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Cleocin IV
CDC Adds More Countries to Zika Travel Alert »
"The Centers for Disease Control and Prevention (CDC) announced today that it has added eight more countries and territories â" some outside the Americas â" to the list that pregnant women should avoid on account of the mosquito-borne Zika virus, wh"...
Read the CDC Adds More Countries to Zika Travel Alert article »
Cleocin I.V.
Cleocin Phosphate®
(clindamycin) Injection, USP and (clindamycin) Injection in 5% Dextrose
To reduce the development of drug-resistant bacteria and maintain the effectiveness of CLEOCIN PHOSPHATE and other antibacterial drugs, CLEOCIN PHOSPHATE should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.
Sterile Solution is for Intramuscular and Intravenous Use
CLEOCIN PHOSPHATE in the ADD-Vantage™ Vial is For Intravenous Use Only
Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including CLEOCIN PHOSPHATE and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.
Because CLEOCIN PHOSPHATE therapy has been associated with severe colitis which may end fatally, it should be reserved for serious infections where less toxic antimicrobial agents are inappropriate, as described in the INDICATIONS section. It should not be used in patients with nonbacterial infections such as most upper respiratory tract infections. C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.
If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.
CLEOCIN PHOSPHATE Sterile Solution in vials contains clindamycin phosphate, a water soluble ester of clindamycin and phosphoric acid. Each mL contains the equivalent of 150 mg clindamycin, 0.5 mg disodium edetate and 9.45 mg benzyl alcohol added as preservative in each mL. Clindamycin is a semisynthetic antibiotic produced by a 7(S)-chloro-substitution of the 7(R)-hydroxyl group of the parent compound lincomycin.
The chemical name of clindamycin phosphate is L-threo-α-D-galacto-Octopyranoside, methyl 7-chloro-6,7,8-trideoxy-6-[[(1-methyl-4-propyl-2-pyrrolidinyl)carbonyl] amino]-1-thio-, 2-(dihydrogen phosphate), (2S-trans)-.
The molecular formula is C18H34CIN208PS and the molecular weight is 504.96.
The structural formula is represented below:
CLEOCIN PHOSPHATE in the ADD-Vantage Vial is intended for intravenous use only after further dilution with appropriate volume of ADD-Vantage diluent base solution.
CLEOCIN PHOSPHATE IV Solution in the Galaxy® plastic container for intravenous use is composed of clindamycin phosphate equivalent to 300, 600 and 900 mg of clindamycin premixed with 5% dextrose as a sterile solution. Disodium edetate has been added at a concentration of 0.04 mg/mL. The pH has been adjusted with sodium hydroxide and/or hydrochloric acid.
The plastic container is fabricated from a specially designed multilayer plastic, PL 2501. Solutions in contact with the plastic container can leach out certain of its chemical components in very small amounts within the expiration period. The suitability of the plastic has been confirmed in tests in animals according to the USP biological tests for plastic containers, as well as by tissue culture toxicity studies.
What are the precautions when taking clindamycin (Cleocin I.V.)?
Before using clindamycin, tell your doctor or pharmacist if you are allergic to it; or to lincomycin; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this drug, tell your doctor your medical history, especially of: kidney disease, liver disease, stomach/bowel disease (e.g., colitis).
Before having surgery, tell your doctor or dentist that you are using this medication.
Caution is advised when using this drug in the elderly because they may be more sensitive to the effects of the drug, especially diarrhea.
Tell your doctor if you are pregnant before using this medication.
This drug passes into breast milk and...
Last reviewed on RxList: 11/22/2016
This monograph has been modified to include the generic and brand name in many instances.
Cleocin I.V. FDA Prescribing Information
Additional Cleocin I.V. Information
Cleocin I.V. - User Reviews
Cleocin I.V. User Reviews
Now you can gain knowledge and insight about a drug treatment with Patient Discussions.
Here is a collection of user reviews for the medication Cleocin I.V. sorted by most helpful.
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Women's Health
Find out what women really need.


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Must see
The collection
There are of course many more masterpieces here in the National Gallery of Australia, which has the largest collection of art in Australia. Owned by all Australians, the national collection has a most comprehensive holding of Australian art and a strong focus on Indian and Southeast Asian art and Pacific arts, as well as 20th-century international art.
Take the opportunity to discover, or rediscover, the national collection.
Sidney Nolan's Ned Kelly series
Ground level, near entrance
See this iconic Australian series in its new, purpose-built gallery.
Sidney Nolan Ned Kelly 1946
National Gallery of Australia
Gift of Sunday Reed 1977
Claude Monet's Waterlilies
Ground level, Moderns
A fine example of Monet�s revolutionary approach to capturing the effect of changing light.
Claude Monet Nymph�as [Waterlilies]
c 1914–17
National Gallery of Australia Purchased 1979
Jackson Pollock's Blue poles
Ground level, Abstract Expressionism
A masterpiece of 20th-century abstract art and arguably the most famous work in the Gallery�s collection.
Jackson Pollock Blue poles 1952
National Gallery of Australia Purchased 1973 © Pollock-Krasner Foundation. Licensed by ARS & VISCOPY, Australia
The sacred bull, Nandi
Ground level, Indian and Southeast Asian art
This superb example of early Indian art is the only significant sculpture of the popular Hindu image in an Australian public collection.
Chola dynasty (9th–13th centuries) The sacred bull Nandi, vehicle of Shiva 11th–12th century
National Gallery of Australia
Purchased with the assistance of Roslyn Packer AO, 2009
Ambum stone
Level 1, Melanesian art
The 3500-year-old Ambum stone is one of the oldest works in the national collection.
Papua New Guinea, Western Highlands, Ambum Valley The Ambum stone c 1500 BCE
National Gallery of Australia
Purchased 1977
Arthur Streeton's Golden summer, Eaglemont
Level 1, Australian Impressionism
Enjoy this evocative depiction of the Australian landscape by this significant Australian Impressionist.
Arthur Streeton Golden summer, Eaglemont 1889
National Gallery of Australia Purchased 1995
Australian Surrealism
Level 1, Surrealiam
One of the finest collections of Australian Surrealism, now on display in a dedicated room.
James Gleeson Spain 1951
National Gallery of Australia
Purchased with the assistance of James Agapitos OAM and Ray Wilson OAM, 2007
Australian Modernism
Level 1, Moderns
See Modernist artists such as Grace Cossington Smith, Margaret Preston, and Clarice Beckett.
Grace Cossington Smith The Bridge in building 1929–30
National Gallery of Australia Gift of Ellen Waugh 2005
Lower Ground level, National Australia Bank Sculpture Gallery & outside, near Lake Burley Griffin
The grand National Australia Bank Sculpture Gallery includes Constantin Brancusi�s sublime Birds in space and other great contemporary works. Outside in the Sculpture Garden enjoy works by Auguste Rodin and other international and Australian artists.
Constantin Brancusi Bird in space c1931–36
National Gallery of Australia
Purchased 1973 © Constantin Brancusi. Licensed by ADAGP & VISCOPY, Australia
Collection toursDaily at 11:00 am, 11:30 am, 12:30 pm, 2.00 pm and 2:30 pm
National Gallery
New Look 2010
The Gallery apologises for any inconvenience caused by the current building work, but it is all in a good cause. In spring 2010, the National Gallery will open its new building and entrance, including:
- eleven specially designed galleries to showcase the largest collection of Indigenous Australian art in the world
- a new and expanded Gallery Shop
- a 380-seat function hall for special events
- an Australian native garden featuring a monumental pyramid-shaped Skyspace designed by renowned American artist James Turrell.
Image above: Ramingining artists The Aboriginal memorial 1987–88, National Gallery of Australia

subset: commoncrawl


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In an excerpt from the splendid PovertyCure series, Michael Fairbanks offers a helpful bit on why our attitudes about competition matter for economic development:
I can predict the future of a developing nation better than any IMF team of economists by asking one question: "Do you believe in competition?" When I go to Venezuela and I say, "do you believe in competition?," they say "competition means the rich get richer and the poor get poorer." They say "competition is the unnecessary duplication of effort because you have two firms doing the same thing." They say "competition is a quaint North American concept that doesn't apply here."
But when I go to Silicon Valley and I say,"What do you think about the word competition?," they say, "Well, I love competition, because even when I lose, I learn something. And my success is due to the fact that I speeded up my failures, and the only way to fail was to compete, and figure out where I wasn't good enough."
As Hayek put it, competition is a discovery procedure. If we neglect, distort, or downplay that process, we can expect the outcomes of discovery — the fruits of our sacrifice and service — to digress accordingly.
PovertyCure DVD Series
Join host Michael Matheson Miller on a journey around the world to explore the foundations of human flourishing, and learn how people are moving toward partnerships and pursuing entrepreneurial solutions to poverty rooted in the creative capacity of the human person made in the image of God. Meet religious and political leaders, entrepreneurs, missionaries, and renowned development experts, and discover the powerful resources Christianity brings to the pursuit of human flourishing.
Visit the official PovertyCure website for more information.


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Board seeks answers about cycling event
By Tom Lappas, Citizen Editor 09/24/12
The UCI World Road Cycling Championships will take place in the Richmond region three years from this week, but Henrico County officials need more information before formally committing to climb aboard for the ride.
Officials from Richmond 2015 – the nonprofit organization that will host the nine-day international event – asked Henrico's Board of Supervisors during a Sept. 11 work session to contribute a total of $1.4 million to the championships during the next three years. But supervisors and County Manager Virgil Hazelett, while pledging support for the event in general terms, bristled at the request because it lacked the specifics they were expecting.
"It is clear to me that we do not have sufficient information," Hazelett said. "My main concern is the cost. I don't have a comfort level yet in what's going to happen."
Richmond 2015 has established a budget of $21.4 million, its CEO, William Flohr, told the board. The City of Richmond has committed a $2 million contribution, he said, and presentations to officials in Hanover and Chesterfield counties followed the visit to Henrico. The organization arrived at its $1.4 million request of Henrico by following the regional funding format that was used for the Greater Richmond Convention Center, to which Richmond contributed 50 percent, Henrico 35 percent, Chesterfield 13 percent and Hanover 2 percent.
Board 'disappointed' in approach
But it was clear during last week's work session that at least some county officials felt slighted by the organization's decision to approach them now to assist with an event that may have quickly outgrown its original scope – and by the implication among some in the public that the county was not being a regional partner.
During a steady and pointed line of questioning, Brookland District Supervisor and board chairman Dick Glover expressed as much, suggesting that Richmond 2015 officials had dropped the ball by waiting more than 18 months to meet with the full Henrico board.
He implied that if the organization had involved Henrico from the beginning (in late 2010), the county would have felt more like a true partner and less like a bank account.
"I am very disappointed that this is almost two years after [the process began] that the Board of Supervisors of Henrico County has been approached," Glover said. "I feel like you've left us out of the picture, and now you're coming to us with not enough information."
Varina District Supervisor Tyrone Nelson was similarly unimpressed.
"You came to us and gave us nothing today," Nelson told the organization's contingent. "I think it's a healthy promotion for our region, but you're asking us to spend a million and a half dollars that are not in our budget. We each have capital improvement projects [awaiting funding] in our districts, and I've got people in my district ready to shoot me because we don't have a new school yet."
Nelson also suggested that if the county were to donate the requested $1.4 million, it should receive more than just one of the 12 races scheduled for the nine-day event – particularly if Richmond's $2 million donation is enough to earn it nine races. (Hanover and Chesterfield also would receive one race each by contributing to the event, Richmond 2015 organizers said.)
Flohr, who joined Richmond 2015 in April, conceded that the organization might have done some things differently before his arrival, in retrospect.
"It perhaps should have been a regional effort," he said, "and we're trying to make it into a regional effort now."
Economic impact debated
Henrico stands to realize a $42 million economic benefit from the event, Flohr said; some 450,000 spectators are expected to attend the races. Flohr told the board that Henrico would receive an additional $832,000 in hotel and lodging taxes during the nine-day period, but Hazelett questioned his math, saying that the county typically receives about that much during the month of September, when the occupancy rate is about 60 percent.
"We can't double that [amount] in nine days with only 40 percent vacancy available," Hazelett said.
The race proposed for Henrico is the initial time trial for men and women, which might begin in Short Pump and travel east to its conclusion in the city. That race would be televised live on a national network, Flohr said. But though Henrico would receive commercials during the broadcast and the opportunity for other exposure, Flohr could provide no specific details. The organization must purchase TV time from a network and has not yet completed the negotiation process, he said.
Tuckahoe District Supervisor Pat O'Bannon told Flohr that the board would need to see a specific list of the benefits it would receive for a $1.4 million donation before determining how to proceed.
Hazelett expressed serious concerns about the costs associated with heavy police and security needed to protect the 1,000 cyclists – some of whom will represent nations with volatile political climates – as well as spectators and citizens.
Those costs, combined with shutting down more than 60 intersections for the race, could total nearly $500,000, Hazelett said – money that he said should be deducted from any donation Henrico makes.
To date, Richmond 2015 has financial commitments from five corporate partners totaling more than $2 million, but Flohr declined to name those companies. He promised Hazelett and the board that he would have specific details and answers to their questions by the first week of October, however.
The UCI event, which began in 1927 and has been held annually since (except for a seven-year period during World War II), will be held in The Netherlands this year, Italy next year and Spain in 2014. The United States has hosted it only once, in Colorado Springs in 1986.
Henrico Democrats nominate Lynch, Rodman
Citizen Staff Reports Government
APR. 29, 6:15 P.M. – Henrico Democrats today selected their party's nominees for the Brookland District Supervisor seat and the 73rd District House of Delegates seat during a party caucus.
Courtney Lynch, the founder of a leadership development company, was somewhat of a surprise winner in the Brookland District supervisor's race. She defeated Virginians for High Speed Rail Executive Director Danny Plaugher, who had been the party's nominee two years ago in the general election for the seat.
Debra Rodman, a Randolph-Macon College professor, earned the party's nomination for the 73rd House District seat, defeating Chelsea Savage, a nurse, in a runoff. Attorney Sarah Smith was third and Bill Coleman, a project manager for a health organization, fourth.
> Read more.
Courtney Lynch, the founder of a leadership development company, was somewhat of a surprise winner in the Brookland District supervisor's race. She defeated Virginians for High Speed Rail Executive Director Danny Plaugher, who had been the party's nominee two years ago in the general election for the seat.
Debra Rodman, a Randolph-Macon College professor, earned the party's nomination for the 73rd House District seat, defeating Chelsea Savage, a nurse, in a runoff. Attorney Sarah Smith was third and Bill Coleman, a project manager for a health organization, fourth.
> Read more.
Therapeutic healing
By Stephanie Hagan, Special to the Citizen 04/28/2017 Features
In a room labeled the garden room, a bright space with lavender-colored walls and pebble-gray chairs, art therapist Becky Jacobson might ask her patients to imagine a safe place, but she doesn't ask them to describe it to her — she wants them to draw it.
The patients are free to draw whatever they envision, expressing themselves through their colored markers, a form of healing through art therapy.
"Some people might not feel safe anywhere because they have had hard things happening to them, and I have the background to help that person reground and feel safe in the group," Jacobson said. > Read more.
Eight's enough? Crowded race for 56th District develops
By Zachary Halaschak, Special to the Citizen 04/28/2017 Government
Following the retirement of Delegate Peter Farrell [R-56th District], a number of candidates have thrown their hats into the ring to vie for the open seat in the Virginia General Assembly district, which contains a portion of Henrico's Far West End.
Democratic challengers include Lizzie Basch and Melissa Dart, while Republican contenders include George Goodwin, Matt Pinsker, Graven Craig, Surya Dhakar, Jay Prendergrast and John McGuire. In addition to a section of Henrico, the district also includes portions of Goochland and Spotsylvania County, as well as all of Louisa County. > Read more.
On the trail to Awareness
Citizen Staff Reports 04/28/2017 Features
Twenty-five teams, composed of some 350 participants, gathered at Dorey Park in Varina April 8 for the Walk Like MADD 5k, to benefit Mothers Against Drunk Driving Virginia. The event raised more than $35,000, with more funds expected to come in through May 7. > Read more.
Leadership Metro Richmond honors St. Joseph's Villa CEO
Citizen Staff Reports 04/28/2017 BusinessNon-Profits
Leadership Metro Richmond honored St. Joseph's Villa CEO Kathleen Burke Barrett, a 2003 graduate of LMR, with its 2017 Ukrop Community Vision Award during its annual spring luncheon April 6.
The award honors a LMR member who demonstrates a purposeful vision, a sense of what needs to be done, clear articulation with concern and respect for others with demonstrated action and risk-taking. > Read more.
Leadership Metro Richmond honors St. Joseph's Villa CEO
Glen Allen H.S. takes second in statewide economics competition
Glen Allen native serves aboard Navy's most advanced submarine
Fresh Air Fund seeks host families
Godwin student wins in statewide STEM essay contest
- More News
Print Edition
Apr. 19, 2017Click here to read the print edition.
Weekend Top 10
Restaurant Watch
Weekend Top 10
Restaurant Watch
Weekend Top 10
- More Entertainment
Obituary – Elizabeth Broaddus Hill
Obituary – Wyoma Rebecca "Becky" Slootweg
Obituary – Michael Musulin
- More Obituaries
READ Center to hold free tutor training
Volunteers sought for Cap2Cap bike ride
YMCA event will focus on teen mental health
- More Community
Make 'em take the pledge: no more snuff boxes!
Thanksgiving, Part II
Storm woes for e-junkies
- More Opinions
RIR to host Smithfield PWBA Tour Championship
RIR bringing back red stripes to track walls
Austin Dillon headlines Track Takeover at RIR
- More Sports
|May 2017
Place an Ad | More Classifieds
CalendarIn observance of National Crime Victims' Rights Week (April 2-8), and to honor victims of crime in Henrico County and raise awareness about crime victims' rights and issues, Henrico County Victim/Witness will hold a commemorative ceremony and informative walk at 3 p.m. in the Henrico County Police Memorial Garden at 4301 E. Parham Rd. The event will include remarks from Henrico County Manager John Vithoulkas, Commonwealth's Attorney Shannon Taylor, and Lt. Col. Clarence Hunter, Jr., Henrico Division of Police. Remarks will be followed by an educational walk on the trail around the Henrico Government Center. For details, call 501-1680. Full text


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A classic German potato soup steals a bit of French style when topped with melted cheese atop toasted bread.
A "gratin" is a French description of a shallow dish of food sprinkled with cheese or buttered bread crumbs and then broiled until crisp and brown. This savory potato soup is garnished with toasted pumpernickel bread covered with melted Swiss cheese.
Pumpernickel is a traditional bread made with a large proportion of rye flour to wheat flour. The loaves are heavy, coarse and slightly sour. A little bit of molasses give pumpernickel its dark color; some bakers add caraway seed or raisins for flavor and texture.
© 2017 ®/TM General Mills All Rights Reserved


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Safe Online Payments
|Number of Buses
|Starting Fare
|Time Taken
|17:30 hrs
|Total Operators
The journey from Bhavani to Kolhapur(Maharashtra) is smoothly covered by a bus in 17:30 hours. The time to travel is dependant on India's traffic, roads and climatic conditions.There are operators running their buses between Bhavani to Kolhapur(Maharashtra) bringing necessary travel convenience for several people in India. Usually, 1 buses are plying from Bhavani to Kolhapur(Maharashtra). All buses are driven by proficient drivers ensuring safety during journey
If you are also looking for return checkout, please ensure to check Kolhapur(Maharashtra) to Bhavani Bus.
A number of prominent operators ply buses from Bhavani to Kolhapur(Maharashtra) ensuring punctuality and safety for its passengers. Major operators offering disparate kinds of bus services are :
Most of the buses pass through various boarding terminals in the route, a few of the many popular points are :
Most of the buses stop at several drop points in the route, a few of the many popular ones are :
Various types of buses serve from Bhavani to Kolhapur(Maharashtra), ensuring safety and comfort for travellers, a few buses services are :
You can now book route tickets from Bhavani to Kolhapur(Maharashtra) at redBus.in. Apply time to time redBus offers on online bus ticket booking. Save some money and memories too!
Kolhapur is a city in the state of Maharastra, widely renowned for its Kolhapuri chappals, textiles and traditional jewellery. The city of Kolhapur holds its own charms with its cultures and traditions, which are happily co-existent with modern customs, thereby, giving the city a unique charm, that allure tourists from all corners of the country. There is plenty to see and do in the region. Few of the popular tourists attractions of the region include the Mahalakshmi Temple, New Palace, Rankala Lake, Shivaji University, Temlabai mandir and much more. Once in Kolhapur, tourists should make a point to gorge on the mouth-watering snack called 'misal'.


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Web Stories
Peace Network to screen 'Bowling for Columbine,' Oct. 1
Posted September 30, 2003; 12:21 a.m.
The Princeton Peace Network will show "Bowling for Columbine" in McCosh 28 at 7:30 p.m. Wednesday, Oct. 1.
Winner of the Academy Award for best documentary and the Cannes Film Festival Jury Prize, Michael Moore's film analyzes gun violence in America.
The event is free and open to the public.
Contact: Lauren Robinson-Brown (609) 258-3601


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I doubt I'm the only one wondering this, so I thought I would ask this question to the MR people:
Any idea what the release dates are for the various Studio Scale Helmets?
I'm curious because I keep seeing them pushed back. I have the Spec Ops, regular, and Star Corps helmets on preorder at StarWars Shop. Although oddly enough, they show the Spec Ops helmet coming before the regular or Star Corps. I figure the regular would come first since the other 2 are painted versions of it.
This is what I see for release dates according to SW Shop:
Spec Ops - Aug 2005
Regular - Nov 2005
Star Corps - Dec 2005
So if an MR rep could clarify this for us, that would be great.


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Free Chronic Disease Self-Management Workshop Begins May 14
Sign up at Woonsocket Senior Services
Free Chronic Disease Self-Management Workshop Begins May 14
Sign up at Woonsocket Senior Services
Woonsocket, Rhode Island - If you have a chronic disease such as
asthma, arthritis, cancer, COPD, chronic pain, diabetes or heart
disease, this free workshop is not to be missed. Six classes will be
held on Tuesdays - May 14, May 21, May 28, June 4, June 11 and June 18
from 9 to 11:30am. Light refreshments will be provided. Participants
will receive a workbook and relaxation CD. Upon completion of the
workshop, participants will also receive a $25 gift card and
Attend and you will learn how to:
• communicate with your family and doctors
• set goals to improve health and lifestyle
• manage symptoms and medications
• work with a healthcare team
• problem-solve effectively
• handle difficult emotions
• exercise safely
• eat well
• relax
To register, call Sue Sgambato at 401-766-3734. Senior Services is
located at 84 Social Street in Woonsocket. Classes are fun and
interactive. Take charge of your health and life. Sign up today. For
more information, attend a short orientation session on Tuesday, May
7th at 9am. This program is funded by Rhode Island Department of
Elderly Affairs.


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Share your style: #myonepieceAdd Your Photo
Lewis Single Toggle Switchplate Item # C9093
Hot-Forged Solid Brass
From the first bulky, round "snap" switches to tidy Push-Button Switches, to today's simple toggle switches, light switches have gotten more slim and trim the longer they've been around. (Ah, if only this evolutionary slimming principle could apply to us…)
Once they emerged in the 1920s, toggle switches have stuck around ever since. And our Lewis Switchplates dress them nicely.
- Hot-forged brass is especially rugged and long lasting
- Items ending in $0.99 are final sale
- Imported
Product Specifications
Need to know all about the details of this product? Get the full set of specs right here.
Want to chat?
We'd love to help you pick the right product or answer any questions you may have. Try our or call us at 888-401-1900.
Customer Service
Need assistance with handcrafted solutions?
Call 1-888-401-1900
email customer service.
More Information
Lewis Single Toggle Switchplate
Hot-Forged Solid Brass


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Attention Missouri Residents and Small Businesses!
Discover up to 60
government grants
and loan
sources for small business in Missouri!
Plus: Get Access Over 200 Federal Government Grant And Loan Programs For Your Missouri Business instantly!
You can apply for $12,000 to start a home-based business or $200 million dollars to build a new office complex. It's the help you always dreamed of from your favorite uncle. You can apply to one program or apply to 100 different programs, including:
- $750,000 To Start Or Expand A Missouri Business
- $10,000,000 in grants and loans For Businesses In Small Towns around Missouri
- $150,000 In Down Payment Money To Buy A Ranch in Missouri
- $500,000 For Missouri Woman-Owned And Minority- Owned Businesses To Get Government Contracts
- $150,000 With A One-Page Application
- $25,000 For Missouri Small Businesses
- $1,000,000 For Missouri Companies Hurt By Defense Cuts
- $150,000 In Loans That Require No Collateral
- $2,400 For Missouri companies Hiring 18-24-Year-Old Employees
- $100,000 For Doing Business In Certain Zip Codes
- $500,000 Grant For Small Businesses To Commercialize Their Ideas
- $22,000 Grant To Missouri Businesses That Employ People With Disabilities
- $200,000,000 To Help Missouri Exporters With Cash Flow Problems
- $750,000 For A Missouri Small Business To Fulfill A Contract
Over 200 Programs - Including up to 60 Missouri State Grants For Business
Maybe you already called the Federal government looking for grants for your business and were told they, "don't have grants for business". They may be right that their office does not offer grants for business but that doesn't mean that the Missouri government doesn't offer grants for business. Depending on current Missouri programs, there are up to 60 government offices that offer grants to businesses and entrepreneurs, and I can assure you that they are not the offices you've already checked. The government is too big for one office to know what is available in every office. Most don't even know everything that is available in their own office!
You will also receive access to apply for little-known Missouri government:
- low interest loans,
- venture capital programs
- free money tax credits.
Plus you get all the contact information for offices in Missouri that offer:
- free consultants who will help you get millions of dollars in Missouri government contracts, and
- free management consultants that offer free management assistance, marketing advice, legal help, as well as information on how to get more money and more business.
Who Gets This Money in Missouri and other places?
Each Year Over 1 Million Businesses and Entrepreneurs Get Grant and Loan Money From The Government AND YOU CAN TOO as a resident or business of Missouri. The smartest entrepreneurs in the United States relied on Government money for their business success including:
- George W. Bush…
Over $200 million grant to build a stadium for his baseball team
- Dick Cheney…
Over $3 billion in government loans and contracts when he was running Halliburton
- Paul Newman…
Government grants to sell his salad dressing overseas
- H. Ross Perot…
Government contracts worth billions
- Donald Trump…
First $1 million deal was with a government property in Cincinnati
Who else gets this money?
Big Companies:
Small Companies:
Entrepreneurs and Others
Your Business has A 66% Chance Of Getting The Money From Missouri
The people who play the state lotteries, which are also run by the government, have only a one in 1 million chance of getting the money. But, the people who apply to the major federal and Missouri state government money programs for business have a 66% chance of getting the money. Two out of every three people who apply get the money they ask for. WOW!
Get It From The Best
If you are going to buy a
government money product from anyone, get it from the best.
Matthew Lesko has spent over 25 years helping Fortune 500
companies as well as thousands of entrepreneurs take
advantage of government money programs. He has more
credentials on this subject than even the government itself.
He has written over 100 books on government money programs.
Two of his books have become New York Times Bestsellers. Two
received Best Reference Book of the Year Awards from the
American Library Association. He has written syndicated
columns for the New York Times and Good Housekeeping
Magazine, and has been a regular contributor to CNN News,
ABC News, The Today Show, Good Morning America, Oprah, Larry
King and National Public Radio. Get it from the best. Get it
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VIDEO: Software for the Right Angle
Delcam's FeatureCAM 2014 R2 is its latest release and is designed to provide support for milling and drilling with right-angle heads.
The 2014 R2 version of FeatureCAM supports the programming and simulation of right-angle heads.
Right-angle heads allow internal pockets to be milled and internal holes to be drilled that would be inaccessible, and so impossible to produce, using a conventional head. They are now available as an option on an increasing range of machines, including a variety of mill-turn equipment.
Delcam's FeatureCAM 2014 R2 is its latest software release from the company and is designed to provide support for milling and drilling with right-angle heads and programming of multiple roughing operations using the company's Vortex area-clearance strategy. Other enhancements include better control of Z-level roughing, and improvements to Wire EDM and chamfering.
The new version is, according to the company, the first release that has the ability to program and simulate both milling and drilling with right-angle heads. These new strategies will allow users to take advantage of the flexibility of machines with this option.
For full details, including video demonstrations of the new functionality, and to download an evaluation version, go to Delcam's website.


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Web Stories
Degen wins Luce prize to work in China
Posted April 24, 2006; 12:19 p.m.
Princeton senior Natasha Degen has been awarded a 2006 Luce Scholarship to spend next year in China, where she will work as an arts and entertainment editor for China Daily, an English-language newspaper based in Beijing.
Degen, an art history major from Rockville Centre, N.Y., has gained considerable journalism experience during her years at Princeton. She has served as managing editor for The Daily Princetonian student newspaper and written about a broad range of campus topics, including the arts. Degen also participated in internships with The Nation magazine, Artforum magazine and The Village Voice newspaper.
Among several grants and awards she has received, Degen won the Mary Quaintance Memorial Prize, awarded annually to an undergraduate for writing on cultural topics; a Martin Dale Summer Fellowship, which she used in 2004 to make a documentary film on the development of the World Trade Center memorial; and an Edwin Ferris Grant, which provides $3,000 for summer internships in writing, publishing or journalism.
Degen also has been a tour guide at the University Art Museum and a Forbes College undergraduate fellow.
In addition to studying art history, Degen is pursuing a certificate in the Woodrow Wilson School of Public and International Affairs and in European cultural studies.
The Luce Scholars program, administered by the Henry Luce Foundation, annually provides stipends and internships for 15 young Americans to live and work in Asia. Dating from 1974, the program aims to increase awareness of Asia among future American leaders.


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Dudley is a 5 year old who male available for stud. Earned his HRCH in August 2010 and earned his Master Hunter in 2013.
Running Dudley is like holding on to the tail of a tornado he has lots of desire, and great marking and memory. He switches gears on blinds demonstrating compliance and control without bucking the system. While Dudley's tempermant in the field is fierce he fits into our family very well, doesn't mind lounging around the house, and the company of the kids.
(Sire) FC / AFC High Tech CEO (Gates)
(Dam) SHR Hunt's Bell
EIC: Clear
Hips: Good
Elbows: Normal
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Tri Factored - BLK coat Genotype: Black - Hidden Yellow and Choc - EeBb
(Can breed with chocolates or yellow and produce that color.)
You can get more information here on his site http://dudleytheduckdeliverydog.info
Send PM with any additional questions.
You can find more information including a 5 generation pedigree, clearance numbers, and contact information here:


text:
Web Stories
Baker, Russell to read from works
Posted February 19, 2009; 12:55 p.m.
Fiction writers Nicholson Baker and Karen Russell will kick off the spring lineup of the Althea Ward Clark Reading Series at 4:30 p.m. Wednesday, Feb. 25, in the Stewart Film Theater, 185 Nassau St.
Baker is the author of seven novels, including "Vox" and "The Mezzanine," and three works of nonfiction, including "Double Fold," which won a National Book Critics Circle Award in 2001. His most recent work, "Human Smoke," explores a critical time in history a few years before the United States entered into World War II.
Russell has been featured in The New Yorker's debut fiction issue and New York magazine's list of 25 people to watch under the age of 26. Her debut collection of stories is titled "St. Lucy's Home for Girls Raised by Wolves."
The reading series is sponsored by the Program in Creative Writing in the Lewis Center for the Arts.


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Topic: OUT OF THE OFFICE
Hi, Everyone! I just wanted to give you a heads up that I will be gone from July 25 - 31. Robin is turning 50 and we are doing a Girl's only Cruise out of LAX for 10 of us Cruis'in Divas! I am excited as this is my first venture away in 2 years! Long overdo, although I know I will go through CC withdrawal. Stay good, stay strong!
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.


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Search Engine Optimisation
What are keywords and why do I need them?
Tuesday 21 June 2011
Keywords in quality content = higher search engine ranking.
In search engine land, the keyword or search phrase a person uses is crucial. Keywords can be a single term, or keyword phases can be used which contain multiple words.
To appear on those first few pages of search engine results, your website must contain a density of keywords or phrases related to the search terms used. It is an imperative part of search engine optimisation for any website.
So how do you get the most out of your keywords?
Read More...


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MAJOR LEAGUE SERVICE TIME: 22 Years
CAREER: Joined the Major League staff in 1997...has worked the 2012 N.L. Wild Card Game, Division Series (2000, 2003-05, 10-11, 15); the League Championship Series (2001, 2006-09, 12); the 2005, 2011 and 2015 World Series; and the 2003 and 2014 All-Star Games...was selected as the crew chief for the 2014 Midsummer Classic at Target Field and the 2015 NLDS and World Series...was behind the plate for the first no-hitter in Mets history, tossed by Johan Santana against the Cardinals, on June 1, 2012...was an instructor at MLB's inaugural Umpire Camps (MLBUC.com), held at MLB's Urban Youth Academy in Compton, California, in November 2006...attended the Bill Kinnamon Umpire School...previously worked in the Midwest League, Eastern League, American Association and Triple-A Alliance...first game as a Major League Baseball umpire (June 1, 1989) was rained out.
PERSONAL: Born in October 1955 in North Dakota...hometown is Minot, ND...married to Theresa has three children received a B.S. in Education from Minot University interests include astrology and archaeology.


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Web Stories
Lecture set on consumption and human future, Oct. 11
Posted October 7, 2004; 04:57 p.m.
A lecture titled "One With Nineveh: Politics, Consumption and the Human Future" is scheduled for 4:30 p.m. Monday, Oct. 11, in 16 Robertson Hall.
Speaking will be Paul Ehrlich, the Bing Professor of Population Studies and professor of biological sciences at Stanford University. He is the author with his wife, Anne Ehrlich, of a 2004 book by the same title, which comes from Rudyard Kipling's poem "Recessional." The poem compares the greatness of the 19th-century British empire to the faded glory of Nineveh, the ancient capital of the Assyrian empire, and warns the imperialists of their precarious position. In their book, the Ehrlichs look at the global problems of overpopulation, overconsumption and political and economic inequity that they say threaten to make the world into a new Nineveh.
Paul Ehrlich has been a pioneer in alerting the public to the problems of overpopulation, raising issues of population, resources and the environment as matters of public policy. He has received numerous awards for his work, including the Crafoord Prize of the Royal Swedish Academy of Sciences (given in lieu of a Nobel Prize in areas where the Nobel is not given).
The lecture is sponsored by the Woodrow Wilson School of Public and International Affairs and the Program in Science, Technology and Environmental Policy .
Contact: Tom Bartus (609) 258-3601


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Topic Title
- Noninvasive Diagnostic Tests for Breast Abnormalities: Update of a 2006 Review
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- Research Review Feb. 13, 2012
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Executive Summary – Feb. 13, 2012
Noninvasive Diagnostic Tests for Breast Abnormalities: Update of a 2006 Review
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Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current.
Table of Contents
Breast cancer is one of the most common malignancies of women, with approximately 200,000 new cases diagnosed every year in the United States.1 Some breast cancers are identified by physical examination (either self-examination or an examination performed by a physician). Population-wide screening programs that use x-ray mammography to examine asymptomatic women for early signs of breast cancer are also in common use.2-4 If a suspicious area is seen on x-ray mammography, women are usually recalled for further examination. The results of these examinations are used to make decisions about further management: return to normal screening/return for short-interval followup/refer for biopsy. In current standard practice the examinations conducted after recall usually consist of diagnostic mammography and possibly ultrasound. More and more often women are being sent for additional imaging during recall workup. Extensive diagnostic ultrasound examinations and MRI are currently the most commonly chosen additional imaging added to the workup, but other imaging technologies are offered by some practitioners.
It is important to triage recalled women into the correct management pathway. Women with readily treatable early-stage cancers who get mistakenly triaged into "return to normal screening" may experience a significant delay in diagnosis and treatment of the cancer. However, the majority of women who are recalled for further assessment after a screening mammography do not have cancer, and significant numbers of healthy women are referred for biopsy or short-interval followup after recall and diagnostic mammography.5,6
A number of noninvasive imaging technologies have been developed and proposed to be useful as part of the workup after recall. This evidence review focuses on additional noninvasive imaging studies that can be conducted (in addition to standard workup) after discovery of a possible abnormality on screening mammography or physical examination. These studies are intended to guide patient management decisions. In other words, these imaging studies are not intended to provide a final diagnosis as to the nature of the breast lesion; rather, they are intended to provide additional information about the nature of the lesions such that women can be more appropriately triaged into the correct management pathway. It is important to evaluate the evidence to see if women do or do not benefit from the addition of these imaging modalities to the standard workup after recall on breast cancer screening.
Because there are no available studies that directly evaluate whether women benefit from additional imaging in this context, we addressed this important question indirectly. First we evaluated the accuracy of the imaging tests in distinguishing between "benign" and "malignant" breast lesions. Inaccurate tests will lead to suboptimal management decisions and less than desirable patient outcomes. The accuracy of the noninvasive imaging tests was primarily measured in terms of sensitivity and specificity. Sensitivity is a measure of how accurately the test can identify women with cancer; specificity is a measure of how accurately the test can identify women who do not have cancer. A test with high sensitivity will rarely misclassify women with cancer as not having cancer, and a test with high specificity will rarely misclassify women without cancer as having cancer.
The accuracy of a test can also be expressed in a more clinically useful measure, namely, likelihood ratios. When making medical decisions, a clinician can use likelihood ratios and test results to estimate the probability of an individual woman having breast cancer. Clinicians use individual patient characteristics (such as age and family history) and features seen on the diagnostic mammogram (such as microcalcifications or distortions) to estimate a woman's risk of malignancy. This estimate is known as a "pre-test" or "prior" probability. The clinician can then use the likelihood ratios (that express the accuracy of the test) to decide if an additional imaging test will be helpful in guiding management decisions. For example, if a clinician estimates a woman's risk of malignancy as greater than 50 percent, most likely the use of any additional imaging test, even a very accurate imaging test, will not change the clinician's management recommendation of a biopsy, and therefore additional imaging will not be beneficial to the woman. However, if a clinician estimates a woman's risk of malignancy as being uncertain or close to a clinical threshold (2%), the likelihood ratios can be used to estimate whether the results of an additional test are likely to change management decisions and possibly affect patient outcomes.
After establishing the accuracy of the various imaging tests, we used the summary likelihood ratios to prepare simple models of various clinical scenarios. In doing so, we attempted to indirectly address the implicit question of whether women benefit from the addition of noninvasive imaging tests to standard workup after recall for evaluation of a possible breast abnormality detected by screening mammography or physical examination.
This report is an update of a Comparative Effectiveness Review (CER) of the same title originally published in 2006.7 In addition to an update of the literature, the Key Questions have been revised and additional noninvasive imaging tests have been added.
Topic Development and Scope
The topic was selected for update by the Effective Health Care program. The Key Questions were posted for public comment. A Technical Expert Panel was assembled to provide expert input, and a protocol for updating the review was developed by the EPC authors and approved by the Agency for Healthcare Research and Quality.
Patient Population
The patient population of interest is the general population of women participating in routine breast cancer screening programs (including mammography, clinical examination, and self-examination) who have been recalled after discovery of a possible abnormality and who have already undergone standard workup (which usually includes diagnostic mammography and/or ultrasound) . In other words, the patient population of interest consists of women who have or might receive a Breast Imaging-Reporting and Data System (BI-RADS®) rating of 0, or 3 to 5, after standard workup. Some of the women evaluated may have had an ultrasound examination before being examined using the technology under study, including the women being evaluated by diagnostic ultrasound. Although not explicitly stated in the studies, in most cases this prior ultrasound seemed to be used primarily to identify women with simple benign cysts, who were then not included in the study. Populations that were not evaluated in this review include: women thought to be at very high risk of breast cancer due to family history or breast cancer (BRCA) gene mutations; women with a personal history of breast cancer; women presenting with overt symptoms (such as pain or nipple discharge); and men.
The noninvasive diagnostic tests evaluated were ultrasound (conventional B mode grayscale, harmonic, tomography, color Doppler, and power Doppler); magnetic resonance imaging (MRI, with gadolinium-based contrast agents) with or without computer-aided diagnosis (CADx); positron emission tomography (PET, with 18-fluorodeoxyglucose [FDG]), with or without concurrent computed tomography (CT) scans (including positron emission mammography [PEM]); scintimammography (with technetium-99m sestamibi [MIBI]), including Breast Specific Gamma Imaging (BSGI).
The accuracy of the noninvasive diagnostic tests were evaluated by a direct comparison with histopathology (surgical or biopsy specimens) or with clinical followup, or a combination of these methods. In addition, the relative accuracy of the different tests under evaluation were directly and indirectly compared as the evidence permitted.
Outcomes of interest are diagnostic test characteristics; namely, sensitivity, specificity, and likelihood ratios. Because predictive values vary as the prevalence of disease changes, we did not calculate predictive values. Adverse events related to the procedures, such as radiation exposure, discomfort, and reactions to contrast agents, were also be discussed as the evidence permitted. Our literature searches did not identify any relevant studies that directly reported the impact of the diagnostic tests on patient-oriented outcomes. Therefore, we used the estimates of accuracy and various clinical scenarios to address the implicit, very important question of whether women benefit from the use of these noninvasive imaging tests.
Any duration of followup, from same day interventions to many years of clinical followup, were evaluated.
Any care setting was evaluated, including general hospitals, physician's offices, and specialized breast imaging centers.
Study Selection
We searched the medical literature, including PubMed and Embase, from December 1994 through September 2010. We included diagnostic cohort studies that enrolled the patient population of interest and used current generation scanners and protocols of the noninvasive imaging technologies of interest. We excluded case-control studies, meeting presentations, and very small (<10 patients) studies. Data were abstracted from the included studies.
Strength of Evidence
We graded the strength of evidence supporting each major conclusion as high, moderate, low, or insufficient. The grade was developed by considering four important domains: the risk of bias in the evidence base (internal validity, or the quality of the studies), the consistency of the findings, the precision of the results, and the directness of the evidence.
Data Analysis
We used a bivariate mixed-effects binomial regression model for meta-analysis of data.8,9 We used summary likelihood ratios and Bayes' theorem to calculate the post-test probability of having a benign or malignant lesion. In cases where a bivariate binomial model could not be fit, we meta-analyzed the data using two random-effects models, one for sensitivity and one for specificity.10 We explored heterogeneity in the data with meta-regressions using standard methodology.9
Peer Review and Public Commentary
The draft received comments from peer reviewers, and from members of the public through an open public comment period.
Magnetic Resonance Imaging
We identified 41studies of MRI that included a total of 3,882 patients with 4,202 suspicious breast lesions.11-51 We combined the data reported by all 41 studies into a bivariate binomial mixed-effects model. The summary sensitivity was 91.7 percent (95% CI: 88.5 to 94.1%) and the summary specificity was 77.5 percent (95% CI: 71.0 to 82.9%). The estimate of accuracy was judged to be supported by a moderate to low strength of evidence (low for the estimate of specificity due to the wide confidence interval). The dataset was very heterogeneous (I2 = 98.4%). We explored the heterogeneity with meta-regression and found that the prevalence of disease in the study population and whether or not the image readers were blinded was statistically significantly correlated with the results. Subgroup analyses found that MRI was less sensitive for evaluation of microcalcifications (84.0% vs. 91.7% summary sensitivity).
The probability that a woman actually has cancer (invasive or in situ) even after a finding of "benign" on MRI depends on her probability of having cancer before undergoing the test. Bayes' theorem and the summary likelihood ratios indicate that if a woman with an estimated 5 to 10 percent chance of having cancer undergoes MRI and has a finding of "benign" she will then have an estimated 1 percent chance of having cancer; a woman with an estimated 20 percent chance of having cancer who has a finding of "benign" on MRI will then have an estimated 3 percent chance of having cancer; and a woman with an estimated 50 percent chance of having cancer who has a finding of "benign" on MRI will then have an estimated 10 percent chance of having cancer.
Positron Emission Tomography
We identified seven studies of PET34,35,41,52-55 and one study of PET/CT16 that met our inclusion criteria. The studies of stand-alone PET included 308 women with 403 suspicious breast lesions. We combined the data reported by the seven studies of PET into a bivariate binomial mixed-effects model. The summary sensitivity was 83.0 percent (95% CI: 73.0 to 89.0%) and the summary specificity was 74.0 percent (95% CI: 58.0 to 86.0%). The estimate of accuracy was judged to be supported by a Low strength of evidence. The dataset contained moderate heterogeneity (I2 = 64.0%). We explored the heterogeneity with meta-regression and did not identify any possible causes. Subgroup analyses found that PET was more sensitive for evaluation of palpable lesions.
The probability that a woman actually does have cancer (invasive or in situ) even after a finding of "benign" on PET depends on her probability of having cancer before undergoing the test. Bayes' theorem and the summary likelihood ratios indicate that if a woman with an estimated 5 percent chance of having cancer undergoes PET and has a finding of "benign" she will then have an estimated 1 percent chance of having cancer; a woman with an estimated 20 percent chance of having cancer who has a finding of "benign" on PET will then have an estimated 6 percent chance of having cancer; and a woman with an estimated 50 percent chance of having cancer who has a finding of "benign" on PET will then have an estimated 19 percent chance of having cancer.
We identified 10 studies of scintimammography14,56-64 and one study of BSGI19 that met our inclusion criteria. The studies included a total of 1,064 suspicious lesions. We combined the data reported by all 11 studies into a bivariate binomial mixed-effects model. The summary sensitivity was 84.7 percent (95% CI: 78.0 to 89.7%) and the summary specificity was 77.0 percent (95% CI: 64.7 to 85.9%). The estimate of accuracy was judged to be supported by a low strength of evidence. The dataset was very heterogeneous (I2 = 93.0%). We explored the heterogeneity with meta-regression and did not identify any possible causes.
The probability that a woman actually does have cancer (invasive or in situ) even after a finding of "benign" on scintimammography depends on her probability of having cancer before undergoing the test. Bayes' theorem and the summary likelihood ratios indicate that if a woman with an estimated 5 percent chance of having cancer undergoes scintimammography and has a finding of "benign" she will then have an estimated 1 percent chance of having cancer; a woman with an estimated 20 percent chance of having cancer who has a finding of "benign" on scintimammography will then have an estimated 5 percent chance of having cancer; and a woman with an estimated 50 percent chance of having cancer who has a finding of "benign" on scintimammography will then have an estimated 17 percent chance of having cancer.
We identified a total of 31 diagnostic cohort studies of ultrasound. Of these, there were 21 studies of B-mode grayscale ultrasound,18,26,65-83 six studies of color Doppler ultrasound,78,80,84-87 and nine studies of power Doppler ultrasound.65,72,75,77,86,88-91 We combined the data reported by these studies into bivariate binomial mixed-effects models. For B-mode grayscale, summary sensitivity was 92.4 percent (95% CI: 84.6 to 96.4%) and the summary specificity was 75.8 percent (95% CI: 60.8 to 86.3%); for color Doppler, summary sensitivity was 88.5 percent (95% CI: 74.4 to 95.4%) and summary specificity was 76.4 percent (95% CI: 61.7 to 86.7%); for power Doppler, summary sensitivity was 70.8 percent (95% CI: 47 to 86.6%) and summary specificity was 72.6 percent (95% CI: 59.9 to 82.5%). These estimates of accuracy were all judged to be supported by a low strength of evidence. The datasets were heterogeneous. We explored the heterogeneity of the largest dataset (21 studies of B-mode) with meta-regression and found that whether the studies blinded the image readers and accounted for inter-reader differences were statistically significantly associated with the results.
The probability that a woman actually does have cancer (invasive or in situ) even after a finding of "benign" on ultrasound depends on her probability of having cancer before undergoing the test. Bayes' theorem and the summary likelihood ratios indicate that if a woman with an estimated 5 to 10 percent chance of having cancer undergoes B-mode grayscale ultrasound and has a finding of "benign" she will then have an estimated 1 percent chance of having cancer; a woman with an estimated 20 percent chance of having cancer who has a finding of "benign" on B-mode grayscale ultrasound will then have an estimated 2 percent chance of having cancer; and a woman with an estimated 50 percent chance of having cancer who has a finding of "benign" on B-mode grayscale ultrasound will then have an estimated 9 percent chance of having cancer.
According to the American College of Radiology, the threshold of suspicion of malignancy at which management of women changes is 2 percent.92 After recall and workup, women with a suspicion of malignancy greater than 2 percent are generally recommended to undergo tissue sampling of some kind (biopsy), and women with a lower suspicion of malignancy are triaged into imaging management pathways (short-interval followup or return to regular screening). We used the 2 percent threshold to explore the clinical usefulness of the various noninvasive imaging technologies as add-ons to the current standard of care; namely, if a woman was recalled for evaluation after a screening mammography, and received standard-of-care workup versus standard-of-care workup plus the noninvasive imaging technology, would use of the noninvasive imaging technology be likely to alter the recommendations for care after the workup?
For all of the technologies evaluated in this assessment, only women with a low suspicion of malignancy after standard-of-care workup might be expected to experience a change in management decisions as a result of additional noninvasive imaging. A woman with a ≤12 percent suspicion of malignancy who has benign findings on MRI could have her suspicion of malignancy drop below the 2 percent threshold, and therefore she might be assigned to short-interval imaging followup management rather than tissue sampling management; a woman with a 1 percent suspicion of malignancy who has benign findings on MRI could have her suspicion of malignancy drop to near 0 percent and therefore she might be assigned to return to normal screening rather than short-interval followup imaging; a woman with a 1 percent suspicion of malignancy who has malignant findings on MRI could have her suspicion of malignancy increase to 4 percent and therefore she might be assigned to tissue sampling management rather than short-interval followup. The equivalent thresholds of pre-test suspicion of malignancy at which additional imaging may change management are: for B-mode grayscale ultrasound, 1 to 10 percent; for scintimammography, 1 to 5 percent; and for PET, 1 to 5 percent.
Therefore, if the 2 percent threshold is chosen, the use of noninvasive imaging in addition to standard workup may be clinically useful for diagnostic purposes only for women with a low suspicion of malignancy. When choosing which noninvasive imaging technology to use for this purpose, diagnostic B mode grayscale ultrasound and MRI appear to be more accurate than PET, scintimammography, or the other types of ultrasound (e.g., Doppler) that were evaluated in this comparative effectiveness review.
Women thought to be at moderate to high risk of malignancy after standard workup will not have their estimate of risk of malignancy change sufficiently after further noninvasive imaging to affect management decisions. For many patients the suspicion of malignancy will not be able to be estimated with sufficient precision for clinicians to feel comfortable recommending return to normal screening (rather than a biopsy or short-interval followup) solely on the basis of additional noninvasive imaging. Estimates of risk of malignancy are based on features of the mammographic images, patient characteristics, patient history, and patient family history. Several of our expert reviewers did not think such precise estimation of risk is feasible using currently available methods. Potential harms of noninvasive imaging, such as radiation exposure, also need to be considered when deciding whether to perform these tests.
Changes Since 2006
This CER is an update of a CER finalized in 2006.7 The updated results are, in general, very similar to the findings of the 2006 report. For MRI, in 2006 we found that the sensitivity was 92.5 percent and the specificity was 75.5 percent; the updated evidence base supported estimates of 91.7 percent sensitivity and 77.5 percent specificity. In both reports, MRI was found to be less sensitive (approximately 85%) for evaluation of microcalcifications than for evaluation of lesions in general. For PET, in 2006 we found that the sensitivity was 82.2 percent and the specificity was 78.3 percent; the updated evidence base supported estimates of 83.0 percent sensitivity and 74.0 percent specificity. In the updated report we attempted to evaluate the accuracy of PET/CT, but only one study that met the inclusion criteria was identified.
For scintimammography, the updated evidence base identified a sensitivity of 84.7 percent, much higher than the sensitivity estimate from 2006 of 68.7 percent. Specificity was estimated at 84.8 percent in 2006, and at 77.0 percent in the update; however, the confidence intervals around the updated estimate of specificity are wide. It is possible that improvements in the technology in the last few years improved the sensitivity of the technique.
For ultrasound, in 2006 we evaluated a relatively small set of studies of B-mode grayscale ultrasound, and estimated a sensitivity of 86.1 percent and a specificity of 66.4 percent. The update included a significantly expanded evidence base on B-mode grayscale ultrasound, and identified a sensitivity of 92.4 percent and specificity of 75.8 percent. In the update we included numerous other types of ultrasound, including power and color Doppler ultrasound, that were not studied in the 2006 report.
Remaining Issues
The conclusions of quantitative accuracy were for the most part rated as being supported by low strength of evidence, due primarily to the imprecision of the estimates (wide confidence intervals around the estimates of accuracy); the publication of additional diagnostic accuracy studies are likely to increase the precision of the estimates of accuracy, which may upgrade the strength of evidence rating. There was also considerable heterogeneity (inconsistency) in the majority of the evidence bases, which contributed to the low strength of evidence rating. Most likely the heterogeneity was due to slight differences in imaging methodology or patient populations across studies; future research intended to tease out factors affecting the accuracy of imaging may be helpful to the clinician when deciding whether a test may be a useful addition to standard workup for management of a particular patient.
However, the publication of additional diagnostic accuracy studies is unlikely to affect the implications of the conclusions. The conclusions of diagnostic accuracy lead indirectly to a conclusion that only women with a low (1 to 12%) suspicion of malignancy will experience a "change in management" (which may or may not be beneficial) from the use of these noninvasive diagnostic tests. Improving the precision of the estimates of accuracy or upgrading the strength of evidence rating in response to the publication of more diagnostic accuracy studies will not affect the indirect conclusion. Studies that address the issue of how to establish more accurate estimates of malignancy from diagnostic mammography for an individual patient may be more clinically relevant than additional diagnostic accuracy studies.
A limitation of the current evidence base that should be addressed in future research is the patient population being evaluated. Many of the currently available studies were conducted only on women who had been scheduled for biopsy after standard workup, and therefore the patient population studied is not truly representative of the entire patient population of interest. Additional studies that enroll women referred for short-interval followup after standard workup are needed to confirm that the findings of this assessment do apply to the patient population of interest.
In addition, the majority of studies did not report data separately for different categories of breast lesions or patient characteristics. Future research should focus on the accuracy of noninvasive imaging technologies for discrete categories of lesions, such as nonpalpable lesions classified as BI-RADS 3, or for discrete categories of women, such as women older than age 75. Information from more granular groupings of women will allow estimates of test accuracy to be more immediately clinically useful.
Future research efforts should also focus on studies that report the impact of the use of noninvasive imaging on patient-oriented outcomes such as quality of life, and on evaluation of newer noninvasive imaging technologies.
Our key findings are summarized in Table A. In conclusion, the use of noninvasive imaging in addition to standard workup after recall for evaluation of a breast lesion detected on screening mammography or physical examination may be clinically useful for diagnostic purposes only for women with a low (1 to 12%) suspicion of malignancy. When choosing which noninvasive imaging technology to use for this purpose, diagnostic B-mode grayscale ultrasound and MRI appear to more accurate than PET, scintimammography, or Doppler ultrasound. However, whether these findings are clinically relevant hinges on whether clinicians can identify those women who, after standard workup after recall, have a risk of malignancy in this range. Several expert reviewers of this report expressed doubt about the feasibility of such precise estimation.
|Summary Sensitivity
|Summary Specificity
|Pretest Probability of Malignancy Thresholda
|Strength of Evidence
|a The threshold at which use of the noninvasive imaging test may change the post-test probability of malignancy sufficiently to trigger a change in patient management.
|B-mode grayscale 2D ultrasound
(84.6 to 96.4%)
(60.8 to 86.3%)
|1 to 10%
(88.5 to 94.1%)
(71.0 to 82.9%)
|1 to 12%
|Moderate (sensitivity) to Low (specificity)
(78.0 to 89.7%)
(64.7 to 85.9%)
|1 to 5%
(73.0 to 89.0%)
(58.0 to 86%)
|1 to 5%
- American Cancer Society (ACS). Cancer facts & figures 2010. Atlanta (GA): American Cancer Society (ACS); 2010. 68 p. www.cancer.org/acs/groups/content/@epidemiologysurveilance/ documents/document/acspc-026238.pdf .
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- U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2009 Nov 17;151(10):716-26, W-236. PMID: 19920272
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- Bruening W, Launders J, Pinkney N, et al. Effectiveness of noninvasive diagnostic tests for breast abnormalities. Comparative Effectiveness Review No. 2 (Prepared by ECRI Evidence-based Practice center under Contract No. 290-02-0019). AHRQ Publication No. 06-EHC005-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2006. http://effectivehealthcare.ahrq.gov/repFiles/BrCADx%20Final%20Report.pdf.
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- STATA statistics/data analysis. MP parallel edition. College Station (TX): StataCorp; 1984-2007. Single user Stata for Windows. www.stata.com .
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- Stavros AT, Thickman D, Rapp CL, et al. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 1995 Jul;196(1):123-34. PMID: 7784555
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- Buadu LD, Murakami J, Murayama S, et al. Colour Doppler sonography of breast masses: a multiparameter analysis. Clin Radiol. 1997;52:917-23. PMID: 9413965
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BIRADSMammographyFourthEdition/ FollowUpandOutcomeMonitoringDoc4.aspx .
Full Report
This executive summary is part of the following document: Bruening W, Uhl S, Fontanarosa J, Reston J, Treadwell J, Schoelles K. Noninvasive Diagnostic Tests for Breast Abnormalities: Update of a 2006 Review. Comparative Effectiveness Review No. 47. (Prepared by the ECRI Institute Evidence-based Practice Center under Contract No. 290-02-0019.) AHRQ Publication No. 12-EHC014-EF. Rockville, MD: Agency for Healthcare Research and Quality; February 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
For More Copies
For more copies of Noninvasive Diagnostic Tests for Breast Abnormalities: Update of a 2006 Review: Comparative Effectiveness Review Executive Summary No. 47 (AHRQ Pub. No. 12-EHC014-1), please call the AHRQ Clearinghouse at 1-800-358-9295 or email email@example.com.


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Turtle Pie
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From the kitchen of Jane Vogel
This recipe has been on northpole.com from the beginning… since 1996! We hope you enjoy this classic North Pole recipe. Let us know your opinion by submitting a review!
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Recipe Details
Total Time:
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|Contains nuts, Good for parties/potlucks
enough chocolate wafers to make 1 1/2 cups crumbs
1/2 cup butter
2 tablespoons white sugar
1 can sweetened condensed milk
6 caramels, unwrapped
4 tablespoons milk
1/3 cup chocolate chips
1/2 cup chopped pecans
8 ounce package cream cheese
Crush enough chocolate wafers to make 1 1/2 cups crumbs, mix with butter and white sugar.
Press into a 9 inch pie pan.
Beat on high speed: cream cheese and condensed milk until thick and creamy (around 7 to 10 minutes). Pour into pie crust.
Melt caramels with 2 tablespoons milk and drizzle over the pie filling.
Melt chocolate chips with 2 tablespoons milk and drizzle over the caramel.
Sprinkle pecans over the top.
Chill for 3-4 hours before serving.
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Lil' Lady says:
I used this recipe for Thanksgiving and the pie sat in the fridge over night and it never set, still maintained the consistency of a liquid :( It looked so delicious when I made it, so if any one else has made this pie and had a different outcome I would love to know what i did wrong so i could try again.


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FDA Permits Marketing of First Brain Wave Test for ADHD »
"The U.S. Food and Drug Administration today allowed marketing of the first medical device based on brain function to help assess attention-deficit/hyperactivity disorder (ADHD) in children and adolescents 6 to 17 years old. When used as part of "...
Read the FDA Permits Marketing of First Brain Wave Test for ADHD article »
(Generic versions may still be available.)
Because of its association with life threatening hepatic failure, CYLERT (pemoline) should not ordinarily be considered as first line drug therapy for ADHD (see INDICATIONS AND USAGE).
Since CYLERT (pemoline) ´s marketing in 1975, 13 cases of acute hepatic failure have been reported to the FDA. While the absolute number of reported cases is not large, the rate of reporting ranges from 4 to 17 times the rate expected in the general population. This estimate may be conservative because of under reporting and because the long latency between initiation of CYLERT (pemoline) treatment and the occurrence of hepatic failure may limit recognition of the association. If only a por-tion of actual cases were recognized and reported, the risk could be substantially higher.
Of the 13 cases reported as of May 1996, 11 resulted in death or liver transplantation, usually within four weeks of the onset of signs and symptoms of liver failure. The ear-liest onset of hepatic abnormalities occurred six months after initiation of CYLERT (pemoline) . Although some reports described dark urine and nonspecific prodromal symptoms (e.g., anorexia, malaise, and gastrointestinal symp-toms), in other reports it was not clear if any prodromal symptoms preceded the onset of jaundice. It is also not clear if the recom-mended baseline and periodic liver function testing are predictive of these instances of acute liver failure. CYLERT (pemoline) should be dis-continued if clinically significant hepatic dysfunction is observed during its use (see PRECAUTIONS).
CYLERT (pemoline) is a central nervous system stimulant. Pemoline is structurally dissimilar to the amphetamines and methylphenidate.
It is an oxazolidine compound and is chemically identified as 2-amino-S-phenyl-2-oxazolin4-one.
Pemoline is a white, tasteless, odorless powder, relatively insoluble (less than 1 mg/mL) in water, chloroform, ether, acetone, and benzene; its solubility in 95% ethyl alcohol is 2.2 mg/mL.
CYLERT (pemoline) is supplied as tablets containing 18.75 mg, 37.5 mg or 75 mg of pemoline for oral administration. CYLERT (pemoline) is also available as chewable tablets containing 37.5 mg of pemoline.
Inactive Ingredients
18.75 mg tablet: corn starch, gelatin, lactose, magnesium hydroxide, polyethylene glycol and talc.
37.5 mg tablet: corn starch, FD& C Yellow No. 6. gelatin, lactose, magnesium hydroxide, polyethylene glycol and talc.
37.5 mg chewable tablet: corn starch FD& C Yellow No. 6, magnesium hydroxide, magnesium stearate, mannitol, Polyethylene glycol, povidone, talc and artificial flavor.
75 mg tablet: corn starch, gelatin, iron oxide, lactose, magnesium hydroxide, polyethylene glycol and talc.
Last reviewed on RxList: 12/8/2004
This monograph has been modified to include the generic and brand name in many instances.
Cylert FDA Prescribing Information
Additional Cylert Information
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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text: Nothing in stores still.. In Newport News/Hampton area.. this is getting depressing. My order came in tho. I opened Aayla, Nom, and Luke, Rest are going on ebay cheap as planned. No Malgus tho cause the online stores want $50 for him. I dont like him THAT much. this is a PATHETIC way to have to go about collecting!!! Hasbro has serious issues!!!


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Drupal Business Day Singapore
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This is the first time this global event has been held in Singapore. Come and hear about WEM and Drupal, and start networking with those who are thinking about the future of the web. Be part of the revolution!


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"Education is the most powerful weapon which you can use to change the world."
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text:
Just spent some time in NW Montana. Hunted Grouse up in the Yaak with the Linehans. Visited my friends Jim and Michelle Drager as well as Jeff Edwards.
And hunted Ducks and Pheasants with John Robinson. What a blast! All these people rolled out the red carpet for Kathy and I. Not sure if I can come up with words strong enough to express my gratitude! These people should be THE "Flathead Valley Welcoming Committee" No doubt about it! Couldn't imagine a more pleasurable hunt OR visit, with anyone, anyplace. And, John, I'll get those photos to you soon as I can. :) Got some good ones! Back to work tommorrow for some serious culture shock. :)