text:
Zite for iPhone: An elegant, personalized reader
It's been a great week to be a news junkie with an iPhone. On Tuesday, iPad darling Flipboard finally appeared on Apple's smart phone. Yesterday, Google launched its aggregator, Currents. And today, completing the trifecta, Zite unveiled its all-new iPhone app.
Previously, Zite had been available solely for the iPad. It established its place in the increasingly crowded aggregator field by focusing on personalization--giving users something of a Pandora-like experience with news: Like something and want to see more from a specific publication or writer? No problem.
Now, the company--which was bought by CNN in August for a … Read more


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If it's November, then it must be time to release the results of our annual Top Doctors survey, a list that's closely watched by both our readers and by the medical community.
There are several new specialties this year (we broke the 100-mark!), as well as the addition of a practice area—organized into subspecialties—that's been absent from the list for many years: cosmetic surgery.
Cosmetic procedures have become so commonplace and accepted in the past couple of decades that it's become more important than ever for consumers to have a resource to help them choose an expert practitioner. And that's what our survey provides as chosen by more than 6,000 physicians in the region.
Indulge me an I-told-you-so here, but as I predicted earlier in this space, the inaugural Baltimore Grand Prix on Labor Day was a big success, affirmed more recently by the announcement by organizers that the race will return for Labor Day of 2012.
A thorough review of the event's economic impact is expected soon, but there was no doubt that the city saw huge benefits in hotel bookings and Inner Harbor restaurant business on what is normally a quiet weekend. The IndyCar drivers were excited about the race, too—the track, the crowds, and the city's support.
Tweaks to the event for next year, already being planned, should improve the track and lessen disruption to traffic and pedestrians, but regardless, it's a great new tradition for Baltimore that promises to build many times over on its initial success. And I hope Charm City remains the race's home far beyond the five-year agreement organizers have with IndyCar.
But don't take it from me: Take it from people like our very own Michael Phelps, who tweeted after the race, "Top 5 coolest things I've ever done!!!! Amazinnggg!!!!!" And he's done some pretty cool things.

subset: commoncrawl


text:
It's Hatched! 180 Bought
Deal Over
If you're a handyman (or woman) needing supplies or helpful hints for your next DIY project, DealChicken knows you'll like this great deal. Pay $25 for $50 worth of merchandise; that's a savings of 50% from Ace Hardware on Apalachee Parkway. Add a bonus of helpful customer service and a knowledgeable crew here to guide you to the right tools, ladders, batteries and storage units for your particular job. Bring fun and beauty to your outdoor living spaces with a new grill or garden supplies, decorative pots, wind chimes and bird baths. You'll discover this store offers more than nuts and bolts when you're in the middle of doing or planning a project to spruce up your digs or dig up your spruce. They're open seven days a week and easy to find.
Owners Jay and Becky Hosford Fanguy make certain their recently opened store lives up to the Ace Hardware motto: 'the helpful place.' Homeowners and DIY-ers like the great customer service and the convenient location just past Capital Circle off Apalachee Parkway.
50% off merchandise at Apalachee Ace Hardware
The Merchant, not DealChicken, is solely responsible for this Deal. This Deal is subject to the Terms of Service and HOW DEALCHICKEN WORKS.
Apalachee Ace Hardware
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Greenville Fire Chief Retires, Son Appointed As ChiefChanges are coming to the Greenville Fire Department -- after 21 years serving as fire chief, Mike Phillips is stepping down... and he has a close tie to the man taking over...
Mike Phillips tells us he's retiring after 40 years in the force, because it's simply his time to go -- but it's a bittersweet goodbye as he watches his son step up as the new fire chief. They say most fire departments are like family. And in the case of the Greenville Fire Department Chief, Mike Phillips says it's very true... He says his time in the fire department has changed his life for the better. "That's what this job and this profession is all about -- it's helping other people. When we come to work each day, we never know what exactly we are going to end up doing, but we know whatever it is, even if it's a medical call, or a fire alarm... we're going to help somebody," Said Mike Phillips. It's helping people that's become his passion. He tells us he's been involved in hundreds of fire and emergency calls the last forty years. "Probably the ones that stick in my mind the most are the ones where we had fatalities and loss of lives that take place, especially with children. That thing really sticks with you," Said Mike Phillips. As he retires from his position, he's known to many in the community as more than just a boss, but also a dad. And it's his son, Chad Phillips, who is the incoming fire chief. He's served the fire department the last 22 years and is currently the EMS Director at the station. He says watching his dad growing up inspired him. "Well of course, this is bittersweet for me, I hate to see my father retire, but I think he'll do well and we wish him well in his retirement. But at the same time, there's so many responsibilities that have been given to me, some changes that we want to make," Said Chad Phillips. Chad Phillips took his official oath of office Monday night. Mike Phillips is also a pastor at a Butler County church. He says with his time off, he hopes to do more church work there and spend more time with his family. Alabama News Network wishes him all the best. |
Click here for a free download of the latest Adobe Flash Player.
PollWhat's onFull ScheduleCW Link |


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Photo submitted Nine Boy Scouts and their leaders had an epic six-day adventure when they biked 50 miles through Delta County, floated 50 miles along the Gunnison River and hiked 50 miles. Above they are traversing a section of the Crag Crest Trail on Grand Mesa."There is no way I can walk 10 miles today!" murmurs Bryce Simler as he steps out of the van that has taken him to the final trail head.
It is Saturday, day six of an epic week-long journey that has included 50 miles of biking, 50 miles of canoeing, and to this point, 40 miles of hiking.
Read more...
Photo submitted
4-H'ers visit Washington, D.C.
Janelle Hollister, representing Delta County, was among this group of Colorado 4-H'ers who were pictured with Senator Michael Bennet. They were delegates attending the Citizenship Washington Focus in Washington, D.C. This conference draws young people and volunteer leaders from all 50 states, Puerto Rico and several Canadian provinces. They learn about the democratic process and their roles as citizens while experiencing Washington, D.C. They were able to attend bill-writing workshops, a national issues forum, mock elections and congressional sessions to help enhance their leadership skills.
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Tuesday, March 11, 2014
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RALEIGH—A dentist in Raleigh is spreading smiles to some people in need Friday.
Village Dental on Edwards Mill Road is offering free cleanings and tooth extraction. The event is sponsored by Dentistry From the Heart, a national nonprofit that provides free dental care for people who can not afford it.
Patients say the event is a huge help for people who have to cut costs in this tough economy.
"You decide, 'Am I going to eat today or am I going to get my teeth cleaned and get dental care.' We do what we have to do. We eat, and we put the dental care and health care on the side burner. But these things, these types of events are really great for us," said patient Shonda Hurtt.
Dentistry From the Heart has provided free dental care to over 25,000 people since it started in 2001. Friday's event runs until 4:30 p.m.


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Campaigns Britain's Day of Shame Spot the Difference? We Only Want the Earth! Campaign for British withdrawal No Means No! No British Royal Visits! Imperialists Out! Reclaim The Republic |
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SKU: 250487 Weight: 0.08
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List Price:$11.58 Your Price:$6.93 You Save: $4.65 (40%) International customers, please view our shipping page for information on additional shipping fees. CLICK HERE
CARON & BOND AMERICA-Needles & Retainer Set. This package contains ten metal needles and two green plastic retainers for use with the Bond America Ultimate Sweater Machine (sold separately). Imported.


text:
EDB Registration
Schemes and Incentives
Trade Shows
Online Trading Platform
Online Promotion
Trade Infomation
Advisory and Training
Trade Statistics
About Us
Our Mandate
Organisational Chart
EDB Act
Citizen's Charter
Ministry of Industry and Commerce (MIC) plays a dynamic role in the development of the industrial sector. It is the key Ministry responsible for promoting industrial development in the country within the wide policy framework of Mahinda Chintana spelt out by the government. This Ministry which is the policy formulating entity for the industrial sector has taken several initiatives to increase the industrial sector performance.
CBI - Centre for the Promotion of Imports from developing countries - is an Agency of the Netherlands Ministry of Foreign Affairs. The CBI contributes to sustainable economic development in developing countries through the expansion of exports from these countries. CBI has worked for several years in Sri Lanka providing market intelligence on the European market, coaching exporters to become sustainable exporters to Europe and strengthening the services for exporters of Business Support Organizations like the EDB.
Watch a video to learn more about CBI's services
Click here to view CBI Market Intelligence Platform
The International Trade Centre is a United Nations Agency and implementing agency of the World Trade Organisation. ITC's mission is to enable small business export success in developing and transition-economy countries, by providing, with partners, sustainable and inclusive development solutions to the private sector, trade support institutions and policymakers. The organisation strives to strengthen the international competitiveness of enterprises in developing countries and transition economies, to develop the capabilities of trade service providers to support exporters and support policymakers in integrating the private sector into the global economy.
Watch a video to learn more from the Executive Director


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4:00 am
Mon March 26, 2012
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By Louisa Lim
A selection committee in Hong Kong has chosen a former Cabinet chief as the southern Chinese financial hubs next leader. The voters were handpicked by Beijing. Leung Chun-ying's term will start in July.


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Get 8 delicious metabolism-boosting meal ideas for breakfast, lunch, dinner—and dessert!
Prep time: 15 minutes
Total time: 45 minutes
Serves 4 (4 potato skins with filling, along with 2 cups romaine lettuce per serving)
4 large baking potatoes, such as Idaho (about 2 pounds)
2 cups baby spinach, thinly sliced
1/2 cup 0% fat plain Greek yogurt
1/3 cup reduced-fat sour cream
1 teaspoon hot sauce
1 tablespoon olive oil
4 ounces nitrate-free turkey bacon, chopped
1/4 pound 7% lean ground turkey
1/2 teaspoon garlic powder
2 tablespoons dried onion
1/2 cup crumbled feta cheese
4 scallions, thinly sliced
8 cups shredded romaine lettuce
1. Fill a large stockpot with 3" water. Bring to a boil. Add the potatoes and cook for 15 minutes, or until fork-tender.
2. Remove the potatoes and transfer to a cutting board. Cut in half lengthwise, scoop out the centers, and place the filling into a large bowl.
3. Add the spinach, yogurt, sour cream, and hot sauce. Mash with a fork to break up the potatoes until fairly smooth and set aside.
4. Preheat the oven to 400ºF. Warm the oil in a medium skillet over medium heat. Add the skins and cook for 2 to 3 minutes per side, or until brown. Transfer to a baking sheet lined with aluminum foil.
5. Add the bacon, turkey, garlic powder, and dried onion to the same skillet. Cook for 4 to 5 minutes, stirring often with a wooden spoon and breaking up the turkey, or until it is brown and no longer pink.
6. Spoon the turkey mixture over the hollow side of the skins. Top with the mashed-potato mixture and scatter with the cheese and scallions. Bake for 10 to 15 minutes, or until the topping is hot. Serve immediately over the lettuce.
Per serving: 398 calories, 32 g protein, 25 g carbohydrates, 5 g fiber, 11 g fat (4 g saturated), 539 mg sodium


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Dear Members,
A few weeks ago, I started to work on docs/126030 [1] in cooperation
with Gavin Atkinson (gavin@) and Giorgos Keramidas (keramida@) to update
chapter ``Source Tree Guidelines and Policies'' of the ``FreeBSD
Developers' Handbook'' [2]. Based on Gavin's original patch, I created
drafts on how to fix the sections in question (and I linked them below).
During the update, I found useful to include a section of Dag-Erling's
Subversion Primer on the Wiki [3] about vendor imports. At the moment,
I do not erase the old text (about vendor imports with CVS) but I kept
it for compatibility reasons (and moved to a separate subsection as des@
advised). However, if somebody says it is deemed to be removed I will
do that.
Because I am not so experienced in vendor imports (as a doc committer)
but I would like to help Gavin (and others who want this book updated),
I ask you to review my changes and express your ideas, comments and
Note: This mail was posted to -doc a few days ago. I have not received
any answer to it (maybe due to its highly technical nature), but I hope
members of list will comment on this.
Draft of section (5.1) MAINTAINER on Makefiles:
Draft of section (5.2) Contributed Software:
Diff for the curious:
Thank you in advance.
[1] http://www.freebsd.org/cgi/query-pr.cgi?pr=docs%2F126030
[2] http://www.freebsd.org/doc/en/books/developers-handbook
[3] http://wiki.freebsd.org/SubversionPrimer/VendorImports


text:
The advisories and warnings for winter weather have been canceled or expired. More>>
VDOT is reportingtraffic issues on I-81 N at mile marker 130.3. That's near the Dixie Caverns exit in Montgomery County. They say a multi-vehicle accident has resulted in traffic backing up as much as 10 miles. More>>
The Eyes of Freedom is made up of life sized portraits include 23 Marines who died during the Iraq war. They were from the same unit based in Columbus, Ohio. More>>
The Lynchburg community is welcoming home a group of Marines that deployed to Africa. Six marines from Charlie Company, a marine reserve unit out of Lynchburg, spent seven months in Africa. More>>
Roanoke County Police say they've seen an increase in tire dumping. They're finding discarded tires at county parks and on rural roads. They have no suspects at this time; and they're looking for your help.Anyone with tips on tire dumping should call Roanoke County Police's non-emergency line at (540)562-3265. More>>
Q99's two-day Care for Kids Radiothon starts this morning at 6 a.m. and runs non-stop until 7 p.m.. They'll continue again Saturday at 8 a.m. until 6 p.m.. More>>
WSLS 10 is on the scene of two tractor trailers that have overturned on Route 220 southbound in Henry County just south of Ridgeway. More>>
Happy Friday!We're following some extremely slick roads and quickly changing conditions across the region this morning. More>>
Russia's parliament supports Crimea's declared upcoming vote to split from Ukraine.
With a solitary Ukrainian athlete taking part in the opening ceremony, Russian President Vladimir Putin opened the Winter Paralympics in Sochi on Friday against the backdrop of his country's military action in Crimea. More>>
Sobbing on the witness stand, the Army captain whose sexual assault accusations triggered the court-martial of a general testified Friday that they had a three-year affair and that he threatened to kill her and her family... More>>
Russia rallied support Friday for a Crimean bid to secede from Ukraine, with a leader of Russia's parliament assuring her Crimean counterpart that the region would be welcomed as "an absolutely equal subject of the... More>>
U.S. employers stepped up hiring in February despite a blast of harsh winter weather, renewing hopes that the economy could accelerate this year. More>>
If potholes are any measure, it's been a hard winter in Virginia. More>>
President Barack Obama ordered the West's first sanctions in response to Russia's military takeover of Crimea on Thursday, declaring his determination not to let the Kremlin carve up Ukraine. He asserted that a... More>>


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Phone: 503-823-6925
1120 SW 5th Ave, Room 1300, Portland, OR 97204
Budget Mapping provides a graphic representation of City of Portland revenues and expenditures. The City is divided into eight areas: the seven neighborhood coalitions plus the Central City. Budget mapping is one way for policy makers and community members to better understand the distribution of spending and the delivery of service throughout Portland.
Budget Maps
These were the first budget maps produced in the spring of 2011


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Remington Sportsman Non-Slip Medium Clip Point Skinner Knife
Part Number: | REM18192 |
Manufacturer: | Remington Knives |
Retail Price: | $21.58 |
Our Price: | $18.95 |
You Save: | $2.63 (12%) |
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REM18192: Remington Sportsman Non-Slip Medium Clip Point Skinner Knife
- Blade Length: 3.75"
- Handle Length: 5.75"
- Total Length: 9.5"
- Blade Material: 440HC Stainless Steel
- Handle Material: Overmolded Rubber
- Comes with a black leather sheath
- Made in China
Leather is known for its durability and traditional appeal. When compared to kydex it is preferred for its silence when bumped against other objects, as well as blade retention.
A nylon polymer that is lightweight and extremely durable, Zytel can be shaped and textured to provide excellent grip.


text:
skip to main navigation
Meet the ultimate palmtop guitar companion and recording studio. Only slightly larger than an iPod, the tiny-yet-powerful MICRO BR is a dream for musicians on the go. The MICRO BR offers four simultaneous playback tracks (plus 32 V-Tracks), MP3 compatibility, onboard multi-effects, built-in rhythm patterns, a tuner, USB, an SD Card slot, and more. No guitar case or gig bag should be without one!
BR in Your Pocket or Guitar CaseThe MICRO BR is so small you can put it in your pocket! It measures just 136.0 mm x 81.0 mm x 21.4 mm (5-3/8" x 3-3/16" x 7/8"). But even though it's tiny, the MICRO BR packs an entire studio's worth of features into its tiny case. There are a dozen buttons on its front panel, nine knobs, and even a built-in microphone for quick capture.
Four Tracks & MoreAt its core, the MICRO BR is a four-track studio with four simultaneous playback tracks and two simultaneous record/input tracks.However, there's more to this recorder than meets the eye. Each of the four main playback tracks also has eight companion V-Tracks (for a total of 32), so you can record take after take after take, then pick your best material for final mixdown.
Drum Machine & Effects OnboardGiven the MICRO BR's small size and low price, you might be surprised to find the next two features onboard: (1) Almost 300 drum patterns are included. Use them for play-along inspiration or even as song foundations. The rhythms don't consume any of the four playback tracks — they play back independently. (2) A quality multi-effects processor is onboard, including a time-stretch algorithm for changing the tempo of your audio tracks without changing pitch — a great tool for both audio editing and phrase training. The Time Stretch feature can also be used with MP3 data; the MICRO BR's Center Cancel feature can be applied to MP3 data as well.
MP3 CompatibilityThe MICRO BR is capable of loading and playing MP3 files. Load up your favorite guitar hero song via USB, slow down the tempo with no pitch change, and learn all of your favorite licks. You can even use the MICRO BR as a standard MP3 player. All of your data is stored on convenient SD (Secure Digital) media found in common electronics shops. The included 128MB card, for example, can record approximately 65 minutes of audio when one mono track is selected.
Portability is of course one of the most important factors in choosing the Micro BR...
Micro-BR DVD Owner's Manual
Click for Details
MICRO BR Play Case
Earphones/Guitar Cable Set
AC-Power Adaptor
Stereo Microphone for MICRO BR®
Stereo Headphones
Binaural Microphones/Earphones
This is the latest version of the BR WAV Converter software for converting BR-532/-600/-800/-864/-900CD/MICRO BR tracks to .WAV files and .WAV files to BR-532/-600/-800/-864/-900CD/MICRO BR tracks.
Supports Microsoft Windows 7/Vista/ XP Home/XP Professional.
Supports Mac OS-X 10.4.2 or later.
If you have a question about operating your Roland or BOSS product, please contact our Product Support department by phone or email.
In addition, we have a library of Support Documents that you can download and reference. If Support Documents are available for this product, they will be listed below.


text:
Behind-the-Scenes Texas
Check out a few of Steven Rinella's photos from the Texas episode of The Wild Within
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Behind-the-Scenes Scotland
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See before and after photos of Robert Irvine's biggest restaurant transformations.
Master Your Cooking Skills
Learn the fundamentals of cooking with Cooking Channel's tips and videos.


text:
Results 1 to 5 of 5
- 11-26-2012, 06:52 PM Thread Author #1
Re: Getting my sgs3
I suggest a zagg shield hd,worked best when I had my s3 and I use one on my one x,their very easy to install. It's a little pricey but its worth the cost. Add a otterbox defender to the equation and you'll have a greatly protected,sexy looking phone.
My one x is better then you one x!!
Re: Getting my sgs3
I have to disagree with the above. Go naked! Lol. Just kidding. It's up to you. I never put cases on my devices. I just can't stomach adding bulk and hiding the sleek form factor. But that's me.
Sent from my SCH-I535 using Android Central ForumsMobile Devices: Nexus 5 32GB Black
Carrier: AT&T
Computer: MacBook Pro (2012) 8GB RAM, 750GB HDD
Other devices: iPad Mini
The Basics: Unlocking and Rooting - http://forums.androidcentral.com/htc...hing-roms.html - 11-27-2012, 04:43 AM #4
Re: Getting my sgs3
I use spigen(ultra crystal) screen protectors, on my S3,with a cruzer lite case, also have a blue aluminum back cover as well .
I wanted to keep the phone thin this time.
I have had otterbox cases ,,, but stopped getting them since my last 2 phone upgrades. - 11-29-2012, 08:28 PM #54G LTE Thunderbolt
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getting my Eris tomorrow...
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how can i get my phone to look like this?
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Will someone please tell me how to get my music on the phone!!!
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What should I know or do when I get my Droid?
By tghockey07#ac in forum Motorola DroidReplies: 6Last Post: 11-10-2009, 01:54 PM


text:
The Pew Charitable Trusts is driven by the power of knowledge to solve today's most challenging problems. Pew applies a rigorous, analytical approach to improve public policy, inform the public and stimulate civic life.
Stay updated with Pew News Now! We invite you to sign up to receive our weekly e-mail newsletter.
Pew offers news delivered to your desktop via RSS feed. Subscribing is easy. To learn more or get started, follow the link below.
Subscribe to News Feed
Source Organization: Pew Safe Credit Cards Project
Author: Nick Bourke
10/03/2008 - In October 2008, the Pew Safe Credit Cards Project shared comments (PDF) based on its recent work on credit cards with the Federal Reserve. Select findings from the project—including information on credit card penalty re-pricing and analysis of credit cards in the market—were included.Pew is no longer active in this line of work, but for more information visit the Safe Credit Cards Project on PewHealth.org.


text:
In early 2000, blood bank regulations were changed to permit specially trained licensed practical nurses (LPNs) to administer blood. Recently, the NYS Board for Nursing and State Department of Health collaborated to revise and clarify the role of LPNs participating in the administration of blood components, resulting in new guidelines that agencies must follow if they choose to permit LPNs to perform such activities. Every hospital in the state has been alerted to the new guidelines. Hospitals must document the curriculum used in training LPNs, and the completion of training and determination of competency of individual participants.
Each institution must specify, in writing, whether LPNs may participate in blood administration and, if so, which tasks they may perform and for which components. The institution must verify and document that RNs have been educated regarding the delegation of blood administration tasks to LPNs. Delegation of these tasks is based on the RN's professional judgment, the competence of the LPN, policies and procedures of the institution, and standards of nursing practice.
The RN retains the ultimate responsibility for administration and clinical management of blood components, including assessment of the patient for signs and symptoms of a transfusion reaction or other adverse event. Since current Education Law does not permit LPNs to make patient assessments, the practice of blood component administration requires an RN's supervisory presence on the patient care unit at all times when blood components are being administered by LPNs.
"The Administration of Blood Components by LPNs" and the "Course Outline for Training Licensed Practical Nurses in the Administration of Blood Components" are available online under "Practice Alerts and Guidelines." Questions on the scope of practice for LPNs or RNs may be answered by calling 518.474.3817, or by e-mail. Questions relating to blood transfusion requirements may be directed to the Blood and Tissue Resources Program: 518.474.5341 or by e-mail.
For questions, contact Education, Practice and Research at 518.782.9400, ext. 282


text:
TransActive is an internationally recognized non-profit focused on serving the diverse needs of transgender and gender nonconforming (GNC) children, youth, their families and allies.
What we do...
award-winning staff specializes in delivering experienced, professional,
compassionate and affirming education, counseling, case management and
advocacy services to
children, youth and families.
Guided by our "Best Practices" model
(RACE) and mindful of other professional
guidelines and Standards of Care,
TransActive leads the
way in serving families, children and youth through close collaboration with
additional service providers, the medical and legal communities and
civil/human rights advocates.
TransActive offers academic, professional community group and family
unit gender identity focused training and educational services through
START Training
Training and education may be associated with a specific family
request or initiated by an organization, agency or community group as
part of diversity or core competency training.
Our Speakers Bureau can also provide
award-winning, knowledgeable and entertaining presenters for
conferences, luncheons, public events, professional seminars and more.
What parents have to say...
Cisgender, Gender Nonconforming, Gender Fluid, Gender Variant, Genderqueer or Transgender?
While everyone's assigned birth gender (male or female) is designated by others based primarily on the external appearance of our anatomy1, our individual gender identity is based solely upon the internal experience of ourselves as masculine, feminine, androgynous, non-gender or a unique blend of all the above.
For most people, their assigned birth gender (more or less) matches how they experience their internal gender identity. This is known as being cisgender (CG).
Many cisgender people do not conform to the social or cultural
stereotypes that are expected of them. This can range from the kind or
color of clothes someone wears, to the way they speak or words
they use when they speak or the way they move or gesture. It can also be
reflected in gender non-stereotypical career choices.
All of these variations (and more) are examples of
gender nonconformity (GNC).
10% of children are singled out due to gender nonconformity2
Transgender ('Trans*' or TG for short) is an 'umbrella' term describing children and youth who do not relate to, experience or express their gender identity in a way that corresponds either to social or cultural gender stereotypes, their physical anatomy or assigned birth sex.
Could your child be transgender?
The short answer is, yes. Transgender identity (or the cultural equivalent3) occurs in children of every nationality, religion, ethnicity and economic status in every corner of the world. Being transgender is as natural as being cisgender... just more rare.
1% of all children may be transgender4
While there is a great deal of misinformation and myths surrounding the lives and experiences of trans people, the truth is that in most ways they are just like everyone else... even if they are kids. And they need the same things all children need, unconditional love and affirmation for who they are.
We hope you find information here that may be helpful.
You are not alone.
1. Some children are born with genitalia that is not obviously male
or female. They may be what is known as 'intersex'. For more
information on this, visit the
Intersex Society of
North America.
2. "Childhood Gender Nonconformity: A Risk Indicator for Childhood
Abuse and Posttraumatic Stress in Youth," Andrea L. Roberts,
Margaret Rosario, Healther L. Corliss, Karestan C. Koenen, S. Bryn
Austin. Pediatrics, doi: 10.1542/peds.2011-1804, online February 20,
Two-Spirit (Native American),
Kathoey (Thailand),
Fa'Fa' Fine
(Samoa), etc.
San Francisco Unified School District School Climate Study


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It's been a rough year for all of us but it feels like we're exiting 2009 with some great momentum. Seeing Call of Duty: Modern Warfare 2 destroy all sales records for an entertainment product felt great after some reports of sluggishness in the business. Also, it was a unique moment to watch more than 1500 Autodesk University attendees in Vegas grab their jaws off the floor after seeing over 30 minutes of Avatar footage in Dolby 3D! Avatar has not only driven some groundbreaking innovation for moviemaking; it is a fantastic immersive experience with an amazing story.
A lot of people wonder what our facilities look like, so here's a quick tour of our Media & Entertainment headquarters at 10 Duke Street in Old Montreal.
Recently, I got to leave behind the yellow and red leaves of Canada for the blooming purple Jacarandas of Australia. It's been great to enjoy a bit of spring as winter approaches fast here.
Our vision for Digital Entertainment Creation encompasses one of a scalable on-demand infrastructure that follows the ups and downs of real life production cycles...
Welcome to the AREA Virtual SIGGRAPH. We'll be featuring live product demos from New Orleans, customer presentations, product videos, free master classes and more.
In his first video blog for AREA, Marc Petit, senior vice president, Media & Entertainment talks about the entertainment industry in these challenging times. He also addresses Autodesk's focus on providing creative tools and enabling production efficiency, as well as a new initiative to help you, the artist, excel in your career.


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Careers | Newsroom | For Health Professionals |
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Home > Methodist Neurological Institute > Nantz National Alzheimer Center > Support The NNAC |
Join Jim Nantz in his fight to eradicate the suffering and devastation of Alzheimer's disease and associated dementia based illnesses through investigations of genetic predisposition, vascular disease and stroke, and multiple environmental factors, including exposure to toxins, concussion and traumatic brain injury. Through NantzFriends.org, you can add your support to that of millions of others and join the team that will fight – and win – the battle against the ravages of this disease through world-class research, education and patient care conducted at the Nantz National Alzheimer Center at Houston Methodist Hospital.
Please join the Nantz Friends team by subscribing to one of the levels of support below. Your gift can be made in your own name, or in honor or memory of a friend or loved one, whose family members will be notified of your gift, if you wish.
The Nantz National Alzheimer Center is a place of healing and hope. It represents a legacy of excellence, as well as an on-going reputation of progressive research and care. The scientific community increasingly sees us as a leader in Alzheimer's disease and dementia, including the role of concussions and other past neurological trauma. Philanthropy helps the NNAC sustain these ideals and chart a new course for the future – a course that leads to improved neurological health in our nation and around the globe.
Please join Nantz Friends by considering a leadership gift opportunity. These gifts and commitments can be made over a three to five year period. To learn more about how you can impact the fight against Alzheimer's through a critical, life-changing commitment to the Nantz National Alzheimer Center, please contact Sandra Nauert at 832-667-5839 or firstname.lastname@example.com.
Academically Affiliated with Weill Cornell Medical College
© 2014. Houston MethodistSM, Houston, TX. All rights reserved.


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Includes veterans' benefits, starting and running a business, unemployment, County job openings, and selling to the County.
Includes the courts, Sheriff-Coroner-Marshal's Office, victims' services, and jury duty
Includes planning, building codes and permits, owning and renting a property, and property tax assessments
Includes child and adult health service, food stamps, foster care, mental health and substance abuse
Includes bereavement, certificates and vital records, and divorce
Includes air quality and burn days, garbage and recycling, sewer, and conservation
Includes adopting a pet, animal control, and local vets and shelters
Includes information on the county, representation, and voting
Includes activities and events, parks, museums, libraries, and volunteerism
Property taxes, business taxes, transient occupancy taxes, and fines.
Includes passports, bus schedules, and road maintenance
Includes forest fires and floods, emergency preparation, and emergency response
2014 Library Holidays & Closures
Memorial Day: Saturday, May 24
Applegate, Colfax, Foresthill, Granite Bay, Kings Beach, Loomis, Meadow Vista, and Tahoe City Libraries closed.
Memorial Day: Monday, May 26
All libraries closed.
Independence Day: Friday, July 4
Labor Day: Saturday, August 30
Labor Day: Monday, September 1
Columbus Day: Saturday, October 11
Columbus Day: Monday, October 13
Veteran's Day: Tuesday, November 11
All libraries closed
Thanksgiving Day: Thursday, November 27
Thanksgiving Holiday: Friday, November 28
Christmas Day: Thursday, December 25


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Theater legend Liza Minnelli (daughter of yet another theater legend, Judy Garland) is scheduled to play herself in an episode of NBC's soapy Broadway-themed television drama Smash, which returns to TV for its second season this coming February.
It is anticipated that the Tony Award-winning Ms. Minnelli (Cabaret, The Act, Flora, the Red Menace) will be singing a new song by Smash's resident songwriters, Marc Shaiman and Scott Wittman (Hairspray). She will have a duet with fellow Tony-winner, actor Christian Borle (recently of Broadway's Peter and the Starcatcher), who co-stars on Smash as Broadway composer Tom Levitt.
The name of the Smash episode that Liza Minnelli will appear in is called "The Surprise Party". Of her guest appearance, NBC Entertainment chairman Bob Greenblatt said, "Liza Minnelli is the essence of a multi-talented, singular show business sensation, particularly for her extraordinary contributions to Broadway. So what could be more fitting than to have her legendary talent on a show that celebrates a world Liza has dazzled for decades?"


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Ali Adam Valenzuela
- Politics
- American Politics
Ali Adam Valenzuela writes and teaches about American electoral politics, with a focus on Latino public opinion, immigrant socialization, voter turnout using field experiments, religion and politics, and the politics of racial and ethnic identity in the U.S. His current research uses surveys and geographic data to investigate contextual and institutional sources of politicized group identities. This work is complemented by field and survey experiments that test the consequences of identity-based political appeals on voter turnout and support for public policies. A third area of his research asks how regular churchgoing and church characteristics influence policy views, interest in politics, group attachments and party identification choices among religious individuals in the U.S. His research has been published in the Quarterly Journal of Political Science, American Politics Research and Presidential Studies Quarterly.
Professor Valenzuela is teaching two courses in Fall 2012: POL 423 (LAO 423 / LAS 423), Latino Politics – new undergraduate seminar; and POL 5xx, Identity Politics – new graduate seminar.
Ph.D. (2011), Stanford University; B.A. (2005), University of California, Los Angeles


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I was hoping to back up Warlock compared to Dazzle and Omni, but wow, I really can't after looking at the numbers.
That being said, I still wouldn't be surprised if he was still picked solely for Fatal Bonds, it can't be denied, that spell is amazing for almost any situation, and works so well in conjunction with most AoE heavy heroes. My friend and I have already been talking about running a Medusa/Warlock lane when she's out, and just going nuts with Fatal Bonds and Split Shot.


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Average Customer Rating: No Product Reviews | Be The First To Submit A Review! Ultragen has produced one of the most advanced recovery formulas ever developed. Included are complex proteins, carbohydrates, cortisol, L- Glutamine, amino acids and essential vitamins, minerals and electrolytes all designed to work synergistically to fully maximize recovery providing the right nutrients to the right place at the right time. 15 servings. Tropical punch, Cappuccino or Orange Creamsicle. Because of the added weight, additional shipping charges may apply to food and drink orders. Please Note: For your safety, we do not restock energy food or drink products returned to us. Item Code: UAW-ULT-045
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Dr. Bouchard is a Fourth-Year Radiology Resident; Dr. Falen is an Assistant Professor of Radiology; and Dr. Molina is a Professor of Radiology, Residency Program Director, and Vice Chairman of Education in the Department of Radiology, University of North Carolina, Chapel Hill, NC. Dr. Molina is also a member of the Editorial Board of this journal.
Lung cancer is the most frequently diagnosed cancer in the world, and the leading cause of death from cancer. 1 Radiology plays a critical role in the initial detection and diagnosis of thoracic malignancies, as well as in pretreatment staging, which is important in identifying patients with localized disease who are likely to benefit from surgical resection. 2 Chest radiography and computed tomography (CT) have been the primary imaging modalities used to fulfill these roles. Positron emission tomography (PET) is rapidly emerging as a clinically useful noninvasive study that complements conventional radiologic imaging in the evaluation of patients with lung cancer. 3 The role of magnetic resonance imaging (MRI) in this regard generally is limited; it is used primarily for specific problem-solving issues, such as the determination of chest wall or mediastinal invasion. 4
Lung cancer is by far the number one cause of cancer death in the United States, regardless of race or ethnic background. This disease burden is a fairly recent phenomenon, arising first in western countries in the 1930s, and rising sharply in subsequent years. Since 1950, lung cancer mortality has risen 197% in men, and 612% in women. In 1998, 20,000 more women died of lung cancer than breast cancer. The survival rate is poor, largely because lung cancer is usually diagnosed at an advanced stage. A cure can only be achieved by surgery, which is feasible only in patients who present in an early stage. However, even in this group, approximately 75% will die of recurrent disease. 1,5 Lung cancer is rare before the age of 40, after which age-specific rates rise sharply. The ages with the greatest incidence are between 65 and 79. 1
There are several extrinsic risk factors, but lung cancer is unique among all malignancies in that a single risk factor accounts for approximately 90% of the risk, specifically, tobacco smoking. The smoker is not the only one at risk. There is general agreement that lung cancer risks are increased by 60% from long-term environmental tobacco smoke exposure, making second-hand smoke a significant added risk factor. Other extrinsic factors include exposure to radon, and occupational exposure to asbestos, arsenic, and chromium compounds. Radon and asbestos share the distinction of having a synergistic relationship with cigarette smoking. There is increasing evidence that genetic factors can contribute to lung cancer risk. However, research has not yet identified the gene locus or the mechanism. 1,5
Lung cancer is a broad term for cancers arising in epithelial tissue in the lining of the bronchi, and also in the trachea, bronchioles, and alveoli. Approximately 90% to 95% of all primary lung cancers are bronchogenic carcinomas. Histologically, about 20% of these cancers are small-cell carcinomas. The other 80% are grouped together as nonsmall-cell lung cancers (NSCLC), which are divided into three subtypes: (1) adenocarcinoma (30% to 40%), (2) squamous cell carcinoma (30% to 40%), and (3) large cell undifferentiated carcinoma (10%). These three subtypes are grouped together because NSCLCs overall have similar treatment options, as well as a better prognosis when disease is still localized at diagnosis. 1,6,7
Approximately 90% of small-cell carcinomas are located centrally, and tend to invade longitudinally along submucosal and intramural portions of the bronchial walls and in the supporting tissues and lymphatics. 7 They are often characterized by extensive, bulky, mediastinal lymphadenopathy. Small-cell lung cancer is considered a nonsurgical disease, with the majority of cases presenting in an advanced stage. 8 The majority of squamous cell carcinomas are also located centrally, and are more frequently associated with bronchial obstruction. This is in contrast to large-cell tumors and adenocarcinomas, which tend to be peripheral. 6 A specific subtype of adenocarcinoma, known as bronchioalveolar carcinoma (BAC), can appear as a single nodule, segmental or lobar consolidation, or as diffuse nodules. 9 Other, more rare types of lung cancer include carcinoid tumors, adenoid cystic carcinomas, and mucoepidermoid carcinomas. 5
The detection and diagnosis of lung cancer usually begins with a chest radiograph, either in a symptomatic patient or in a patient undergoing a chest radiograph for an unrelated reason. The appearance of lung cancer is variable, and can range from a subtle finding, to the dramatic, depending on location, stage at presentation, and associated findings.
Central tumors may be visible on the chest radiograph as an abnormal convexity or density in the hilar region. In many cases, however, the major radiographic abnormality is abnormal parenchymal opacification due to atelectasis or postobstructive pneumonitis, which may obscure the central tumor. The distribution of parenchymal findings depends on the tumor location, and can range from subsegmental atelectasis to the collapse of an entire lobe or lung (Figure 1). 10,11 Occasionally, the cancer remains identifiable as a central contour bulge, and if it obstructs the right upper lobe bronchus, it may result in the S-sign of Golden. The peripheral concave portion of the S is formed by the interface between the collapsed right upper lobe and the remaining hyperinflated lung. The more central convex portion of the S represents the tumor itself. Other, less frequently seen manifestations of a central tumor include mucoid impaction, air trapping, and pulmonary vascular occlusion or reflex vasoconstriction leading to oligemia or infarction. 10
Often, the first indication that a cancer exists is the finding of a solitary pulmonary nodule (SPN) on a chest radiograph. The SPN is usually defined as a single round or oval opacity in the pulmonary parenchyma, measuring <3 cm in diameter. The SPN is one of the most common radiographic abnormalities detected, seen in up to 1 in 500 chest radiographs, with an estimated malignancy rate between 20% and 40%. 12 With studies of good quality, a SPN larger than 1 to 2 cm is usually not difficult to detect, but can be overlooked easily in certain locations, such as the lung apices, the parahilar and paramediastinal regions, below the domes of the diaphragm, and overlying the spine. As many as 90% of small peripheral lung cancers have been reported to be visible retrospectively on prior chest radiographs, and missed lung cancer is a leading cause of malpractice litigation against radiologists. 10 Bronchogenic carcinoma is most often located in the upper lobes, particularly the right upper lobe, and not surprisingly, most missed cancers are in the right upper lobe (Figure 2). A 1991 study of 93 patients with SPNs found 63% to be in the upper lobes, with the right lower lobe being the next most common site. 13
Once discovered, certain characteristics of an SPN, such as size, calcification, shape, edge characteristics, cavitation, and growth rate can help differentiate between a benign and malignant lesion. The size of a lesion is not only important in terms of its visibility, but also because of the relationship of size to malignancy. Once a nodule reaches a size >3 cm, it is more likely to be malignant. However, the incidence of primary malignancy in smaller lesions, even in those <1.5 cm, is substantial enough that size alone is insufficient for differentiation. 10
Certain types of radiographically visible calcification, such as lamellated or central calcification in granulomas, and the popcorn pattern in hamartomas, are highly specific for benignity. Caution must be exercised, however, as a growing lung cancer may surround a calcified granuloma. In addition, dystrophic calcifications may rarely be seen in both primary and metastatic tumors, and a minority of carcinoid tumors also calcify. 6
The margin of a lesion can also provide useful information. Lobulation of a nodule is a worrisome feature that suggests uneven growth, and supports malignancy. Lobulations are thought to be caused by contraction or differential growth rates within the tumor. Spiculations, defined as linear strands extending from the nodule into the lung parenchyma, are of even greater concern, and are thought to represent a desmoplastic response to local tumor extension. 6,7,10,13
Cavitation is seen in a minority of lung cancer, mostly squamous cell carcinoma, but also occasionally in adenocarcinoma or large cell types (Figure 3). Usually, the cavity wall is thick (>5 mm) and may demonstrate a nodular internal margin. A maximum wall thickness <4 mm is unlikely to be malignant, but rare cases do exist with thin walls simulating bullae. 10
Growth correlates with doubling time, which is a measure of volumetric growth, not diameter. The natural history of lung malignancy is to double its volume 40 times before death occurs. Once a nodule has reached the reliably detectable size of 9 mm, it has already undergone 30 doublings. Most tumors have a doubling time of between 30 and 490 days (mean value 120 days), and doubling times that are either shorter or longer suggest a benign etiology. A 9-mm SPN with a doubling time of 100 days will measure 1.1 cm at 3 months and 1.4 cm at 6 months, making accurate measurement critical. Discovery of an SPN on a chest radiograph should prompt every effort to obtain more remote films for comparison. The absence of growth over a 2-year period is the most reliable indicator of benignity. 6,10 Unfortunately, making a firm diagnosis for all pulmonary nodules, especially for small nodules ¾ 1 cm, remains problematic, as evidenced by a high rate for resection of benign nodules. 12
Cancers arising in the lung apex, known as superior sulcus or Pancoast tumors, are a distinct subgroup because of their characteristic location and constellation of symptoms (Figure 4). Radiographic findings can be quite subtle and are frequently obscured by, or misinterpreted as, overlying musculoskeletal structures, brachiocephalic vessels, or benign pleural thickening. Findings suggestive of malignancy include an apical cap >5 mm, asymmetry of apical caps >5 mm, an apical mass, and adjacent bone destruction. 10 Clinical symptoms of arm pain (secondary to involvement of the brachial plexus) and a Horner's syndrome (meiosis, ptosis, and anhydrosis, secondary to involvement of the stellate ganglion) are classically associated with a Pancoast tumor. CT and MRI are superior to chest radiography in evaluating the lung apex, particularly MRI, because of its ability to image directly in multiple planes and visualize the brachial plexus. 11,14
Lung cancer occasionally takes the form of focal or multifocal consolidation, typically with bronchioalveolar carcinoma (BAC). Although the most common appearance of BAC is as a SPN (43%), consolidation is the second most common radiographic pattern (30%). This pattern is caused by tumor growth along the framework of peripheral airways and alveoli, combined with mucoid secretions. Air bronchograms and air alveolograms are characteristic, but not specific, features. A pattern of focal or multifocal nodularity can result from involvement of one or more acini, and when confluent, can resemble non-neoplastic conditions, such as pneumonia, aspiration, or edema (Figure 5). However, the clinical course of bronchioalveolar carcinoma is more chronic, and without signs and symptoms of infection. The consolidative pattern has a poorer prognosis than the solitary nodular pattern. Bronchorrhea (copious white mucoid or watery expectoration), once considered the clinical hallmark of this disease, is an unusual and late manifestation seen only with diffuse bronchioalveolar carcinoma. 6,9,10
Hilar and/or mediastinal adenopathy is sometimes the sole manifestation of lung cancer. Small-cell carcinoma tends to have bulky, central adenopathy with a relatively inconspicuous separate primary lung parenchymal site, but all cell types can have metastatic spread centrally. Careful inspection of the normal contours, lines, and stripes that classically define the mediastinum may reveal enlargement of the aortopulmonary window, right paratracheal thickening or soft-tissue density, a double density adjacent to the aortic knob, or an abnormal convexity in the azygoesophageal recess, all of which are frequent findings of mediastinal metastasis of lung carcinoma. 10 The lateral film can be especially helpful in the evaluation of suspicious increased hilar or mediastinal density.
Intrathoracic spread of lung carcinoma is not limited solely to mediastinal and hilar adenopathy. The pleura, chest wall, heart, great vessels, diaphragm, and nerves are additional structures that can be involved secondarily. Such involvement significantly impacts tumor staging, treatment, and prognosis. Pleural involvement usually manifests as a pleural effusion, with or without pleural masses. Pleural effusion (either free-flowing or loculated) implies seeding by tumor, but a nonmalignant effusion can result from central lymphatic obstruction, or a coincidental benign cause, such as pneumonia, congestive heart failure, or pulmonary embolus. 10,11 Direct invasion of the pleura is also possible, but cannot be distinguished on a chest radiograph. Bone involvement is common, and can be due to direct extension or metastatic spread. Pancoast tumors are typically associated with direct extension to ribs or vertebral bodies, but this can also occur with other peripheral cancers. Metastatic disease may also involve other bones on the chest radiograph, as evidenced by bony destruction or lytic lesions in the humerus, sternum, clavicle, and scapula. Bronchogenic carcinoma can also involve the heart, either by direct extension or by manifesting as a malignant pericardial effusion, seen as an enlarging cardiac silhouette on serial radiographs. Elevation of the diaphragm may indicate phrenic nerve involvement by tumor, or be mimicked by a subpulmonic effusion. A history of hoarseness can be secondary to tumor involvement of the recurrent laryngeal nerve in the aortopulmonary window. 2,6,10
The chest radiograph plays a critical role in the detection and evaluation of the protean appearances and manifestations of lung cancer. However, once the suspected tumor is identified, additional important information is often necessary that cannot be provided by the chest radiograph. Therefore, the next step in the diagnostic work-up of lung cancer is computed tomography.
Thoracic CT scanning plays several vital roles in the evaluation of patients with known or suspected lung cancer. One is to further characterize a suspicious abnormality seen on a chest radiograph, and to provide a more complete evaluation of a primary neoplasm. A second and indispensable role is that of pretreatment or pre- operative staging, for which CT is the primary imaging modality. Additionally, chest CT helps provide a roadmap for other staging procedures such as bronchoscopy, mediastinoscopy, transthoracic needle biopsy, and video-assisted thorocoscopy. 14 Most, if not all, of the various manifestations of lung cancer described for chest radiography can be better evaluated with CT. Cross-sectional imaging can help further clarify a tumor's location, whether in a central or peripheral location, and delineate its relationship to pleura, chest wall, and mediastinal structures. The level and degree of obstruction by central tumors leading to atelectasis and postobstructive pneumonitis can be visualized easily with cross-sectional imaging (Figure 6). Squamous cell cancers arise in the cells lining the mainstem, lobar, or segmental bronchi, and are frequently associated with this pattern of obstruction. 6 Trapped secretions distal to an obstructing lesion can produce the so-called mucous bronchogram.
Imaging features used to characterize an SPN on a chest radiograph are equally as useful on CT, including size and growth rate, calcification, shape and margins, and cavitation, along with the additional characteristics of density and contrast enhancement. As with chest radiography, increasing size, especially >3 cm, correlates with an increasing chance of malignancy. CT enjoys the added advantage of more accurate measurement of a nodule's size to better detect and quantify interval growth. 6,7,12 CT can better detect and evaluate calcifications within a nodule. The distribution of calcium, rather than its presence alone, is a more important diagnostic consideration. Thin layers of calcium in a lamellar pattern are indicative of a granuloma, and popcorn calcifications with associated fat density, are associated with a benign hamartoma. 6
A smooth peripheral margin on CT is associated more frequently with benign lesions. As with chest radiographs, lobulations and spiculations are worrisome findings. In addition, the finding of a pleural tag, defined as a linear area of high attenuation, surrounded by aerated lung, originating from the edge of the mass and extending peripherally to contact the pleural surface, is also associated more frequently with malignant lesions. As with spiculations, a pleural tag correlates with a desmoplastic response. 6,7,13
The wall thickness of a cavitary lesion can be measured more accurately with CT. One study found that the majority (94%) of cavitary solitary pulmonary nodules with a wall thickness ¾ 4 mm were benign, and the majority (95%) with a wall thickness >= 15 mm were malignant. Lesions with wall thicknesses between 5 and 15 mm were almost equally divided between benign and malignant. CT also has the added advantage of better evaluating the contour of a cavity's wall. A smooth inner wall is more commonly associated with a benign etiology, while a nodular internal margin reflects focal tumor excrescences. 6
Several other characteristics of an SPN can be evaluated with CT, such as attenuation and contrast enhancement. Homogeneous attenuation has been found to be associated more often with a benign, rather than a malignant lesion. Thin collimation CT is more sensitive than standard CT for assessment of attenuation. 13 In 1980, an early study with CT reported that benignity was correlated with high Hounsfield units (>164), but further studies have demonstrated that the CT numbers of an SPN cannot be viewed as an absolute value, but rather are a relative indication of attenuation, dependent on scanner and patient variables. 15-18 These studies resulted in the introduction in the 1980s of a reference phantom that could be used as a standard with which the attenuation of a pulmonary nodule could be compared. Although there is controversy regarding the use of a reference phantom versus thin-section CT alone, a 1991 study found that a phantom is useful if the initial thin-slice CT is indeterminate. Also, if the attenuation of the nodule in question exceeds the attenuation of the phantom by 10%, it has a high probability of being benign. 13,19,20
A newer technique for the assessment of the SPN is based on differential nodule enhancement with IV contrast material, as measured with thin-slice CT. It relies on qualitative and quantitative differences in the blood supply to benign and malignant nodules. Results from a 1992 study suggest that malignant nodules tend to enhance significantly more (20 HU increase) than benign nodules, with the most diagnostically important measurement made at 2 minutes postinjection. 21
One additional CT finding that may be helpful in the evaluation of lobar consolidation and the clinical suspicion of bronchioalveolar cell carcinoma is the CT angiogram sign (Figure 7). This is defined as branching pulmonary vessels extending >3 cm in the midst of completely consolidated pulmonary parenchyma that is of diffusely homogeneous lower attenuation than that of muscle. This finding has been noted to be present in a large majority of cases of BAC, but is a nonspecific finding and can be seen in pneumococcal or tuberculous pneumonia, pulmonary infarction, and even lymphoma. 22,23
Of all newly diagnosed cases of lung cancer, approximately 80% are NSCLC. Surgical resectability, chemotherapy and radiation options, and survival rates are all related to the stage of disease. Small-cell lung cancer remains a nonsurgical disease, with the majority of patients presenting in advanced stages. The intrathoracic and extrathoracic staging of lung cancer involves assessment of the primary tumor and potential sites for metastases. The TNM staging system (Table 1), most recently revised in 1997, is the most widely accepted and utilized classification for preoperative staging. Accurate and reproducible staging is crucial in the clinical management of this disease. Since the development of CT scanning, this modality has become the mainstay in radiologic staging of chest malignancies. 8,14,24
With CT, the primary tumor is evaluated for initial size and location, as well as possible extension beyond the lung parenchyma. The primary tumor may involve the pleura, chest wall, mediastinal structures, or vertebral bodies. Hilar tumors may invade the trachea or carina. Metastatic sites include mediastinal lymph nodes, as well as distant sites such as liver, adrenals, brain, bone, and soft tissue. 2,6,14
Approximately 5% to 10% of patients who present with lung cancer have a pleural effusion. Unfortunately, diagnostic thoracentesis has a high (65%) false-negative rate of cytology for malignant cells. 8 The CT hallmark for a malignant effusion is soft-tissue nodularity along the pleural surface accompanying the effusion. Pleural nodularity or fissural thickening without an effusion can also be a sign of pleural metastasis. Pleural tumor dissemination is classified as T4 disease, and is usually considered unresectable. 2,8,11
Approximately 5% of all lung cancers invade the parietal pleura and chest wall (Figure 8). CT has demonstrated a wide range of results when assessing for chest wall invasion by tumor. Sensitivity ranges from 38% to 87%, and specificity ranges from 40% to 90%, depending on the study. 2 The best criterion for diagnosing chest-wall invasion with CT is bony destruction, with or without tumor extension into the chest wall. Other, less reliable signs of chest-wall invasion include pleural thickening, loss of the extra-pleural fat plane, an obtuse angle between the mass and the chest wall, and >3 cm of contact between the mass and the chest wall. Chest-wall invasion does not necessarily exclude resection, but there is increased morbidity and mortality associated with en bloc resection and chest-wall reconstruction in this setting. 2,8,11
Mediastinal structures that can be invaded by tumor extension include the trachea and carina, esophagus, mediastinal vessels, heart and pericardium, and vertebral bodies (Figure 9). Disease involving these mediastinal structures is classified as T4. Although gross mediastinal invasion by bronchogenic cancer can be diagnosed confidently on CT, attempts to distinguish subtle mediastinal invasion from mere mediastinal contiguity have met with limited success. 11 However, there are certain CT criteria that suggest technically feasible resectability. These include tumor contact of ¾ 3 cm with the mediastinum, less than 90š of contact with the aorta, and the presence of mediastinal fat between the mass and mediastinal structures. Unfortunately, the opposite findings (>3 cm contact with mediastinum, >90š of contact with the aorta, and obliteration of fat planes) are unreliable signs of either invasion or unresectability. 2
CT is the preferred imaging technique for evaluating adenopathy. The accurate localization of abnormal lymph nodes, whether peribronchial, hilar, mediastinal, scalene, or supraclavicular, is important in determining the N classification of the disease. The American Thoracic Society's mediastinal nodal stations are used by most surgeons, radiologists, oncologists, and pathologists to describe sites of nodal metastases in thoracic malignancies specifically 14 (Figure 10).
Lymph nodes are generally identified on CT as nonenhancing soft-tissue densities surrounded by mediastinal fat. Several studies have shown that the short axis diameter is the best predictor of actual nodal volume. 2 In practice, increased nodal size is the only useful criterion for malignancy, and a node measuring >1 cm is generally considered abnormal. Increased nodal size is not an absolute indicator of malignant disease, however, as nodes <1 cm in size may contain microscopic metastases, and enlarged nodes may represent benign reactive adenopathy to an unrelated process in the chest. Central low density can represent fat in a normal node, or necrosis in a malignant node. 2,25 The accurate description of abnormal nodal location is essential information in assisting the surgeon, bronchoscopist, or radiologist in planning a more invasive staging procedure.
Estimates of the overall prevalence of extrathoracic metastases (M1 classification and therefore stage 4 disease) range from 18% to 50%. 7,8 The most frequent sites of hematogenous metastases are bone, brain, contralateral lung, liver, adrenals, soft tissue, and skin. Distant metastatic disease implies surgical unresectability, and the median survival once distant metastases are diagnosed ranges from weeks to months, with few patients surviving beyond 1 year. At most institutions, a chest CT in patients with suspected lung cancer is extended inferiorly to include the superior portion of the liver and the adrenal glands. 8,11 A careful review of bone windows is also necessary in these circumstances, to exclude metastatic deposits in ribs, the sternum, the scapula, and the vertebral column.
It is well accepted that CT is the imaging modality of choice for staging patients with lung cancer. Compared with MRI, CT is faster, less expensive, has better spatial resolution, offers superior evaluation of the lung parenchyma, and is more sensitive in detecting calcification. However, in certain circumstances, MRI may play a complementary role to CT because of its superior tissue contrast, multiplanar imaging capability, and superb delineation of thoracic vessels. 4 There are areas of the chest where the geometry of the structures of interest are better imaged with MRI. Perhaps the best example is the evaluation of Pancoast tumors, in which direct coronal and sagittal imaging with MRI facilitates assessment of invasion of the chest wall, brachial plexus, subclavian vessels, vertebral bodies, and neural foramina 11,14 (Figure 11).
The superior contrast resolution of MRI suggests an advantage over CT in detecting subtle mediastinal invasion, but its poorer spatial resolution limits this advantage. The replacement of high signal intensity mediastinal fat by lower signal intensity tumor on T1-weighted MR images suggests the presence of mediastinal invasion, but one study comparing CT and MRI for this purpose showed similar accuracies of 56% and 50%, respectively. Some investigators have shown MRI to be superior to CT in detecting mediastinal extension when there is associated vessel involvement. MRI is also believed to be more accurate in establishing superior vena caval patency or obstruction, which may be due to thrombus, compression by soft-tissue mass, or direct invasion. 4,11
MRI may also demonstrate chest wall invasion better, with one study reporting a sensitivity of 90% and a specificity of 86%. 4 Signs of chest-wall invasion on MRI include loss of the subpleural fat stripe and visualization of soft-tissue tumor extension into the chest wall. Some early data suggest that MRI can also differentiate benign (low signal intensity) pleural nodules from malignant (high signal intensity) pleural nodules with T2-weighted and proton density weighted images with a specificity of 87%. 4
In early studies it was initially thought that tumor within lymph nodes would generate differential signal changes with respect to normal nodes, leading to increased sensitivity and specificity of MRI when compared with CT. However, several studies comparing these modalities for detection of mediastinal nodal metastases report similar sensitivities and specificities of MR and CT. A significant disadvantage of MRI is its poorer spatial resolution, which can lead to adjacent nodes on CT appearing as an enlarged mass on MRI, resulting in the mistaken diagnosis of abnormal nodal enlargement. 11
CT and MR imaging of the chest provides valuable information about the morphology of a lesion. However, morphologic information alone may not offer all the information necessary to direct proper clinical management. Many lesions are indeterminate as to whether they are benign or malignant by morphologic imaging techniques, such as CT and MRI, and further investigation is warranted. Patients may require an invasive biopsy procedure for further evaluation. Depending on the size and location of the lesion, CT-guided fine needle aspiration biopsy, transbronchial biopsy, mediastinoscopy, video-assisted thorocoscopy, or even thoracotomy may be considered to determine the nature of the lesion. There are risks associated with these procedures and some will be nondiagnostic. Also, >50% of radiographically indeterminate lesions that are thoracoscopically resected are found to be benign. 26
One of the more recent advances in oncologic imaging that has generated a renewed interest in diagnosis, staging, and response to therapy is positron emission tomography (PET). PET imaging with [2-18F]fluoro-2-deoxy-D-glucose (F-18 FDG) allows for the evaluation of the relative level of metabolic activity of a lesion compared with other tissues. PET imaging with F-18 FDG is based on the principle that there is increased utilization of glucose in malignant cells compared with most normal tissues. 27 The mechanism for the increase in F-18-FDG uptake is thought to be the result of an increase in the number of glucose transporters in malignant cells. 28 There is also an increase in the glycolytic rate as a result of increased hexokinase activity. 29 When F-18 FDG is administered intravenously, it competes with glucose for transport into cells. Once intracellular, it also competes with glucose for phosphorylation by hexokinase to F-18 FDG-6-phoshate. However, F-18 FDG-6-phosphate is not a substrate for glycolysis and is not further metabolized. Thus, it becomes trapped in the cancer cells, and the resultant accumulation of F-18 FDG-6-phosphate reflects glucose metabolism and allows for imaging. Malignant lesions demonstrating increased metabolism will appear as abnormal focal areas of increased radiotracer accumulation (ie, focal areas of hypermetabolism) (Figure 12).
F-18 FDG PET imaging has been shown to be an accurate, noninvasive imaging test for the assessment of pulmonary nodules and larger mass lesions. A comprehensive meta-analysis by Gould et al 30 of 40 eligible studies, including 1474 focal pulmonary lesions of any size, found the mean sensitivity and specificity for detecting malignancy were 96.0% and 73.5%, respectively. However, in this analysis, there was little data for nodules <1 cm in diameter.
When a lung mass is shown to be malignant, it is important to stage the extent of disease accurately. Appropriate clinical management depends on whether there is mediastinal involvement and/or distal disease. Several studies have shown that PET is more accurate than CT for the staging of NSCLC. A tabulated summary of FDG PET literature in lung cancer from 1993 through June 2000 showed PET to have a sensitivity of 96% for the diagnosis of malignancy versus 67% for CT. For NSCLC staging, the sensitivity and specificity for PET were 83% and 91%, respectively, versus 64% and 74% for CT. 31
PET appears to be more accurate than CT in detecting metastatic mediastinal lymphadenopathy. In one retrospective study of 96 patients, 66 with histologically proven malignant tumors and 30 with benign masses, the sensitivity and specificity of PET for detecting malignancy in the pulmonary lesions was 97% and 89%, respectively. 32 In this study, 111 surgically sampled sites were from lymph nodes. The accuracy of FDG PET in predicting malignancy of nodes was 91% compared with 64% for CT. The sensitivity and specificity of FDG PET in detecting metastatic mediastinal lymph nodes was 98% and 94%, respectively. 32 Imaging with PET was more accurate than CT for diagnosis of both mediastinal and distant metastases.
Valk et al 33 conducted a prospective study in 76 patients of PET imaging for staging of NSCLC in which mediastinal PET and CT findings were compared with the results of surgical staging. They reported the sensitivity and specificity for the diagnosis of N2 mediastinal nodal disease were 83% and 94% for PET and 63% and 73% for CT, respectively. 33
In another prospective study by Pieterman et al, 34 a logistic regression analysis was used to evaluate the ability of PET and CT to identify malignant mediastinal lymph nodes and distant sites in 102 patients with resectable NSCLC. The sensitivity and specificity of PET for the detection of mediastinal metastases were 91% and 86%, respectively. 34
PET improves the rate of detection of local and distant metastases in patients with NSCLC. Detection of unsuspected metastatic disease by PET may permit reduction in the number of thoracotomies performed for nonresectable disease (Figure 13). For broad groupings of NSCLC stage, 10% of cases were downstaged and 33% upstaged after PET. Staging that incorporated PET provided a more accurate prognostic stratification than did staging with conventional means. 35
In NSCLC, PET may reduce the need for mediastinoscopy when the primary lesion standard uptake value is <2.5 and the mediastinum is PET negative. 36 The high negative predictive value of PET suggests that lesions that are negative on PET are benign, biopsy is not needed and radiographic follow-up is recommended. 37 After potentially curative therapy of NSCLC, abnormalities or symptoms suggesting recurrence can be difficult to characterize. Early detection is important because salvage therapies are available for localized recurrence. PET better assesses the status of disease and stratifies prognosis than does conventional staging, effects patient management, and should be incorporated into paradigms for suspected recurrence of NSCLC. 38
Though there is much excitement about the use of PET in oncology, the technique has its limitations. False-positive FDG PET scans can occur with infectious or inflammatory processes. Abnormally increased FDG uptake can be seen with sarcoidosis, tuberculosis, histoplasmosis, cryptococcosis, aspergillosis, and other infections. 37
False-negative FDG PET scans have been seen with pulmonary carcinoid tumors. 39 False-negative scans have also been reported with bronchioloalveolar lung carcinoma. 40 False-negative PET imaging is also a problem if the lesion is too small for the resolution of the machine. This is most worrisome for lesions <1 cm in diameter.
In a study by Valk et al, a decision tree sensitivity analysis was used to assess the cost-effectiveness of a PET-based strategy for staging of NSCLC. They considered CT alone versus CT with thoracic PET. The CT plus PET strategy in the conservative decision tree showed a saving of $1154 per patient without a loss of life expectancy. 41 Another decision tree sensitivity analysis by Gambhir et al 38 demonstrated that a strategy using PET plus CT is more economical and has a marginal increase in patient life expectancy compared with the conventional strategy of staging patients with CT alone. 42
Lung cancer is an extremely prevalent disease that most radiologists will encounter on a frequent basis. Familiarity with the various manifestations of lung cancer on chest radiography may help suggest the initial diagnosis, especially in an older patient with a history of cigarette smoking. Once a suspicious abnormality is detected, CT is the next step in the diagnostic work-up. This is necessary to help confirm the diagnosis by identifying CT features of an abnormality that would more likely suggest cancer, and to stage the disease.
The emerging role of PET offers an exciting new diagnostic tool that can quantify the metabolic activity of a tumor or node, and can reveal additional sites of disease unsuspected on CT, thereby increasing the accuracy of the staging process. The role of MRI generally is limited to specific problem-solving areas, or when CT findings are equivocal or indeterminate. AR


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philipjterry - 4:00 pm on Dec 20, 2012 (gmt 0)
Excellent clarification - thank you. What other branches are there outside link beg? Link Bait and... Any other coined terms...?
One thing I have been doing lately is honing straight in on sites with phone numbers in the whois or contact info *first* seeing as I find making personal contact my main strength and leveraging the power of picking up the phone.
Once I prioritize sites with phone numbers I then proceed to check for defunct outbound links....
Does anyone have any inkling which pitch carries the most persuasive weight - broken pages or broken outbound links? I'm guessing pages if they are internally linked from other places in their site. They would appreciate it more if it's a big breakage.


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The gathering of the international youth organizations and groups during the process of the international youth and crime prevention summit has resolved to establish the International Youth-led Development Platform under the auspices of Baobabconnections.
This international platform aims to involve children and youth across the world as active partners in Community Safety and Urban Crime prevention.
We believe that to address crime and violence one has to tackle poverty, empower women and children, and most importantly establish global economic policies that make globalization work for all
We call on the United Nations, all spheres of government, civil society and the business community to support our endeavor to involve youth and children as active partners in the planning and decision making.
The international youth-led development platform is committed to developing an action plan in the course of the year.
This will include the establishment of:
The international youth lead platform calls on the Government of South Africa, the provincial government of KZN, and the municipality of eThekwini to:
We would like to thank UN-Habitat for having associated youth groups in the design of the Conference from day one; the Department of Community Safety and Liaison of KZN for hosting and resourcing the conference; the MEC for having embraced the idea of the Resource Centre and its adoption and the Government of South Africa.
We thank everybody for their commitment and we as the international Youth-led Development platform will do our part.