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Why bother to wade through yet another indictment of CEO pay? To read the current crop of articles on the subject, you are either led to believe that chief executives spend all their time figuring out how to bilk shareholders, or you are dragged through a morass of "data" only to be told that pay is not correlated with anything. We have found a better way to align your interest as CEO with shareholders', minimize distractions to your board, forge together your management team, and (incidentally) share in the wealth created for others. We even developed a simple test you and your team can apply to your own pay packages, in order to gauge their effectiveness in this pursuit. How could we succeed while so many others are on the same scent? First, our methodology for valuing CEO pay-as opposed to that used in all the general business magazines-provides an uncluttered view of what is being delivered in any particular year. And second, rather than searching for a performance measure which somehow correlates with pay (relevant or not), we took the opposite tack-identifying an aspect of CEO pay which is present in successful companies but lacking from less successful ones. Our conclusion? There are two key ways to develop an effective pay plan for CEOs. First, make certain that pay is aligned with performance; that is, high performance needs to yield high pay; conversely, low performance should hurt the CEO, just as it does the shareholder. Second, design a plan which ensures that sufficient leverage is built into pay opportunities. The good news in this third annual study of CEO pay is that progress is being made toward aligning pay with performance; the bad news is that the ball is being dropped on the leverage side. The rest of the business press is finally reporting what was established in a survey we conducted last year: CEOs and board members believe that the weakest aspect of CEO pay plans is the lack of a longer-term focus. Two-thirds of the respondents to our survey felt that long-term incentives should be emphasized, and that most CEO pay plans could benefit from greater leverage-both up and down. But our findings suggest that although their sentiments are in the right place, little progress is being made to correct the lack of leverage. It's encouraging that pay and performance are aligned. In fact, 67 percent of our 225-company sample did align pay with performance this year (i.e., those companies that deliver high pay got high performance, whereas those with low performance delivered low pay). This is a slight increase over last year's 65 percent of companies aligned, and the 64 percent that aligned pay with performance the year before. The good news continues as shareholders' return has increased substantially, averaging 15.7 percent over the 1984-1988 performance period. Last year, the annual return to shareholders from market price appreciation and dividends averaged only 11.4 percent, down from the previous year's 17.5 percent average. CEO PAY INCREASES LAG SHARE GROWTH Yet while performance is recovering from a slump, the increases in CEO pay are relatively modest. In the face of higher shareholder returns, total performance pay (which consists of base salary, annual bonus, plus the annualized present value of long-term incentives) increased by only 5.2 percent. What caused this slowdown in CEO pay increases? (The slowdown is more dramatic in view of last year's 8.1 percent increase despite plummeting shareholder returns.) Although salaries increased by 8.8 percent and total cash (salary plus bonus) went up by 13.7 percent, the amounts provided by long-term incentives remained virtually the same. Moreover, the types of long-term incentives used have shifted away from "pure" market-based incentives (such as stock options), toward less market-sensitive vehicles such as restricted stock grants, performance shares, and performance unit plans. When performance is up, these "less market sensitive" places deliver relatively less pay. In last year's survey, we developed a method of quantifying the rewards and penalties CEOs received relative to the value they created for shareholders. Comparing pay premiums or penalties with performance premiums or penalties (see box, "Methodology and Terms"), this year's average pay premium per $100 in performance premium is only $0.50-down from an average of $1.06 last year. Consistent with last year's findings, the $0.19 average pay penalty per $100 in performance shortfall is substantially less than the premium. This tells CEOs that there continues to be less downside risk than upside potential, but even the magnitude of upside potential is being cut back. So while pay is becoming aligned, the degree of leverage afforded CEOs is decreasing. What is particularly disturbing about this trend is that alignment of pay, in and of itself, means relatively little. We could find no evidence that companies that have aligned pay with performance are more likely to provide shareholders with greater value. In the past, we've said that in the case of high paid/low performing CEOs, the board would (presumably) be forced to take action. But after three years of compiling data, we may have overestimated the willingness (or ability) of boards to take decisive action. Of the 42 companies that changed their CEO, we only found evidence in five instances that the departure was anything other than normal retirement. Although no chief executives from our sample left for other, better-paying positions, we predict that the lure of LBO opportunities will entice the best to trade in their $0.50 per $100 premiums for the $5 per $100 available to those willing to take a calculated risk. So what is our advice to CEOs? Be certain that pay and performance are aligned and that your pay program contains enough leverage. To determine how much leverage is enough, we direct you to Exhibit 1, the leverage index chart. We constructed this index by determining how much pay would be delivered if the company's share value increased by 15 percent per year. We then calculated the amount of pay which would result given no growth in market value. Dividing the 15 percent scenario by the zero growth mode, then subtracting one, yields the leverage index. As the chart implies, those companies with more leverage have provided the greatest returns to shareholders. How should leverage be enhanced? The accounting, cash flow and tax advantages afforded by stock options still make them the best bet in our eyes. Variations on this theme, such as leveraged stock options or the offset-carry plan (see "The Absolute Best Takeover Defense," May/June 1989), may be adapted for virtually any organization. But the basic theme remains the same: It is not the absolute amount of pay which best predicts company performance; rather, it is the degree of faith CEOs have in their cornpany (as evidenced by how much pay they are willing to risk) which tracks shareholder return. Who knows? If any financial analysts read this, they may start digging through proxies to identify those whose pay plans establish them as true entrepreneurs-those who assume the risk of success. PAY AND PERFORMANCE STILL LINKED
David R. Meredith is chairman and cofounder of Personnel Corporation of America (PCA), a New York-based consulting firm specializing in human resource management. A former principal of McKinsey and chairman of Meredith Associates, Inc., he holds a Ph.D. from M.I.T.'s Sloan School of Management and a B.A. from
Not How Much, But
Nobody likes to be evaluated. Especially if your pay outstrips your performance. In our third annual study of chief executive pay, we take CEOs to task for their high earnings: Are they worth it? Sometimes yes…


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"This was so much fun!!"
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Cracking job, JacquiC!!! I especially like the great detail you did on his paws and eyes! Gromit looks great!!
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02-24-2010, 11:58 PM | #911 (permalink) |
Posts: n/a
T-Rex Denver, CO this is the first time i've lived in a place that i get to ride more than 3-5 days a season.. but i've been doing the "vacation" thing for 12-15 years now... not new to snowboarding.. not terrible at it either. I work at Echo Mountain Park and get to ride everyday! |
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02-25-2010, 07:43 AM | #912 (permalink) |
Junior Member
Join Date: Feb 2010
Posts: 9
My turn.
I'm not really new here, I've been reading for quite a while, but decided it was time to sign up. I'm 22, Belgian and an IT consultant. I've been boarding for 9-10 years now, but only started progressing decently the last 2-3 years. I currently ride a Forum John Jackson Seeker 159 with Flow Team '09s (yup, the horrible flow teams... though once set up I rather like them) and a pair of Rome Libertines. Mostly a cruiser, but I do like to pretend to ride park/powder every now and then. |
02-25-2010, 03:18 PM | #914 (permalink) |
Junior Member
Join Date: Feb 2010
Posts: 1
Just started earlier this year. After the first time I loved it and I've been getting together with some guys and going about every other week since then.
Closest place unfortunately is 3-4 hours away. Located in South Eastern VA. |
02-26-2010, 04:52 PM | #916 (permalink) |
Posts: n/a
Hey, I'm a beginner boarder from Australia. I snowboarded three days last year and got hooked on day one once I started linking turns. I think I fell every possible way down Blue Cow that first morning (I was too stubborn to have a lesson, particularly since I was too late for the free morning one) and I didn't realise until the last run of the day that I was regular, not goofy. Swapped my bindings around half-way down Front Valley and bam, linking turns. Now I'm just counting down until our snow season starts here, and envying all the people in the northern hemisphere, as well as friends who travelled there to board. Someday.... that'll be me... Canada and Japan.. and every other place with snow!!!
02-27-2010, 02:56 PM | #920 (permalink) |
Junior Member
Join Date: Feb 2010
Location: east coast
Posts: 21
I'm 25 and have live in NJ. I have been snowboarding since early high school with a few seasons cut short due to injuries. I wouldnt say Im a beginner but I am definitely not a pro either. I just love the freedom and relaxation or riding. Nothing better in life
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This report makes the case—not for the first time—that recognition of the burden that cancer imposes and some level of response are feasible in every country. It also identifies feasible opportunities of particular importance in the countries where resources have constrained the response to cancer. Another critical element is support—both in resources and in expertise—from the "global community." Until now, international support has been forthcoming almost exclusively from cancer-focused organizations, but not from the broader based health and development sector, such as foreign aid from individual countries (through agencies such as the U.S. Agency for International Development, or USAID), the World Bank, and major nonprofit organizations, which provide substantial support for health infrastructure and for infectious diseases in low- and middle-income countries (LMCs). Another largely untapped resource is the U.S. and international academic community, particularly given a large increase in interest in global health and the establishment and growth of university global health programs. The support of all of these groups strongly influences the health agendas of the recipient countries. A lack of focus on cancer from these external parties easily translates to a lack of focus of LMCs themselves on cancer.
This chapter reviews the programs and activities of major sectors of the international community in relation to cancer control in LMCs and discusses further needs and opportunities. The role of advocacy, including by the global community, is covered separately in Chapter 9.
Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
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Cancer Control Opportunities in Low- and Middle-Income Countries
Expanding the Role of the Global Community in Cancer Control
This report makes the case—not for the first time—that recognition of the burden that cancer imposes and some level of response are feasible in every country. It also identifies feasible opportunities of particular importance in the countries where resources have constrained the response to cancer. Another critical element is support—both in resources and in expertise—from the "global community." Until now, international support has been forthcoming almost exclusively from cancer-focused organizations, but not from the broader based health and development sector, such as foreign aid from individual countries (through agencies such as the U.S. Agency for International Development, or USAID), the World Bank, and major nonprofit organizations, which provide substantial support for health infrastructure and for infectious diseases in low- and middle-income countries (LMCs). Another largely untapped resource is the U.S. and international academic community, particularly given a large increase in interest in global health and the establishment and growth of university global health programs. The support of all of these groups strongly influences the health agendas of the recipient countries. A lack of focus on cancer from these external parties easily translates to a lack of focus of LMCs themselves on cancer.
This chapter reviews the programs and activities of major sectors of the international community in relation to cancer control in LMCs and discusses further needs and opportunities. The role of advocacy, including by the global community, is covered separately in Chapter 9.
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Cancer Control Opportunities in Low- and Middle-Income Countries
A few major organizations support cancer control internationally: United Nations (U.N.) organizations, mainly the World Health Organization (WHO) and its research affiliate, the International Agency for Research on Cancer (IARC), and the health program of the International Atomic Energy Agency (IAEA); government cancer institutions, such as the National Cancer Institute (NCI) of the U.S. National Institutes of Health (NIH), the International Network for Cancer Treatment and Research; cancer societies and advocacy groups, such as the American Cancer Society and the international umbrella organization for cancer societies and advocacy, the International Union Against Cancer (UICC). All these groups play high-level, visible roles in raising awareness about the magnitude of the cancer problem, and in promoting cancer control.
Beneath the layer of major organizations and major programs is a much broader array of organizations and professionals with narrower roles, confined either to a country or area, or to a particular aspect of cancer control research or practice. No global inventory of these efforts exists. Efforts include, for example, the Open Society Institute and the Diana Fund, which are major supporters of expanding hospice and palliative care programs in Eastern and Central Europe, Africa, and elsewhere. Individual cancer centers in Europe and the United States have entered into "twinning" relationships with centers in low-resource settings, providing technical assistance, training, research support, and financial support, over the long term. Professional societies, notably the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO), provide training, fellowships, and other types of assistance to colleagues and institutions in LMCs. Some multinational pharmaceutical companies have programs to make oncology drugs available to cancer centers in low-resource countries where patients or governments otherwise would not be able to afford them. Foundations also fund research projects and service delivery. The Gates Foundation has been the main supporter of cervical cancer prevention research in low-resource settings.
The United Nations and its agencies relate directly to national governments. Governments look to WHO for guidance on health priorities, policy, and planning and for technical assistance. IAEA also acts through agreements with governments. It has pursued an active role in establishing and upgrading radiotherapy facilities and providing for their safe and effective operations.
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World Health Organization Cancer Control Activities
WHO is the most prominent voice in global health. WHO has maintained at best a modest cancer control program for the past 30 years. As part of a reorganization in 2006, the program became part of the Department of Chronic Diseases and Health Promotion. Cancer control is also a part of other WHO programs, including those focused on tobacco control, reproductive health, occupational health, childhood immunizations, and essential medicines.
The high-level policy of WHO is carried out largely at the Geneva, Switzerland, headquarters. Work performed in countries is carried out mainly through the six WHO regional offices and the offices maintained in every member country.
The WHO cancer control program has concentrated on the following areas:
Promoting and strengthening national cancer control programs
Building international networks and partnerships for cancer control
Promoting organized, evidence-based interventions for early detection of cervical and breast cancers
Developing guidelines on disease and program management
Advocating for a rational approach to effective treatments for potentially curable cancers
Supporting low-cost approaches to pain relief and palliative care
The work of the cancer control program contributed strongly to adoption by the 58th World Health Assembly of a resolution on cancer prevention and control in May 2005, a milestone for the field (see Chapter 1). The resolution is designed to reinforce comprehensive cancer policies and strategies among all member states. It urges development and integration of comprehensive cancer control programs into current and future health care initiatives; the sharing of scientific research; and the development of appropriate information systems, including outcome and process indicators that support planning, monitoring, and evaluation of cancer prevention and control programs.
WHO's 2002 report, National Cancer Control Programs: Policy and Managerial Guidelines (World Health Organization, 2002), provides information on planning, implementing, managing, and evaluating cancer programs. It outlines the scientific basis for cancer prevention, early detection, cure, and care; discusses the appropriateness of particular technologies; and describes how to manage national programs tailored to different resource settings. (See Chapter 1 for a more complete discussion.)
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The Cancer Control Programme has co-established or actively promoted the following programs and initiatives for cancer prevention:
The Tobacco Free Initiative (TFI), established in July 1998 to focus international attention, resources, and action on the global tobacco epidemic. TFI provides global policy leadership, encourages mobilization at all levels of society, and promotes the WHO Framework Convention on Tobacco Control.
WHO Framework Convention on Tobacco Control (FCTC), ratified in November 2004 and the first public health treaty negotiated under the auspices of WHO. FCTC includes provisions that set international standards on tobacco price and taxes, advertising, labeling, illegal trade, and secondhand smoke. The Treaty became law for the signatories in February 2005.
Global Strategy on Diet, Physical Activity and Health, endorsed by the May 2004 World Health Assembly, to improve public health through healthy eating and physical activity.
WHO Initiative for Vaccine Research, including vaccines against some of the infections that can cause cancer, such as hepatitis B and C and human papillomavirus, as well as schistosomiasis and other helminths.
The INTERSUN Program, established in 1992 by WHO and a number of international partners, to improve protection against ultraviolet radiation and prevent its effects, including skin cancer.
Global Strategy on Occupational Health for All: The Way to Health at Work, supporting healthier workplaces, including reduction in exposure to carcinogens.
"A Community Health Approach to Palliative Care for HIV and Cancer Patients in Africa," a joint project including five countries1 to improve the quality of life of HIV/AIDS and cancer patients in sub-Saharan Africa.
WHO Regional Offices
WHO divides the world into six regions: Africa, the Americas, Southeast Asia, Europe, Eastern Mediterranean, and Eastern Pacific. One country in each region houses the permanent regional office. The staff of regional offices work directly with their designated countries. In addition, each country has its own resident WHO representative and delegation of varying size. Regional staffs include a chronic disease advisor, who may or may not be a cancer specialist (although no current advisors are cancer specialists).
Botswana, Ethiopia, Tanzania, Uganda, and Zimbabwe.
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International Agency for Research on Cancer
IARC, established in May 1965 as a WHO agency, is a research organization located in Lyon, France. Its mission is to "coordinate and conduct research on the causes of human cancer, the mechanisms of carcinogenesis, and to develop scientific strategies for cancer control." IARC's work focuses on epidemiology, environmental carcinogenesis, and research training. IARC does not conduct clinical trials or conduct research on other aspects of cancer patient care, nor is it directly involved in the implementation of control measures or legislation aimed at controlling carcinogens. Most of IARC's efforts have been in and about high-income countries, but they have maintained an interest and some specific initiatives directed at LMCs in each major area of emphasis.
IARC has four main objectives (International Agency for Research on Cancer, 2006):
Monitoring global cancer occurrence: IARC gathers data on incidence, mortality, and survival for hundreds of countries. The data are available electronically and in published reports. Most prominently, the 8th edition of its report, Cancer Incidence in Five Continents, includes information on more than 200 countries. IARC also estimates cancer incidence and mortality for every country in the world in its GLOBOCAN electronic database.
Identifying the causes of cancer: Through committees, IARC assesses the carcinogenicity to humans of various agents, mixtures, and exposures. More than 800 agents have been reviewed since 1972 and published through the IARC Monographs Programme on the Evaluation of Carcinogenic Risks to Humans.
Exploring the mechanisms of carcinogenesis: IARC laboratory research concentrates on the interaction of carcinogens with DNA, with particular emphasis on identifying carcinogen-induced, endogenous, and inherited mutations. The aim is to identify potential points of intervention to prevent progression to clinical disease.
Developing scientific strategies for cancer control: The goals of IARC's programs are primary prevention and early detection of cancer. A recent example is the evaluation of low-technology screening methods for cervical, breast, and oral cancers in developing countries.
IARC maintains a number of databases related to its core functions. These include descriptive epidemiology, carcinogens, and molecular epidemiology.
Training Programs
IARC coordinates an annual 3-week summer school program of 1-week modules designed to stimulate cancer research by improving scientific
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knowledge and developing skills. Course selection preference is given to professionals from resource-poor countries to strengthen their research institutions and build local capacity. Researchers and support staff from groups or institutions involved in cancer monitoring, evaluation of care practices, prevention activities, or etiological research are eligible to attend IARC training programs. Subjects of the modules may include cancer registration, epidemiologic methods and research, and interpretation of cancer statistics.
More than 500 cancer research fellowships have been awarded to junior scientists since 1966. Recently, the program was broadened to award postdoctoral fellowships to junior scientists from LMCs to work directly with one of the research groups at IARC headquarters.
Visiting Scientist Awards are also offered for experienced investigators from universities or research institutions to spend up to one year at IARC working with one of the research groups on a topic related to the Agency's objectives.
International Atomic Energy Agency (UN)
IAEA may seem an unlikely home for a cancer control program for resource-poor countries, but it takes its mandate directly from the 1956 statute creating the "Atoms for Peace" agency: "The Agency shall seek to accelerate and enlarge the contribution of atomic energy to peace, health and prosperity throughout the world" (IAEA, 1956). IAEA began in 1980 to provide radiotherapy equipment and train staff in its use in LMCs. IAEA has provided more than $145 million in cancer-related assistance to developing countries (IAEA, 2006). In 2004, the Programme of Action for Cancer Therapy (PACT) was established as a comprehensive cancer control assistance program, with IAEA leading collaborations with a wide range of partners (IAEA, 2004) (see Chapter 8 for a discussion of PACT's potential role in supporting cancer centers in LMCs). This perspective represents a significant evolution of strategic thinking and investment on the part of IAEA, beyond radiotherapy. In the past IAEA has established a number of radiotherapy-only centers. In some places, these have formed a nucleus for developing more comprehensive treatment, but in other places they have remained solely radiotherapy centers.
Historically, IAEA Member States asked for assistance with radiotherapy through "technical cooperation" projects, which ranged from setting up a country's first radiotherapy center to upgrading facilities. All projects included providing equipment as well as training in clinical use of
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the machinery, dosimetry, safety, and maintenance, following internationally accepted guidelines for safety (Levin et al., 2001).
Where the request from a Member State was for a first radiotherapy center, a comprehensive feasibility study was carried out by IAEA and involving the relevant Ministry of Health and the medical community. Staff training, equipment, and expertise needs were estimated and a layout of the buildings was produced. The framework for feasibility studies is laid out in IAEA technical documents that cover various aspects of the use and safe operation of radiotherapy units. Since 1995, radiotherapy has been initiated in several resource-poor countries, such as Ethiopia, Ghana, Namibia, Uganda, Mongolia, Zambia, and Yemen, and expanded or upgraded in numerous others.
Projects in Eastern Europe, for example, have focused on upgrading technology and improving the skills of radiotherapy professionals, both of which had deteriorated during the period of regional economic decline following the collapse of the Soviet Union. Two regional projects, with cost sharing by recipient governments, upgraded facilities in Albania, Armenia, Bosnia and Herzegovina, Croatia, Macedonia, Georgia, and Moldova. Several hundred radiotherapy professionals from these countries were supported for participation in basic and continuing professional development courses. These projects continue and others have been initiated to address the still-serious inadequacies in low- and middle-income countries in Africa, Latin America, Asia, and Eastern Europe (Levin et al., 2001).
Radiotherapy Resource Inventories
In 1959 IAEA began compiling a registry of radiation therapy facilities in clinical settings, with a final update published in 1976. The inventory was restarted in 1995 as the Directory of Radiotherapy Centres (DIRAC) and is now available on the Internet (http://www-naweb.iaea.org/nahu/dirac/default.shtm). DIRAC is updated as IAEA receives information from the various countries.
National Research Agencies: The Example of the U.S. National Cancer Institute
NCI is the main source of U.S. government support for international cancer research and training. Most of the international interaction is with other high-income countries, but NCI has a substantial portfolio of work in
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LMCs. NCI works cooperatively with the Fogarty International Center of NIH and with extramural institutions through bilateral agreements, grants, and contracts. NCI international expenditures are primarily devoted to foreign grants and contracts, bilateral scientist exchanges and training under the NIH Visiting Program, workshops, and international dissemination of cancer information.
Most recently, in 2006, NCI has made a major commitment to partner with IAEA and the PACT Alliance (see above and Chapter 8) to improve cancer control in LMCs. NCI will support a pilot of the expanded PACT, which will involve providing a team of cancer control experts from the United States (Clanton, 2006).
Two of the most prominent activities supported by NCI in LMCs are the Middle East Cancer Consortium (MECC; see below) and the International Network for Cancer Treatment and Research (INCTR; see below). The other area of emphasis in multiple countries is cancer registration. Training is carried out through the scientist exchange programs and other educational opportunities, and research through a large number of individual research projects involving LMCs. NCI also contributes support to many large and small workshops and meetings around the world.
Scientist Exchange and Other Training Programs
In FY 2005, more than 1,000 foreign scientists spent time at NCI, about one-third of them from LMCs. NCI also supports scientists from developing countries for training in U.S. laboratories outside of NCI, and in overseas laboratories in developed countries.
The Oncology Research Faculty Development Program helps young but established scientists from developing countries prepare for careers as investigators and for leadership positions in cancer research in their home country. The cost is shared by NCI and the sponsoring laboratory. Participants from LMCs are also given support to attend an annual NCI course on cancer prevention and control offered by the NCI Division of Cancer Prevention.
NCI Research
NCI supports a wide range of research in all aspects of cancer control and in many LMCs. A few examples include:
A community-based, randomized-control evaluation of low-cost methods for early detection of breast and cervical cancers in women at the Tata Memorial Hospital, in Mumbai, India, including clinical breast examination without mammography, self-examination, and visual inspection of the cervix by trained female health workers
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Research on esophageal cancer in China, where incidence of the disease is highest in the world, including two nutritional intervention trials, in collaboration with the Chinese Academy of Medical Sciences
A collaborative study between NCI and investigators in Ukraine and Belarus to study the long-term health consequences of the Chernobyl nuclear accident
A binational study with Brazil on Epstein-Barr virus-associated lymphoma, particularly Burkitt's lymphoma, in Brazil
Cancer Registration in Developing Countries
NCI assists with training and sponsors participation of personnel from developing countries at courses on cancer registration conducted by IARC in Lyon, France, and the School of Public Health at Emory University in Atlanta, Georgia. In cooperation with the Middle East Cancer Consortium, cancer registry training programs have been held around the Middle East. In recent years, training programs also have been held regionally around the world, drawing participants from many countries.
The Middle East Cancer Consortium
MECC was founded in 1996 as a partnership between the United States and the Ministries of Health of Cyprus, Egypt, Israel, Jordan, the Palestinian Authority, and most recently, Turkey. The MECC objective is to reduce the incidence and impact of cancer in the Middle East through collaborative research. Since its inception, MECC's major activities have been the Cancer Registry Project and the Small Grants Programme. Cancer communication is another priority.
The Cancer Registry Project supports population-based cancer registries within member countries, and develops linkages among them. The first monograph about cancer incidence in the region, based on the new registries, was published in 2006 (Freedman et al., 2006). The consortium also supports training, basic research, enhancement of public health and patient care, quality control, and international communications.
The Small Grants Programme is for clinicians and scientists to conduct research. All research projects, which are funded based on a merit review, require collaboration between more than one MECC country.
International Network for Cancer Treatment and Research
INCTR is a not-for-profit, nongovernmental organization dedicated to cancer control in the developing countries of Asia, Africa, and Latin America. It was founded in 1998 by UICC and the Institut Pasteur in Belgium, and
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is supported by NCI as well as by membership fees, project-related grants and contracts, and corporate sponsorships. INCTR headquarters are at the Institut Pasteur, with branches and offices in the United States, France, England, Brazil, Egypt, Tanzania, India, and Nepal.
Mission and Strategy
INCTR's mission is to build capacity for cancer treatment and research in countries with limited resources through long-term collaborative projects focused on local or regional problems. Projects are designed to bring immediate benefits to patients or to prevent cancer in the population while providing professional education and training as well as opportunities for cancer research. INCTR promotes collaborations between wealthy countries and countries with limited resources, and encourages the formation of cooperative groups, consortia, networks, and partnerships with corporate, professional, academic, and governmental and nongovernmental organizations. Partners include IARC (for cervical cancer screening), NCI (for education and training), King Faisal Research Center in Saudi Arabia (for translational research), and Eli Lilly and Novartis (for clinical trials workshops and data management).
Projects are developed with the advice and participation of various INCTR committees and strategy groups as well as independent scientific advisors and the Special Panel of the INCTR Advisory Board, which is made up of distinguished oncologists and pathologists from developing countries.
INCTR Collaborating Units, Associate Members, Branches, and Offices
Projects are conducted in participating institutions or their departments, referred to as INCTR collaborating units, which are involved with cancer research, treatment, and education in the developing world. Projects, whether related primarily to research or to training and education, are conducted jointly, often in concert with other organizations or INCTR member institutions. They may entail the preparation of protocols, guidebooks, or training manuals; the transfer of technology; or the development of policy.
INCTR Associate Members include individuals, corporations, institutions, and organizations (e.g., professional societies and associations) from developed and developing nations. Branches are legally independent nonprofit entities at the national or regional level, working to raise and disburse funds in support of the INCTR mission. Branches interact with cancer centers or units, professional organizations, or elements of national or regional governments, and coordinate ongoing INCTR programs and projects within the country or region. Each branch has an administrative
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structure and may employ medical, scientific, and support staff. Current INCTR branches include:
Alliance Mondiale Contre le Cancer (France)
INCTR Egypt
INCTR Brazil
Nepalese Network for Cancer Treatment and Research
INCTR offices, which are extensions of INCTR, Brussels, conduct activities similar to branches and may evolve into branches. Offices currently exist in Tanzania, United Kingdom, and India.
Education Program
INCTR runs workshops, training courses, and symposia, as well as a Visiting Expert Program in which cancer specialists in a variety of disciplines spend days to weeks in institutions in developing countries. Training is conducted in-country where possible by Visiting Experts, or in INCTR-accredited centers in nearby countries of similar socioeconomic status. An attempt is made to focus training activities on specific countries, which currently include Iraq, Jordan, Afghanistan, and several African countries.
The Education Program has a strong focus on clinical trials and data management, oncology nursing, pediatric oncology, and hematological neoplasms. Past meetings have included:
Workshop on Chemotherapy Administration and Palliative Care for Oncology Nurses (Yaoundé, Cameroon, March 2003)
Pediatric Oncology Update (with Shaukat Khanum Memorial Cancer Hospital & Research Centre, Dubai, October 4–6, 2003)
Lymphoma Workshop (Cairo, Egypt, October 16–18, 2003)
Cancer Nursing Training (Cairo, Egypt, October 16–18, 2003)
Pediatric Oncology Update (with the Chinese Pediatric Oncology Society, Chongqing, November 20–23, 2003)
Clinical Trials Workshop (São Paolo, Brazil, September 2004)
Multidisciplinary Workshop (for social workers, psychologists, and others involved in the support of patients with cancer, São Paolo, Brazil, September 2004)
Palliative Care Program
INCTR has begun work in palliative care in Nepal. INCTR has sent medical and nursing palliative care experts to Nepal and identified four
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institutions where patients can receive palliative care. Training has been organized for local staff members, and patients are now being cared for in these units. A home hospice program is also being established. INCTR plans to use this as a demonstration program and to train personnel. Similar work is planned for other countries in Asia and Africa.
Translational Research
The Translational Research Program is based at the King Fahad National Children's Cancer Centre within the King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia. This program is focused on improving understanding of pathogenesis, improving diagnosis, and defining prognostic factors, particularly in acute lymphoblastic leukemia (ALL).
Other Activities
INCTR has helped to establish three cooperative groups to carry out epidemiological research and clinical trials in developing countries. They are described below.
The Leukemia Study Group of India This group is focusing initially on ALL, conducting clinical trials with the aim of improving survival rates through a better understanding of epidemiology, clinical features, and biological characteristics. The major cancer centers organizing the effort will serve as regional centers for education and training for peripheral centers and hospitals.
The Middle East Children's Cancer Association MECCA has members from 13 Middle Eastern countries who have agreed to work together in improving the prevention, early detection, and treatment of children with cancer. The group will focus initially on ALL.
The Retinoblastoma Group of Mexico This group has representatives from most regions in Mexico and is in the process of establishing a registry for retinoblastoma and common treatment protocols.
In the only analysis of its type, Michaud (2004) examined the share of development assistance going toward noncommunicable diseases (referred to in this report as chronic diseases), including cancer. The chronic disease portion of the global burden of disease by region in 2001 was a point of
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reference. Worldwide, chronic diseases accounted for 46 percent of the global burden of disease and communicable diseases, 42 percent (the balance of disease burden is due to injuries). In developing regions chronic diseases accounted for about 40 percent of the total burden of disease, in contrast to developed countries, where the corresponding figure was nearly 80 percent. Heterogeneity is also significant among developing regions: Communicable diseases still predominate in sub-Saharan Africa and part of the Eastern Mediterranean region. Everywhere else—Latin America and the Caribbean, parts of the Eastern Mediterranean, Southeast Asia, and the Western Pacific, representing 3.8 billion people—chronic diseases have surpassed noncommunicable diseases.
Data Sources
The review included the major sources of data on funding provided by bilateral and multilateral agencies to developing country health sectors. For bilateral development agencies, the Organization for Economic Cooperation and Development (OECD) creditor reporting system (CRS) is the most comprehensive source of comparable data. The database lists all projects funded by donor and recipient country, with a short description of the project and the total funding. Chronic disease projects were identified through the project descriptions. The only multilateral agencies for which projects related to chronic diseases could be identified were WHO and the World Bank. To improve comparability and minimize year-to-year fluctuations, the funding levels (commitments in the case of WHO and disbursements for all others) are reported as 3-year rolling averages.
The overall result is likely an underestimate of the actual amount. For some projects, the descriptions were not specific enough, and other projects (e.g., infrastructure projects) could have a wide range of effects, including improved chronic disease control. Finally, other sources of funding, such as IAEA, are not included.
Bilateral Agencies
In 2002, the latest year in the analysis, official development assistance from bilateral agencies totaled $2.9 billion. A total of $3.2 million—0.1 percent—was allocated to the prevention and control of chronic diseases. The 8-year total from 1995 to 2002 was $35.5 million. The 3-year rolling averages increased from $3.4 million in the early period (1995 to 1997) to $5.5 million for 1998 to 2000, and decreased to $4.4 million for 2000 to 2002. Of the total allocated to chronic diseases from1995 through 2002, 6
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percent was allocated to cancer, 35 percent to mental disorders, 8 percent to tobacco control, and the remaining 50 percent for other NCDs. The specific projects identifiable as cancer related (including tobacco control) are listed in Table 10-1.
On the donor side, the United Kingdom and Sweden contributed 43 percent of the 8-year total ($8.7 million and $6.7 million, respectively). Trends over the period for individual donor countries were mixed. Australia and Sweden increased funding the most. Finland and the Netherlands substantially decreased their commitments. For all other countries, there was little change (Table 10-2).
The Eastern Mediterranean region and Europe received the most bilateral funding for chronic diseases ($6.4 million and $5.7 million, respectively, 1995–2002). Southeast Asia received the least ($1.4 million) (Table 10-3).
Multilateral Agencies
In 2002, WHO allocated 3.6 percent of its total budget ($44 million) to chronic diseases (Table 10-4). About one-third went to mental health, 30 percent to tobacco control, and 37 percent to unspecified chronic disease projects. The chronic disease share of total regional expenditures was lowest in sub-Saharan Africa (1.6 percent) and highest in Southeast Asia (6.6 percent). The specifics of global and interregional activities (apart from tobacco control and mental health) were available for about half the total $7.6 million. Approximately $1.1 million went for risk factor prevention and risk factor surveillance for diet, nutrition and physical activity, and cardiovascular risk management. A total of $2.4 million was allocated to cardiovascular diseases, diabetes, cancer, chronic respiratory conditions, and aging.
WHO expenditures for noncommunicable diseases (NCDs) nearly tripled between 1998–1999 and 2002, increasing from $16 million to $43.6 million per year, with most of the increase in funding for tobacco control and mental health. For all other chronic diseases, the increase was from $9.4 million to $14.3 million per year.
World Bank loans for chronic diseases between 1997 and 2002 totaled $109.5 million, with the 3-year average increasing from $7 million (1997–1999) to $20–21 million between 1998 and 2002. Nearly all of these loans went to Eastern Europe (the Russian Federation, Albania, Armenia, Latvia, Croatia, Lithuania, Romania, and Azerbaijan) as part of larger health-sector loans, mostly for cardiovascular disease prevention and the control of smoking and alcohol abuse.
In late 2005, the World Bank began to reexamine its investments in chronic diseases. A new work program will examine the economic and health burden of the major chronic diseases in the Bank's client countries,
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TABLE 10-1 Bilateral Development Assistance Projects for Cancer 1995–2002
Short Description
Americas unspecified
Cervical cancer research
Tobacco policy research initiative
Tobacco control political mapping
Africa unspecified
Workshop on tobacco control
Tobacco control research initiative
Cervical cancer and sexually-transmitted diseases (STDs)
South Africa
Tobacco control
WHO Tobacco or Health program
Tobacco policy research
Tobacco control strategies
Tobacco control political mapping
Cervical cancer and STDs
International initiative for tobacco policy research
International initiative for tobacco policy research
Tobacco and ecohealth workshop
Epidemiologic study of hepatic neoplasia risk
Technical assistance to Habib Hospital and Cancer Institute of Tunisia
United Kingdom
Cervical cancer prevention
Health education for tobacco control
Technical assistance to Habib Hospital and Cancer Institute of Tunisia
Tobacco control capacity-building workshop
Cervical cancer and STDs
International initiative for tobacco policy research
South Africa
International initiative for tobacco policy research
Health education: diseases and disability due to tobacco
Tobacco policy cooperation
Tobacco control
United Kingdom
Cervical cancer prevention
1995–2002 Total Cancer-Related Projects
1995–2002 Total All Chronic Disease Projects
SOURCE: Reprinted, with permission, from Michaud (2004). Copyright 2004 by Catherine M. Michaud, Harvard Initiative for Global Health.
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TABLE 10-2 Bilateral Commitments 1995–2002 for Noncommunicable Diseases by Country, US$ 000s
Donor Country
1995–2002 Commitment
United Kingdom
United States
New Zealand
SOURCE: Reprinted, with permission, from Michaud (2004). Copyright 2004 by Catherine M. Michaud, Harvard Initiative for Global Health.
TABLE 10-3 Bilateral Commitments 1995–2002 for Noncommunicable Diseases by Recipient Region, US$ 000s
WHO Region
1995–2002 Commitment
Eastern Mediterranean
Southeast Asia
Western Pacific
Unallocated to region
SOURCE: Reprinted, with permission, from Michaud (2004). Copyright 2004 by Catherine M. Michaud, Harvard Initiative for Global Health.
the rationale for public interventions and the roles of government in the control of chronic disease, and the Bank's comparative advantage in assisting clients in chronic disease control. It will define a strategy to address the priorities across multiple sectors to lay the basis for improved policy advice to clients, as well as more efficient allocation and use of existing resources
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TABLE 10-4 WHO Budget by Region and Major Chronic Disease Component, 2002, US$ 000
NCD Subcategories
WHO Region
Total Budget
Total for NCDs (% total)
Unspecified NCDsa (% NCD total)
Mental Health (% NCD total)
Tobacco (% NCD total)
4,927 (1.6)
2,131 (43)
1,306 (27)
1,490 (30)
Eastern Mediterranean
2,234 (2.1)
1,257 (56)
416 (19)
562 (25)
Western Pacific
2,784 (3.3)
919 (33)
1,327 (48)
537 (19)
Southeast Asia
7,313 (6.6)
3,118 (43)
2,339 (32)
1,856 (25)
2,242 (4.8)
1,148 (51)
508 (23)
587 (26)
3,194 (4.7)
656 (21)
865 (27)
1,673 (52)
Regional total
22,694 (3.2)
9,229 (41)
6,760 (30)
6,705 (29)
Global and interregional total
21,542 (4.0)
7,612 (35)
7,491 (35)
6,439 (30)
Overall total
44,236 (3.6)
16,841 (38)
14,251 (32)
13,144 (30)
aCancer is included in this category.
SOURCE: Reprinted, with permission, from Michaud (2004). Copyright 2004 by Catherine M. Michaud, Harvard Initiative for Global Health.
for impact on chronic diseases (Personal communication, O. Adeyi, Coordinator, Public Health Programs, Human Development Network, World Bank, October 13, 2005).
The allocation of funds for chronic diseases in recent years bears little relation to the importance of these diseases in terms of burden of disease. The traditional communicable disease targets still dominate health-sector funding.
Major universities across the United States and elsewhere have become increasingly interested and involved in global concerns, especially in health in developing countries. Many have established formal global health programs, the primary goal of which is teaching students. However, some portion of their effort is also directed at carrying out research or other activities in developing countries. Both faculty and students may participate in the overseas portion of these programs.
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University global health programs are an untapped resource for cancer control. The point is already made that progress in cancer control involving collaborations between low- and high-resource countries will require services and research at ground level. The example of institutional "twinning" has involved cancer centers per se, not global health programs, and the expertise required is largely clinical, including clinical research. However, many major universities house cancer centers as well as global health programs. One could envision a collaboration with a core clinical component that also takes on other projects. Examples might be helping to develop cancer registries along with IARC, working on community education and outreach about cancer, and exploring the legal and policy aspects of opioid drug availability (e.g., in collaboration with the WHO Coordinating Center for Policy and Communications in Cancer Care). This type of commitment could contribute in a meaningful way to improving cancer control in the partner country and provide opportunities for faculty and students in a variety of disciplines. The challenge is, at least in part, letting those in decision-making roles in global health programs know what opportunities exist or could be created in cancer control. The formation of a university consortium on global health could aid this process (see next section).
University Consortium on Global Health
Representatives of 17 major North American universities with active commitments to global health, and several academic associations, met in April 2005 at Boston University to explore the potential value of coming together in a consortium to support and expand global health programs and promote "global health literacy." A main purpose of the consortium—should it be developed formally—would be to create the means for a collective voice for global health that could communicate with greater strength than individual members. It would also be a place for exchange of ideas among members and for input from outside the academic community. We propose that an explicit goal be to explore the range of opportunities that could be open to university global health programs, with the aim of broadening the areas in which work is taking place. The consortium idea appears to have a good chance of taking hold, with next steps being planned (Keusch, 2006).
Global health and development organizations and institutions are highly influential in helping LMCs develop, funding, and carry out their health agendas. Historically, the priorities have been overwhelmingly the infectious diseases that kill children and increasingly adults (mainly AIDS
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and tuberculosis). Cancer, although not the leading health problem in these countries, imposes a significant and growing burden, but has been overlooked by most of the global development and academic communities. The exceptions are those that are exclusively cancer focused, which do concern themselves to varying degrees with cancer in LMCs. Still, only a tiny share of global health resources has been devoted to cancer.
There are signs that the balance has begun to change, with recognition by WHO and others that chronic, noncommunicable diseases must be addressed at the same time as infectious diseases. However, the danger is that the common risk factors for other chronic diseases will continue to dominate activities, leaving cancer (which shares fewer risk factors) behind. Cancer must have its own identity and recognition if the compelling opportunities across the spectrum of cancer control, highlighted in this report, are going to be acted upon.
RECOMMENDATION 10-1. International Organizations
WHO should maintain a strong capacity for cancer control analysis and guidance to assist the many countries that rely on them for health-related information and policy advice. Capacity is needed both at WHO headquarters and in the regional offices.
RECOMMENDATION 10-2. Development Assistance
The bilateral aid agencies, including the U.S. Agency for International Development, should consider adding aspects of cancer control to their discussion agendas with LMCs, and adding funding for specific projects that fit into national cancer control plans and programs.
RECOMMENDATION 10-3. National Institutions
The U.S. National Cancer Institute and other established cancer research and funding organizations both in the United States (e.g., the Centers for Disease Control and Prevention) and in other countries should help to establish and facilitate relationships between U.S. cancer centers and centers in LMCs and encourage U.S. researchers, through grant programs, to undertake collaborative research of relevance to LMCs.
RECOMMENDATION 10-4. The Academic Community
Universities with active global health programs should consider opportunities in cancer control, as well as the more traditional areas of focus. If a university consortium is developed, one function should be to encourage and facilitate a broader agenda of topics, cancer control among them.
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Clanton M. 2006. Implementing the IAEA Program for Action in Cancer: The National Cancer Institute's Supporting Role. Presented at the UIC World Cancer Congress 2006, Washington, DC. Unpublished.
Freedman LS, Edwards BK, Ries LAG, Young JL, eds. 2006. Cancer Incidence in Four Member Countries (Cyprus, Egypt, Israel, and Jordan) of the Middle East Cancer Consortium (MECC) Compared With US SEER. Bethesda, MD: National Cancer Institute.
IAEA (International Atomic Energy Agency). 1956. Statute of the International Atomic Energy Commission.
IAEA. 2004. Strengthening the Agency's Activities Related to Nuclear Science, Technology and Applications: Resolution Adopted on 24 September 2004. Vienna, Austria.
IAEA. 2005. Where We Work. [Online]. Available: http://www.iaea.org/pact/where_we_work/index.html [accessed December 1, 2005].
International Agency for Research on Cancer. 2006. IARC's Mission: Cancer Research for Cancer Control. [Online]. Available: http://www.iarc.fr/ENG/General/index.php [accessed January 23, 2006].
Keusch G. 2006 (July). Meeting of the University Consortium on Global Health, Executive Summary and Participant Comments, Boston University, April 26–27, 2005.
Levin V, Meghzifene A, Izewska J, Tatsuzaki H. 2001. Improving cancer care: Increased need for radiotherapy in developing countries. IAEA Bulletin 43(2):25–32.
Michaud CM. 2004. Official Development Assistance for Noncommunicable Diseases, 1995–2002. Background paper prepared for the WHO report "Towards a WHO Long-Term Strategy for Prevention and Control of Leading Chronic Diseases," submitted April 2004. Typescript.
World Health Organization. 2002. National Cancer Control Programmes: Policies and Managerial Guidelines. 2nd ed. Geneva, Switzerland: World Health Organization.


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Alabama EMS Region One (AERO) will be offering continuing education opportunities in 2014. AERO covers the north region which includes the following counties: Colbert, Cullman, DeKalb, Franklin, Jackson, Lauderdale, Lawrence, Limestone, Madison, Marshall, and Morgan.
AERO posts courses to their Facebook Events page and also works with CentreLearn to offer training opportunities all year long. The CentreLearn course listings can be accessed through your CentreLearn account.


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Be a part of our growing family! Know more on how to become a Franchisee. Read our requirements & qualifications.>>
read what our customers have to say "Hello MINISTOP! Keep up the good work!" "Sarap ng Chicken nyo lalo na ung mainit at bagong luto (breast part) with matching cold C2..." "Sarap nung cheesecakè flavor :)" "Cheesecake flavored sundae... masarap..." "I just wanted to say thank you for releasing a P49.00 Fish Fillet budget meal." "Perfect ang MINISTOP...love it" "Good service and Good quality ang mga service!"


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Gastroenteritis (cont.) IN THIS ARTICLE
Bacteria (Clostridium difficile, Salmonella, Shigella, and Campylobacter, and E coli)Bacteria may cause gastroenteritis directly by infecting the lining of the stomach and intestine. Some bacteria such as Staphylococcus aureus produce a toxin that is the cause of the symptoms. Staph is a common type of food poisoning. Escherichia coli infection can cause significant complications. E. coli O157:H7 (one type of the bacteria) can cause complications in approximately 10% of affected individuals (for example, kidney failure in children [hemolytic-uremic syndrome or HUS), bloody diarrhea, and thrombotic thrombocytopenic purpura (TTP) in the elderly. Salmonella, Shigella and CampylobacterSalmonella, Shigella and Campylobacter are also common causes of illness.
Clostridium difficileClostridium difficile (C difficile) bacteria may overgrow in the large intestine after a person has been on antibiotics for an infection. The most common antibiotics that pose a potential risk for C difficile include:
Other risk factors for C difficile infection include hospitalization, individuals 65 years of age or older, and pre-existing chronic medical conditions. The CDC lists C. Difficile as one of the most common causes of death due to gastroenteritis and suggest that new strains of the bacteria have become more aggressive and dangerious. Medically Reviewed by a Doctor on 12/31/2014
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Gastroenteritis is a nonspecific term for various pathologic states of the gastrointestinal tract.


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You Do It Because You Love It | |||||||||||
by S.A. Griffin | |||||||||||
Last summer we offered our friend Kurt Heintz word to the wise on choosing where to enter your poems in competition. The idea of competition in poetry remains a perennial debate topic in all kinds of poetic communities, from the small chapbook presses to the slam to the big name prizes -- not to speak of the ongoing arguments about how competitions are administered, contest entry fees, etc. The subject arises regularly in the online poetry discussion lists, and we think our friend S.A. Griffins recent comments on the PoetsAllOver mailing list at Yahoo are worth rereading for a perspective on why we keep doing this art, making poems.
Margy Snyder & Bob Holman Its been an interesting debate, to say the least. I personally am completely opposed to fees and especially contests whether in print or performance. Never have and never will believe in subjecting the muse to contest. As a long time editor, publisher, performer, producer and writer of poetry and performance, I have cultivated these opinions through experience as well as personal p.o.v. It is all completely subjective, to say the very least.
Ultimately, we all make our way. When I was involved in publishing a magazine (or zine) the money came from ads, sales and, as always, out of pocket. The zines almost always lost money -- I went into it knowing as much. The chapbooks/books always broke even or made money. I have been lucky. It does take some time to recoup expenses -- sometimes years -- but I have never asked for money from anyone to create anything. I personally dont believe in it. I do, though, understand why it happens. I must say that it has been my experience that it is mostly on the level of scam, a way for somebody to slack off of the need of others.
In the end, it is completely up to the individual whether they do or dont. I also have been fortunate enough to make my living as an actor these past 24 years. The same holds true for that profession/craft: you dont pay to play, although many do and it is almost always a scam. There is presently a somewhat heated debate in the entertainment industry regarding such practices as casting directors making thousands of dollars off of out-of-work and novice actors trying to get work any way they can. The poets plight is much the same with much the same results. Very few benefit except the gatekeepers asking for the money.
I have been a working actor and poet for going on 25 years, so I do know something of what I am talking about. In the end, no matter how you cut it, practicing your art & getting it seen is always ongoing, hard work. The rewards are often little or nil. You do it because you want to, because you love it. I have always done it because I always felt it was the only choice for me, and it has paid off. Im not well wired for the 9-5. Hopefully, my luck will continue to hold.
To each his or her own.
Peace, S.A. Griffin is a Los Angeles poet, actor, publisher & editor who feels lucky to have been involved in many poetry adventures, on the road and off. The Lost Tribe, The Carma Bums & White Trash Apocalypse are among the poetry performance ensembles you can read about at his Web site, The Open Ended It. By Date | By Topic |


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Glossary of Diabetes Terms
In this article
Insulin resistance syndrome or Metabolic syndrome: This syndrome is defined by a cluster of medical conditions that raise the risk of developing type 2 diabetes and heart disease. A diagnosis is important, because you can make health improvements that lessen the risk.
Insulin resistance syndrome or metabolic syndrome is diagnosed when a person has 3 or more of the following:
- Blood pressure equal to or higher than 130/85 mmHg
- Fasting blood sugar (glucose) equal to or higher than 100 mg/dL
- Large waist circumference (a waistline of 40 inches or more for men; 35 inches or more for a woman)
- Low HDL cholesterol (under 40mg/dL for men; under 50 mg/dL for women)
- Triglycerides equal to or higher than 150 mg/dL
Insulin shock: A severe condition that occurs when the level of blood sugar drops quickly.
Intermediate-acting Insulin: Covers insulin needs for about half the day or overnight; this type of insulin is often combined with rapid- or short-acting insulin. Includes NPH and Lente.
Intermittent claudication: Pain in the muscles of the legs that occurs off and on, usually while walking or exercising; the pain results from atherosclerosis of the blood vessels feeding the muscles of the lower extremities. Claudication usually increases with age and is most common in people in their sixth or seventh decade of life. Risk factors for developing narrowing of the arteries that can cause claudication include smoking cigarettes, high blood pressure, and diabetes. Drugs are available to treat this condition.
Jet injector: A device that uses high pressure to push insulin through the skin and into the tissue.
Juvenile-onset diabetes: Former term used for type 1 diabetes.
Ketoacidosis: See diabetic ketoacidosis (DKA).
Ketone bodies: Often simply called ketones, one of the products of fat burning in the body; when there is not enough insulin, your body is unable to use sugar (glucose) for energy and your body breaks down its own fat and protein. When fat is used, ketone bodies, an acid, appear in your urine and blood. A large amount of ketones in your system can lead to a serious condition called ketoacidosis. Ketones can be detected and monitored in your urine at home using products such as Ketostix, Chemstrips, and Acetest. When your blood sugar is consistently greater than 250 mg/dl, if you are ill or if you are pregnant and have diabetes, ketones should be checked regularly.
Kidney disease (nephropathy): In a person with diabetes, nephropathy is any one of several conditions caused by changes in the very small blood vessels in the kidneys. These changes cause scarring of the kidneys, which can eventually lead to kidney failure. People who have had diabetes for a long time may develop nephropathy. An early sign of nephropathy is when proteins can be detected in the urine.
Kidney threshold: See renal threshold.
Lancet: A fine, sharp pointed needle for pricking the skin; used in blood sugar monitoring.
Laser treatment: The use of a strong beam of light (laser) to heal a damaged area; a person with diabetes might receive laser treatments to heal blood vessels in the eye.
Late-onset diabetes: Former term used for type 2 diabetes.
Lipid: Another term for a fat or fat-like substance in the blood; the body stores fat as energy for future use, just like a car that has a reserve fuel tank. When the body needs energy, it can break down lipids into fatty acids and burn them like glucose. Excess amounts of fats in the diet can cause fat buildup in the walls of the arteries -- called "atherosclerosis." Excess amounts of calories from fats or other nutrients can lead to an increase in weight gain.
Low blood sugar, low blood glucose: See hypoglycemia.
Metabolism: All of the physical and chemical processes in the body that occur when food is broken down, energy is created and wastes are produced.
Mg/dL (milligrams per deciliter): Measurement that indicates the amount of a particular substance such as glucose in a specific amount of blood.
Mixed dose: A prescribed dose of insulin in which two types of insulin are combined and injected at once; a mixed dose commonly combines a fast-acting and longer-acting insulin. A mixed dose can either come in a pre-mixed syringe or mixed at the time of injection. A mixed dose may be prescribed to provide better blood sugar control.
Nephropathy: Disease of the kidneys caused by damage to the small blood vessels or to the units in the kidneys that clean the blood; people who have had diabetes for a long time may develop nephropathy.
Neurologist: A doctor who treats people who have problems of the nervous system (brain, spinal cord, and nerves).
Neuropathy: Nerve damage; people who have had diabetes that is not well controlled may develop nerve damage.
Non-insulin dependent diabetes: Former term for type 2 diabetes.
Nutritionist: See dietitian.
Obesity: A term uses to describe excess body fat; it is defined in terms of a person's weight and height, or his/her body mass index (BMI). A BMI over 30 is classified as being obese. Obesity makes your body less sensitive to insulin's action. Extra body fat is thought to be a risk factor for diabetes.
Ophthalmologist: A doctor who treats people with eye diseases.
Optometrist: A person professionally trained to test the eyes and to detect and treat eye problems, as well as some diseases, by prescribing and adapting corrective lenses.
Oral diabetes medications: Medications that people take to lower the level of sugar in the blood; oral diabetes medications are prescribed for people whose pancreas still produces some insulin. These medications are not used in diabetes during pregnancy.
Pancreas: An organ behind the lower part of the stomach that is about the size of a hand; it makes insulin so the body can use sugar for energy.
Peak action: The time when the effect of something is as strong as it can be, such as when insulin is having the most effect on blood sugar.
Periodontal disease: Damage to the gums and tissues around the teeth; people who have diabetes are more likely to have periodontal disease than people who do not have diabetes.
Peripheral neuropathy: A type of nerve damage most commonly affecting the feet and legs.
Peripheral vascular disease (PVD): An abnormal condition that affects the blood vessels outside the heart, usually the hands and feet; often occurs as a result of decreased blood flow and narrowing of the arteries from atherosclerosis; people who have had diabetes for a long time may develop PVD.
Podiatrist: A health professional who diagnoses and treats foot problems.
Polydipsia: Excessive thirst that lasts for long periods of time; may be a sign of diabetes.
Polyphagia: Excessive hunger and eating; may be a sign of diabetes. When insulin levels are decreased or there is insulin resistance, the cells of the body do not get enough sugar, and hunger develops. People with polyphagia often lose weight, even though they are eating more than normal, because the excess calories are lost in the urine as sugar (glucose).
Polyunsaturated fat: A type of fat that can be substituted for saturated fats in the diet and can reduce LDL ''bad'' cholesterol.
Polyuria: Increased need to urinate often; a common sign of diabetes.
Protein: One of three main classes of food; proteins are made of amino acids, which are called the "building blocks of the cells." Cells need protein to grow and to mend themselves. Protein is found in many foods, like meat, fish, poultry, eggs, legumes, and dairy products.
Is This Normal? Get the Facts Fast!
Your level is currently
If the level is below 70 or you are experiencing symptoms such as shaking, sweating or difficulty thinking, you will need to raise the number immediately. A quick solution is to eat a few pieces of hard candy or 1 tablespoon of sugar or honey. Recheck your numbers again in 15 minutes to see if the number has gone up. If not, repeat the steps above or call your doctor.
People who experience hypoglycemia several times in a week should call their health care provider. It's important to monitor your levels each day so you can make sure your numbers are within the range. If you are pregnant always consult with your health care provider.
Congratulations on taking steps to manage your health.
However, it's important to continue to track your numbers so that you can make lifestyle changes if needed. If you are pregnant always consult with your physician.
Your level is high if this reading was taken before eating. Aim for 70-130 before meals and less than 180 two hours after meals.
Even if your number is high, it's not too late for you to take control of your health and lower your blood sugar.
One of the first steps is to monitor your levels each day. If you are pregnant always consult with your physician.
Did You Know Your Lifestyle Choices
Affect Your Blood Sugar?
Use the Blood Glucose Tracker to monitor
how well you manage your blood sugar over time.
This tool is not intended for women who are pregnant.
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text:
Ora King Salmon From New Zealand Launches Nationwide
Unique Breed of King Salmon Now Available to Foodservice and Specialty Retail Trade Nationwide
PR Newswire
PICTON, New Zealand, Dec. 5, 2012
PICTON, New Zealand, Dec. 5, 2012 /PRNewswire/ -- This October, the Marlborough-based New Zealand King Salmon Company launched Ora King, its unique best-of-breed King salmon. Now available to the foodservice trade nationwide and at select finer retail markets, the launch of Ora King is a result of decades of dedication in cultivating the renowned taste, color and texture inherent in the King salmon species.
The Ora King brand represents the culmination of world-leading, sustainable practices developed by New Zealand King Salmon Company during 20 years of farming in the pristine waters of the South Island's Marlborough Sounds.
"Our classical breeding program combines 20 years of time-honored husbandry practices and seven generations of King salmon," said Ian Rolmanis, Breeding Program Supervisor for Ora King. "This has produced over 90 distinct King salmon families, chosen so that only the finest examples of King salmon, with the best culinary traits, are carried forward to subsequent generations."
"The pure and isolated waters of the Marlborough Sounds enable us to raise Ora King salmon in a natural and wholesome manner, with our seafarms comprising 97.5% water space to just 2.5% salmon," said Mark Preece, General Manager of Aquaculture for Ora King. "We are also proudly committed to humane harvesting techniques to ensure the process is quick, effective and as stress-free as possible for the salmon."
A Quality at the Source philosophy is the foundation for raising Ora King salmon. The salmon are nurtured throughout their lifecycle, minimizing stress and fatigue, and are humanely harvested using a percussive stunning method based on the traditional Japanese Ike Jime technique. These efforts to reduce stress result in a minimum release of lactic acid, which along with rapid chilling, help ensure a desirable texture.
Once the Ora King salmon complete their journey to the processing facility, each one undergoes a thorough cleaning, washing, grading and preparation process. Master Graders, dedicated to Ora King, then review each fish against standards for size, color and quality. Once approved, an individually numbered Ora King gill tag is attached to allow for authenticity of origin and traceability for customers. The salmon are shipped in the newly designed Ora King carton, a recyclable, insulated container, ensuring delivery in optimum condition to customers around the world.
Being an introduced species, Ora King salmon pose no threat to indigenous wild populations, and their feed is sourced from sustainable, certified GMO-free suppliers. No antibiotics, vaccines or pesticides of any kind are used as the Marlborough Sounds provide a clean and pristine environment in which to raise salmon.
The majority of Ora King salmon are sold whole or as fillets via seafood distributors to restaurants throughout the U.S. Also available is Ora King Smoked Salmon, a traditional cold smoked salmon that is filleted and pinboned by hand, brined with sea salt and cold water, and slowly smoked for nine hours over native manuka wood.
To date, Ora King is served at numerous, well-respected restaurants and specialty retailers throughout the U.S., including:
- Craft (Los Angeles, CA)
- Nobu (New York, NY, Dallas, TX, Waikiki, HI)
- The French Laundry (Yountville, CA)
- The Pineapple Room by Alan Wong (Honolulu, HI)
- Roka Akor (Scottsdale, AZ and Chicago, IL)
- Public (New York, NY)
- Dean & Deluca (New York, NY)
- Waldorf Astoria (New York, NY)
- Mitch's Sushi (Honolulu, HI)
- Bull & Bear Steakhouse (New York, NY)
- The Lobster Place (New York, NY)
- Lure Fishbar (New York, NY)
- Chaya Brasserie (Los Angeles, CA)
- Fairway Market (locations in New York and New Jersey)
"Ora King salmon is a great product to work with and serve. The consistency and top quality means that I know what I'm getting every time I order it," said Robin Lee, Executive Chef at Nobu Waikiki. "Ora King's vibrant colors practically jump off the plate, and the full flavor profile makes it perfect for many of the dishes we serve at Nobu."
In a new initiative, Ora King has developed a specialist food service team to interact directly with chefs and the hospitality industry supported by seafood and specialty food distributors in major metropolitan markets throughout the U.S. and Canada.
For more information, please visit www.OraKingSalmon.com, and follow Ora King on Twitter at http://twitter.com/OraKingUSA.
Ora King salmon is available for consumer purchase through Honolulu Fish Company, http://www.honolulufishstore.com/Section.aspx?CategoryID=25, and Gilt Taste, http://www.gilttaste.com/.
About Ora King Salmon
The New Zealand King Salmon Company sustainably farms Ora King salmon from two sea farms comprising five separate areas in the cool, deep waters of the South Island's Marlborough Sounds of New Zealand. The New Zealand King Salmon Company invests heavily in research and development and is recognised worldwide for its best in class King salmon farming practices. It is firmly committed to the sustainability and viability of a renewable resource with its success centred on maintaining the quality of the waters in which the salmon are farmed. King salmon has the highest natural content of healthy long chain Omega-3 fatty acids among all salmon species.
SOURCE Ora King Salmon
The information on this page is provided by PR Newswire. All rights reserved. Reproduction or redistribution of this content without prior written consent from PR Newswire is strictly prohibited. Pacific Business News is not responsible for this content. Learn more about this service.
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Hawaiian Airlines
Donna Takeda
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Laureen Kalawe
First Hawaiian Bank
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MacArthur Sotheby's International Realty
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Honolulu HomeLoans
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First Hawaiian Bank


text:
a. An ocean-bottom deposit containing up to 75% terrigenous materials of dimensions below 0.03 mm. The depth range occurrence is about 750 to 16,800 ft (229 to 5,120 m). Colors range from reddish to brownish at the surface, but beneath the surface, the colors of the wet muds are gray to blue. AGI
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text:
Basketball league disappears during regional tournament
A local team says a nationwide youth basketball league picked up and left overnight — right in the middle of a tournament.
A local team says a nationwide youth basketball league picked up and left overnight — right in the middle of a tournament.
Newport News police have arrested a mother and daughter, who are accused in the assault of a 51-year-old woman.
A crash involving a car and lawn tractor blocked a portion of Godwin Boulevard in Suffolk Monday afternoon.
An 80-year-old woman missing out of Virginia Beach was found in Chesapeake on Tuesday.
An judge ruled Monday that the case will move forward against a trio accused of stealing a dog from an Eastern Shore front yard.
Virginia Beach police found 14-year-old Sierra Smith, who was missing for about 12 hours Monday.
An investigation from last week is now a homicide after 1 of 2 alleged shooters died from injuries sustained in an exchange of gunfire.
A local boxer's friends and family say he passed away Monday, after collapsing during a match Saturday night.
A Virginia Beach man claims something fell from the Downtown Tunnel ceiling and damaged his new Lexus.
The Cavaliers will have to defend their ACC crown without their best player.
Portsmouth police detectives are investigating the death man who died while imprisoned at Portsmouth City Jail Monday morning.
A Virginia Beach family is suing a home health care agency for $50 million after a man died in a mobile home fire last year.
Darren Sharper has been removed from the William and Mary Athletics Hall of Fame. He was inducted with the class of 2008.
Hampton police responded to 6 separate spice overdoses, all of which required hospitalization, and one that caused death.
A controlled burn at Mackay Island National Wildlife Refuge in Knotts Island filled a sunny afternoon sky with smoke Monday, April 13.
Businesses were evacuated and streets closed as crews worked to contain a gas leak at the Oceanfront Monday afternoon.
Police are investigating the death of an infant, following a 911 call from a Hampton home early Sunday morning.
Emergency dispatchers got a 911 call around 2:15 p.m. requesting help for a woman who had been shot in on Holladay Street.
Police say the theft happened March 23 in the 1500 block of Sam's Circle.
A controlled burn filled a sunny afternoon sky with smoke Monday.
Police say a man was shot during a robbery in Norfolk, early Monday morning.


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text:
Know all Men by These Presents, That we,
M Carter as
prinipal, and
Joseph Pale as
are held and firmly bound unto the State of Missouri, in
the just and
full sum of Onehundred
Dollars, lawful money of the
United States, for the payment of which we
bind ourselves, our heirs, executors
and administrators, firmly by
these presents, sealed with our seals, and
dated this 8 day of
Aug A.D.
The condition of the above Obligation is such, that whereas, the said
Carter has
applied to the County Court
of St. Louis County for, and obtained a
license to reside in the State of
Missouri, during good behavior: Now,
if the said applicant shall be of
good character and behavior during
his residence in the State of Missouri,
then this obligation to be void, else of full force and virtue.
M his X mark Carter
SEAL.Joseph Pale
M Carter
Filed Aug 8. 1850
L. F Lacy Clk.


text:
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Reporting Suspected Adult Abuse/Neglect
Always call 9-1-1 anytime there is an emergency situation with adult abuse or neglect!
During business hours, Monday-Friday from 8 a.m. - 5 p.m., call the Department of Social Services at 703-792-4200.
After business hours (5 p.m. to 8 a.m.) and on the weekends, call the Prince William County Police non-emergency number at 703-792-6500; or the Virginia State Hotline at 1-800-552-7096.
What to do if you suspect abuse/neglect?
The Department of Social Services is responsible for proviging Protective Services to adultsi in our community. This consists of the receipt and prompt investigation of valid reports of abuse, neglect and exploitation of
individuals with disabilities who are eighteen (18) years of age or older or anyone over the age of sixty (60).
The investigation includes an assessment to determine if the adult needs protective services and if so the arrangement of the appropriate services.
Who are mandated rep
Any person licensed certified or registered by health regulatory boards listed in §54.1-2503 except licensed by the Board of Veterinary Medicine:
Board of Audiology and Speech Pathology: Audiologists; Speech-Language Pathologists; School
Speech-Language Pathologists
Board of Counseling: Licensed Professional Counselors; Certified Substance Abuse Counselors; Counseling Assistants; Certified Rehabilitation Providers; Marriage and Family Therapists; Licensed Substance Abuse Treatment Practitioners
Board of Dentistry: Dentists and Dental Hygienists
Board of Funeral Directors and Embalmers: Funeral Service Providers Directors and Embalmers; Resident Trainees; Crematories; Surface Transportation and Removal Services; Courtesy Card Holders
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Board of Medicine: Doctors of Medicine; Surgery Osteopathic Medicine Podiatry and Chiropractic; Interns and Residents; University Limited Licenses; Physician Assistants; Respiratory and Occupational Therapists; Radiological Technologists and Technologists Limited; Licensed Acupuncturists; Certified Athletic Trainers
Board of Nursing: Registered Nurses (RN); Licensed Nurse Practitioners (LNP); Licensed Practical Nurses (LPN); Clinical Nurse Specialists; Certified Massage Therapists; Certified Nurses Aides (CNA)
Board of Optometry: Optometrists
Board of Pharmacy: Pharmacists Pharmacy Interns and Technicians; Permitted Physicians; Medical Equipment Suppliers; Restricted Manufacturers; Humane Societies; Physicians Selling Drugs; Wholesale Distributors;
Board of Physical Therapy: Physical Therapists and Physical Therapists Assistants
Board of Psychology: School Clinical and Applies Psychologists; Sex Offender Treatment Providers; School Psychologists - Limited
Board of Social Work: Registered Social Workers; Associate Social Workers; Licensed Social Workers; Licensed Clinical Social Workers
Any mental health services provider as defined in §54.1-2400.1
Any emergency medical services personnel certified by the Board of Health pursuant to §32.1-111.5
Any guardian or conservator or an adult
Any person employed by or contracted with a public or private agency or facility and working with adults in an administrative supportive or direct care capacity
Any person providing full intermittent or occasional care to an adult for compensation including but not limited to companion chore homemaker and personal care workers
Any law-enforcement officer
Adult Long Term Care
Medicaid long-term
care screenings are conducted with nursing staff from the Health Department.
Companion services are performed by an individual provider who assists adults unable to care for themselves without assistance and where there is no one available to provide the needed services without cost.
Those services are provided to the extent that federal and/or state funds are made available and are designed for low-income clients of the Department of Social Services.
Companion services include light housekeeping meal preparation dressing supervision and/or companionship.
To inquire about becoming a companion provider call 703-792-7500.
Prince William guardianship reports are reviewed for adult protective services concerns.