Twitter, please login with it instead.
You must be a member of Bad Left Hook to participate.
We have our own Community Guidelines at Bad Left Hook. You should read them.
You must be a member of Bad Left Hook to participate.
We have our own Community Guidelines at Bad Left Hook. You should read them.
Choose an available username to complete sign up.
In order to provide our users with a better overall experience, we ask for more information from Facebook when using it to login so that we can learn more about our audience and provide you with the best possible experience. We do not store specific user data and the sharing of it is not required to login with Facebook.


text:
Thirteen years ago, Jack Winter lay dying in a graveyard. Jack called upon a demon and traded his soul for his life… and now the demon is back to collect its due. But Jack has finally found something to live for. Her name is Pete Caldecott, and because of her, Jack's not going to Hell without a fight.
Pete doesn't know about Jack's bargain, but she does know that something bigger and far more dangerous than Jack's demon is growing in the Black. Old gods are stirring and spirits are rising--and Jack doesn't stand a chance of stopping them without Pete's help.
Sign up to receive information about new books, author events, and special offers.
Praise for the Black London series:
Caitlin Kittredge is the author of the Nocturne City and Black London series, as well as several short stories. She started writing novels at age 13, and after a few years writing screenplays, comic books and fan-fiction, she wrote Night Life, her debut novel. She is the proud owner of an English degree, two cats, a morbid imagination, a taste for black clothing, punk rock, and comic books. She's lucky enough to write full time and watches far too many trashy horror movies. She lives in Olympia, Washington.
Caitlin Kittredge


text:
Comparing Five Music Players
On modern computers, music players are as standard as word processors and spreadsheets, but how do you choose one? You can take for granted that music players using the same soundcard and speakers will produce roughly the same quality of sound. You also can assume that any music player you try will be able to play any music format that your operating system supports, including, for GNU/Linux, the free Ogg Vorbis format. A modern music player will support various sources as well, ranging from the local collection of tracks on your hard drive to CDs, DVDs, external players and on-line sources, such as Internet radio and podcasts. So, how do you decide?
To suggest an answer, I looked at five of the most popular music players for GNOME and KDE—Amarok, Banshee, Exaile, Rhythmbox and Songbird—using the current versions available in the Debian unstable repository. After comparing them in each of six general usability categories, I ranked them and tallied the results.
Dragging and dropping tracks, desktop notifications and minimizing music players to the notification tray are all standard features these days. The differences in how each music player handles those features are usually minor, although Amarok, like most current KDE apps, provides the most customization for notifications. It also repurposes its middle context pane when you are moving tracks from the media source pane on the left to the playlist on the right by temporarily transforming it into live links that you can drop selections on to get different results.
However, the largest problem for all these music players is how they handle collections of local tracks and podcasts and music stores that easily can number in the thousands these days. Unfortunately, in four out of five cases, the handling of all this information is not well thought out.
The endless displays of tracks, albums, artists and playlists not only make for a cluttered window, but also can leave users with a feeling that they have too much information. At times, what controls actually do can be difficult to discover, as with the filters for Rhythmbox's search filter, which easily can be mistaken as controls for altering the panes displayed in the window. Too often, the space for each column in a pane is so limited and track or album names are so truncated in anything less than a full-screen view, they almost might not be listed at all.
The exception to this rule is Amarok, whose three main panes maximize the display space in the window while using every sort of trick—from expanded trees to hiding music sources not currently in use—to reduce the clutter and information overload. Exaile and Songbird manage some of the clutter in their default views with tabs, but Banshee and Rhythmbox both have a series of permanent panes that feel badly in need of cleanup. You can, of course, greatly improve the layout of all the music players via the View menu by selecting which panes or columns to display, but Amarok remains far ahead in general appearance. If you really want to remove the clutter, you can hide the middle context pane, reducing the information in Amarok to a functional minimum. Another possibility is to undock one or more of Amarok's panes to create a separate floating window that you can refer to only as needed.
Still, all five players do what they can to help users navigate. All can sort lists in ascending and descending order, and all include search filters, although Amarok gives you more control over both sorting and filters. In addition, Amarok and Banshee both offer bookmarks.
After Amarok, the best-designed is Songbird, whose Web structure gives it an instant familiarity. Songbird also features skins, called feathers, and a zoom for changing the size at which information is displayed, but these features, although novel and convenient, are not enough to challenge Amarok seriously.
Banshee, Exaile and Rhythmbox (tie)
-- Bruce Byfield (nanday)
What about the simple Audacious?
I'm a simple user, with simple needs. Just need an easy to use media player to play my mp3/wma files. I tried to use Amarok lots of times, but beside it makes me remember the stupid itunes, is also a very annoying. Only Audacious allows me to select a folder o more, put them on a playlist and press play button, after that I minimize the frontend, so why loose resources or time with visual stuffs?
I think you should also analyze and compare this players tested with Audacious.
Thanks anyway for being one of my Linux sources!
QuodLibet ftw.
QuodLibet ftw.
one more player
Quod Libet... its perfect for people with large albums
Rhythmbox automated playlists
"With all five players, you can randomize the order in which the tracks on a playlist are played. However, with Rhythmbox, that is as far as automation goes."
Not true. Rhythmbox does offer iTunes style smart playlists. While they may not be as advanced as other systems, it is a far cry from nonexistant.
Linux has become a key foundation for supporting today's rapidly growing IT environments. Linux is being used to deploy business applications and databases, trading on its reputation as a low-cost operating environment. For many IT organizations, Linux is a mainstay for deploying Web servers and has evolved from handling basic file, print, and utility workloads to running mission-critical applications and databases, physically, virtually, and in the cloud. As Linux grows in importance in terms of value to the business, managing Linux environments to high standards of service quality — availability, security, and performance — becomes an essential requirement for business success.
Sponsored by Red Hat
If you already use virtualized infrastructure, you are well on your way to leveraging the power of the cloud. Virtualization offers the promise of limitless resources, but how do you manage that scalability when your DevOps team doesn't scale? In today's hypercompetitive markets, fast results can make a difference between leading the pack vs. obsolescence. Organizations need more benefits from cloud computing than just raw resources. They need agility, flexibility, convenience, ROI, and control.
Stackato private Platform-as-a-Service technology from ActiveState extends your private cloud infrastructure by creating a private PaaS to provide on-demand availability, flexibility, control, and ultimately, faster time-to-market for your enterprise.
Sponsored by ActiveState
Trending Topics
|August 2014 Issue of Linux Journal: Programming
|Aug 01, 2014
|August 2014 Video Preview
|Aug 01, 2014
|Open-Source Space
|Jul 31, 2014
|Silicon Mechanics Gives Back
|Jul 30, 2014
|Reglue: Opening Up the World to Deserving Kids, One Linux Computer at a Time
|Jul 29, 2014
|diff -u: What's New in Kernel Development
|Jul 23, 2014
- August 2014 Issue of Linux Journal: Programming
- Open-Source Space
- Numerical Python
- New Storage Solution is Music to the Ears of Fast-Growing Digital Music Company
- Reglue: Opening Up the World to Deserving Kids, One Linux Computer at a Time
- Silicon Mechanics Gives Back
- Linux Systems Administrator
- Senior Perl Developer
- Technical Support Rep
- UX Designer
Featured Jobs
|Linux Systems Administrator | Houston and Austin, Texas
|Host Gator
|Senior Perl Developer | Austin, Texas
|Host Gator
|Technical Support Rep | Houston and Austin, Texas
|Host Gator
|UX Designer | Austin, Texas
|Host Gator
|Web & UI Developer (JavaScript & j Query) | Austin, Texas
|Host Gator


text:
All games at 7:30 p.m. unless noted
Ayden-Grifton at Farmville Central
Bunn at Corinth Holders
C.B. Aycock at Goldsboro
Camden County at Columbia
Cape Hatteras at Manteo
Cardinal Gibbons at Broughton, 7 p.m.
Cary at Garner, 7 p.m.
Cary Christian at Southampton Academy
Cedar Ridge at Durham Riverside, 7 p.m.
Chatham Central at W. Montgomery
Cleveland at Green Hope, 7 p.m.
Clinton at Whiteville
D.H. Conley at West Carteret
Davidson Day at Harrells Christian
East Wake at Heritage, 7 p.m.
Eastern Wayne at Greene Central
Fay. Victory Christian at Granville Central
First Flight at Currituck
Franklinton at Northwest Halifax
Graham at Orange
Harnett Central at Overhills
Havelock at Kinston
Hillside at Greensboro Dudley
Hunt at Northeastern
J.H. Rose at Rocky Mount
Jones Senior at Wallace-Rose Hill
Jordan at Panther Creek
Kinston Parrott at Word of God
Knightdale at Enloe, 7 p.m.
Lakewood at Midway
Lawrence Academy at Halifax
Lee County at Western Harnett
Leesville Road at Athens Drive, 7 p.m.
Lumberton at Fayetteville Seventy-First
Millbrook at Northern Durham, 7 p.m.
Nash Central at Hertford County
New Bern at Jacksonville
New Hanover at Purnell Swett
North Brunswick at S. Brunswick
North Duplin at Dixon
North Edgecombe at SE Halifax
Northeast Academy at Hobgood Academy
Northern Nash at Wayne County
Northwood at Carrboro
Pamlico at Holmes
Parkland at Pinecrest
Parkwood at Jordan Matthews
Person at Halifax Va.
Perquimas at Creswell
Pine Forest at Gray's Creek (E)
Princeton at North Johnston
Richmond at Fayetteville Britt
Riverside-Martin at Southside
Rosewood at Lejeune
Sanderson at Holly Springs
Scotland at Southern Durham, 7 p.m.
Smithfield-Selma at Clayton, 7 p.m.
South Central at North Pitt
South Columbus at W. Brunswick
South Johnson at Red Springs
South Stanly at North Moore
South View at Hoke County
S. Alamance at East Chapel Hill, 7 p.m.
Southern Nash at Roanoke Rapids
St. David's at Rocky Mount Academy
Tarboro at SouthWest Edgecombe
Terry Sanford at Cape Fear
Triton at Southern Lee
Union at Hobbton
Wake Forest at Wilmington Hoggard
Wakefield at Southeast Raleigh, 7 p.m.
Warsaw Kenan at East Duplin
West Johnston at Fuquay-Varina
White Oak at Wilmington Ashley
Wilson Beddingfield at Wilson Fike


text:
Washington, D.C. The commercialization of an innovative telemetry communications system developed through a U.S. Department of Energy research program will help U.S. producers tap previously hard-to-reach natural gas resources deep underground, resulting in access to additional supplies that will help enhance national energy security.
Using novel new technologies normally associated with interplanetary deep space navigation and missile guidance systems, the technology is designed to transmit data to and from downhole equipment in real time, enable surface processing of downhole sensor data, and control downhole tools directly from the surface. The technology allows the system to successfully operate at greater depths than other EM systems and to propagate signals through formations that typically weaken electromagnetic waves.
Rights to the EM technology were purchased in September by Sharewell of Houston, Texas, which plans to utilize the technology as part of its measurement-while-drilling (MWD) systems.
DOE's Deep Trek Program was established in 2002 to develop "smart" systems to address the needs of U.S. producers drilling to depths of 15,000 feet and deeper, where more than 125 trillion cubic feet (Tcf) of untapped natural gas is estimated to be in place. For comparative purposes, DOE's Energy Information Administration estimates technically recoverable U.S. natural gas resources at 2,119 Tcf, with proved reserves of 238 Tcf.
Natural gas is an important energy source for the U.S. economy, providing nearly one-quarter of total energy consumption in 2009. It is expected to remain a significant energy option for meeting increased energy consumption in the years ahead, and domestic supplies beyond traditional resources will be required to meet demand. Technology innovations through FE's Oil and Natural Gas R&D Program will be important in helping locate and develop these and other diverse natural gas resources in an environmentally responsible manner.


text:
Jose Alberto Miranda
Jul 24, 2014
Juan Sanchez-Rodriguez
Jul 16, 2014
Anthony M. Kay
Jul 10, 2014
Paul Grace
Jun 26, 2014
Home » News » Crime
AG holds off releasing name of man killed by Weare police
"We are not releasing that at this time," Assistant Attorney General Susan G. Morrell said.
On Thursday she said that an undercover drug buy was to take place at Dunkin' Donuts at Lanctot's Plaza on Route 114 about 10 p.m. Wednesday. Several Weare police officers, two confidential informants and the alleged male target of the investigation were in the plaza.
- Man hospitalized following Rochester shooting; suspect still at large - 0
- Police seeking help to identify alleged credit card thieves - 0
- Manchester Crimewatch: Man accused of new crimes while out on bail faces hearing - 0
- Gorham man arraigned for kidnapping Abigail Hernandez, but details remain scarce - 0
- Ex-Manchester police officer pleads guilty to felonies related to helping drug dealer - 2
- Lancaster man indicted for possessing child sex abuse images - 0
- Former Nashua court officer waives hearing on sexual assault charges - 0
- MBTA police officer arrested two more times following house party arrest in Salem - 0
- Mass. man charged in car registration tax dodge - 1
Police say youths at New Boston underage drinking party resisted arrestREADER COMMENTS: 0
- Distracted legislating: Our baseless cellphone ban - 0
- Another View -- Betsy McCaughey: Our free lunch President - 0
- Another View -- Karlyn Borysenko: Workplace bullying is a serious problem, governor - 0
- Workplace abuse: Governor gets one right - 0
- Red Sox pull Lester from Wednesday start amid trade rumors - 0
- Accused Abby kidnapper Kibby had past minor brushes with police - 0
- Muskrats, Swamp Bats split twinbill - 0
- Jays' Stroman stymies Red Sox - 0
- NH medical board suspends Manchester doctor's license - 0
Charles M. Arlinghaus: Taxation without representation again?READER COMMENTS: 0
Win tickets to see ZZ Top
Win tickets to see the Pretty Reckless
Abby's alleged kidnapper held on $1M bail
When company comes, opt for variety
Dover man sought in Rochester shooting
Supporters are now 'Abby Strong'
Canobie Lake Park shuts down popular ride
- Mass. Supreme Judicial Court has found upskirt photos taken on a subway aren't illegal. Should such voyeurism be a crime?
- Yes
- 83%
- No
- 17%
- Total Votes: 917