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A pancreatic pseudocyst is a fluid-filled sac in the abdomen, which may also contain tissue from the pancreas, pancreatic enzymes, and blood.
The pancreas is an organ located behind the stomach that produces chemicals (called enzymes) needed to digest food. It also produces the hormones, insulin and glucagon.
Pancreatic pseudocysts most often develop after an episode of severe, acute pancreatitis. Acute pancreatitis is sudden swelling (inflammation) of the pancreas.
A pancreatic pseudocyst may occur in someone with chronic pancreatitis. It may also occur after trauma to the abdomen, more often in children.
The cyst happens when the ducts (tubes) in the pancreas are damaged by the inflammation or swelling that occurs during pancreatitis.
Symptoms can occur within days to months after an attack of pancreatitis, and include:
The health care provider may feel your abdomen for a pseudocyst, which feels like a lump in the middle or left upper abdomen.
Tests that may help diagnose pancreatic pseudocyst include:
Treatment depends on the size of the pseudocyst and whether it is causing symptoms. Many pseudocysts go away on their own. Those that remain for more than 6 weeks and are larger than 5 cm in diameter often need treatment.
Possible treatments include:
The outcome is generally good with treatment. It is important to make sure that it is not a pancreatic cancer that starts in a cyst, which has a worse outcome.
Rupture of the pseudocyst is an emergency situation. Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of bleeding or shock, such as:
The way to prevent pancreatic pseudocysts is by preventing pancreatitis. If pancreatitis is caused by gallstones, it is usually necessary to remove the gallbladder with surgery (cholecystectomy).
When pancreatitis occurs due to alcohol abuse, you must stop drinking alcohol to prevent future attacks.
When pancreatitis occurs due to high blood triglycerides, this condition should be treated.
Forsmark CE. Pancreatitis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 146.
Forsmark Ce, Baillie J. AGA Institute Technical Review on acute pancreatitis. Gastroenterology. 2007;132:2022-2044.
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|Team: Denizli
W: 240 lbs
Bday: 11/25/1984
(32 Years Old)
Current: PF/C
Possible: PF
|Agent: Sam Goldfeder
High School: Peekskill
Hometown: Peekskill, NY
Drafted: Pick 12 in 2006 by Hornets
Best Case: Channing Frye
Worst Case: Mikki Moore
|Height w/o Shoes
|Height w/shoes
|Standing Reach
|Body Fat
|No Step Vert
|Max Vert
|NBA Pre-Draft Camp
|6' 9.5"
|6' 10.25"
|7' 4"
|9' 1"
|Height w/o Shoes
|Height w/shoes
|Standing Reach
|Body Fat
|No Step Vert
|Max Vert
|NBA Pre-Draft Camp
|6' 9.5"
|6' 10.25"
|7' 4"
|9' 1"
Overview: An athletic forward-center who is a legitimate backup at this point. Not very tall for a center, but compensates with a 7-4 wingspan. Extremely well built, and has added some bulk since his college days. Could stand to continue adding weight. Not a late bloomer physically, but is the definition of the tag from a basketball perspective. Averaged roughly 10 minutes per game in his first three seasons at UConn. Blew up as a senior, primarily on the defensive end. Named Big East Conference Defensive Player of the Year in 2006. Showed enough promise offensive to propel himself into the lottery. Hasnt been a major impact player in the NBA, and needs to have a similar spike in production to avoid being labeled an underachiever. Turnovers, an aversion to rebounding and his inability to stay out of foul trouble have all been major issues for him thus far. Will need to work hard to earn his minutes behind former UConn teammate Emeka Okafor and faced competition from Ike Diogu. Consistency and focus will be the name of the game for him moving forward. Question marks abound regarding his physical and mental toughness.
Offense: Has covered a huge amount of ground on the offensive end in the past few seasons. Much more skilled than he was early in his career. Has all kinds of potential on this end, but rarely is able to show it on a consistent basis. Gets about a quarter of his offense in the post, with the rest coming from hustle plays and an occasional spot up jumpers. Shows a solid turnaround jumper from over his right shoulder when operating down low, as well as a developing hook with his left hand. Appears comfortable making hook shots with both hands, but isnt as consistent when he takes one on the move. Shows a drop step to the baseline and an up-and-under move every now and against as well. Will often just turn into his man over his left shoulder and shoot over him. Has a high release point on his jumper, which helps him taken advantage of his quick leaping ability and not get his shot blocked under defensive pressure. Strong enough to take contact at the rim and still get the ball up. Excellent finisher on the whole. Not a great foul shooter though, which hurts his efficiency. Shows adequate form on his jumper, but lacks consistency. Doesnt have a fluid release, which hurts him. Would be well served to take the time to refine his midrange game, as it would help his face up game immensely. Has all kinds of issues when he puts the ball on the floor against pressure, but isnt a bad ball handler in space. Wants to go left or come back to his left hand with a spin move if he does put the ball on the floor. Has some issues catching bullet passes in the lane. Struggles badly with turnovers, coughing up about 30% of his possessions over the last two years. Often looks lost in his teams half-court sets. Decent offensive rebounder who uses his mobility well on the glass and in transition. Shows signs, but seldom strings together good performances. Needs to continue working hard to polish his skills, and especially become tougher and more aggressive on this end of the floor.
Defense: Average defensive player who could definitely be better. Not aggressive defensively and doesnt seem to have a great deal of fight in him. Uses leverage to compete for position down low, but doesnt always keep his man from catching the ball on the block. Lack of ideal bulk hurts him when defending the center position. Susceptible to fakes as well, which takes away from his quickness and lets his man score with counter moves. Has improved his weakside defense to an extent, but only to the point that he attempts to contest shots, often still arriving a step late. Will block most of his shots coming from behind, or surprising his man with his wingpan and leaping ability at the rim. Uses his length well out on the perimeter too when contesting shots, but needs to be more aggressive and work harder when defending the midrange. Extremely poor rebounder on the defensive end, has the tools, but just doesnt pursue the ball hard enough. Needs to give his all defensively in an effort to compensate for his still developing offensive game. Doesnt look bad when hes giving a good effort and throwing his body around, but that unfortunately does not happen enough.
The former UCONN power forward came through with a good performance today, taking advantage of the inferior defenders he was matched up with. Armstrong utilized his strength and experience to get off a number of post moves against Clippers rookie DeAndre Jordan and his quickness to get to the rim against Nick Fazekas. Armstrong is the total package athletically, but his skill set is now starting to come together nicely. He possesses good touch from the midrange, and has a number of spin moves and fakes that he uses, primarily operating over his right shoulder. The Clippers had no answer for Armstrong today, and he had his way in the paint. Armstrong still needs to work on his finishing ability and continue working on his left hand, as well as maintaining a consistent focus level throughout the game, but hes come a long way since his days in college. Defensively, Armstrong showed nice explosiveness, blocking one of Jordans dunk attempts, and doing a good job holding position. Though hes a dominant player on the Summer League level, Armstrong still has a lot of work to do to become a consistent threat in the NBA.[Read Full Article]
Although The Hornets failed to win a game, Hilton Armstrong managed to showcase the progress hes made since last season in the four games he appeared in. Armstrong played relatively well for New Orleans as a rookie last season, but looked like a completely different player during the Summer League. He showed the same intensity when rebounding and blocking shots, but appears to have made great strides on the offensive end.
The first thing that immediately stood out about Armstrong was his physique. He looked noticeably more muscular than he did last season, especially in his lower body. While he hasnt added a lot of bulk, he seems to be attacking his weight gaining goals in the right way by adding lean mass. Even with this added size, Armstrong showed vastly improved quickness in his post moves, which only added to the impact of the newly developed post game that he displayed.
Armstrongs showed more improvement to his post game that arguably anyone in the Summer League. At times, Armstrong was simply dominant with his back to the basket, showing a nice turnaround jump shot, some up and under moves, and a solid repertoire of fakes and drop steps. The most impressive thing Armstrong has added to his game is the spin move he went to when facing his man up. His footwork has improved on the whole, but it was especially apparent when Armstrong was taking his man off the dribble and spinning around the defense to get easy buckets around the rim.
While Armstrong has made solid strides in his game, he still isnt consistent enough to hurt a defense on an every game basis. His midrange jump shot was an especially good example of this lack of reps, as he showed vastly improved touch and range, but just didnt knock his shots down at a consistent clip. As he gets more playing time, he could become an effective offensive player. Armstrong will need to continue adding muscle and polish to his game, and should get every opportunity to do that while serving as the primary backup to both Tyson Chandler and David West.
Hilton Armstrong has a good set of physical attributes to play PF/C in the NBA, possessing a great combination of height, length, and athleticism. Armstrong is about 611 with a massive wingspan to boot. For a big man, hes very quick off the ground, both on his first and second jump. He has the ability to run the floor well for a big man, is very mobile on both ends of the floor, and is coordinated in all his movements.
Offensively, Armstrong has a very versatile set of skills, though they were not always on display in UConns offense, where Armstrong often played a small role in regards to scoring. When Armstrong was given the opportunity, he showed a potent inside-out game with no major weaknesses to speak of.
Armstrongs most NBA-ready offensive skill is his mid to long range jumper, which he can consistently hit from up to 16-18 feet away from the basket. His shot has good form, a high release point, and he gets good elevation, which along with his height and length, makes the shot very difficult to block. In the right situation, Armstrong could have a major offensive impact with his jump shot in his rookie year, similar to how Knicks rookie Channing Frye did this past season.
Armstrongs perimeter skills dont stop at his jump shot, as he also possesses a respectable off-the-dribble game to complement his shot, making him tough to defend on the perimeter. Using the threat of his jump shot, Armstrong is good at taking his man off the dribble to the right, and has enough ball-handling ability to get to the basket without getting in trouble. He finishes well at the basket, possessing good body control when he makes contact with a defender. He also uses the glass and rim very well, understanding how and when to use the glass or go reverse on a lay-up.
Armstrong didnt show much of a low-post game until his senior year, but has made outstanding progress over the course of the season, now possessing a respectable array of moves in the post, which he converts with very good efficiency. Armstrongs most reliable move in the post is a jump-hook across the lane, which with his length, is extremely hard to contest. He also has a nice dropstep towards the baseline, which he can finish with a jam, a lay-in, or a reverse lay-in. He also uses fakes well, doing so to either get his man off his feet or by faking one way and going the other. He has a very nice touch around the rim, shooting 61% from the field on the year, albeit on not a very large number of shot attempts.
Armstrong doesnt get many opportunities to use his passing abilities, but he shows good court vision and awareness from both the low and high post, recognizing double teams and making strong, crisp passes on kick-outs to the three-point line.
Defensively, Armstrong is most well-known for his weakside shot-blocking, which was his greatest contribution to UConn this season. Armstrong averaged 3.1 blocks in 27.7 minutes for the Big East powerhouse, doing so against great competition, while still having the potential to have done even more. Armstrong combines his length and athleticism with impeccable timing to swat away shots both near and away from the basket. On the low block, when focused, Armstrong quickly moves from the weakside to contest or block shots near the basket, both against opponents slashing and posting up. When he exerts himself, Armstrong has a very strong presence near the basket, having the ability to alter every shot an opponent takes in the lane.
Armstrongs ability to block shots is magnified even further because of his excellent mobility, which allows him to impact the game both near the basket and on the perimeter. When Armstrong is pulled out to the perimeter to defend his man, he has the ability to pick up slashers entering from the top of the key, following them in their route to the basket, and using his length, athleticism, and timing to block their shot from behind. He has this same ability when his own man gets past him on the perimeter, having an excellent chance to recover with a block from behind. He also can be utilized to step up and double team on the perimeter, as he can quickly recover back to his own man in the post.
In terms of man-to-man defense, Armstrong is adequate on the perimeter, possessing decent lateral quickness for a big man, a good fundamental base, and when all else fails, the ability to recover with a block from behind if his man gets past him. In the post, Armstrong has a solid fundamental base, and great length, which he can use to alter shots and poke at the ball. When strength is not an issue, Armstrong does well to contain his man in the post, often being able to block his man one-on-one if he goes at him. He understands how to use his body, arms, and legs to man up with his opponent. With his excellent length and athleticism, Armstrong is also very good at fronting the post.
Because of his length and athleticism, Armstrong has the ability to get rebounds from out of position, and also can track down long rebounds with his mobility. Overall, Armstrong is a decent rebounder, usually being in good position on the defensive end, and usually boxing out his man.
Armstrong had a small role in Connecticuts offense, indicating that hes a coachable player. He often is the one setting picks on the perimeter, not having his number called very often. Because of the extremely high talent level on his team, his skills were often underutilized on the offensive end. He is young for a senior, only 21 years old, and just really began to tap into potential in this his senior year. He made major strides in his game in this one season, still being fairly raw with plenty of room to improve.
Armstrong has some physical weaknesses, most notably with his strength, which affects many aspects of his game. He is lacking in both upper and lower body strength, and although he certainly has room to add more bulk, he is somewhat limited by a narrow upper frame for someone his size. This lack of strength affects his post defense, post offense, and rebounding especially.
Armstrong has enough ball-handling ability to take a few straight dribbles to the basket with his right hand from free-throw line extended, but he could use more work on his ball-handling if he intends to expand his face-up dribble-drive game. Armstrong can't really create with his dribble, and only gets occasional opportunities to drive because of the threat of his jump shot.
Armstrongs post game is inconsistent in overall productivity, partly due to his limited role in UConns offense, but also partly due to a lack of assertiveness in calling for the ball in the post. Due to his strength, Armstrong also can have trouble establishing position against stronger opponents, or in getting off his moves. He relies mostly on finesse moves, and wont be able to use any power moves in the NBA without adding more strength.
Armstrongs man-to-man defense in the post is the area that will give him the most problems in the NBA if he does not add some more strength. He had some problems in the NCAA against stronger opponents, not being able to contain them and often being out-battled for position on the block. This would be magnified even further in the very physical pro game.
In terms of weakside defense, Armstrong has a lot of room to improve, mostly in his approach to the game. While Armstrong posted great shot blocking numbers in his senior year, he had the ability to have done much more. Armstrong has a tendency to be very tentative on the defensive end, sometimes watching opposing players go by, or not going out of his way to contest shots that are within his range. He often looks complacent, and rarely shows the aggressiveness needed to have the impact he is capable of. Armstrong also sometimes loses focus and fails to make all of the rotations, sometimes even looking completely lost on the defensive end. To fully make use of his abilities, he needs to play with greater tenacity and focus for every second hes on the floor.
Armstrongs lack of tenacity carries over to rebounding, where he is often reluctant to mix it up, many times standing and watching as others battle for rebounds. This reluctance could in part be due to a lack of strength, and is something that can definitely be improved upon.
Most of Armstrongs weaknesses come from either a lack of physical strength or a lack of consistent mental toughness, both of which are within his capacity to fix. At times, Armstrong can be very focused and energetic, but at others he looks very tentative and unassertive. He sometimes looks sluggish running the floor and going through the motions on either end of the court, so his conditioning may need a little work. But that could also be attributed to the lack of consistent focus and concentration.
As a high school player, Armstrong was largely considered a mid-major caliber recruit, garnering offers from schools such as LaSalle, Hartford, Canisius, and Niagara before eventually settling on UConn. Coach Jim Calhoun saw something special in him, and things eventually worked well for both parties. The two still enjoy a special relationship, with Calhoun half-jokingly saying that he misses having him by his side on the bench when hes in the game. Armstrong is the definition of a late bloomer, standing 6 feet 2 inches when he began high school, and growing 7 inches by his senior year and then another 2 inches since then. He played just over a thousand minutes in his first three years at UConn, peaking at 12.4 minutes per game as a junior while scoring 3.8 points and 3.4 rebounds. With Emeka Okafor, Charlie Villanueva and others out of the picture, Armstrong finally exploded onto the national scene as a senior, averaging a discreet 10 points, 6.6 rebounds and 3.1 blocks in 28 minutes on what was still an incredibly stacked team, but showing tremendous upside throughout the year. Still 6 months away from turning 22, Armstrong is younger than many juniors in this draft.
Armstrong should be able to contribute considerably to the right team in his rookie year, and he also has the possibility to vastly improve on his already solid game. Because Armstrong didnt get many minutes until his senior year, considering how much he improved in that one year, and because he is so young for his class, he still has a lot more upside to build on. Armstrong immediately needs to add some more bulk to his frame, which should instantly improve many aspects of his game.
Armstrongs skillset and current situation are remarkably similar to Channing Fryes at this time last year. Frye also had an extremely versatile skillset on both ends of the floor that was not fully utilized at Arizona, where he played a small role in favor of more prolific scorers, just as Armstrong did at UConn. Frye had similar weaknesses, both with his lack of strength and his sub-par rebounding, due in part to both his strength and his unwillingness to consistently mix it up inside. Frye bulked up considerably in the offseason, adding a reported 10-20 pounds of weight, something Armstrong absolutely needs to do. Armstrong will also be able to ride his mid-range jump shot as the rest of his game develops, just as Frye did for most of his rookie season.
Father Hilton Sr. led Division II in FG% and was drafted by the San Antonio Spurs, then in the ABA.
]Armstrongs final performance for UConn was a mixed bag. He showed flashes of quite a few things in this game, but didnt really stand out in any one area. On the offensive end, he showed an 18-foot jumper on one occasion, a turnaround jumper in the post, and a spin move for a lay-in in the post. He showed some evidence of a face-up off-the-dribble game from mid-range, but wasnt able to convert it into any points. He also drew some fouls down low and showed some good passing out of the low and high post.
Defensively, Armstrong had four blocks, but didnt have the impact he shouldve in this game. He often seemed either complacent or hesitant in the lane when approached by opposing slashers, not contesting their shots as fiercely as he could, if at all. He has the athleticism, length, and timing to be a real force on the weakside, but needs to show more of a killer instinct to be fully effective with it. In terms of man defense, he had his hands full with George Mason PF Jai Lewis all night long, often being overpowered by the 275-pounder. Armstrong showed a pretty good fundamental base in the post, but simply couldnt dictate the situation at all because of his strength deficiency. Lewis backed him down and repeatedly scored on him. Armstrong did manage to use his length to compensate for his strength on a few occasions, poking the ball away from Lewis before he could complete his move.
Armstrong projects as a mid to late-first round in this summers draft, but could still use a lot of work on his game. He most importantly needs to get stronger to improve his man defense in the post, but he could also use some polish on his offensive game. He has a good base of skills right now, but definitely has room to expand on them. If Armstrong has a strong performance at the Orlando pre-draft camp or in workouts and adds a few extra pounds of bulk in the next few months, it may be enough to push him into the lottery.
One of the best stories of the year in college basketball (if you're not a fan of a rival Big East conference school) has been the blossoming of Hilton Armstrong from a skinny, passive and uncoordinated underclassman to a game changer on both ends of the floor. Armstrong's height, terrific length and outstanding athleticism have made him a force as a shot-blocker especially, showing not just the physical attributes, but also the natural instincts to average nearly 3 and a half blocks per game and help UConn lead the country in this department for the umpteenth time in a row.
Armstrong has shown flashes of excellence on the offensive end as well at times, helping the Huskies relieve the full-court pressure they often see on their lone ball-handler Marcus Williams, stepping back to 16 feet to knock down a smooth looking jump shot, and scoring efficiently in the paint with the jump-hook. He doesn't get too many touches on a team that is absolutely loaded at every position, but he makes the most of what he does, to the tune of 62% shooting from the field on the year.
Continuing to be aggressive is what scouts will look for the most out of Armstrong. He wasn't expected to be the factor that makes or breaks UConn's season, and that trend will likely continue in the NCAA tournament. His physical attributes and raw skills alone will get him plenty of looks regardless in the first round, but a consistent showing throughout the tournament would certainly not hurt his stock.
Anytime a long and athletic 6-11 big man strings together a couple of nice plays and makes his presence felt on both ends of the floor semi-consistently against high-level competition, you have to take notice. When that player plays for arguably the best team in the country, its almost impossible not to. Its been a long time coming for Hilton Armstrong, and it finally appears that hes physically and mentally ready to make the type of impact that many expected him to in his senior year.
Armstrong looked particularly good rebounding the ball, playing good defense and getting to the line in UConns semifinal victory against Arizona. He looked very impressive bouncing up and off the floor repeatedly for rebounds, showing a nice combination of athleticism, length and determination. For a player whose biggest weakness has always been considered his physical and mental toughness, thats a great sign. He still has a long ways to go in terms of showing the kind of consistent ability as a senior to make up for the time he lost sitting on the bench behind Emeka Okafor, Charlia Villanueva and others, but he is clearly off to a good start. Hes nowhere near a finished product yet, as evidenced by his almost non-existent post moves in the paint, but still clearly looked better and more active than fellow teammate and more highly touted draft prospect (so far) Josh Boone.

subset: commoncrawl


text: December 9 -- The Obama administration's recent proposal to significantly reduce the amount of clean-burning renewable fuels that must be included in the fuel supply in 2014 is a shocking capitulation to Big Oil that threatens to significantly damage our state's economy, puts consumers at risk through higher prices at the pump and would hurt the environment. The renewable fuels standard (RFS) was passed with strong bipartisan support to promote the development of a domestic renewable fuels industry. It requires an increasing amount of renewable fuels to be included in nation's fuel supply, and it has worked extremely well. >>View Article


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The IT Help Desk provides first-level technical support to all faculty, staff, and students of Gratz College. We should be your first point of contact for problems in the following areas:
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Tour DeFleur 5K Run to be held at Binghamton University
Lace up your sneakers for the third annual Tour DeFleur 5K Run to be held at 11 a.m. Saturday, November 1, on the Binghamton University campus. Registration begins at 10 a.m. in lot E-1 located behind the East Gym tennis courts.
The race will follow the Binghamton Varsity Cross Country course concluding with an awards presentation. Prizes will be given to the top three male and female finishers, as well as the best in each age category.
New this year is a 100-yard dash Kids Fun Run, starting at 11:45 a.m. The Binghamton Zoo Mobile will also be hand, as well as a variety of games and activities, a costume contest, and free snacks.
Runners and walkers can sign up in the East Gym Membership Services Office, Room #139. The pre-registration fee is $7.00 and day of race registration is $10, which includes post-race refreshments. The first 100 registrants will receive a t-shirt.
Tour DeFleur is sponsored by Sodexo, Campus Recreation, and the Eating Awareness Committee. All proceeds will be donated to the Ross Park Zoo and the Binghamton University Eating Awareness Committee.
For more information contact firstname.lastname@example.com or visit http://campusrecreation.binghamton.edu/TourDeFleur.html


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And the feds want to run helath care???
And the feds want to run helath care???
Bob Gutermuth
Canvasback Chesapeakes
Those same dead people were probably registered to vote by ACORN, and voted for Obami.
Last edited by Hoosier; 05-15-2009 at 09:52 AM.
Uhh ... are they also sending monthly SS payments to these dead people? It wouldn't be the first time that happened either!The Social Security Administration, which sent out 52 million checks, said some of those checks mistakenly went to dead people because the agency had no record of their death. That amounts to between 8,000 and 10,000 checks for millions of dollars.
"Know in your heart that all things are possible. We couldn't conceive of a miracle if none ever happened." -Libby Fudim
I don't use the PM feature, so just email me direct at the address shown above.
"All those things bother me: The populism, the lying and the scapegoating and the xenophobia bother me, but then theres a layer of incompetence here. I suppose, in a way, we should be thankful: If he had a coherent ideology, hed probably be more dangerous." P J O'Rourke


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Latest update : 2012-06-07
Political and social events from the Americas, with exclusive reports and interviews. Every Wednesday at 5.45 pm Paris time.
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This week, we focus on the woman known as the "Trump whisperer". Kellyanne Conway is a character full of contradictions, who studied at Oxford and talks about spy microwaves with...


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Synergy HomeCare is a nationally-recognized, locally-owned in-home care company serving clients of all ages in Clark County, Washington. Our ultimate goal is to either provide or find in-home services for the people of our community who contact us looking for assistance. We are fully licensed,...
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Photo of the Day: Semmy Schilt the Sumo
- Written by Dave Walsh
You have to give it up for Semmy Schilt - the big guy is always willing to put himself out there and go for it, no matter how goofy it may make him look. Here we see the 4 time K-1 champion taking part in a Japanese TV program that takes celebrities and athletes from other sports and has them compete in sumo matches. The show will air on May 1. Also taking part were Dream fighter Mach Sakurai and K-1 head referee Kakuda - although Sakurai clearly wimps out and wears a pair of shorts under his mawashi. For shame Mach!
Click here for more pictures.


text: An image in the latest Insider shows the upcoming Disney exclusive Starspeeder 1000 from Star Tours. This has been mentioned before by Disney, but never shown until now. It's made to fit with the Hasbro line, but not necessarily tooled by Hasbro, from what I understand (though that may have changed since it was first announced). The issue mentions that it will have "10 functioning passenger doors pop-out laser cannons, removable roof, changeable destination screens, removable R2-D2, I-360 camera droid, and authentic lights and sounds from the attraction itself." It can hold 9 figures as well as a pilot, and will cost $54.95 when it comes out in December. Due to its price I bet it will be at the parks for a little while, but this looks pretty awesome.


text:
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A kidney stone is a solid mass made up of tiny crystals. One or more stones can be in the kidney or ureter at the same time.
Renal calculi; Nephrolithiasis; Stones - kidney
Kidney stones are common. Some types run in families. They often occur in premature infants.
There are different types of kidney stones. The cause of the problem depends on the type of stone.
Stones can form when urine contains too much of certain substances that form crystals. These crystals can develop into stones over weeks or months.
Calcium stones can also form from combining with phosphate or carbonate.
Other types of stones include:
The biggest risk factor for kidney stones is not drinking enough fluids. Kidney stones are more likely to occur if you make less than 1 liter of urine a day.
You may not have symptoms until the stones move down the tubes (ureters) through which urine empties into your bladder. When this happens, the stones can block the flow of urine out of the kidneys.
The main symptom is severe pain that starts suddenly and may go away suddenly:
Other symptoms can include:
The health care provider will perform a physical exam. The belly area (abdomen) or back might feel sore.
Tests that may be done include:
Stones or a blockage can be seen on:
Treatment depends on the type of stone and the severity of your symptoms.
Kidney stones that are small usually pass through your system on their own.
Some people with severe pain from kidney stones need to stay in the hospital. You may need to get fluids through a vein.
For some types of stones, your doctor may prescribe medicine to prevent stones from forming or help break down and remove the material that is causing the stone. These medicines can include:
Surgery is often needed if:
Today, most treatments are much less invasive than in the past.
Talk to your doctor about what treatment options may work for you.
Kidney stones are painful but most of the time can be removed from the body without causing lasting damage.
Kidney stones often come back. This occurs more often if the cause is not found and treated.
You are at risk for:
Call your health care provider if you have symptoms of a kidney stone.
If you have been diagnosed with blockage from a stone, passage must be confirmed either by capture in a strainer during urination or by follow-up x-ray.
If you have a history of stones:
Curhan GC. Nephrolithiasis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 128.
Finkelstein VA. Strategies for preventing calcium oxalate stones. CMAJ. 2006;174:1407-1409.
Ferrandino MN, Peitrow PK, Preminger GM. Evaluation and medical management of urinary lithiasis In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 46.
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text:
www.twitter.com/FinsJesseDolphins have named Jeff Nixon their RBs coach and Darren Krein their head strength and conditioning coach.
www.twitter.com/FinsJesseDolphins have named Jeff Nixon their RBs coach and Darren Krein their head strength and conditioning coach.
Follow me at www.twitter.com/robi2184, always updating Dolfans with the latest Miami Dolphins news.
Zach Thomas: I played against New England twice a year every year my whole career. I learned to not like that team. I wasn't going to join them.
Whew! I was hoping we would get one of them two, not in my wildest dreams did I think we could land both of them............Who are they?
www.twitter.com/Jeff_DarlingtonThe Dolphins added a couple of assistants today: Running backs coach Jeff Nixon and strength coach Darren Krein, moving quick to fill voids.
Nixon, the new running backs coach, spent 2007-2010 as Eagles' special teams quality control coach. Krein has been in Seattle since 1997.
2 guys whove spent a lot of time with coaches who use the WCO
Darren Krein is a former stand out player for the University of Miami Hurricanes in the 90's.
Here's Nixon
PLayed RB at both West Virginia and PSU in the Mid 90's. Started his coaching career in college as RB coach at Princeton (2 years after graduating), then at Shippensburg and Tennessee Chattanooga, before being an assistant for Al Golden at Temple in 2007. He's been with Philly since
Here's Krein
Former All-Conference Performer for the Miami Hurricanes. Former 4th round draft pick of the Chargers but never played due to injuries (did play in World Football League with the Barcalona Dragons). As the assistant S&C coach in Seattle since 2001, he is given the most credit in helping Matt Hasselback develop physically into the QB he was for most of the decade.
Has Krein call Vernon Carey yet to get his Fat Arsh on a diet and in the gym!
Short answer: NoSeriously we are now bashing the hirings of the running backs coach and strength coach? Can the Dolphins make any moves without people criticizing it?
Long Answer: This is finheaven


text:
OK Pat, you're right...poor choice of words. What I should have said is that the former administration did a laudable job of putting plans and infrastructure in place for just such an event.
Cory, you're right too, the sky is not falling. The appearance of novel influenza virus is significant because it opens yet another door for a pandemic to emerge whether this one does now, or not. This strain has met the criteria of a pandemic capable virus. But, that doesn't mean it will cause a pandemic.
As far as virulence goes, it's too early to calculate a reliable case fatality ratio, but the virus has demonstrated the ability to kill healthy young adults.


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- Home
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EHC Component
- EPC Project
Topic Title
- Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women
Full Report
- Research Review Jun. 12, 2012
Related Products for this Topic
- Research Protocol Dec. 8, 2010
- Disposition of Comments Report Dec. 3, 2012
Related Topics
Original Nomination
Executive Summary – Jun. 12, 2012
Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women
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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
- Background
- Objectives
- Analytic Framework
- Methods
- Results
- Discussion
- Glossary
- References
- Full Report
- For More Copies
Cardiovascular disease is the leading cause of mortality for women in the United States.1 Coronary heart disease—which includes coronary artery (or atherosclerotic) disease (CAD), myocardial infarction (MI), acute coronary syndromes, and angina—is the largest subset of this mortality.1 According to the American Heart Association (AHA), approximately one in three female adults has some form of cardiovascular disease. Since 1984, the number of deaths attributed to cardiovascular disease in women has exceeded that in men, reaching 454,613 in 2005—more than deaths from all forms of cancer combined.2 It is estimated that 8.1 million women alive today have a history of heart attack, angina pectoris (chest pain or discomfort caused by reduced blood supply to the heart muscle), or both, and experts predict that in 2010 alone an estimated 370,000 women will have a new or recurrent MI. Overall, women who have had an acute MI—particularly those older than 55 years of age—have a worse prognosis than men, with a greater recurrence of MI and higher mortality.1 More women (5.5 million) than men (4.3 million) have angina in total numbers. However, the prevalence of CAD in women with chest pain is about 50 percent, compared with 80 percent in men, which complicates diagnosis in women.3
The AHA suggests there is evidence showing that women at risk for CAD are less often referred for the appropriate diagnostic test than are men.1 Coronary anatomy and pathology have traditionally been defined and identified by invasive, catheter-based x-ray angiography, also referred to as coronary angiography.4 In this invasive procedure, a catheter is inserted into the femoral, brachial, or radial artery and passed up through the aorta to directly engage the right and left coronary arteries; an iodinated contrast agent is then injected into each artery while digital x-ray images are recorded.4 The major benefits of invasive coronary angiography over noninvasive techniques are that the use of a catheter makes it possible to see the coronary arteries with greater anatomic precision and resolution and to combine diagnosis and treatment in a single procedure. The limitations of the procedure include the invasive nature of the test and the limited data on the functional impact of a luminal obstruction. These limitations are generally considered to be minor when compared with the benefits of the procedure, and coronary angiography is now the reference (gold) standard for clinical care of patients who have chest pain suggestive of CAD.
Coronary angiography, however, is not risk-free.4 Arterial bleeding can occur at the access site, and manipulation of the catheter within the aorta and coronary arteries may cause an atherosclerotic embolus that, in turn, could result in stroke or heart attack. Separation of material from the inner lining of the artery may also cause a blockage downstream of the catheter tip. The contrast agent used during the procedure to visualize the coronary arteries may cause anaphylaxis, renal impairment, or injury, and there is radiation exposure during the digital x-ray imaging. Although it is a rare occurrence, the catheter can puncture an artery and cause internal bleeding.
Coronary angiography is generally indicated in patients who have chest pain and are at high risk for CAD. For intermediate-risk patients, clinicians have a wide range of noninvasive diagnostic modalities to choose from, with wide variability in reported sensitivities and specificities. Noninvasive technologies (NITs) are especially important options for patients who have contraindications to invasive catheterization, or for those who would be put at higher risk for complications with invasive screening.4
Types of Noninvasive Technologies
NITs can assess functional status (i.e., ischemia or no ischemia) or visualize anatomic abnormalities (i.e., no CAD, nonobstructive CAD, or obstructive CAD). Types of NITs include the following:
- Functional modalities:
- Exercise/stress electrocardiography (ECG) exercise/stress or resting
- Exercise/stress echocardiography (ECHO) with or without a contrast agent
- Exercise/stress radionuclide myocardial perfusion imaging, including single proton emission computed tomography (SPECT) and positron emission tomography (PET)
- Anatomic modalities:
- Stress myocardial perfusion and wall motion magnetic resonance imaging (CMR)
- Coronary computed tomography angiography (coronary CTA)
The AHA and the American College of Cardiology (ACC) recommend that women with suspected CAD should be classified as either symptomatic or asymptomatic and further classified as being at low, intermediate, or high risk for the disease to guide the decision about which diagnostic test to use first.1 In 2005, the AHA developed a consensus statement on the role of noninvasive testing in the clinical evaluation of women with suspected CAD. In this statement, the AHA recommended that women who are symptomatic and at intermediate to high risk of having CAD should undergo noninvasive diagnostic studies (i.e., exercise electrocardiography and cardiac imaging studies) and that those who are asymptomatic and at low risk of CAD should not undergo cardiac imaging studies.1 The AHA consensus statement was a thorough synopsis of the extant literature regarding the diagnosis of CAD in women with expert-guided recommendations for the workup of symptomatic women but did not include a comparative effectiveness review of the accuracy of the various NIT modalities in women.
The goal of this comparative effectiveness report was to conduct a systematic review of the peer-reviewed medical literature assessing (1) the accuracy of different NITs for diagnosing CAD in women with symptoms suspicious of CAD, (2) the predictors affecting test accuracy, (3) the ability to provide risk stratification and prognostic information, inform decisionmaking about treatment options, and affect clinical outcomes, and (4) the safety concerns and risks to women undergoing these tests. The following Key Questions (KQs) were considered in this comparative effectiveness review:
- KQ 1. What is the accuracy of one NIT in diagnosing obstructive and nonobstructive CAD when compared with another NIT or with coronary angiography in women with symptoms suspicious for CAD?
- Exercise ECG stress test, including resting ECG technology (e.g., multifunctional cardiogram)
- Exercise/stress ECHO with or without a contrast agent
- Exercise/stress radionuclide myocardial perfusion imaging, including SPECT and PET
- CMR imaging
- Coronary CTA
- KQ 2. What are the predictors of diagnostic accuracy (e.g., age, race/ethnicity, body size, heart size, menopausal status, functional status, stress modality) of different NITs in women?
- KQ 3. Is there evidence that the use of NITs (when compared with other NITs or with coronary angiography) in women improves:
- KQ 3a. Risk stratification/prognostic information?
- KQ 3b. Decisionmaking regarding treatment options (e.g., revascularization, optimal medical therapy)?
- KQ 3c. Clinical outcomes (e.g., death, myocardial infarction, unstable angina, hospitalization, revascularization, angina relief, quality of life)?
- KQ 4. Are there significant safety concerns/risks (i.e., radiation exposure, access site complications, contrast agent-induced nephropathy, nephrogenic systemic fibrosis, anaphylaxis, arrhythmias) associated with the use of different NITs to diagnose CAD in women with symptoms suspicious for CAD?
Analytic Framework
Figure A shows the analytic framework for the systematic review of NITs for the diagnosis of CAD in women.
Figure A. Analytic framework
Abbreviations: CAD = coronary artery disease; KQ = Key Question; NSF = nephrogenic systemic fibrosis
Input From Stakeholders
The Evidence-based Practice Center (EPC) followed AHRQ's recommended methodology, described in Methods Guide for Effectiveness and Comparative Effectiveness Reviews,5 for literature search strategies, inclusion/exclusion of studies, abstract screening, data abstraction and management, assessment of methodological quality of individual studies, data synthesis, and grading of evidence for each KQ.
During the topic refinement stage, we solicited input from Key Informants, representing clinicians (cardiology, primary care, cardiac imaging), patients, scientific experts, and Federal agencies to help define the KQs. The KQs were then posted for public comment for 30 days, and the comments received were considered in the development of the research protocol. We next convened a Technical Expert Panel (TEP), comprising clinical, content, and methodological experts, to provide input in defining populations, interventions, comparisons, or outcomes as well as identifying particular studies or databases to search. The Key Informants and members of the TEP were required to disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Any potential conflicts of interest were balanced or mitigated. Neither Key Informants nor members of the TEP did analysis of any kind and did not contribute to the writing of the report.
Data Sources and Selection
We included studies published in English from January 1, 2000, through September 12, 2011. Search strategies were specific to each database in order to retrieve the articles most relevant to the KQs. Our search strategy used the National Library of Medicine's medical subject headings (MeSH) keyword nomenclature developed for MEDLINE® and adapted for use in other databases. We used PubMed®, Embase®, the Cochrane Database of Systematic Reviews, and the Cochrane Central Registry of Controlled Trials for our literature search. We also searched the grey literature of study registries and conference abstracts for relevant articles from completed trials, including Clinicaltrials.gov; metaRegister of Controlled Trials; ClinicalStudyResults.org; WHO: International Clinical Trials Registry Platform Search Portal; CSA Conference Papers Index; and Scopus. The exact search strings used in our strategy are given in Appendix A of the full report. Reference lists of articles applicable to the relevant KQs of previous AHRQ reports on this topic6,7 and from identified systematic reviews and meta-analyses were manually hand-searched and cross-referenced against our library, and additional manuscripts were retrieved. All citations were imported into an electronic bibliographic database (EndNote® Version X4; Thomson Reuters, Philadelphia, PA).
We developed a list of article inclusion and exclusion criteria for the KQs (Table A). Using the prespecified inclusion and exclusion criteria, titles and abstracts were examined independently by two reviewers for potential relevance to the KQs. Articles included by any reviewer underwent full-text screening. At the full-text screening stage, two independent reviewers read each article to determine if it met eligibility criteria. At the full-text review stage, paired researchers independently reviewed the articles and indicated a decision to "include" or "exclude" the article for data abstraction. When the paired reviewers arrived at different decisions about whether to include or exclude an article, we reconciled the difference through a third-party arbitrator. Articles meeting our eligibility criteria were included for data abstraction. Relevant systematic review articles, meta-analyses, and methods articles were flagged for hand-searching and cross-referencing against the library of citations identified through electronic database searching.
|Study Characteristic
|Inclusion Criteria
|Exclusion Criteria
Study design
An article was included if the following two criteria were met:
Study included adult women (age ≥ 18 years of age) who present symptoms of symptoms suspicious for CAD (e.g., exertional dyspnea, shortness of breath, and/or angina) with or without a known diagnosis of CAD; data for women must be presented separately from data for men
All subjects were < 18 years of age, or some subjects were under < 18 but results were not broken down by age
NITs for the diagnosis of obstructive and nonobstructive CAD included:
Coronary artery calcium scoring by electron beam computed tomography since this modality is often used to screen asymptomatic patients for CAD
Another NIT or coronary angiography
Study did not compare one NIT with another, or with coronary angiography
Primary outcome—accurate diagnosis of obstructive and nonobstructive CAD
Outcomes not related to diagnostic accuracy for detecting CAD
KQ 1 patient-level outcomes:
Vessel-based outcomes
KQ 2 outcomes: Predictors of diagnostic accuracy—age, race/ethnicity, body size, heart size, menopausal status, functional status, stress modality
Outcomes of women not reported separately from total population
KQ 3 outcomes:
Outcomes of women not reported separately from total population
KQ 4 outcomes: Safety and adverse events—radiation exposure, access site complications, contrast agent-induced nephropathy, nephrogenic systemic fibrosis, anaphylaxis, arrhythmias—and how these events varied by demographic factors
Outcomes of women not reported separately from total population
Inpatient or outpatient settings, primarily primary care and cardiology clinics
Publication languages
English only
Given the high volume of English-language publications (including the majority of known important studies), non-English articles were excluded
Abbreviations: CAD = coronary artery disease; KQ = Key Question; NIT = noninvasive technology
Data Extraction and Quality Assessment
The investigative team created forms for abstracting the data elements for the KQs. Based on their clinical and methodological expertise, two researchers were assigned to abstract data from the eligible articles pertaining to the research questions. One researcher abstracted the data, and the second overread the article and the accompanying abstraction form to check for accuracy and completeness. Disagreements were resolved by consensus or by obtaining a third reviewer's opinion if consensus was not reached by the first two researchers. To aid in both reproducibility and standardization of data collection, researchers received data abstraction instructions directly on each form created specifically for this project with the DistillerSR data synthesis software program (Evidence Partners Inc., Manotick, ON, Canada). We designed these forms to collect the data required to evaluate the specified eligibility criteria for inclusion in this review as well as to collect demographics and data needed to determine outcomes (intermediate outcomes, health outcomes, and safety outcomes). Appendix B of the full report lists the elements used in the data abstraction forms.
Appendix C of the full report contains a bibliography of all studies included in this review, organized alphabetically by author. When appropriate, methods articles providing additional detail were considered when abstracting data for an included study.
The studies included in this comparative effectiveness review were assessed on the basis of the quality of their reporting of relevant data. We evaluated the quality of individual studies using the approach described in AHRQ's Methods Guide for Effectiveness and Comparative Effectiveness Reviews (hereafter referred to as the Methods Guide).5 To assess study quality, we (1) classified the study design, (2) applied predefined criteria for quality and critical appraisal, and (3) made a summary judgment of the study's quality. To evaluate methodological quality, we applied criteria for each study type that were derived from the core elements described in the Methods Guide5 and from QUADAS,8 a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. To indicate the summary judgment of the quality of the individual studies, we used the summary ratings of Good, Fair, and Poor based on the study's adherence to well-accepted standard methodologies (such as QUADAS) and adequate reporting standards.
We used data abstracted on the population studied, the intervention and comparator, the outcomes measured, settings, and timing of assessments to identify specific issues that may have limited the applicability of individual studies or a body of evidence as recommended in the Methods Guide.5,9 We used these data to evaluate the applicability to clinical practice, paying special attention to study eligibility criteria, demographic features of the enrolled population in comparison with the target population, the intervention used in comparison with technologies currently in use, and clinical relevance and timing of the outcome measures. We summarized issues of applicability qualitatively. Appendix D of the full report summarizes our assessment of the quality and applicability for each included study as well as the assessed QUADAS quality scores for diagnostic accuracy.
Data Synthesis and Analysis
We summarized the primary literature by abstracting relevant continuous data (e.g., age, sensitivity, specificity, event rates) and categorical data (e.g., race/ethnicity, presence of CAD). Data for patients with no known diagnosis of CAD were collected and analyzed separately from data for mixed CAD populations that included patients with and without known CAD. We then determined the feasibility of completing a quantitative synthesis (i.e., summary receiver operating characteristic [SROC] curves for diagnostic accuracy or meta-analysis for other outcomes). The feasibility of a meta-analysis or SROC curve depended on the volume of relevant literature, the homogeneity of the studies in terms of the populations studied, the interventions included or the outcomes assessed, and the completeness of the results reporting. For each SROC calculation, we ran separate analyses of the accuracy of each NIT modality compared with coronary angiography on the no-known CAD and mixed CAD populations using random-effects models to quantitatively synthesize the available evidence. In our primary analyses, we evaluated these performance characteristics in the population of women who had no previously known CAD. In secondary analyses, we explored a broader patient population by including those studies that had women from mixed populations of known and no known CAD. We also assessed the impact on our findings if, in each population, we restricted our analyses to those studies that were assessed to be good quality. We then compared the performance characteristics of the NIT modalities with each other in a generalized linear mixed model. In a final exploratory analysis, we evaluated the test performance of the modalities in women compared with men in a similar generalized linear model with sex as a covariate. We presented summary estimates and confidence intervals (CIs).
For synthesizing the accuracy data for studies included in our assessment of KQ 1, we used the following approach as advocated by Leeflang,, et al.10 This approach allows the paired nature of sensitivity and specificity and randomness between studies to be taken into account. The analyses are based on true positive (TP), false negative (FN), false positive (FP), and true negative (TN) frequencies abstracted from relevant publications. Estimated study specific sensitivity (TP/[TP+FN]) and specificity (TN/[TN+FP]) values are displayed in paired forest plots together with exact 95% CIs.11 The fixed-effects estimates and their variance–covariance matrix provided (after reverse logit transformation) summary sensitivity and specificity values and a joint confidence region (dotted oval shape on figures) as well as separate CIs for summary sensitivity and specificity as presented on figures and forest plots in the report. We used the Rutter and Gatsonis12 SROC curve as described by Arends,, et al.,13 and it is presented in figures as a solid line over the range of the available data.
Grading the Body of Evidence
The strength of evidence for each Key Question was assessed using the approach described in AHRQ's Methods Guide on Medical Test Reviews for grading the evidence related to the diagnostic accuracy of the NITs (KQ 1),14 and the Methods Guide for Effectiveness and Comparative Effectiveness Reviewsfor grading the evidence related to the other Key Questions (KQs 2–4).5,15 The evidence was evaluated using the four required domains: risk of bias (low, medium, or high), consistency (consistent, inconsistent, or unknown/not applicable), directness (direct or indirect), and precision (precise or imprecise). Additionally, when appropriate, the studies were evaluated for the presence of confounders that would diminish an observed effect, the strength of association (magnitude of effect), and publication bias. The strength of evidence was assigned an overall grade of High, Moderate, Low, or Insufficient according to the following four-level scale:
- High—High confidence that the evidence reflects the true effect. Further research is very unlikely to change our confidence in the estimate of effect.
- Moderate—Moderate confidence that the evidence reflects the true effect. Further research may change our confidence in the estimate of effect and may change the estimate.
- Low—Low confidence that the evidence reflects the true effect. Further research is likely to change the confidence in the estimate of effect and is likely to change the estimate.
- Insufficient—Evidence either is unavailable or does not permit estimation of effect.
The flow of articles through the literature search and screening process is depicted in Figure B. Of the 8,231 citations identified by our searches, 634 were duplicates. A manual search identified an additional 445 citations for a total of 8,042 citations. After applying inclusion/exclusion criteria at the title-and-abstract level, 1,772 full-text articles were retrieved and screened. Of these, 1,662 articles were excluded at the full-text screening stage. Of these, we excluded 1,376 (83 percent) for not reporting data on women and 615 (37 percent) for looking only at a population with known CAD. (Note that an article may have been excluded for more than one reason.) The final set comprised 110 articles representing 104 studies.
Of the 104 studies, 1 was an RCT, 79 were prospective observational, and 24 were retrospective observational with study cohorts comprising individuals who presented for NIT testing and received diagnostic coronary angiography (100 studies) or another NIT modality only (4 studies). The four studies without coronary angiography compared ECHO with ECG16,17 or ECG with SPECT.18,19 Three of these studies were applicable to KQ 3,16-18 and one was applicable to KQ 2.19 Of the 94 studies included in the KQ 1 results, 5 reported NIT versus NIT comparisons in addition to coronary angiography.20-24
Figure B. Literature flow diagram
Abbreviations: CAD = coronary artery disease; KQ = Key Question; NIT = noninvasive technology; SR = systematic review
Summary of Key Findings
We analyzed the results by study population (no known CAD and mixed CAD populations) and by study quality (good quality rating). Table B and Figure C show the summary sensitivities and specificities for each NIT modality. Table C summarizes our key findings.
|Quality of Included Studies
|Number of Studies
|Number of Women
|Summary Sensitivity
|Summary Specificity
No known CAD
62% (55%–68%)
70% (58%–79%)
68% (63%–73%)
62% (53%–69%)
Mixed population
61% (54%–67%)
65% (52%–76%)
65% (58%–72%)
60% (52%–68%)
No known CAD
79% (74%–83%)
79% (69%–87%)
83% (74%–89%)
85% (68%–94%)
Mixed population
78% (73%–83%)
77% (65%–85%)
86% (79%–91%)
89% (76%–95%)
No known CAD
81% (76%–86%)
83% (52%–95%)
78% (69%–84%)
72% (37%–92%)
Mixed population
82% (77%–87%)
82% (72%–88%)
81% (74%–86%)
79% (66%–87%)
No known CAD
72% (55%–85%)
72% (55%–85%)
84% (69%–93%)
84% (69%–93%)
Mixed population
78% (61%–89%)
76% (55%–89%)
84% (74%–90%)
84% (72%–91%)
Coronary CTA
No known CAD
93% (69%–99%)
85% (26%–99%)
77% (54%–91%)
73% (17%–97%)
Mixed population
94% (81%–98%)
83% (58%–94%)
87% (68%–96%)
77%% (40%–94%)
Abbreviations: CAD = coronary artery disease; CI = confidence interval; CMR =cardiac magnetic resonance; CTA = computed tomography angiography; ECG = exercise/stress electrocardiogram; ECHO = echocardiogram; SPECT = single proton emission computed tomography
Figure C. Summary of accuracy of NITs compared with coronary angiography for diagnosing CAD in women with no known CAD (all studies)
|Key Question
|Strength of Evidence
KQ 1: Diagnostic accuracy of NITs in women
ECG: High
94 studies described the diagnostic accuracy of NITs in comparison to another NIT or coronary angiography in women. Of these 94 studies, 78 studies included sufficient data to estimate the sensitivity and specificity of the NIT compared with coronary angiography.
KQ 1 (continued)
Sensitivity analyses exploring mixed populations of women with known and no known CAD showed no statistically significant difference in the sensitivities and specificities from our primary analysis. An analysis exploring the prevalence of CAD across the different NIT modality studies also showed no statistically significant difference. In addition, there were very few studies (1 SPECT, 1 ECHO, and 3 ECG) that did not complete a coronary angiography in all patients who underwent the NIT; therefore the results are minimized for verification bias. Finally we found no evidence of publication bias across the different modalities in our 4 populations of interest (studies of women with no known CAD, good quality studies of women with no known CAD, studies of women from mixed populations, and good quality studies of women from mixed populations).
KQ 2: Predictors of diagnostic accuracy in women
11 studies (4 good quality, 5 fair, 2 poor) described diagnostic accuracy, and 9 of these examined predictors of diagnostic accuracy of different NITs in women.
KQ 3: Improving risk stratification, decisionmaking, and outcomes in women
13 studies (3 good quality, 9 fair, 1 poor) reported prognostic, outcome, or decisionmaking data comparing one NIT with another NIT or with coronary angiography in women with symptoms suspicious for CAD.
KQ 4: Safety concerns
13 studies (9 good quality, 4 fair) reported data pertinent to safety concerns or risks associated with the use of NITs to diagnose CAD in women with symptoms suspicious for CAD.
In summary, the findings of this comparative effectiveness review provide evidence for the accuracy of exercise/stress ECG, ECHO, SPECT, CMR, and coronary CTA compared with coronary angiography used for diagnosing CAD in women. The diagnostic accuracy appears to be consistent over time except for the sensitivity of CMR, which appears to be increasing over time (although the large confidence intervals reflect the underlying uncertainty in this measure). We are confident that the summary statistics for ECG, ECHO, and SPECT are robust and unlikely to change with the addition of new studies based on both the number of good-quality trials comparing these modalities with coronary angiography and the tight confidence intervals. More good-quality studies comparing CMR or coronary CTA with coronary angiography in the no-known CAD population and reporting sex-based results are needed to strengthen the summary statistics for those modalities.
Decisions around performing tests (either noninvasive or invasive) in patients with symptoms suspicious for CAD revolve around first understanding the pretest probability and testing/action thresholds for patients from the AHA/ACC stable angina guidelines and appropriate use criteria for the various NIT modalities.25-28 Specifically, clinicians faced with patients who have a guideline-defined low-to-intermediate pretest probability of CAD may decide to obtain a noninvasive test, ideally with a high negative predictive value in this population and low risk of adverse events, in order to "rule out" disease. These may be patients with atypical chest pain (e.g., reflux or musculoskeletal disease) who are concerned about a heart problem and who require reassurance that their symptoms are not cardiac in origin. In contrast, in patients with high pretest probability of CAD (greater than 90 percent chance), a test with very high positive predictive value in this population and potentially more risk may be chosen since the disease of interest is thought to be present; in these cases, invasive angiography—the gold standard—is recommended by the current clinical practice guidelines. Finally, it is the spectrum of intermediate probability between 10 and 90 percent for which the clinicians must choose noninvasive tests that provide the right balance of sensitivity, specificity, and clinical risk to warrant testing. The choice of NIT may differ by clinician preference, availability, or setting (outpatient vs. chest pain unit of an emergency department).
It is in this context that the findings of this report on the effectiveness of NITs in women must be considered. First, women are thought to be at lower pretest probability of CAD when evaluated in comparison with men of the same age. When comorbidities or risk factors are taken into account, the pretest likelihood increases with a higher number of comorbidities. Second, women susceptible to some of the adverse effects of testing may have poor test performance or have higher rates of complication from invasive arterial access. Third, because of body shape and limited functional capacity, women may not obtain the same test performance that men do from noninvasive testing. Finally, because of the lack of full representation of women across the spectrum of disease, the available literature may not provide data on performance at the ends of the probability spectrum. Spectrum bias may be present since the studies we evaluated had potentially varied populations and varied disease definitions.
While readers may assume that requiring coronary angiography as the comparator would bias this report toward a higher risk CAD population, we found that the mean CAD prevalence ranged from 0.26 to 0.44; thus there was a broad spectrum of CAD prevalence in these studies. In fact, the range of CAD prevalence in this review is similar to a recent analysis of a large administrative database of patients referred for coronary angiography in which the prevalence of significant obstructive disease was 38 to 40 percent.29 The patient population that does not require coronary angiography can be characterized as having symptoms with low suspicion for CAD or pretest probability of less than 10 percent (note that all included studies enrolled patients with "suspected CAD"). Thus, results from this review would not apply to patients with low pretest probability of disease (e.g., gastroesophageal reflux, musculoskeletal pain, or panic attacks) where an NIT may be performed for clinical reassurance that their symptoms are noncardiac in origin.
In general, because there are few patients with high pretest probability, most clinicians would prefer to have patients undergo one NIT prior to determining a treatment choice or referral to coronary angiography. More than one NIT test is often required when the initial test results are equivocal. Our review did not identify studies that discussed the order in which different NITs were used for evaluating CAD. In fact, multiple testing or layered-testing strategies are areas where significant research is needed.
The current data suggest that NITs with higher sensitivity include coronary CTA and SPECT, and stress ECHO may represent an NIT with higher specificity. Stress CMR shows emerging data that may be in the upper range for both sensitivity and specificity. Additionally, the findings also demonstrate that NIT performance in women is not as good as in men, likely due to the reasons addressed above. The accuracy may also be location or operator dependent, and thus the results of published studies conducted at highly specialized centers may not uniformly apply to those seen in routine practice. Choice of NIT—and whether to use exercise or pharmacological stress imaging—may be influenced by functional capacity, which tends to be lower in women compared with men. Of note, the accuracy data for NIT modalities in men appeared a little higher than expected given previous meta-analyses of diagnostic accuracy data in the total population, which is likely because the published literature combined the accuracy data for men and women. Taken in context, these findings give support to the current ACC/AHA recommendations and studies on noninvasive testing in women.
Women are more likely than men to have false-positive stress tests; i.e., abnormal stress imaging with nonobstructive CAD on coronary angiography. In fact, up to 9 percent of women presenting with acute coronary syndrome will not have obstructive CAD when they undergo coronary angiography for potential PCI.30 Some experts suggest that these phenomena are due to the presence of microvascular obstruction, the incidence of which is hard to determine since there is no clear diagnostic test used to establish the diagnosis.
Currently, there is debate on whether NITs that measure heart function abnormalities (ECG abnormalities, wall motion abnormality, ischemia), including exercise ECG, stress ECHO, and cardiac nuclear imaging, are equivalent or inferior to NITs that measure anatomic abnormalities (detection of CAD) by CMR or coronary CTA. Will knowing the coronary anatomy (nonobstructive or obstructive) in symptomatic patients lead to better implementation of secondary measures—control of blood pressure, diabetes, and hyperlipidemia—to reduce future cardiac events? Or is it more important to intervene with medications and/or revascularization when ischemia is present? Though this review does not answer these important questions, we describe this evidence gap in the Future Research section.
Limitations of This Review
Despite identifying 104 studies (110 articles) that met the inclusion criteria, this systematic review has several limitations. First, our search focused on comparator studies of the various NITs with a gold standard of coronary angiography for establishing the diagnosis of CAD in symptomatic patients. While this focus was adequate for identifying studies to assess the diagnostic accuracy of the NIT modalities in women, we found very few comparative studies that reported the influence of clinical characteristics or patient demographics on diagnostic accuracy. Few comparative studies (NIT vs. coronary angiography, or NIT vs. NIT) provided information on incremental risk stratification, prognostic information, or meaningful information regarding decisionmaking, and few reported the significant risks in women. Study results on these issues were reported for the total patient population and did not separate the effects by sex. Many of the included studies were single-sex (women) studies and limited our ability to fully evaluate sex differences. Also, by focusing on symptomatic patients, this report did not review the use of coronary artery calcium scoring for asymptomatic, high-risk populations.
We are aware that there are several noncomparator studies of each of the NIT modalities that address these issues in women since routine clinical care does not require two NIT modalities or an NIT modality plus coronary angiography for the diagnostic workup of suspected CAD. Given the focus on comparative effectiveness, we did not include these noncomparator studies in our review. By focusing the review on comparative studies, however, we are reducing the bias that is inherent in noncomparative studies. Noncomparative studies have selection, spectrum, and intervention biases for the following reasons: The choice of NIT is determined by the treating provider; only a subset of patients with indeterminate or positive results are referred for further NIT testing or coronary angiography; and the clinical outcomes may be influenced by the medical treatments or revascularization options that are offered. Second, the sample size and low representation of women in most of the comparator studies may affect the authors' ability to analyze the results by sex, therefore reducing the number of studies reporting these findings separately. Third, most studies lacked long-term followup of the patient population, which affected our ability to find studies that reported prognostic information on how the different NITs influenced clinical outcomes. Finally, our summary of the harms and risks of NITs is limited by the lack of disclosure of periprocedural and postprocedural complications in most of the studies.
This systematic review has provided evidence for the summary sensitivities and specificities of exercise/stress ECG, ECHO, SPECT, CMR, and coronary CTA compared with coronary angiography in women. There was limited or insufficient evidence on the influence of clinical and demographic factors on comparative diagnostic accuracy, risk stratification, prognostic information, treatment decisions, clinical outcomes, and harms from different NITs specifically in women. Modifying the search criteria to include noncomparator studies of NIT modalities may increase the number of studies that address this limitation.
AHA American Heart Association
ACC American College of Cardiology
CAD coronary artery disease
CMR cardiac magnetic resonance imaging
CTA coronary computed tomography angiography
ECG electrocardiogram, electrocardiography
ECHO echocardiogram, echocardiography
KQ Key Question
MeSH Medical Subject Heading
NIT noninvasive technology
NSF nephrogenic systemic fibrosis
PET positron emission tomography
MI myocardial infarction
SPECT single proton emission computed tomography
TEP Technical Expert Panel
- Mieres JH, Shaw LJ, Arai A,, et al. Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: Consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. Circulation 2005;111(5):682-96. PMID: 15687114
- Lloyd-Jones D, Adams RJ, Brown TM,, et al. Heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation 2010;121(7):e46-e215. PMID: 20019324
- Stangl V, Witzel V, Baumann G,, et al. Current diagnostic concepts to detect coronary artery disease in women. European Heart Journal 2008;29(6):707-17. PMID: 18272503
- Matchar DB, Mark DB, Patel MR,, et al. Non-invasive imaging for coronary artery disease. Technology Assessment. Rockville, MD: Agency for Healthcare Research and Quality, October 2006. http://www.cms.gov/determinationprocess/downloads/id34TA.pdf. Accessed December 7, 2010.
- Agency for Healthcare Research and Quality. Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Rockville, MD: Agency for Healthcare Research and Quality. http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=318. Accessed August 22, 2011.
- Grady D, Chaput L, Kristof M. Results of Systematic Review of Research on Diagnosis and Treatment of Coronary Heart Disease in Women. Evidence Report/Technology Assessment No. 80. (Prepared by the University of California, San Francisco-Stanford Evidence-based Practice Center under Contract No 290-97-0013.) AHRQ Publication No. 03-0035. Rockville,MD: Agency for Healthcare Research and Quality. May 2003. http://archive.ahrq.gov/downloads/pub/evidence/pdf/chdwom/chdwom.pdf. Accessed July 14, 2011.
- Grady D, Chaput L, Kristof M. Diagnosis and Treatment of Coronary Heart Disease in Women: Systematic Reviews of Evidence on Selected Topics. Evidence Report/Technology Assessment No. 81. (Prepared by the University of California, San Francisco-Stanford Evidence-based Practice Center under Contract No 290-97-0013.) AHRQ Publication No. 03-E037. Rockville, MD: Agency for Healthcare Research and Quality. May 2003. http://www.ahrq.gov/downloads/pub/evidence/pdf/chdwomtop/chdwmtop.pdf. Accessed July 14, 2011.
- Whiting P, Rutjes AW, Reitsma JB,, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003;3:25. PMID: 14606960
- Atkins D, Chang SM, Gartlehner G,, et al. Assessing applicability when comparing medical interventions: AHRQ and the Effective Health Care Program. J Clin Epidemiol 2011;64(11):1198-207. PMID: 21463926
- Leeflang MM, Deeks JJ, Gatsonis C,, et al. Systematic reviews of diagnostic test accuracy. Ann Intern Med 2008;149(12):889-97. PMID: 19075208
- Blyth CR, Still HA. Binomial Confidence-Intervals. Journal of the American Statistical Association 1983;78(381):108-116. PMID: ISI:A1983QG01500024
- Rutter CM, Gatsonis CA. Regression methods for meta-analysis of diagnostic test data. Acad Radiol 1995;2 Suppl 1:S48-56; discussion S65-7, S70-1 pas. PMID: 9419705
- Arends LR, Hamza TH, van Houwelingen JC,, et al. Bivariate random effects meta-analysis of ROC curves. Med Decis Making 2008;28(5):621-38. PMID: 18591542
- Agency for Healthcare Research and Quality. Methods Guide for Medical Test Reviews [posted November 2010]. Rockville, MD. http://archive.ahrq.gov/downloads/pub/evidence/pdf/chdwomtop/chdwmtop.pdf. Accessed August 22, 2011.
- Owens DK, Lohr KN, Atkins D,, et al. AHRQ series paper 5: Grading the strength of a body of evidence when comparing medical interventions—Agency for Healthcare Research and Quality and the Effective Health-Care Program. J Clin Epidemiol 2010;63(5):513-23. PMID: 19595577
- Dodi C, Cortigiani L, Masini M,, et al. The incremental prognostic value of pharmacological stress echo over exercise electrocardiography in women with chest pain of unknown origin. Eur Heart J 2001;22(2):145-52. PMID: 11161916
- Sanfilippo AJ, Abdollah H, Knott TC,, et al. Stress echocardiography in the evaluation of women presenting with chest pain syndrome: a randomized, prospective comparison with electrocardiographic stress testing. Can J Cardiol 2005;21(5):405-12. PMID: 15861257
- Shaw LJ, Mieres JH, Hendel RH,, et al. Comparative Effectiveness of Exercise Electrocardiography With or Without Myocardial Perfusion Single Photon Emission Computed Tomography in Women With Suspected Coronary Artery Disease: Results From the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) Trial. Circulation 2011. PMID: 21844080
- Siegler JC, Rehman S, Bhumireddy GP,, et al. The Accuracy of the Electrocardiogram during Exercise Stress Test Based on Heart Size. PLoS One 2011;6(8):e23044. PMID: 21857990
- Doyle M, Fuisz A, Kortright E,, et al. The impact of myocardial flow reserve on the detection of coronary artery disease by perfusion imaging methods: an NHLBI WISE study. J Cardiovasc Magn Reson 2003;5(3):475-85. PMID: 12882078
- Lehmkuhl HB, Siniawski H, Lehmkuhl E,, et al. Value and limitations of dobutamine stress echocardiography in women with suspected coronary artery disease. Zeitschrift fur Herz-, Thorax- und Gefasschirurgie 2007;21(6):250-258. PMID: 2008012568
- Lu C, Lu F, Fragasso G,, et al. Comparison of exercise electrocardiography, technetium-99m sestamibi single photon emission computed tomography, and dobutamine and dipyridamole echocardiography for detection of coronary artery disease in hypertensive women. Am J Cardiol 2010;105(9):1254-60. PMID: 20403475
- Miller TD, Roger VL, Milavetz JJ,, et al. Assessment of the exercise electrocardiogram in women versus men using tomographic myocardial perfusion imaging as the reference standard. Am J Cardiol 2001;87(7):868-73. PMID: 11274942
- Raman SV, Donnally MR, McCarthy B. Dobutamine stress cardiac magnetic resonance imaging to detect myocardial ischemia in women. Prev Cardiol 2008;11(3):135-40. PMID: 18607148
- Hendel RC, Patel MR, Kramer CM,, et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol 2006;48(7):1475-97. PMID: 17010819
- Taylor AJ, Cerqueira M, Hodgson JM,, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Comput Tomogr 2010;4(6):407 e1-33. PMID: 21232696
- Douglas PS, Garcia MJ, Haines DE,, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians. J Am Coll Cardiol 2011;57(9):1126-66. PMID: 21349406
- Bonow RO, Douglas PS, Buxton AE,, et al. ACCF/AHA methodology for the development of quality measures for cardiovascular technology: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures. Circulation 2011;124(13):1483-502. PMID: 21875906
- Patel MR, Peterson ED, Dai D,, et al. Low diagnostic yield of elective coronary angiography. [Erratum in: N Engl J Med. 2010 Jul 29;363(5):498.] N Engl J Med 2010;362(10):886-95. PMID: 20220183
- Patel MR, Chen AY, Peterson ED,, et al. Prevalence, predictors, and outcomes of patients with non-ST-segment elevation myocardial infarction and insignificant coronary artery disease: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE) initiative. Am Heart J 2006;152(4):641-7. PMID: 16996828
Full Report
This executive summary is part of the following document: Dolor RJ, Patel MR, Melloni C, Chatterjee R, McBroom AJ, Musty MD, Wing L, Coeytaux RR, Ross AK, Bastian LA, Anderson M, Kosinski AS, Sanders GD. Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women. Comparative Effectiveness Review No. 58 (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-2007-10066-I.). AHRQ Publication No. 12-EHC034-EF. Rockville, MD: Agency for Healthcare Research and Quality. June 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
For More Copies
For more copies of Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women: Comparative Effectiveness Review Executive Summary No. 58 (AHRQ Pub. No. 12-EHC034-1), please call the AHRQ Publications Clearinghouse at 1-800-358-9295 or email email@example.com.


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American Revolutionary War 225th Anniversary Commission meets, Dec. 13
Posted December 11, 2000; 05:40 p.m.
University will host the convening meeting of New Jersey's 225th Anniversary of the American Revolutionary War Celebration Commission in Nassau Hall on Wednesday, Dec. 13. The 10 a.m. meeting, which is open to the public, will be chaired by Secretary of State DeForest B. Soaries, Jr. The 23-membered Commission will be greeted by University Vice President for Public Affairs Robert K. Durkee, who will note Princeton's significant links to the war, including the four months in 1783 that Nassau Hall served as the Capitol of the United States.
The Commission was established by Gov. Christie Whitman in July to plan and coordinate state events, from 2001 through 2008, that celebrate and increase awareness of New Jersey's crucial role in the American Revolutionary War. The Commission also will work with local communities and others involved in such events. Among its duties, it is charged with planning a special observance, on Sept. 3, 2008, to mark the signing of the Treaty of Paris, which formally ended the Revolutionary War.
Nassau Hall served as the nation's Capitol after mutinous American troops forced the Continental Congress to flee Philadelphia. The site was chosen primarily because Continental Congress President Elias Boudinot had grown up in Princeton.
Several significant events happened during these months, from June to November, 1783, including commendation of George Washington for his conduct in war; the receipt of word that the Treaty of Paris had been signed and the receipt of the first foreign minister accredited to the independent United States, Peter John van Berkel from the Netherlands. Nassau Hall also served as the meeting site of New Jersey's first State Legislature, in 1776, and was used, at different times, as a barracks and hospital during the Revolutionary War.
There will be limited public seating for the meeting, which will be held in the Faculty Room of Nassau Hall on campus. For more information, contact Lauren Robinson-Brown, University Communications, 609-258-3601, or Mike Kinney, Department of State, 609-777-2533.
Contact: Marilyn Marks (609) 258-3601


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Though cancer has been known since antiquity, some of the most significant advances in scientists' understanding of it have been made since the middle of the 20th century. Those advances led to major improvements in cancer treatment, mainly through the development of methods for timely and accurate diagnosis, selective surgery, radiation therapy, chemotherapeutic drugs, and targeted therapies (agents designed against specific molecules involved in cancer).
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