text:
At a Glance
Why Get Tested?
To diagnose an infection with the parasite Trichomonas vaginalis, which causes the sexually transmitted disease trichomoniasis
When to Get Tested?
When a woman has symptoms of infection, such as a foul-smelling vaginal discharge, genital itching, and/or pain during urination, or when a man has genital itching or irritation, burning after urination or ejaculation, and/or a discharge from the urethra
Sample Required?
In women, a swab of vaginal or cervical secretions; in men, a urethral swab. In some cases, urine may be tested.
Test Preparation Needed?
The Test Sample
What is being tested?
Testing can detect an infection with Trichomonas vaginalis, a microscopic, single cell (protozoan) parasite that is usually transmitted sexually, causing vaginal infections in women and urethral infections (urethritis) and prostatitis in men.
According to the Centers for Disease Control and Prevention (CDC), trichomoniasis, which is caused by the infection, is the most common, curable sexually transmitted disease (STD). In the U.S., an estimated 3.7 million people have the infection, but only about 30% develop any symptoms. Symptoms are more common in women than in men.
Trichomonas vaginalis is one of the most common causes of vaginitis (inflammation of the vagina) in women. When they occur, symptoms include:
- Vaginal swelling
- Itching, irritation, soreness
- Burning sensation
- Frothy, yellow-green vaginal discharge
- Foul-smelling vaginal discharge
- Frequent urge to urinate
- Possible blood-spotting
In men, symptoms may include:
- Burning after urinating or ejaculating
- Itching or irritation of the urethra
- Discharge from the urethra
These symptoms may take 5 to 28 days after exposure to an infected person or longer to develop; however, once diagnosed, trichomoniasis is easily treated with prescription antibiotics. During treatment, an infected person should cease sexual activity and inform partners so that they can also be treated and prevent re-infection.
How is the sample collected for testing?
In women, a swab of secretions is collected from the vagina. The sample may be obtained from the same thin-layer collection vial used for a Pap smear. In men, a swab is inserted into the urethra. Urine samples may also be used.
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.
Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
Is any test preparation needed to ensure the quality of the sample?
No test preparation is needed.
The Test
Common Questions
Ask a Laboratory Scientist
This form enables you to ask specific questions about your tests. Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, American Society for Clinical Laboratory Science. If your questions are not related to your lab tests, please submit them via our Contact Us form. Thank you.
* indicates a required field
Article Sources
NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.
Sources Used in Current Review
Centers for Disease Control and Prevention. Trichomoniasis - CDC Fact Sheet. Available online at http://www.cdc.gov/std/trichomonas/STDFact-Trichomoniasis.htm through http://www.cdc.gov. Page last updated August 3, 2012. Accessed January 2013.
Centers for Disease Control and Prevention. Sexually Transmitted Disease Treatment Guidelines. Available online at http://www.cdc.gov/std/treatment/2010/genital-ulcers.htm#hsv through http://www.cdc.gov. Page last reviewed January 28, 2011. Accessed January 2013.
American Sexual Health Association. Trichomoniasis. Available online at http://www.ashastd.org/std-sti/trichomoniasis.html through http://www.ashastd.org. Copyright 2012. Accessed January 2013.
MedlinePlus Medical Encylopedia. Trichomoniasis. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/001331.htm. Accessed January 2013.
Mission Pharmacal Company. Trichomoniasis: The most common curable sexually transmitted disease. Available online at http://www.trichomoniasis.org/Diagnosis/Index.aspx through http://www.trichomoniasis.org. Copyright 2013. Accessed January 2013.
Arup Laboratories. Laboratory Test Directory. Available online through http://www.aruplab.com/. Accessed April 2013.
Quest Diagnostics. Test Center. Available online through http://www.questdiagnostics.com. Accessed April 2013.
Sources Used in Previous Reviews
Centers for Disease Control and Prevention: Trichomonas Fact Sheet. Available online at http://www.cdc.gov/ncidod/dpd/parasites/trichomonas/factsht_trichomonas.htm through http://www.cdc.gov.
American Social Health Association: VAGINITIS/TRICHOMONIASIS, Questions & Answers. Available online at http://www.ashastd.org/learn/learn_vag_trich.cfm through http://www.ashastd.org.
Wu, A. (2006). Tietz Clinical Guide to Laboratory Tests, Fourth Edition. Saunders Elsevier, St. Louis, Missouri. Pp 1618.
Planned Parenthood: Trichomoniasis. Available online at http://www.plannedparenthood.org/health-topics/stds-hiv-safer-sex/trichomoniasis-4282.htm through http://www.plannedparenthood.org. Accessed June 2009.
Centers for Disease Control and Prevention. Fact Sheet: Trichomoniasis. Available online at http://www.cdc.gov/std/trichomonas/STDFact-Trichomoniasis.htm through http://www.cdc.gov. Accessed June 2009.
American Social Health Association: VAGINITIS/TRICHOMONIASIS. Available online at http://www.ashastd.org/learn/learn_vag_trich_tri.cfm through http://www.ashastd.org. Accessed June 2009.
MedlinePlus Medical Encylopedia: Trichomoniasis. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/001331.htm. Accessed June 2009.
TeensHealth: Trichomoniasis. Available online at http://kidshealth.org/teen/infections/stds/std_trichomoniasis.html through http://kidshealth.org. Accessed June 2009.
Petrin D, Delgaty K, Bhatt R, et. al. Clinical and microbiological aspects of Trichomonas vaginalis. Clin Microbio Rev 11:300-317, 1998.
Briselden AM, Hiller SL. Evaluation of Afirm VP microbial identification for Gardnerella vaginalis and Trichomonas vaginalis. J Clin Microbiol 32:148-152, 1994.
DeMeo LR, Draper DL, McGregor JA, et. al. Evaluation of deoxyribonucleic acid probe for the detection of Trichomonas vaginalis in vaginal secretions. Am J Obstet Gynecol 174:1339-1342, 1996.
Rubino S, Muresu R, Rappelli P, et. al. Molecular probe for identification of Trichomonas vaginalis DNA. J Clin Microbiol 29:702-706, 1991.
Witkin SS, Inglis SR, Polaneczky M, et. al. Detection of Chlamydia trachomatis and Trichomonas vaginalis by polymerase chain reaction in introital specimens from pregnant women. Am J Obstet Gynecol 175:165-167, 1996.
Campbell L, Woods V, Lloyd T, Elsayed S, Church DL. Evaluation of the OSOM Trichomonas rapid test versus wet preparation examination for detection of Trichomonas vaginalis vaginitis in specimens from women with a low prevalence of infection. J Clin Microbiol 2008 Oct; 46(10):3467-9.


text:
BackcountryEdge.com will be briefly unavailable for maintenance beginning at approximately 9AM ET on Tuesday, April 28th
Mountain House's Raspberry Crumble dessert is a sweet raspberry sauce mixed with rich chocolate cookie crumbs. Just add water, mix and enjoy a tasty dessert! Perfect for group outings, the Raspberry Crumble dessert provides four 4 oz. servings.
Perfect for quenching your on-the-trail ice cream cravings, Mountain House's Neapolitan Ice Cream Bar is a ready-to-eat dessert of vanilla, chocolate and strawberry freeze-dried ice cream. No preparation required!

subset: commoncrawl


text:
MultiCam Chattanooga
Traffic web cams for commuters in Chattanooga TN. Ready to head home and you want to check the traffic? MultiCam is the fastest way to get to the traffic web cams that matter to you. Instead of browsing to a web site and working your way through the menus and map graphics to find a web camera just open MultiCam on your iPhone and go straight to the camera you want with one click. Flick through the other cameras along your route, in order, with a simple Next button.
Should I stay or should I go?
The traffic is slowing to a crawl. Is it going to clear quickly or is it time to bail and find a better route? Open MultiCam, select the nearest camera with one click and then flick through the web cams along your route to see how far the congestion continues.
Touch the Favorite button on any camera page to copy the traffic cameras that matter to you to your Favorites list for faster access. Switch quickly from Show All to Favorites mode. In Favorites Mode the Previous and Next buttons follow the Favorites list.
MultiCam Chattanooga comes pre-loaded with 61 traffic cameras including I-24, I-75, US-27 and Highway 153. Use the show / hide button, new in version 2.2, to add or remove highways from the scrolling list.
This is not a video playing app. Traffic cameras take pictures at regular intervals, usually every one or two minutes. MultiCam displays the latest image from each camera. Touch the refresh button to update the picture.
Cameras are maintained by the Tennessee Department of Transportation. Individual cameras may be inoperative due to weather conditions or maintenance requirements.
Thank you for your interest, support and suggestions. We really do appreciate your help in making MultiCam better.
What's new
Fixes a faulty More Information link on the About page
Share with Others
- Last changed:
- Jul 23, 2013
- Category:
- Utilities
- Developer:
- Stanton Software
- Version:
- 7.32
- Size:
- Current Version Average Rating:
- 1.00 (1)
- All Versions Average Rating:
- 3.00 (17)
- Other Apps By This Developer
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• MultiCam Albany
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• MultiCam Ottawa
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• MultiCam Salt Lake City
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• MultiCam St Louis
• MultiCam Tacoma
• MultiCam Toronto
• MultiCam Washington Ferries
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• MultiCamPlus Alberta Highway
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• Philadelphia Traffic Cam +Map
• Pittsburgh Traffic Cam +Map
• St Louis Traffic Cam +Map
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• Vancouver Traffic Cam +Map


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An ambidextrous person. Obviously, short for "AMBIdextrous".
I'm so lucky. I'm an ambie. I can use both my hands equally.
por Mimzyyyyyyy
12 de Janeiro de 2010
2 more definitions
Top Definition
Girl who is very loving. Funky and cute but not too sassy. Loves to cuddle and craves attention. Heart of gold!
"Ambie your the greatest friend!"
por amber
16 de Abril de 2005
A sweet, self proclaimed "loner" who has no problem telling just what she thinks of your pathetic self. A great friend to have or an aweful enemmy. If you hurt her or attempt to her sometimes blond friend Erica will KILL YOU!!!
Doug: I am sooooo hot!
Ambie: "You are soooo not!"
Ambie: "You are soooo not!"
por Moo_E
12 de Dezembro de 2005


text:
Product Details
Chrysler 300 2010, Cat-Back Exhaust System by Corsa®, Dual Rear Exit. 2.5" Tubing. With Single Tips. The patented Reflective Sound Cancellation (RFC) technology provides a unique combination of a Reserved, Distinctive Performance Sound on acceleration, and No-Drone Comfort when touring. These mirror-shine polished stainless steel performance exhausts outlasts all competitors, sounding and looking good all the way.
- Reserved but Distinctive Performance Tone
- No Drone at Touring Speeds
- Cat-Back System
- Straight-Through Nonrestrictive Design for Improved Performance and Fuel Economy
- Gas Flow Increased Up To 35% Over Stock
- Up to 12 HP and 13 ft-lbs Torque Gains Over Stock
- Patented RSC™ Technology Provides a True Performance Voice Without Drone
- Pro-Series Stainless Steel Tips
- All Components Made in Stainless Steel to Ensure Never Changing Good Looks and Sound
- Designed, Engineered and Manufactured in Berea, OH, USA
- Easy Bolt on Installation
- No Welding Needed
- All Necessary Hardware and Detailed, Full-Color Instructions Included
- 50-State Emissions Legal
- Limited Lifetime Warranty for as Long as You Own Your Vehicle
The Corsa performance mufflers are true straight-through mufflers that provide an unrestricted gas flow, making for better exhaust scavenging and more torque and horsepower from your engine. Mandrel bent pipes and a carefully chosen pipe diameter for each application provides a very high overall efficiency for the Corsa performance exhaust systems.
The Corsa mufflers are of a unique and patented design that combines the performance advantages of straight-through mufflers with the sound control advantages of precision engineered baffled mufflers. By exact positioning and design of the baffles, Corsa's acoustical engineers can choose which sound frequencies to cancel out. Every vehicle has certain resonance frequencies that cause an irritating, and sometimes even nauseating, drone. Corsa mufflers are adapted to each application, with the mufflers cancelling out the sound frequencies that cause drone in the vehicle the muffler is designed for. This is how Corsa mufflers can keep an unrestricted performance and sound for acceleration while providing a comfortable sound level for cruising speeds. Corsa exhaust systems come in different tunings, catering to different customer tastes.
- Xtreme systems provide and Aggressive and Deep Sound. The sound is a race inspired big sound with a deep throaty growl.
- Sport system sound is Robust and Bold. Sport sound levels offer the popular Corsa growl when on the throttle. This is perfect for customers who want to be noticed on acceleration or when passing, but tour in comfort. Sport systems are ideal in combination with other moderate modifications such as performance air intakes.
- Touring sounds are Reserved but Distinctive. The Touring sound is just a notch above stock. The Touring systems are perfect for those who are adding other major power modifications to their car such as headers, to keep the sound blended perfectly at cruising speeds.
Corsa Performance Exhausts are the highest quality, best looking and most long-lasting exhaust systems you can find on the market. Corsa only uses the highest quality automotive grade stainless steel, polished to mirror shine. And this goes for all the components, including hangers and clamps, which makes for a better looking and more long-lasting installation than any other brand. There is no packed insulation material in the mufflers that can come loose or disintegrate (which is the major cause of failure for other straight-through mufflers). The Corsa system will keep its sound properties and good looks forever, if properly cared for. This is why Corsa performance exhaust systems are backed by a lifetime warranty. They will last you a lifetime without problems.
1,303.19 1,553.85Corsa Performance Exhausts® leads the premium exhaust market forward through advanced engineering and innovation. Utilizing the patented RSC™ technology, Corsa continues to enhance driving experiences, delivering powerful sound and noticeable performance gains without sacrificing the pleasure of cruising. Since entering the Corvette market in 1998, Corsa has engineered the most advanced exhaust systems in the world. Each exhaust system is tailored to deliver exactly what that vehicle – and more importantly, the owner – needs. Every system features the patented RSC™ Technology, developed to eliminate drone while cruising, a straight-through muffler, designed to maximize horsepower, and a sound that is acoustically styled to be a voice that fits the personality of a vehicle and its driver. Utilizing the most advanced manufacturing methods and making every part in the USA, the team at Corsa Performance Exhausts ensures that all products meet the highest standards of quality. Starting with advanced 3-D Modeling, through the engineering phase, the development, the advanced acoustic engineering, and the operation of automatic mandrel benders and coordinated measuring equipment, the team at Corsa takes great pride in their work. This is why Corsa exhaust systems fit, every time. Corsa Performance Exhausts focuses on drivers and the enhancement of driving experiences. This is a focus supported by the entire team of dedicated associates. The company recognizes and values the importance of employees at all levels of the organization, creating long-term value and focus on developing and sustaining job opportunities. As a brand of TMG Performance Products, a Division of The Mifsud Group, Corsa Performance Exhausts is committed to its employees, its partners, its values and to delivering premium performance exhausts to consumers.
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You will never pay more with CARiD! Not only will we match prices from any competitor's website or other reputable source, we will continue to honor that promise for up to one year after your purchase.
We'll match the price at time of purchase, or refund you the difference if done after the purchase. Either way, we are totally committed to providing you the best online shopping experience.
We're car and truck enthusiasts, just like you! And it's enthusiasts we hire in our Sales and Service Centers. Many of our staff are ASE certified and have spent years in the retail auto business.
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text:
Kraus 30" x 18" Undermount Kitchen Sink with Faucet and Soap Dispenser
This product has additional required/recommended options. To configure, add to your cart.
Special Offer:
24 Issues of Better Homes and Gardens
Included with purchase ($10 value).
Kraus 30" x 18" Undermount Kitchen Sink with Faucet and Soap Dispenser
Additional Documents
Weights & Dimensions
Additional Weights & Dimensions
Installation Type: Undermount | Finish: Stainless steel |
Gloss Finish: Yes | Material: Stainless steel |
Stainless Steel Gauge: 16 | Number of Items Included: 7 |
Pieces Included: Sink, faucet, bottom grid, basket strainer, strainer, towel, and soap dispenser | Scratch Resistant: Yes |
Stain Resistant: Yes | Rust Resistant: Yes |
Heat Resistant: Yes | Chip Resistant: Yes |
Tarnish Resistant: Yes | Acid Resistant: Yes |
Drip-Free: Yes | Non-Porous: Yes |
Number of Basins: 1 | Sink Shape: Rectangular |
Drain Assembly Included: Yes | Drain Placement: Rear |
Number of Faucet Holes: 0 | Faucet Included: Yes
Deck Plate Required: No | Handles Included: Yes
Valve Included: No | Cartridge Included: Yes
Overflow Hole: No | Garbage Disposal Included: No |
Basin Rack Included: Yes
| Basket Strainer Included: Yes |
Soap Dispenser Included: Yes
| Dish Towel Included: Yes |
Sound Dampening: Yes | Required Countertop Depth: 22 Inches |
Maximum Deck Thickness: 2.5 Inches | Outdoor Use: Yes |
Commercial Use: Yes | Eco-Friendly: No |
Product Care: Stainless steel sinks should be rinsed and dried after each use, and wiped with a mild cleaner approximately once per week. We recommend Bio-Clean for cleaning all Kraus products. | Country of Manufacture: China |
Assembly Required: No | Installation Required: Yes
Product Warranty: Limited lifetime |
ADA Compliant: Yes | ANSI A112.18.1 Compliant: Yes |
ASME A112.18.1 Compliant: Yes | California AB 1953 Compliant: Yes |
CSA Certified: Yes | IAPMO Certified: Yes |
Low Lead Compliant: Yes | NSF Certified: Yes |
NSF 61 Certified: Yes | SCC Compliant: Yes |
UPC Certified: Yes | cUPC Certified: Yes |
WaterSense Certified: Yes |
About the Manufacturer
Living in a new Era of Modern Evolution, Kraus continuously researches and explores broader markets, seeks new trends and designs, and maintains superior quality at unprecedented prices. The Kraus collection has the widest selection of exquisite styles perfect for modern residences or countryside homes. Their design team always looks ahead to fulfill consumers' ever-evolving desires and tastes at reasonable and affordable prices. As a result, their products are in high demand with shoppers worldwide. Kraus brings you the latest styles and provides the newest trends in exclusive bathroom décor. Their mission is to provide products of the highest quality at the lowest price, without ever compromising the excellence of their products.For Kraus, durability and reliability have always been the vital components in order to achieve the highest standards. Every model they offer undergoes rigorous testing and inspection prior to distribution. Kraus's key element of success is their customer's satisfaction.
Step into the Kraus world of perfection. With their supreme quality and unique designs, you will never feel the same about your bathroom décor. Let your imagination become reality!
Kraus 30" x 18" Undermount Kitchen Sink with Faucet and Soap Dispenser
Still have questions about this product? We're here to help
Tell Us What You Think!
Tell us what you think about this product. It will help us provide you with better products in the future and help your fellow shoppers make better purchases.
Write the first review Reference
30" x 18" Undermount Kitchen Sink with Faucet and Soap Dispenser is also sometimes listed under the following manufacturer numbers: KHU100-30-KPF2160-SD20


text:
Hendrix Small Smart Technology™ Desk
- In-Home Delivery
- Overview
At a country flea market, we spotted a carpenter's work bench with a vise attached to one leg. We designed this desk to replicate its bold design and sturdy craftsmanship. Details like a faux vise and an asymmetrical drawer lend authenticity, and a divided trough in back organizes supplies and conceals a three-plug Smart strip for plugging in laptops, phones and more.
- 60" wide x 26" deep x 30" high
- Crafted of pine and finished in heirloom pine.
- Hardware finished in antique bronze.
- Smart feature provides three electrical plugs in a recessed compartment to keep all gadgets tidy.
- View our Furniture Brochure.
- Read more on our blog about the inspiration behind this product.
- Dimensions & Care
- Frame is crafted of kiln-dried solid pine.
- Top is constructed of pine veneer over particle board.
- Finish is applied by hand and sealed with lacquer for moisture resistance.
- Overall: 60" wide x 26" deep x 30" high
- Top: 60" wide x 26" deep x 2" thick
- Drawer: 18" wide x 16.5" deep x 3" high
- Recessed Cubby in Top (3): 5.5" wide x 2" deep x 0.5" high
- Clearance under desk: 38.5" wide x 22.5" deep x 24.5" high
- Weight: 118 pounds
- Shipping Info
This is an oversized item.
View our Shipping Information
Customer Service - Shipping Information
Return Policy
At Pottery Barn, we take great pride in the quality and craftsmanship of our products. Attention to design, materials, safety and construction is our priority. We carefully inspect your order prior to shipment. Upon receipt, please inspect your purchase and notify us of any damage; we will arrange for a prompt replacement. If, within 7 days for Quick Ship upholstery and 30 days for all other products, you are dissatisfied for any reason, you may return your purchase for a refund of the merchandise value. Mattresses are final sale and may not be returned or exchanged.
We cannot accept returns on monogrammed, personalized, special-order items, or on items damaged through normal wear and tear. We also cannot accept returns of final-sale items which are identified by a price which ends in .99.
For returns of items purchased from your Pottery Barn registry, we will gladly provide a refund or exchange for the merchandise within 90 days of your event or within 90 days of purchase, whichever date is later.
You may return merchandise through the mail for a refund or replacement. For detailed procedures for returning items through the mail, please contact Customer Service at 1.888.779.5176, 7 days a week, 5:00am - 9:00pm (PT).
Also in this Collection
Hendrix Lateral File Cabinet
Lateral File Cabinet
- In-Home Delivery
Hendrix Bookcase
- In-Home Delivery


text:
Top Definition
To exude tremendous effort, to try extremely hard.
I decided to slack off and get a B in the class, but Ross went balls out and got a 100%
από Casey
11 Ιούνιος 2003
22 more definitions
Originally referred to the governor on old steam engines that had two ball that rotated across one another that would control speed depending on how fast they spun. Balls out meant going full speed or power.
That old steam tractor was going balls out.
από tradesman
21 Νοέμβριος 2003
This refers to the governor on a steam engine. Two heavy balls are attached to the engine so that as engine speed increases, the centrifigal force of the flywheel causes the balls to rise. As the balls top out, they govern (limit) the engine, thereby controlling maximum engine speed. "Balls out," then, refers to running the engine at maximum speed.
The engineer was running the train at a "balls out" pace while trying to make up time.
από Blueglowizard
18 Απρίλιος 2009
giving your all in a certain situation, being courageous
You should've seen me out there, I started to choke but then I went totally balls out.
από skrilla
17 Ιούνιος 2003
a unit of measure regarding to the top end speed of something.
when asked by the officer how fast he was going bill replied "im not sure but it was pretty ballsout.
από tellitizaman
6 Σεπτέμβριος 2010
Old timey terminology: on steam engines, they had steel balls in there that resricted steam flow. When the conductor was ready to pick up speed, he'd yell "Balls out!", signaling the help to do just that, thereby letting them haul some ass.
"Balls out! We got to mow down those hobos!"
από Dutch Grosse
29 Σεπτέμβριος 2003
Balls Out means many things. 1. Literal balls out of pants 2. No fear 3. Goin for it 100%
it's what we are. Steel Panther is Balls Out.
- Stix
- Stix
από better than tessa
4 Σεπτέμβριος 2011


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The Two-Way
5:37 pm
Tue October 11, 2011
Senate Passes Bill On Chinese Currency
Originally published on Tue October 11, 2011 6:41 pm
Update at 6:29 p.m. ET. With a 63-35 vote, the Senate passed a controversial bill that seeks to curb what lawmakers see as a Chinese advantage based on the country's manipulation of its currency.
The bill is mostly symbolic, because the House has said it will not move on its version of the bill until the White House expresses its opinion. The White House has said it is worried about whether the bill might violate international trade rules.
Our Original Post Continues:
This afternoon the Senate is set to vote on a bill that would impose tariffs on imports from countries that deliberately undervalue their currency. The move is aimed at China, which the U.S. has long accused to controlling the price of its yuan to keep its exports cheap.
As ABC News reports, the legislation has its detractors, who say it "could trigger a trade war" with China. ABC reports:
The currency legislation, expected to pass the Senate easily on Tuesday, has both strong advocates, who say it will make American goods more competitive and support more than 1 million new jobs, and critics who warn that will provoke Chinese retaliation and hurt Americans in one of their fastest-growing markets.
The bill could die in the House, where a companion measure has the sponsorship of more than half the members but lacks the support of the GOP leadership.
House Speaker John Boehner, R-Ohio, like the many large multinational companies that oppose the legislation, has said it would be dangerous to dictate another country's currency policies, and he can prevent the bill from ever being considered.
Reuters reports that China warned if the U.S. passed a law like the one on the table it would hurt relations.
"Should the proposed legislation become law, the only result would be a trade war between China and the U.S. and that would be a lose-lose situation for both sides," China's Vice Foreign Minister Cui Tiankai said on Monday. He added that a law like this would "hinder global economic recovery."
The White House, reports ABC News, hasn't come out against the bill, but they have expressed concerns that it "might violate international trade rules."
The Washington Post reports the House has said it will not move on its version of the bill until the White House gives its opinion.
"I think the debate would be well-served by the White House stepping up and detailing where its concerns are," House Majority Leader Eric Cantor (R-Va.) told the Post. "The (U.S. Trade Representative), the State Department, Commerce Department — they all have an interest in this and certainly the president does. This is a significant trading partner and it would have a tremendous impact, I would imagine, if a bill like this was passed — on consumers and pricing and the rest."


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Submit News
Dutch Anti-Islam Film Site Taken Down by U.S. Service Provider
Jason Mick
March 24, 2008 12:15 PM
comment(s) - last by
Mar 29
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A defaced image of the website promoting the film, which was removed by ISP Network Solutions.
(Source: Klein Verzet)
The current notice appears when visiting fitnathemovie.com.
(Source: DailyTech)
The video and the site sparked a large protest Saturday in Amsterdam.
(Source: Fred Ernst / AP)
Dutch filmmaker Geert Wilders faced with possible removal by his ISP may seek possible alternate distribution means for his radical film
The Netherlands is becoming the surprising center of conflict over the extent of free speech, religion and allegations of racism. The debate centers around an upcoming film by a local politician, which expresses strong criticism against Islam faith.
Several Islamic government have sought to ban materials criticizing Islam. The most recent example of this was when
Pakistan blocked the website YouTube
for promoting non-Islamic or anti-Islamic materials,
inadvertently crippled the country's internet traffic
Nearby Denmark found itself in the center of a similar controversy when a Danish newspaper aired cartoons depicting the Prophet Muhammad, the most important Islamic historic religious figure, in an embarrassing light. The cartoon led to protests worldwide outside Dutch embassies, death threats and at least one murder.
Now Holland is back in the limelight. Dutch lawmaker Geert Wilders, head of a reactionary party which controls 9 seats in the 150-seat Dutch Parliament, promoted his new film which portrays Islam in an extremely critical light, only to find his website taken down amid a storm of criticism. The film was promoted on the site which formerly had a simple title image, the words "Fitna" ("Coming Soon"), and an image of a gilded Qu'ran.
website has since been taken down
, and a note is posted stating that Network Solutions, the U.S. based service provider, is investigating whether the site violates its terms of service. The note about Wilder's site states, "Network Solutions has received a number of complaints regarding this site that are under investigation."
Network Solutions hosts the website of Hezbollah, a Lebanon-based organization labeled by the U.S. government as a terrorist organization.
While the company could not be reached for comment, its terms of service do include a broad provision banning, "objectionable material of any kind or nature." While the former website gave scant details about the upcoming 15-minute film, to be released on March 31st, it is certain to be found objectionable by some. Filmmaker Wilders says the film will underscore his belief that the Islamic holy book is "fascist."
Wilders prepared to distribute the video over the internet after being met with refusal from television stations unwilling to grant it airtime. Wilders, who lives under police protection due to death threats, refuses to be deterred, and was quoted Dutch news agency
on Saturday stating, "How many ways are there left for me to be worked against? If necessary, I'll go hand out DVDs personally on the Dam." The Dam is a colloquial name for Amsterdam's central square.
On Saturday protesters crowded the Dam to voice their distaste for Wilders. Amid sleet and heavy wind, between 2,000 and 3,000 protesters of mixed ethnicities assembled "Netherlands Shows Its Colors" in an advanced reaction against the film. Protesters carried signs such as "Standing Together Against the Right-Wing Populist Witch-Hunt."
One protester, Elisa Trepp, said, "I'm very much against Geert Wilders and racism in general. I think it's really important to show not only Holland but the rest of the world that there's a lot of people who do not agree with his ideas."
Hassan Iaeti, another demonstrator, traveled for hours to make it. He states, "The government could really do something. That's in the interest of the country - stop him, just stop him."
Dutch officials fear that the film may spark violent protests worldwide. Free speech in the U.S. is currently solely limited against making statements that would incite imminent lawless action (riots) as defined by the case Brandeburg v. Ohio. Similar limits to free speech exist throughout much of Europe, much to the chagrin of free speech advocates. As the video may spark worldwide lawlessness, the government may see it fit to block the video.
However the government remains relatively apathetic to the situation by all indications. No prominent politicians showed up at the protest. Prime Minister Jan Peter Balkenende has said previously that he did not agree with Wilders views, but supported his right to free speech. Balkenende did add that the video could threaten Dutch interests worldwide.
In Afghanistan protesters burned effigies of Wilders and demanded the withdraw of NATO-deployed Dutch troops from the country. A Dutch court will hear complaints against the film lodged by Muslim groups, on March 28th, however Wilders can elect to release the film before then.
remember me
This article is over a month old, voting and posting comments is disabled
Has Network Solutions lost it's mind?
My jaw hit the ground when I heard that NSI had actually precensored a domain name and it's associated website. The company's whole existence over the years has depended on its acting in an even-handed manner in domain name registrations.
Once you start precensoring and censoring domain names it's impossible to stop. How can fitnathemovie.com get banned and hizbollah.org, for example, not also get banned.
The people who did this massively idiotic move need job retraining to the tune of learning how to say "do you want fries with that?"
"Death Is Very Likely The Single Best Invention Of Life" -- Steve Jobs
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January 1, 2008
55 comments:
Such adorable photos! Love it:)
My Wordless Wednesday is up as well! Happy New Year!looks like you really had a heavy snow there..;) those are really cute photos..;)
I hope you had a Blast New Year Eve! Post mine tooThey both look happy!! Must've been fun :) Happy 2008!
It's not a Weekend;It's a Lifestyle- AnonymousJanuary 02, 2008 5:27 AM
Kids... snow... a recipe for a disaster of sogginess... but SOOOOOOO CUTE!
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how to make your family hate cycling -
37 posts
• Page 1 of 2 • 1, 2
how to make your family hate cycling -This is definitely not original but adapted from a book i read recently - ' JUST RIDE - a radically practical guide to riding your bike ' by Grant Petersen -
fits my fella to a tee - bless him: - we are all new riders -he has been playing with bikes for years 1.be coach and trainer - make sure you instruct the family on proper technique and critique their performance - especially everything that they get wrong 2.insist on proper saddle height (even though we were all scared stiff of falling over - and can't reach the ground when we are stopped unless we but our bits on the top thingy) took a while to figure out that it was OK to lean the bike a bit and hence touch the ground..... 3. emphasis the wonders of drafting even at family riding speeds- make sure everyone is scarily close to each others wheels and emphasise the importance of rotaing pace lines - its never too early to make the family into a 'peleton' - there are 6 of us so he has his own little bunch. 4. buy every one expensive bikes and then remind them how expensive they were - thus ensuring that they get ridden - guilt is a bugger 5. make sure they know that expensive bikes make riding up hills easy so that when it gets hard we know its our fault we are not quicker, better, stronger.. 6. make sure we all wear lycra - its really practical but getting a body conscious 17 year old into knicks - really??? 7. clipless are a must - no sooking - much more efficient and they will come undone if you crash!!! 8. make sure you point out to your wife all the really fast female riders that go past her - if she tries harder she can do it! see they are.... My fella really is a good guy - love him to bits - but I can relate to all of the above- anyone else??? - fiona
Re: how to make your family hate cycling -He did all that and you're still riding? What does a man need to do to go riding in peace
Nice work Fiona! Trying to encourage the rewoman to ride more so its probably a good thing I avoided most of those.
Re: how to make your family hate cycling -Mmm......time to make sure he gets handed a copy of the book JUST RIDE........print out your post in the form of a book marker, delete the section where "you love him to bits", and place it in the book in a prominent position.
Re: how to make your family hate cycling -I am confident that I am not that guy - but my family may not agree
. . . . . . .
Re: how to make your family hate cycling -Falling off and losing half my face in a faceplant has seriously helped my family hate cycling!
Not so much a cyclist...more of a sit down comedian
Re: how to make your family hate cycling -I've done 1,2 & 8 at various times in my life. Number 8 was about 20 years ago though. I've learnt since then.
Re: how to make your family hate cycling -Original - by the same author. Good website for non-racer riders.
Re: how to make your family hate cycling -I'm not that guy. When I ask the kids "can you ride back to see if my rear light is on", and then make a massive break-away off the front, it's only so that they won't fall for that one when they're riding in Tour de France.
Re: how to make your family hate cycling -I was teaching my eldest daughter (11) how to (a) ride a fixie and (b) draft and swap turns on Friday night. I'm not going to be towing her for the rest of my life, she's got to take a turn up front as well.
Re: how to make your family hate cycling -Glad you guys are all on the side on the angels...and would never do any of those things.....
Can't call him on it - he's working in WA around Tom Price only home every 5 weeks- bikes are banned on site so he is struggling that we are riding and he is stuck on a spin bike.... would be nice to think we could catch him up and while he's away but not much hope. He might get a bit sensitive if he knew I was broadcasting his approach to the world...he might think I was taking the mickey...too old to get a new bloke so better to leave him to his delusions that he is 'just helping' fiona
Re: how to make your family hate cycling - I know you love him, but can I give him a slap for being so silly! I don't have a significant other at the moment but the last thing I would want to do was to pressure them into loving my recreational activities. Furthermore such things should be about enjoyment! Not about having to do things 'right'. Funny thing is that I never could get an ex of mine into cycling while we were dating. However I lent her a bike after we broke up. Now she is more of a cyclist (at least the lycra clad variety) than I am!
Re: how to make your family hate cycling -
+1 (said with gap toothed grin ). When man invented the bicycle he reached the peak of his attainments- Elizabeth West.
Re: how to make your family hate cycling -
Mea culpa I'm guilty of this. I held back in Amy's Gran Fondo giving helpful riding tips to my bloke until I was given the heave ho and told to leave him alone. Result! Got to ride off ahead.
Re: how to make your family hate cycling -
And won a world cup medal as well! I hope you rubbed it in his face.
Re: how to make your family hate cycling -
Have I stopped talking about that yet? Apparently not
Re: how to make your family hate cycling -Ensure that you are the leader, everyone falling behind to admire your highly stretched semi-stransparent riding nicks which you insist do not need any undies.
Unchain yourself-Ride a unicycle
Re: how to make your family hate cycling -Hey, vitamins E, P and O just help the kids breathe better on the family bike rides around the park.
Re: how to make your family hate cycling -
...so that they can read "Rule #5" which you had tattooed on your behind.
Re: how to make your family hate cycling -Hi Fiona,
I've read a number of your threads thinking "why doesn't she just ask her husband?" but the approach and long absences answer the question. Good on you for reaching out and doing this for yourself. In the meantime would you care to rate the performance of my mate here: http://youtu.be/J0_lukcqOtk
Re: how to make your family hate cycling -Lol....
Sometimes riding with family gets in the way of riding for yourself. So you want family to be riding fast, efficient and far. My wife is talking keenly about getting clip in pedals so she can feel more connected to the bike when hitting up jumps on the trails. Looking forward to the first few clip stacks...
Re: how to make your family hate cycling -Anyway, my family don't ride so there is not much that I can do to discourage them further. Indeed even the two exercise bikes get no use.
Unchain yourself-Ride a unicycle
Re: how to make your family hate cycling -You're lucky. My hubby says,
'you're paying WHAT for a bike????" He thinks that because I use road shoes that I'm a Tour De France try hard...
Re: how to make your family hate cycling -OH Rhubarb - that's just plain mean - firstly to film it and then to youtube it....don't you love how they are just making sure you do it the right way...bless...you're young, you still have time, train him well....and lose the camera - you get maximum points for 1. the elegant topple and 2. not throwing a tantrum.
Mind you, mine is still very good and I would not swap him (except when he is providing training tips, especially on hills and in heavy traffic on narrow roads!!!) or when I am over tired, hormonal or just cranky.... Its all good fun and I must admit I am too competitive for my own good - probably wouldn't get nearly as antsy if I could keep up with him. Anyway joining a local cycling group for sat rides from tomorrow and local bike shop for wednesday rides, & going to a coach on Tuesday - should keep me busy and save me annoying everyone on the forum with my endless questions! hope you didn't lose any skin - I could not even speak while riding in clipless for the first 10 days - was scared to death and just had to keep repeating clip in clip out - must have appeared a complete noodle!! BionicW - despite my whinging I am lucky - he is generally a good egg - does not complain when I take off for 3-6 months on little overseas volunteering projects, has always supported my obsessions (horses and all that goes with them are hideously expensive and time consuming) and has been (is a) great dad - BUT I am not allowed to get electronic gears til he does and no bike upgrade til I can ride 50km at 30-35kph average - His money is safe!!!
Re: how to make your family hate cycling -LOL !!!
Sorry Fiona. I'm a bloke. That guy literally is a mate and that was his wife, not me. She was very good about it though I thought.
Re: how to make your family hate cycling -Oops so sorry Rhubarb- I obviously took mate the wrong way!!!
your frind can be saved - but his wife is way better behaved than me. sorry again for gender re assignment....Fiona
37 posts
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Summary of Evidence
Separate PDQ summaries on Endometrial Cancer Prevention; Endometrial Cancer Treatment; and Uterine Sarcoma Treatment are also available.
Transvaginal Ultrasound
There is no evidence that screening by ultrasonography (e.g., endovaginal ultrasound or transvaginal ultrasound) reduces mortality from endometrial cancer. Most cases of endometrial cancer (85%) are diagnosed at low stage because of symptoms, and survival rates are high.
Based on solid evidence, screening asymptomatic women will result in unnecessary additional biopsies because of false-positive test results. Risks associated with false-positive tests include anxiety and complications from biopsies.
- Study Design: Evidence obtained from cohort studies.
- Internal Validity: Fair.
- Consistency: One study for endometrial biopsy and one study for hysteroscopy.
- Magnitude of Effects on Health Outcomes: Small negative magnitude.
- External Validity: Fair.
Endometrial Sampling (Biopsy)
There is inadequate evidence that screening by endometrial sampling (i.e., biopsy) reduces mortality from endometrial cancer. Most cases of endometrial cancer (85%) are diagnosed at low stage because of symptoms, and survival rates are high.
Based on solid evidence, endometrial biopsy may result in discomfort, bleeding, infection, and rarely, uterine perforation.
- Study Design: Evidence obtained from cohort studies.
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Incidence and mortality
Endometrial cancer is the most common invasive gynecologic cancer in U.S. women, with an estimated 54,870 new cases expected to occur in 2015 and an estimated 10,170 women expected to die of the disease.[1] Endometrial cancer is primarily a disease of postmenopausal women with a mean age at diagnosis of 60 years.[2] Age-adjusted endometrial cancer incidence in the United States has declined since 1975, with a transient increase in incidence occurring from 1973 to 1978, which was associated with estrogen therapy, also known as hormone therapy;[3] there was no associated increase in mortality. From 2007 to 2011, incidence rates of endometrial cancer increased by 2.4% per year . During that same time frame, the endometrial cancer mortality rates increased by 1.9%.[1] Most cases of endometrial cancer are diagnosed because of symptoms, which are nonetheless "early" stage and have high survival rates.
Risk Factors
Estrogen therapy unopposed by progesterone therapy is a cause of endometrial cancer in women with an intact uterus. However, women taking combination estrogen-progesterone therapy (hormone therapy) exhibit similar risk to women who do not take postmenopausal hormone therapy.[4-8] Tamoxifen therapy is also a cause of endometrial cancer. Results from the National Surgical Adjuvant Breast and Bowel Project P-1 trial, report a doubling of the risk of endometrial cancer associated with an annual rate of 2.30 per 1,000 for women taking tamoxifen compared with 0.91 per 1,000 for women receiving placebo; the increased risk was seen primarily in postmenopausal women.[9]
In addition to the increased risk of developing endometrial cancer that is observed in women who use unopposed estrogen therapy or tamoxifen, a number of additional risk factors have been identified, and most appear to be related to estrogenic effects. Among these factors are obesity, a high-fat diet, and reproductive factors such as nulliparity, polycystic ovarian syndrome, early menarche, and late menopause. Hereditary nonpolyposis colorectal cancer (HNPCC) syndrome is associated with a markedly increased risk of endometrial cancer compared with women in the general population. Among women who are HNPCC carriers, the estimated cumulative incidence of endometrial cancer ranges from 20% to 60% by age 70 years (refer to the PDQ summary on Genetics of Colorectal Cancer for more information).[10-12] This risk appears to differ slightly based on the germline mutation; for MLH1 carriers the lifetime risk at age 70 years is 25% while MSH2 mutation carriers have a 35% to 40% lifetime risk of endometrial cancer by age 70 years. The mean age of diagnosis for MLH1 or MSH2 carriers is 47 years compared with 60 years for noninherited forms of endometrial cancer.[13] The prognosis and survival are similar between HNPCC-related and noninherited forms of endometrial cancer.[14]
Major differences exist between black and white women in stages of endometrial cancer at detection and at subsequent survival. Although the incidence of endometrial cancer is lower among black women, mortality is higher. The National Cancer Institute initiated a Black/White Cancer Survival Study [15] and concluded that higher-grade and more aggressive histologies appear to be related to excess risk of advanced-stage disease in black women. It is difficult to disentangle the effects that biology and socioeconomic status may have on the lower survival rates of African American women with endometrial cancer. Evidence suggests that lower income is associated with advanced-stage disease, lower probability of undergoing a hysterectomy, and lower survival rates.[16] Others, however, assert that there is no black/white difference in the interval from patient-reported symptoms to initial medical consultation, making it unlikely that patient delay after onset of symptoms could explain much of the excess of advanced-stage disease found in black women.[17] Further research is necessary to understand why black women tend to be diagnosed with more aggressive disease and have a higher probability of dying than white women, despite their lower incidence of endometrial cancer.
- American Cancer Society: Cancer Facts and Figures 2015. Atlanta, Ga: American Cancer Society, 2015. Available online. Last accessed April 1, 2015.
- American Cancer Society: Detailed Guide: Endometrial Cancer: What are the Risk Factors for Endometrial Cancer? Atlanta, Ga: American Cancer Society, 2005. Available online. Last accessed December 3, 2014.
- Jick H, Walker AM, Rothman KJ: The epidemic of endometrial cancer: a commentary. Am J Public Health 70 (3): 264-7, 1980. [PUBMED Abstract]
- Pike MC, Peters RK, Cozen W, et al.: Estrogen-progestin replacement therapy and endometrial cancer. J Natl Cancer Inst 89 (15): 1110-6, 1997. [PUBMED Abstract]
- Persson I, Weiderpass E, Bergkvist L, et al.: Risks of breast and endometrial cancer after estrogen and estrogen-progestin replacement. Cancer Causes Control 10 (4): 253-60, 1999. [PUBMED Abstract]
- Heiss G, Wallace R, Anderson GL, et al.: Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA 299 (9): 1036-45, 2008. [PUBMED Abstract]
- Doherty JA, Cushing-Haugen KL, Saltzman BS, et al.: Long-term use of postmenopausal estrogen and progestin hormone therapies and the risk of endometrial cancer. Am J Obstet Gynecol 197 (2): 139.e1-7, 2007. [PUBMED Abstract]
- Barakat RR, Bundy BN, Spirtos NM, et al.: Randomized double-blind trial of estrogen replacement therapy versus placebo in stage I or II endometrial cancer: a Gynecologic Oncology Group Study. J Clin Oncol 24 (4): 587-92, 2006. [PUBMED Abstract]
- Cuzick J, Forbes JF, Sestak I, et al.: Long-term results of tamoxifen prophylaxis for breast cancer--96-month follow-up of the randomized IBIS-I trial. J Natl Cancer Inst 99 (4): 272-82, 2007. [PUBMED Abstract]
- Watson P, Vasen HF, Mecklin JP, et al.: The risk of endometrial cancer in hereditary nonpolyposis colorectal cancer. Am J Med 96 (6): 516-20, 1994. [PUBMED Abstract]
- Aarnio M, Mecklin JP, Aaltonen LA, et al.: Life-time risk of different cancers in hereditary non-polyposis colorectal cancer (HNPCC) syndrome. Int J Cancer 64 (6): 430-3, 1995. [PUBMED Abstract]
- Aarnio M, Sankila R, Pukkala E, et al.: Cancer risk in mutation carriers of DNA-mismatch-repair genes. Int J Cancer 81 (2): 214-8, 1999. [PUBMED Abstract]
- Berends MJ, Wu Y, Sijmons RH, et al.: Toward new strategies to select young endometrial cancer patients for mismatch repair gene mutation analysis. J Clin Oncol 21 (23): 4364-70, 2003. [PUBMED Abstract]
- Boks DE, Trujillo AP, Voogd AC, et al.: Survival analysis of endometrial carcinoma associated with hereditary nonpolyposis colorectal cancer. Int J Cancer 102 (2): 198-200, 2002. [PUBMED Abstract]
- Barrett RJ 2nd, Harlan LC, Wesley MN, et al.: Endometrial cancer: stage at diagnosis and associated factors in black and white patients. Am J Obstet Gynecol 173 (2): 414-22; discussion 422-3, 1995. [PUBMED Abstract]
- Madison T, Schottenfeld D, James SA, et al.: Endometrial cancer: socioeconomic status and racial/ethnic differences in stage at diagnosis, treatment, and survival. Am J Public Health 94 (12): 2104-11, 2004. [PUBMED Abstract]
- Coates RJ, Click LA, Harlan LC, et al.: Differences between black and white patients with cancer of the uterine corpus in interval from symptom recognition to initial medical consultation (United States). Cancer Causes Control 7 (3): 328-36, 1996. [PUBMED Abstract]
Evidence of Benefit
Measuring endometrial thickness (ET) with transvaginal ultrasound (TVU) and endometrial sampling with cytological examination have been proposed as possible screening modalities for endometrial cancer. The Papanicolaou (Pap) test, used successfully for screening for cervical cancer, is too insensitive to be used as a screening technique for the detection of endometrial cancer,[1] although occasionally the Pap test may fortuitously identify endometrial abnormalities, such as endometrial cancer.
Routine screening of asymptomatic women for endometrial cancer has not been evaluated for its impact on endometrial cancer mortality.[2,3] Although high-risk groups can be identified, the benefit of screening in reducing endometrial cancer mortality in these high-risk groups has not been evaluated. Using the same cutoffs to define an abnormal ET in asymptomatic women [4] as used in symptomatic women [5] would result in large numbers of false-positive test results and larger numbers of unnecessary referrals for cytological evaluations. Published recommendations for screening certain groups of women at high risk for endometrial carcinoma are based on opinion regarding presumptive benefit.[6]
Modalities of Endometrial Cancer Screening
Ultrasonography in women with vaginal bleeding
TVU is used as a diagnostic tool to evaluate symptomatic women with vaginal bleeding. Among women with postmenopausal uterine bleeding and cancer, 96% will have an abnormal ET (>6 mm). The specificity varies by whether women used hormone therapy. Among nonusers, the specificity was 92%.[5] Much less work has been done to evaluate the accuracy of TVU among asymptomatic women. If the same endometrial thickness cutoff is used among asymptomatic women, the false positives will be extremely high, resulting in a very low positive predictive value.[4] No studies have evaluated the efficacy of screening with TVU in reducing mortality from endometrial cancer.
A group of researchers used dilation and curettage (D&C) as a gold standard, to evaluate TVU measurement of ET as a predictor of endometrial cancer in women reporting postmenopausal bleeding (estrogen-progestin therapy [hormone therapy] and nonhormone therapy users). Of the 339 participants, 39 (11.5%) were diagnosed with endometrial cancer (four had an ET of 5–7 mm and 35 had an ET > 8 mm) based on histopathology from curettage. No cancers were detected in women with an ET of less than 4 mm. Using a cutoff point of 4 mm, TVU has 100% sensitivity and 60% specificity.[7] In this population, 46% (156) of the women had an ET greater than 4 mm.
Ultrasonography in women without vaginal bleeding
A comparison of TVU and endometrial aspiration was conducted among asymptomatic postmenopausal women potentially eligible for an osteoporosis prevention trial [8] as part of determination of eligibility for randomization. TVU was performed on 1,926 women. Of these, 93 women had ET greater than 6 mm. Among the 93 women with abnormal ET, 42 had endometrial aspiration with one finding of abnormal pathology (defined as adenocarcinoma or atypical hyperplasia). Of the 1,833 women with ET measuring 6 mm or less, 1,750 women had endometrial aspiration and five of these women had an abnormal pathologic biopsy. Among this population of asymptomatic postmenopausal women, the estimated sensitivity for TVU with a threshold value of 6 mm was 17% and 33% for a threshold value of 5 mm.
One study assessed the usefulness of TVU among a cohort of postmenopausal, asymptomatic women receiving hormone therapy. Utilizing the Postmenopausal Estrogen and Progestin Interventions Trial participants who had undergone both TVU and endometrial biopsy, sensitivity, specificity, positive predictive value, and negative predictive value were determined for women who received placebo, estrogen alone, and estrogen-progestin therapy. At a threshold value of 5 mm for ET, TVU had 90% sensitivity and 48% specificity. Using this threshold, more than half the women would receive a biopsy while only 4% of them had serious disease.[9]
Another study obtained endometrial biopsy specimens from 801 asymptomatic perimenopausal and postmenopausal women prior to enrollment in a hormone therapy study. Of the specimens, 75% of the samples contained sufficient tissue for diagnosis. Among these women, one case of endometrial cancer was diagnosed, illustrating the low yield of screening among asymptomatic women and the difficulty with endometrial cavity access.[10]
Although TVU can be used to evaluate asymptomatic and occult endometrial pathology, the technique has not been evaluated as a screening method for reducing mortality in asymptomatic women.
Ultrasonography in women using tamoxifen
Tamoxifen is widely used as part of adjuvant therapy for breast cancer and as chemoprevention for women at increased risk of breast cancer. In addition to the protective effects for breast cancer, the biological and endocrine effects of tamoxifen increase patients' risk of developing endometrial pathology, including endometrial polyps, endometrial hyperplasia, and endometrial carcinoma.
There is interest in trying to reduce the morbidity from endometrial cancer through early detection, and there has been interest in using endovaginal ultrasound as a method to screen women to detect endometrial cancer.
In a prospective, observational study of 304 women using tamoxifen over 6 years, women underwent annual endovaginal ultrasound screening; women with abnormal ultrasound findings and women who were symptomatic with bleeding all underwent endometrial biopsy. Thirty-two percent of the ultrasound examinations had associated significant uterine abnormalities identified that required further medical or surgical investigation and treatment. However, most abnormalities (80%) represented benign polyps for which no treatment was needed. Six cases of primary endometrial cancer were detected, and all cases presented with irregular bleeding. The sensitivity of ultrasound was only 63.3%, with a specificity of 60.4%, and had a low positive predictive value for cancer of only 1%.[11]
Other reports have noted similar results. Routine ultrasound surveillance in asymptomatic women using tamoxifen is not useful because of its low specificity and low positive predictive value. Evaluation of the endometrium in women taking tamoxifen should be limited to women symptomatic with vaginal bleeding.
Sonohysterography (hydrosonography) is a diagnostic test among asymptomatic women, and is able to separate space occupying endometrial lesions from an abnormal endometrial-myometrial junction in order to help guide biopsies. There is no evidence that routine screening sonohysterography will confer clinical benefit.
Endometrial sampling in women with uterine bleeding
In the setting of abnormal uterine bleeding, endometrial sampling has gained favor largely as an alternative to more invasive procedures such as fractional D&C. Several methods of biopsy exist (e.g., Pipelle, Tao Brush, and Uterine Explora Curette) to identify endometrial pathology. Although endometrial sampling has largely replaced D&C as the first choice in the evaluation of women with bleeding, issues of access to the endometrial cavity and sampling error limit the clinical significance of a negative result. In the Arimidex, Tamoxifen, Alone or in Combination trial, 36% of biopsies had insufficient tissue for diagnosis.[12]
No studies have evaluated the use of endometrial sampling as routine screening in reducing endometrial cancer mortality.
Hysteroscopy is used in the office setting to directly visualize the uterine cavity. A group of researchers noted that hysteroscopy is not as useful in detecting endometrial cancer as biopsy or D&C.[13] It has not been evaluated as a screening tool.[14]
- Burk JR, Lehman HF, Wolf FS: Inadequacy of papanicolaou smears in the detection of endometrial cancer. N Engl J Med 291 (4): 191-2, 1974. [PUBMED Abstract]
- Pritchard KI: Screening for endometrial cancer: is it effective? Ann Intern Med 110 (3): 177-9, 1989. [PUBMED Abstract]
- Eddy D: ACS report on the cancer-related health checkup. CA Cancer J Clin 30 (4): 193-240, 1980 Jul-Aug. [PUBMED Abstract]
- Smith-Bindman R, Weiss E, Feldstein V: How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol 24 (5): 558-65, 2004. [PUBMED Abstract]
- Smith-Bindman R, Kerlikowske K, Feldstein VA, et al.: Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 280 (17): 1510-7, 1998. [PUBMED Abstract]
- Burke W, Petersen G, Lynch P, et al.: Recommendations for follow-up care of individuals with an inherited predisposition to cancer. I. Hereditary nonpolyposis colon cancer. Cancer Genetics Studies Consortium. JAMA 277 (11): 915-9, 1997. [PUBMED Abstract]
- Gull B, Karlsson B, Milsom I, et al.: Can ultrasound replace dilation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer. Am J Obstet Gynecol 188 (2): 401-8, 2003. [PUBMED Abstract]
- Fleischer AC, Wheeler JE, Lindsay I, et al.: An assessment of the value of ultrasonographic screening for endometrial disease in postmenopausal women without symptoms. Am J Obstet Gynecol 184 (2): 70-5, 2001. [PUBMED Abstract]
- Langer RD, Pierce JJ, O'Hanlan KA, et al.: Transvaginal ultrasonography compared with endometrial biopsy for the detection of endometrial disease. Postmenopausal Estrogen/Progestin Interventions Trial. N Engl J Med 337 (25): 1792-8, 1997. [PUBMED Abstract]
- Archer DF, McIntyre-Seltman K, Wilborn WW Jr, et al.: Endometrial morphology in asymptomatic postmenopausal women. Am J Obstet Gynecol 165 (2): 317-20; discussion 320-2, 1991. [PUBMED Abstract]
- Fung MF, Reid A, Faught W, et al.: Prospective longitudinal study of ultrasound screening for endometrial abnormalities in women with breast cancer receiving tamoxifen. Gynecol Oncol 91 (1): 154-9, 2003. [PUBMED Abstract]
- Duffy S, Jackson TL, Lansdown M, et al.: The ATAC adjuvant breast cancer trial in postmenopausal women: baseline endometrial subprotocol data. BJOG 110 (12): 1099-106, 2003. [PUBMED Abstract]
- Bradley WH, Boente MP, Brooker D, et al.: Hysteroscopy and cytology in endometrial cancer. Obstet Gynecol 104 (5 Pt 1): 1030-3, 2004. [PUBMED Abstract]
- Gumus II, Keskin EA, Kiliç E, et al.: Diagnostic value of hysteroscopy and hysterosonography in endometrial abnormalities in asymptomatic postmenopausal women. Arch Gynecol Obstet 278 (3): 241-4, 2008. [PUBMED Abstract]
Special Populations
Hormone Therapy
There is no evidence to suggest that screening women prior to or during estrogen-progestin therapy, also known as hormone therapy, would decrease endometrial cancer mortality.[1,2] Thus women on hormone therapy should have a prompt diagnostic work-up for abnormal bleeding. Although women using certain hormone regimens have an increased risk of endometrial cancer, most women who develop cancer will have vaginal bleeding. There is no evidence that screening these women would decrease mortality from endometrial cancer.
Hereditary Nonpolyposis Colorectal Cancer
The lifetime risk of endometrial cancer for women with hereditary nonpolyposis colorectal cancer (HNPCC) and for women who are at high risk for HNPCC is as high as 60%. These cases are often diagnosed in the fifth decade, 10 to 20 years earlier than sporadic cases.[3-7] Based on limited evidence, it appears that 5-year survival among HNPCC women diagnosed with endometrial cancer is similar to that of nonhereditary cases in the general population.[8] Because the risk of endometrial cancer is so high among these women, international guidelines suggest gynecologic surveillance including annual transvaginal ultrasound with endometrial biopsy for women aged 25 to 35 years.[9,10] The most recent American Cancer Society Cancer Detection Guidelines (updated January 2005) recommend annual screening with endometrial biopsy beginning at age 35 years.[11]
Tamoxifen-Treated Women
The risk of endometrial cancer is increased in women who are treated with tamoxifen and is even greater in the subset of women who have a history of prior estrogen therapy.[12] Beyond a routine gynecologic examination eliciting any history of abnormal bleeding, it has been recommended that screening studies and procedures for detecting endometrial pathology in women taking tamoxifen should be left to the discretion of the individual gynecologist.[13] Commonly, there are endometrial abnormalities in women taking tamoxifen, especially in false-positive endovaginal ultrasound screening tests. More importantly, any abnormal uterine bleeding should be completely evaluated.
Endometrial cancers that occur in tamoxifen-treated women are very similar to those cancers occurring in the general population, with respect to stage, grade, and histology.[14-16] Prognosis is good and not affected by early detection.[17]
To date, there have been no published studies evaluating the effect of endometrial cancer-screening modalities on mortality among women taking tamoxifen for breast cancer treatment or prevention.
- ACOG committee opinion. Routine cancer screening. Number 185, September 1997 (replaces no. 128, October 1993). Committee on Gynecologic Practice. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 59 (2): 157-61, 1997. [PUBMED Abstract]
- Korhonen MO, Symons JP, Hyde BM, et al.: Histologic classification and pathologic findings for endometrial biopsy specimens obtained from 2964 perimenopausal and postmenopausal women undergoing screening for continuous hormones as replacement therapy (CHART 2 Study). Am J Obstet Gynecol 176 (2): 377-80, 1997. [PUBMED Abstract]
- Watson P, Vasen HF, Mecklin JP, et al.: The risk of endometrial cancer in hereditary nonpolyposis colorectal cancer. Am J Med 96 (6): 516-20, 1994. [PUBMED Abstract]
- Aarnio M, Sankila R, Pukkala E, et al.: Cancer risk in mutation carriers of DNA-mismatch-repair genes. Int J Cancer 81 (2): 214-8, 1999. [PUBMED Abstract]
- Vasen HF, Wijnen JT, Menko FH, et al.: Cancer risk in families with hereditary nonpolyposis colorectal cancer diagnosed by mutation analysis. Gastroenterology 110 (4): 1020-7, 1996. [PUBMED Abstract]
- Dunlop MG, Farrington SM, Carothers AD, et al.: Cancer risk associated with germline DNA mismatch repair gene mutations. Hum Mol Genet 6 (1): 105-10, 1997. [PUBMED Abstract]
- Lancaster JM, Powell CB, Kauff ND, et al.: Society of Gynecologic Oncologists Education Committee statement on risk assessment for inherited gynecologic cancer predispositions. Gynecol Oncol 107 (2): 159-62, 2007. [PUBMED Abstract]
- Boks DE, Trujillo AP, Voogd AC, et al.: Survival analysis of endometrial carcinoma associated with hereditary nonpolyposis colorectal cancer. Int J Cancer 102 (2): 198-200, 2002. [PUBMED Abstract]
- Burke W, Petersen G, Lynch P, et al.: Recommendations for follow-up care of individuals with an inherited predisposition to cancer. I. Hereditary nonpolyposis colon cancer. Cancer Genetics Studies Consortium. JAMA 277 (11): 915-9, 1997. [PUBMED Abstract]
- Vasen HF, Mecklin JP, Khan PM, et al.: The International Collaborative Group on Hereditary Non-Polyposis Colorectal Cancer (ICG-HNPCC). Dis Colon Rectum 34 (5): 424-5, 1991. [PUBMED Abstract]
- Smith RA, Cokkinides V, Eyre HJ: American Cancer Society Guidelines for the Early Detection of Cancer, 2005. CA Cancer J Clin 55 (1): 31-44; quiz 55-6, 2005 Jan-Feb. [PUBMED Abstract]
- Barakat RR: Tamoxifen and endometrial neoplasia. Clin Obstet Gynecol 39 (3): 629-40, 1996. [PUBMED Abstract]
- ACOG committee opinion. Tamoxifen and endometrial cancer. Number 169, February 1996. Committee on Gynecologic Practice. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 53 (2): 197-9, 1996. [PUBMED Abstract]
- Fisher B, Costantino JP, Wickerham DL, et al.: Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 90 (18): 1371-88, 1998. [PUBMED Abstract]
- Barakat RR, Wong G, Curtin JP, et al.: Tamoxifen use in breast cancer patients who subsequently develop corpus cancer is not associated with a higher incidence of adverse histologic features. Gynecol Oncol 55 (2): 164-8, 1994. [PUBMED Abstract]
- Fornander T, Hellström AC, Moberger B: Descriptive clinicopathologic study of 17 patients with endometrial cancer during or after adjuvant tamoxifen in early breast cancer. J Natl Cancer Inst 85 (22): 1850-5, 1993. [PUBMED Abstract]
- Barakat RR, Gilewski TA, Almadrones L, et al.: Effect of adjuvant tamoxifen on the endometrium in women with breast cancer: a prospective study using office endometrial biopsy. J Clin Oncol 18 (20): 3459-63, 2000. [PUBMED Abstract]
Evidence of Harms
Abnormal ultrasound typically requires further investigation including endometrial biopsy (sampling). The evidence is solid that endometrial sampling may result in discomfort, bleeding, infection, and rarely uterine perforation. A study designed to evaluate performance, patient acceptance, and cost-effectiveness of blind biopsy, hysteroscopy with biopsy, and ultrasound, in 683 women with vaginal bleeding, reported that minor events, including discomfort and distress, occurred in 16% of women who had hysteroscopy with biopsy, and in 10% of the women who had a blind biopsy.[1] A group of researchers studied 13,600 diagnostic and operative hysteroscopic procedures and found a lower complication rate among diagnostic procedures (0.13%) compared with operative procedures (0.28%).[2] Risks associated with false-positive test results include anxiety and additional diagnostic testing and surgery. Endometrial cancers may be missed on endometrial sampling and ultrasound.
- Critchley HO, Warner P, Lee AJ, et al.: Evaluation of abnormal uterine bleeding: comparison of three outpatient procedures within cohorts defined by age and menopausal status. Health Technol Assess 8 (34): iii-iv, 1-139, 2004. [PUBMED Abstract]
- Jansen FW, Vredevoogd CB, van Ulzen K, et al.: Complications of hysteroscopy: a prospective, multicenter study. Obstet Gynecol 96 (2): 266-70, 2000. [PUBMED Abstract]
Changes to This Summary (02/13/2015)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Updated statistics with estimated new cases and deaths for 2015 (cited American Cancer Society as reference 1).
This summary is written and maintained by the PDQ Screening and Prevention Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.
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This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about endometrial cancer screening. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
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National Cancer Institute: PDQ® Endometrial Cancer Screening. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://cancer.gov/cancertopics/pdq/screening/endometrial/HealthProfessional. Accessed <MM/DD/YYYY>.
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There are no translations available. Homeopathic Materia Medica by FarringtonLlNARIA VULGARIS(lina)This drug produces fainting. It may be serviceable in fainting of cardiac origin. The "patient faints dead away without apparent cause." Linaria has repeatedly produced that symptom. It is true that there is some difficulty in confirming such a symptom as this, because in most cases the patient quickly returns to consciousness without recourse to any remedy. But if a patient who is subject to attacks of fainting of this kind is not only relieved but is cured by taking this drug, you know that this is the result of the remedy.


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