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All hotels in Hyannis, Massachusetts, United States of America
1 room, 2 adults
1 South Street, Hyannis, MA, 02601, United States of America, 800 1205131 (Singapore Toll Free) +1-817-524-0058 (From abroad)
Anchor In Distinctive Waterfront Lodging
Lowest priceS$280
Best Price Guarantee
Bayfront Hyannis inn with outdoor pool
- Free continental breakfast, free WiFi, and free parking
Main amenities
- 42 smoke-free guestrooms
- Marina
- Near the beach
- Outdoor pool
- Business center
- Terrace
- Coffee/tea in the lobby
- Air conditioning
- Daily housekeeping
- Computer station
- Lobby fireplace
- Front desk safe
What's around
- On the waterfront
- Hyannis Harbor (0.3 mi / 0.5 km)
- John F. Kennedy Hyannis Museum (0.5 mi / 0.8 km)
- Cape Cod Baseball Hall of Fame (0.5 mi / 0.9 km)
- St. Francis Xavier Church (0.6 mi / 1 km)
- Wild Animal Lagoon (0.7 mi / 1.2 km)
We were taken care of so nice. The upgrade they gave us was Great. We are already coming…
Quick first time visit to "the Cape" and The Anchor Inn was perfect.
TripAdvisor Traveller Rating: 4.5
From 805 reviews
Enter dates to check prices
Hotel Info: 800 1205131from S$280
- Executive Double Room, 2 Queen Beds, Harbor View
- Executive Room, 1 King Bed, Harbor View
- Deluxe Room, 1 King Bed (Harborside)
- Standard Double Room, 2 Double Beds
- Deluxe Room, 1 King Bed (Harborview)
- Deluxe Room (Harborview)
- Deluxe Room (Harborside)
Recommended hotels
At a glance
Key facts
Hotel size
- This hotel has 42 rooms
- This hotel is arranged over 2 floors
- Check-in time 3 PM-11 PM
- Check-out time is 11 AM
If you are planning to arrive after 11 PM please contact the property in advance using the information on the booking confirmation.
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
- Minimum check-in age is 25
Travelling with others
- Pets not allowed (service dogs only)
- Free WiFi in public areas
- Free WiFi in rooms
- Free self parking
Other information
- Smoke-free property
Nearby Three Star Hyannis hotels
In the hotel
Food and drink
- Free continental breakfast
- Coffee/tea in the lobby
Things to do
- Beach towels
- Outdoor seasonal pool
- Outdoor pool
- Marina on site
- Pool sun loungers
- Pool umbrellas
Working away
- Business center
- Computer station
- Front desk (limited hours)
- Tours/ticket assistance
- Free newspapers in lobby
- Number of buildings/towers - 2
- Safe-deposit box at front desk
- Terrace
- Fireplace in lobby
- Television in common areas
- In-room accessibility
In the room
Home comforts
- Climate control
- Air conditioning
- Coffee/tea maker
- Bathrobes
- Iron/ironing board
Sleep well
- Hypo-allergenic bedding available
- Down comforter
- Blackout drapes/curtains
Things to enjoy
- Furnished balcony
Freshen up
- Private bathroom
- Designer toiletries
- Hair dryer (on request)
Be entertained
- 38-inch flat-screen TV
- Cable TV channels
- DVD player
Stay connected
- Desk
- Free newspaper
- Free WiFi
- Free local calls
Food and drink
- Refrigerator
- Daily housekeeping
- In-room safe
Top Hyannis hotels
Recently reviewed hotels in Hyannis
- The Ocean Club on Smuggler's BeachFrom
"This location is actually a time share beach condo. The unit we had was well maintained and the room is big with a sitting area and small kitchenette. It has a nice beachfront…"May 16, 2015
- Four Points by Sheraton Eastham Cape CodFrom
"Wonderful little hotel that is within a short distance to Nauset Light and its beach. Comfortable beds and the most comfortable comforter I have ever had the pleasure to use. On…"Sep 24, 2014
- The Chatham MotelFrom
"We arrived late and had a warm welcome. Management was friendly and helpful. Our room was large and well maintained. Chatham is a nice town - we loved watching the seals at the…"Sep 20, 2013
Nearby hotels
Special features
On Site
- Marina on site
- Bicycle rentals nearby
- Ecotours nearby
- Golfing nearby
- Hiking/biking trails nearby
- Kayaking nearby
- Sailing nearby
- Water skiing nearby
- Windsurfing nearby
Anchor In Distinctive Waterfront Lodging's small print
Also known as
- Anchor In Distinctive Waterfront Lodging
- Anchor In Distinctive Waterfront Lodging Hyannis
- Anchor In Distinctive Waterfront Lodging Inn
- Anchor In Distinctive Waterfront Lodging Inn Hyannis
Only registered guests are allowed in the guestrooms.
This property does not have elevators.
Optional extras
Cribs/Infant beds are available for an extra charge
We have included all charges provided to us by this hotel. However, charges can vary, for example, based on length of stay or the room you book.


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Quiet sixth-grader pitches in to fill classroom needs
Lisa Deaderick • U-T
During the first week of school, Sophia Mendez Bernal was noticed despite her attempts at avoiding it.
"She doesn't like the attention on her," her teacher, Brenda Robles, recalled. "She's just very quiet, watching every move I made, but at the same time, if I was alone without anybody else around, she was like, 'Can I help you with anything?' "
Sophia consistently demonstrated this helpful attitude, along with continually improving academically and her leadership skills to lead Robles to nominate her for Student of the Month recently for Nicoloff Elementary School in San Ysidro. She's 12 and in the sixth grade, and considered a role model.
"She's always willing to help others within our class, but she also holds them accountable," Robles said. "Like when there's group work, she's really good about saying, 'You need to be on task' or 'You need to get this completed.' She's just really well-rounded."
The honor for the month came with a certificate and communicated to her that she worked hard and was a responsible person, she said. Her favorite subjects are math and history.
"I like history because I like to learn more about other special persons and different kinds of stories," Sophia said.
Though those are her favorite subjects, her teacher says that language arts has been her strongest, which is unusual for most people who are language learners, like Sophia. Most students learning another language tend to favor and excel at math, but Robles credits a large part of Sophia's language success to the high level of parent involvement she receives and Sophia's ability and willingness to take advice that will help her improve.
"She's just very good with feedback. I have no trouble (from her) with me communicating that we still need to work on something, and she puts her effort into fixing it right away. So, she's very self-motivated," Robles said.
Sophia would like to grow up to become an accountant because of her love for numbers and math. Sometimes her parents give her money to go to the store on her own and buy some of what they need for the home, and she likes to budget and count the change.
"She's the oldest of four, I think," Robles said. "She's used to responsibility and maturity."
Do you know of a student who should be in the spotlight? Contact Lisa Deaderick at (619) 293-2503, or firstname.lastname@example.com

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I would like to find a good source for this fabric. Have any of you bought it online, or know of a good source that I could buy it without buying a whole bolt. Right now I am looking for the acetate or cotton, but silk could work also.
Thanks for your information. -- Edited on 5/30/13 12:27 PM --
Try contacting Vogue Fabrics. It's not on their website, but they probably have silk moire.
vogue fabrics
------I am going for a level of perfection that is only mine... Most of the pleasure is in getting that last little piece perfect...Inspiration is for amateurs. The rest of us just keep showing up and doing the work.
Chuck Close, painter, printmaker, photographer
Hope has two lovely daughters: Anger and Courage
St. Augustine
What are you wanting to do with it? Our Hobby Lobby regularly stocks several colors in their home dec section. (And by "regularly," I mean that I bought some in 2007, and they still carry the same color!)
------~Gem in the prairie
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Newcastle United record goalscorer and lifelong fan Alan Shearer has promised to do all he can to keep the club in the Premier League after being appointed as manager until the end of the season. Shearer has been given eight games to save Newcastle from relegation, after the north-east strugglers confirmed on 1 April his appointment as their fourth manager this term.
Former Newcastle striker Shearer, 38, a hero to the Magpies' fans for his exploits on the pitch, having scored 206 goals in 404 appearances during a ten year spell at his home town club, has long been tipped as a future manager, but he could never have envisaged taking over in such difficult circumstances. Newcastle are currently third from bottom of the table, two points adrift of Blackburn Rovers, the club currently occupying the last survival spot.
Despite having no coaching experience, Shearer has been given the task of saving the club from the financially calamitous consequences of relegation and Chelsea's visit on 4 April means he will have a tough start to his reign. His appointment ends the caretaker spell in charge of Chris Hughton, who remains on the staff. Hughton took over in February after Joe Kinnear was forced to take a break from managing the club because of heart surgery.
Explaining how he got the job, ex-England striker Shearer, speaking after Newcastle announced his appointment, said: "I got a call over the weekend off Derek Llambias [managing director] and Mike Ashley [owner] and I went round for a chat.
"They kindly asked if I would take charge for the remaining eight games and I asked for a little time to think and spoke to a few people," said Shearer. "It's a club I love and I, just like many thousands of people, desperately don't want the club to go down and I will do everything I can to try to prevent that.
"I believe I can help it, along with the players. There is a nucleus here that can get this club out of trouble," he said. "They are very good players lacking confidence and it's up to me and the staff to get the best out of them."
Shearer, who has completed all but one of his coaching badges and is still to gain his FIFA Pro Licence, has brought in former Southampton team-mate and ex-Queens Park Rangers' manager Iain Dowie to assist him and will hold his first training session soon. He insisted he was just concentrating on the short-term goal of securing Newcastle's top-flight status: "This is for an eight-game spell, I'm looking no further than that," Shearer said.
"Joe Kinnear is in the job at the moment and recovering well from his operation. I'm here for eight games and eight games only and [I aim] to try to keep this team in the Premier League," he added.
An excited Llambias said: "Everyone at Newcastle United is absolutely delighted that Alan has taken on this challenge. Already there is a buzz around the club and the city. The news has given everyone a massive boost."
Shearer's appointment was confirmed by Newcastle soon after they'd announced that executive director Dennis Wise had left the club. Former Chelsea and England midfielder Wise was reviled by fans for, as they saw it, forcing out popular manager Kevin Keegan in September in a row over transfer policy. Newcastle turned to Shearer, like Keegan once a revered Newcastle forward, as it became clear that, under Hughton, they were drifting towards disaster after a run of just one win in their last 12 league matches.


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Yeahhh.. without a doubt!
Freddie Gibbs Review
Directed by Orson Whales (Shahan Jafri + Alex Germanotta)
It's time for another new edition of The Hip-Hop Shop. Episode #126 is called From Japan to New Jerusalem. We span the globe to bring you music by everybody from DJ Toshi to Keith Murray to Venomous2000. For compliments or feedback hit me on Twitter @angrymarks. Artists please send your podsafe music and advertising requests to email@example.com. Thanks for listening and remember to share the show with a friend and tell them to check it out every Tuesday on RapReviews.com!
Download Here (right click to save)
Tracks featured this week:
* Elemental Zazen - Words That I Write* Venomous2000 f/ DJ Priority - Drop of Venom* DJ Toshi f/ Abraham, BURNTmd, Keith Murray, Rachit - Tsunami Relief* SKAM2 f/ Low Life - Stand Like a Man* Rockwell Knuckles - Baking Soda* Savant a/k/a Stanstro - Fresh She Is
From Nancy B:
Trae Tha Truth's 3rd Solo Album Drops on June 28th
Houston, TX ~ After three long years of mix tapes, touring and keeping the music news busy with music, videos, cartoons and lawsuits, Houston's Trae Tha Truth will finally release his much anticipated third solo album, "Street King" (ABN Entertainment/Prez Entertainment/Fontana) on June 28th.Album features include Lil Wayne, Rick Ross, Wiz Khalifa, Tha Game, Big Boi, Lupe Fiasco, Wyclef, Wale and Lloyd, as well member of Trae's ABN Gang. Production duties are handled by Vdon, Drumma Boy, Mr Rogers, Mr Inkredible, Cyfyre and Rockaway Productions.The promo run will include a week-long media run in New York (June 20th - 24th); featuring a live show at SOBs on Monday, June 20th hosted by Low Key from YouHeardThatNew.com, an album listening session at the Fontana offices on Tuesday, June 21st, an album release concert at Houston's HOB on June 28th, featuring a live band and performances by friends Wacka Flocka, Jadakiss, Lupe Fiasco and Yung Joc and shows all over the south.Follow us on Twitter via @TraeABN and @RapPublicist.
From Yo! PR:
Video: Skweeky Kleen - "Get Mine"
From V2K:
Video: Venomous2000 w/ DJ Priority - "Drop of Venom"
Visit http://SamKhan.Com to download this BANGER from Sam Khan (7 Time Jumpoff Champion, BBC Radio 1xtra) and watch out for A LOT MORE to come. Lyrically, musically, this kid is a problem!
From Monstaville Music:
MP3: Facetime - "Smile" (prod. Rob Base)
1st and foremost, alot of the sites recieving this email have been long time supporters of our music here at Monstaville and we truely appreciate that. We hope to continue building a strong working relationship with all of you. As we always do, we offer the same support back through our home site which has a huge following: www.408inc.com and covers the entire South Bay Area.
On June 7th we are back with a New Release titled FACETIME (a group album: Tha Critic, Playa Rae & Trey C) which will be distributed by Empire Distribution (www.empiredistribution.com) / 408INC DIGITAL (www.408inc.com) and Monstaville of course. The album features Royalty, Smigg Dirtee, Natureboy Rowe, Stik Gilatine & C-Rena. It will be priced to win at $5.99 via iTunes and other online retailers. Hard copies include a 45min DVD and are $9.99 via www.408incshop.com - June 21st is the date to lock in.
From Mr. Smith:
Video: Mr. Smith f/ Malcolm Young - "Another Level"
Download "Seeya Later" Here
Download "Seeya Later" Here
After years of standing by as a spectator, a fan and avid lover of Hip-Hop, Natural, also known in many circles as Nasty Nat, felt it was no longer enough just to listen. A writer his entire life, Natural had produced various forms of storytelling through many different mediums. From novel writing to screenplays, poetry classes to philosophy groups, Nat always felt the need to share his personal experiences along with the people around him. It wasn't until 2009 that he finally recognized hip-hop as his true calling.
Born in Boston, Natural split time between his household in Milton and his cousins residence in Dorchester. The oldest of five in a close knit Irish-American neighborhood, Natural was responsible for his siblings from a very young age. He credits the high level of responsibility his parents entrusted to him along with his entire family's unwavering support in all avenues of artistic creativity as major reasons for his progression as an artist.
In late 2009 Natural began the beginning stages of recording. He started small with a cheap mic and industry beats in his bedroom. He slowly started to show recorded material to people he knew would give it to him straight, and the high level of positive response gave him the final push of confidence he needed.
He contacted Peter "Needy" Needham, a friend of his cousin, who had majored in audio production in college and created the "Stay Puft Productions" group. Within weeks, Natural began to write and record original material over these beats, and the two began a blueprint for the future--It was here they found a Natural fit.
Nat's music invites listeners into his own world, one guided by family and the close bonds within his small circle. His words are marked with a realistic portrayal of himself and feed off of his surroundings in the small city of Boston--his story is just one of the many tales shared through his music.
Despite his suburban background, Nat's deep routed connections with the inner city have allowed him lines of sight from both sides of the tracks. Employments and experience range from his current position at an inner city public school all the way to working with troubled youth groups over in Ireland. Bartending and bouncing in some of the roughest areas of the city while also holding down jobs in some of the trendiest spots downtown. Either way you spin it, Nat draws from a plethora of experiences and carries a unique ability to connect with many different demographics of people.
On June 21st Natural will be dropping "The Bartender". In his first release, Natural shares stories from his personal life and the lives of others, lending people a voice to confront the harsh realities and problems we all face on a daily basis. Nat also leaves room for the good times shared with the fast living collective of family and friends around him. The 16 track release encompasses life from all angles: Happiness, struggle, love, hate, employment, stress, the illegal dealings of the underworld, corruption, politics, sports, police brutality and community. It is an uncompromising vision from an artist that has finally found his calling. His style is a mix of aggressive wordplay, sharp lyricism and heavily sarcastic whit that creates a deeply honest and passionate vibe. Armed with a keen sense of self awareness and an unapologetic flow, Nat epitomizes confidence with the microphone. Hip-Hop has a new voice, and Natural's uninhibited honesty and no holds barred approach refuses to be silenced. Listen up and watch the rest unfold.
Welcome to RapReviews.com for the week of December 1st, 2015!!
Please shop Amazon through RapReviews and
like us on Facebook so
we can bring you new material every week. We're back in effect this week
with TEN NEW ITEMS for your perusal:
Agallah's "Agalito's Way,"
the Twenty Important Rap Videos From 2013 in
two separate installments,
Freddie Gibbs' "Shadow of a Doubt" (our featured review),
Jus Allah's "MMA,"
Steve 'Flash' Juon's The Hip-Hop Shop #353,
a Lance Palmer interview,
pausemc's "Blue,"
royceBIRTH's "Art On Fire!!" and
Emanuel Wallace's The (W)rap Up for November 24, 2015!
Be sure to check the RapReviews newsfeed for the
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Also this writing service can help you with academic review assignment.
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Northampton County has been cleared by the U. S. Dept. of Justice for Nov. 6 school board elections.
The notification was sent to County Attorney Bruce Jones on May 23.
Jones petitioned the Justice Dept. on April 1, days after HB 2176 was signed into law. ...


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Rangers Photos
Photos: Nelson Cruz homers off Nick Martinez; Rangers play sloppy defense; Orioles win again vs. Texas, 8-3
Photo: Joy R. Absalon/Joy R. Absalon-USA TODAY Sports
Jul 1, 2014; Baltimore, MD, USA; Texas Rangers pitcher Nick Martinez (22) and bench coach Tim Bogar (27) fist bump before a game against the Baltimore Orioles at Oriole Park at Camden Yards. Mandatory Credit: Joy R. Absalon-USA TODAY Sports
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NEX-5N First Impressions
Started Sep 16, 2011 | Discussions thread
Shop cameras & lenses ▾
Hi fredyr,
There is no way to turn off the OSS on the lens. The steadyshot is on the setup menu that can be turned on and off.
Thanks for looking.
Fredy Ross wrote:
Thanks for you review. I am waiting for mine to arrive next week. Just one question if one uses a tripod does one turn off the IS in the kit lens? Thanks.
crisg0112's gear list:crisg0112's gear list
Sony RX1 Sony RX100 II
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- Share the videos you've shot - it's easy!
Greenstein urges foe to back family planning
Assemblywoman Linda Greenstein is urging her state Senate opponent to join her in voting to restore $7.5 million in family planning funds.
Greenstein (D-Plainsboro) yesterday called on state Sen. Tom Goodwin, her opponent in the upcoming 14th District state Senate special election, to unite with her in an effort to restore the family planning and women's health funds the governor vetoed in July.
"If the state Legislature does not override the governor's veto and health care services are not restored, thousands of New Jerseyans will be left without access to critical care," Greenstein said in a press release. "We cannot afford to leave these people out in the cold without preventative care, gynecological or prenatal treatment, or necessary screenings."
Greenstein has been pushing for Senate Bill 2139/Assembly Bill 3019, which is scheduled for a vote in the state Senate on Monday. The bill would restore $7.5 million for family planning services including gynecological exams, mammograms, breast and cervical cancer screenings and prenatal care at women's health clinics -- services that might not be there for women and families if the funding evaporates, Greenstein said.
"Senator Goodwin has one decision to make on Monday: Will he stand up for the women of New Jersey or will he fall in line with the conservative Republican Party that has distorted this issue for political purposes?" she said.
Supporters of the bill have maintained the $7.5 million would come out of the $205 million state employee prescription drug account the nonpartisan Office of Legislative Services says Christie had overbudgeted.
In his original veto, Christie said he would not put "the prescription drug benefits of state employees at risk," and some Senate Republicans said using those funds would put the state prescription fund into a deficit.
Goodwin did vote against restoring $7.5 million.
Called for comment, Matt Mowers, Goodwin's campaign manager, released the following statement:...
- Talk about the news in our forums.
Even lib rags realize he's a loser... by CaptJetes_2 2:47 PM How do you measure success? by oldbullhead 1:17 PM 사다리게임방법 ∠‰... by fgdadsrweasfea 4:59 AM 사다리토토 ∠‰... by fgdadsrweasfea 4:56 AM 네임드사다리 ∠‰... by fgdadsrweasfea 4:55 AM


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Even though it pangs a bit that I'll only be with the family via Skype this year, it's exciting with something new and unknown to do
Published 07/12/2012 | 18:00
Usually you could set your watch by my Christmas routine. Every year, I arrive home to the family pile, proceed to eat my way through the entire south-east, meet friends to get ossified on Christmas Eve (ah, 'tis a sacred time), pig out on Christmas Day, hibernate for St Stephen's Day in the company of one Indiana Jones, and then, by the 27th, consider re-emerging into the outside world.
Not this year, though. This year I'll be staying in London for the festive period. It's my first time not going home for Christmas, which feels like a rite of passage, but that doesn't make it feel any less strange.
At 31 years of age, some might say I should have reached this milestone before now.
Well, first up, typical of my generation, I have a severe case of arrested development. I'm a fully-signed-up 'kidult', or, as comic writer Mindy Kaling – who is around my age and even shares my birthday. Call me Mindy! – likes to call us, "teen-plus".
Second of all, I'm not married nor do I have kids, owing in large part to that gay gene I was born with after my mother stood too close to a microwave or didn't say enough Hail Marys in a post-Confession penance in that dark winter of 1980, or whatever the latest science says about the causes of homosexuality.
On top of that, I'm single, and have been for a while (choice vs circumstance: a debate for another time), so there hasn't been the alternative option of spending Christmas with a partner's family.
Besides, my family signed contracts a while back stipulating that they have to put up with me for at least two non-consecutive visits in the one calendar year.
Legalities aside, it's always nice to come home, especially at the one time of year that we all have a bit of time off to catch up and just arse around.
However, as I said, that won't be the case this year. I started a new job a while back, and I'm working on Christmas Day.
It's not a bad deal – I get time off around the 25th in lieu – but that hasn't stopped my mother from mentally re-casting the organisation as the evil Sheriff of Nottingham in Robin Hood: Prince of Thieves.
But the truth is, I was thinking of sticking around London for Christmas, even before I knew of my work rota.
One of my best friends from home lives in London with his wife, and we got talking about our plans back in October. They were staying too, mostly because of work, but he also said something that really stuck with me.
"It's time we started making our own traditions," he argued.
He's right. My group of friends are mostly all in our early 30s now.
At some point, we all have to make decisions that may ultimately take us away from our families at times like Christmas.
It's the price of wanting – needing – to live and to make your own life.
I won't be lonely over Christmas. I have those friends and some others who are sticking around, too. It'll be nice to see what this city is like at Christmas time.
Honestly, even though it still pangs a bit that I'll only be with the family via Skype this year, it's exciting having something new and unknown to do. It feels proactive and independent.
There's probably another term for it, one I try to avoid as much as I can. But I couldn't dodge it any longer when one friend from home with whom I would normally spend every Christmas Eve out on the razz told me she's going to her boyfriend's place up the country this year.
"We have to grow up sometime!" she texted when confirming her plans. And I suppose she's right.
I'm still allowed my Indiana Jones duvet day, though, right?
Day & NightFollow @Independent_ie


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pike was engaged to her Pride & Prejudice director Joe Wright—but the wedding was called off in 2008.
The pike River coal mine is about 50 miles northeast of Greymouth and is in a steep mountainous area.
Check out the popular bakery Piroshky Piroshky in pike Place Market for some Eastern European stuffed delights.
Many probably believed he would emerge from the side carrying a pike with the head of a banker.
That makes it a really odd time for a big old Hollywood movie all about him to be coming down the pike.
The next moment he fell, face downward, in the struggling mass, with a Venetian pike thrust through his thigh.
Then he crept out of the room, got on the mare, and rode up the pike.
The long tongue of the lock island projects down stream like the nose of a pike.
Quite and clane the contrary—when the shillelah's up, the pike's down.
We launched a ship called the Madison, about this time, and we laid the keel of another, that was named the pike.
"highway," 1812 shortening of turnpike.
"weapon with a long shaft and a pointed metal head," 1510s, from Middle French pique "a spear; pikeman," from piquer "to pick, puncture, pierce," from Old French pic "sharp point or spike," a general continental term (cf. Spanish pica, Italian picca, Provençal piqua), perhaps ultimately from a Germanic [Barnhart] or Celtic source (see pike (n.4)). Alternative explanation traces the Old French word (via Vulgar Latin *piccare "to prick, pierce") to Latin picus "woodpecker." "Formerly the chief weapon of a large part of the infantry; in the 18th c. superseded by the bayonet" [OED]; hence old expressions such as pass through pikes "come through difficulties, run the gauntlet;" push of pikes "close-quarters combat." German Pike, Dutch piek, Danish pik, etc. are from French pique.
"voracious freshwater fish," early 14c., probably short for pike-fish, a special use of pike (n.2) in reference to the fish's long, pointed jaw, and in part from French brochet "pike" (fish), from broche "a roasting spit."
"pick used in digging," Middle English pik, pyk, collateral (long-vowel) form of pic (source of pick (n.1)), from Old English piic "pointed object, pickaxe," perhaps from a Celtic source (cf. Gaelic pic "pickaxe," Irish pice "pike, pitchfork"). Extended early 13c. to "pointed tip" of anything. Pike, pick, and pitch formerly were used indifferently in English. Pike position in diving, gymnastics, etc., attested from 1928, perhaps on the notion of "tapering to a point."
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Artist: Donovan
Album: Open Road
Genre: Rock
Open Road
New Year's
Do what you've never done before
See what you've never seen
Feel what you've never felt before
Go where you've never been
Sing what you've never sung before
Say what you've never said
Bear what you've never borne before
Hear what you've never heard
All is not as it would appear
Nothing ever remains the same
Change is life's characteristic
Bend and flow play the game
Lose your chain
And do what you like
Get on your bike and do what you like
So many time I was the one who stopped myself from doing things
So many times I was the one who grounded myself and clipped my wings
So I say
Do what you've never done before
For fear of losing face
You have nothing to defend now
In your state of grace
So get on your bike and do what you like
Love is the gift of man
Yet he will not receive
Within the church of man
Yet he cannot perceive
Without is the real of man
He yet cannot receive
Man is the plague of man
Yet he will not believe
There go you go I
There go you go I
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With a crime rate of 64 per one thousand residents, Albuquerque has one of the highest crime rates in America compared to all communities of all sizes - from the smallest towns to the very largest cities. One's chance of becoming a victim of either violent or property crime here is one in 16. Within New Mexico, more than 98% of the communities have a lower crime rate than Albuquerque.
Importantly, when you compare Albuquerque to other communities of similar population, then Albuquerque crime rate (violent and property crimes combined) is quite a bit higher than average. Regardless of how Albuquerque does relative to all communities in America of all sizes, when NeighborhoodScout compared it to communities of similar population size, its crime rate per thousand residents stands out as higher than most.
The crime data that NeighborhoodScout used for this analysis are the seven offenses from the uniform crime reports, collected by the FBI from 17,000 local law enforcement agencies, and include both violent and property crimes, combined.
Now let us turn to take a look at how Albuquerque does for violent crimes specifically, and then how it does for property crimes. This is important because the overall crime rate can be further illuminated by understanding if violent crime or property crimes (or both) are the major contributors to the general rate of crime in Albuquerque.
For Albuquerque, we found that the violent crime rate is one of the highest in the nation, across communities of all sizes (both large and small). Violent offenses tracked included rape, murder and non-negligent manslaughter, armed robbery, and aggravated assault, including assault with a deadly weapon. According to NeighborhoodScout's analysis of FBI reported crime data, your chance of becoming a victim of one of these crimes in Albuquerque is one in 122.
In addition, NeighborhoodScout found that a lot of the crime that takes place in Albuquerque is property crime. Property crimes that are tracked for this analysis are burglary, larceny over fifty dollars, motor vehicle theft, and arson. In Albuquerque, your chance of becoming a victim of a property crime is one in 18, which is a rate of 56 per one thousand population.
Importantly, we found that Albuquerque has one of the highest rates of motor vehicle theft in the nation according to our analysis of FBI crime data. This is compared to communities of all sizes, from the smallest to the largest. In fact, your chance of getting your car stolen if you live in Albuquerque is one in 182.
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Summer was always meant for kids and teens to have fun and enjoy the weather on their days out of school.
That's what it meant for a lot of people, but not anymore.
Kids still have fun in the good weather, but at certain times, certain areas, and that's not because of mean parents taking control of their life, it's the parents trying to protect them.
People call Chicago "Chiraq" because of a war zone, and of the murder rate increasing.
Teens have to worry about getting one place to another safely without being robbed or shot.
Parents having too worry so much about their kids safety, and worrying about getting a call from a friend or police telling them that their child has been shot and killed.
Summer in Chicago isn't the summer it used to be, because everybody wants control and respect and power.
Spike Lee is making a movie about Chicago called Chiraq, but says he could never live here.
If the violence in Chicago keeps up, the army is going to have Martial Law, and it's going to make things very hard on everyone.
It's time to put the guns down, and end this endless violence.
I remember getting chased by 65th and Western by five to ten people because they thought I was affiliated in gang activity, and it's hard to be safe when people take your safety away, and may end up as them also taking your life away.
They refer to Illinois as Drillinois because everybody is shooting each other.
The summer is where people get affected by the heat and do stupid things.
Be safe, and don't fall under the influence.
Written by Ke'Avery Woodall from Urban Prep Charter Academy-Englewood Campus


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Photos: Top 45 Dallas-area sports moments
Photo: DMN/DMN
43. (Dec. 24, 2009): The Mustangs pounded Nevada in their first bowl in 25 years. It validated the hiring of June Jones in 2008. The Mustangs paid Jones $2 million annually to resurrect the program that had not played in a bowl since the death penalty in 1987. -Eddie Sefko


text: > View Product Details Please select the size of the product. Please enter valid quantity. Autumn Cashmere grapevine cashmere v-neck handkerchief hem sweater overview details Retail: $330.00 Bluefly: $198.00 25% Off : $148.50 color : We're sorry. This style is sold out. Grapevine Give yourself the gift of soft, luxurious cashmere when you bundle up in this Autumn Cashmere sweater this winter. Color: Grapevine Soft, lightweight cashmere knit Rib banded v-neck Raw edge stitching Long sleeves Rib banded cuff and hem Handkerchief hem Contemporary fit 100% Cashmere; Hand Wash or Dry Clean; Imported; style#318545403


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When 19 year-old Casey Reid, Alpha Luke Greyback's mate finds out she's pregnant with his baby she is forced to give up the baby as soon as it's born leaving it unknown to whom it's parents are. Almost 17 years pass and their baby boy still doesn't know who it's birth parents are. What happens when shortly after his 16th birthday he shifts into a werewolf? Will he think he's the only one of his kind? Or will he go out on an adevnture to find another wolf and his parents? Follow the Alpha's unwanted son on his adventure to find himself. Cover made by me! :)
Godess8080 2 years ago
oh my gosh! I hate it when guys r like that! cuz some people can't have kids! do like COUNT YOUR BLESSINGS! ...
rebelliousgoddess 2 years ago
Bastards don't lifelong Luke, live it, learn it, remember it, and never forget it
apgirl305 3 years ago
Can I put a hole in his face for being a jerk come on It's a baby for crying out loud.....Ugh...Some guys don't deserve to be father let alone being called daddy
Cappuccinos 3 years ago
omg, how he be so cold hearted? :( it must be really hard for Casey to give birth and then giving up the child!
TheUltimateFatMan 3 years ago
Holy crap that was cool! i want to know more now! Demons? i'm totally down! fantastic prologue!
KendrickSupnet 3 years ago
By the prologue, I can just judge the whole story out.. Overall: 9/10..


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Shielded (2Z) bearings are fitted with two metal dust shields to prevent the ingress of dirt and foreign matter. 2RZ bearings are 2Z bearings fitted with two low friction seals.Deep groove ball bearings are extremely versatile and robust in operation, they also require little maintenance. Deep groove ball bearings are the most widely used bearing type due to their simple design and suitability for high speeds.
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Hair Loss (cont.)
Medical Author:
Gary W. Cole, MD, FAAD
Gary W. Cole, MD, FAAD
Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
Medical Editor:
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
What is traction alopecia?
This is a small or localized hair loss area caused by repetitive or persistent pulling or traction on hair roots. Tight braids and ponytails can pull hard enough on hairs to make them fall out. If this happens, it's best to choose hairstyles that put less tension on hair. The sooner this is done the better to avoid permanent damage.
What is trichotillomania?
This refers to the habit of someone voluntarily pulling at their own hairs or twisting them, sometimes without realizing it. The scalp and eyelashes are often affected. Unlike alopecia areata patches, which are perfectly smooth, hair patches in trichotillomania show broken-off hairs. Treatment is often entirely behavioral. One has to notice the behavior and then consciously stop. Severe or resistant cases may require stress counseling with a therapist or psychologist or medical treatment with a psychiatrist. Several antidepressant or anxiety medications have been shown to help with this condition.
What is tinea capitis?
Tinea is the medical word for fungal infection, and capitis means head. Tinea capitis is fungal infection of the scalp that for the most part affects school-age children. Tinea capitis is more common in black African or African-American scalps. This condition is rare in healthy adults. Bald spots usually show broken-off hairs and is accompanied by a dermatitis. Oral antifungals can penetrate the hair roots and cure the infection, after which hair grows back. Sharing hats or combs and brushes may transmit tinea capitis.
What is generalized (diffuse) hair loss?
This is an overall hair thinning without specific bald spots or patterns. While this type of hair loss may not be noticeable to others, often the individual will feel their hair is not as thick or full as it previously was. Common conditions in this category are
Medically Reviewed by a Doctor on 3/19/2015
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'Political & Politicians' Archives
Billionaires against health care
Koch-backed group launches $9 million ad campaign against health law By Elise Viebeck A conservative advocacy group closely aligned with the Tea Party announced a $9 million swing-state push against President Obama and the healthcare law. The announcement by Americans for Prosperity (AFP), which is largely funded by the conservative Koch brothers, comes one day after the Supreme Court ruled to uphold the vast majority of the law in a major coup for Obama. "While ... Full Story
A cornucopia of opinion on Obamacare
Obamacare will help drive down health care costs By Jill R. Horwitz and Helen Levy, Special to CNN (CNN) -- Now that the Supreme Court has upheld the constitutionality of the individual mandate, it's time to focus on what has always been a key goal of health reform: Controlling health care costs. No matter how you count it, health care spending is large -- and growing at a worrisome rate. In 2011, Americans spent $2.7 trillion on health care, almost 18% of our GDP. The ... Full Story
Romney and the GOP, hypocrites
Romney's amazing hypocrisy By Donna Brazile, a CNN contributor and Democratic strategist, is vice chairwoman for voter registration and participation at the Democratic National Committee. She is a nationally syndicated columnist, adjunct professor at Georgetown University and author of "Cooking With Grease." She was manager for the Gore-Lieberman presidential campaign in 2000. (CNN) -- Recently, we learned two important things about Mitt ... Full Story
More war is coming
"Netanyahu has decided to attack Iran before the U.S. Elections in November." by Michael Carmichael Senior Israeli officials now confirm that Prime Minister Binyamin Netanyahu has, "decided to attack Iran before the U.S. elections in November." Netanyahu's agenda is much broader than knocking out Iranian nuclear installations for his aim is to reshape the political landscape in the USA and Israel shifting everything to the far, far right in order to create a new ... Full Story
Fast and Furious, Post Opinion
Why 'Fast and Furious' is a political loser Posted by Chris Cillizza and Aaron Blake The fight over Operation "Fast and Furious" recommences this week, as Congress returns to Washington today with a contempt vote on Attorney General Eric Holder looming. Darrell Issa (R-CA) before a hearing on "Fast & Furious: Management Failures at the Department of Justice" on Capitol Hill in Washington, in this February 2, 2012, file photo. REUTERS/Kevin ... Full Story
Republican admits Voter ID laws designed to suppress
The Cat's Out Of The Bag: One Republican Admits Voter ID Laws Are Meant to Suppress Democrats Written by Annie-Rose Strasser This weekend, Pennsylvania Republican House Leader Mike Turzai (R-PA) finally admitted what so many have speculated: Voter identification efforts are meant to suppress Democratic votes in this year's election. At the Republican State Committee meeting, Turzai took the stage and let slip the truth about why ... Full Story
United States on the road to Fascism?
The 14 Defining Characteristics Of Fascism Free Inquiry Spring 2003 Dr. Lawrence Britt has examined the fascist regimes of Hitler (Germany), Mussolini (Italy), Franco (Spain), Suharto (Indonesia) and several Latin American regimes. Britt found 14 defining characteristics common to each: 1. Powerful and Continuing Nationalism - Fascist regimes tend to make constant use of patriotic mottos, slogans, symbols, songs, and other paraphernalia. Flags are seen everywhere, as are flag symbols ... Full Story
Kill gays and non-virgins?
By David Pakman For years, I've been discussing common propaganda techniques used by conservative media to influence audience opinion in ways more reminiscent of brainwashing and indoctrination than informing and reporting. AlterNet's Cynthia Boaz wrote a riveting exposé of 14 of these techniques, and every single one is easily recognizable a regular basis on Fox News, in conservative media of all kinds, and particularly ... Full Story
The girl who silenced the world for five minutes
Thirteen-year old girl addresses United Nations meeting.


text:
It takes only a few seconds scrolling through Philip Hitchcock's Facebook page to realize the guy likes to take a selfie.
Those taken in the past few months show him in Berlin, him with his love, him without a shirt. Several without a shirt, in fact.
Hitchcock is what you might call an aficionado of selfies. Next month, he is staging an exhibit of the digital self-portraits.
Hitchcock joins a growing group of artists and academics who are investing serious thought to the selfie.
"I'm smart enough to know that it can seem incredibly shallow, narcissistic and vain," said Hitchcock, of his impressive collection of selfies.
But, as he put it, "everyone, everywhere does it."
That would seem to be the case.
President Barack Obama was seen taking a selfie with prime ministers from the United Kingdom and Denmark during a memorial service for Nelson Mandela in December.
Ellen DeGeneres set a record for most retweeted selfie in March after posting on Twitter a photo of herself and a bevy of actors at the Academy Awards.
Last month, Vice President Joe Biden posted his first selfie on Instagram, a shot of him with Obama.
And a few weeks ago, Pope Francis walked into a crowd at St. Peter's Square following a Palm Sunday service to pose for a few selfies.
What once was an act reserved for teenagers and attention-starved celebrities such as Kim Kardashian has seemingly been commandeered by world leaders.
Still, results of a survey by the Pew Research Center released in March show that 55 percent of millennials -- those ages 18 to 33 -- have posted a selfie on a social media site compared to 26 percent of all Americans.
So ubiquitous is the selfie that last year the Oxford Dictionaries declared "selfie" word of the year. And the video for a song titled #SELFIE has been viewed 103 million times since it was posted Jan. 29 on YouTube.
Self-portraits, of course, are not new, going back 175 years to when photography was a burgeoning technique.
The selfie is the frat party version of the self-portrait. With phones now doing double-duty as cameras, it takes just a few seconds to take a photo of yourself, then share it on sites such as Twitter, Facebook or Instagram.
The latter has proved especially popular because it comes with various filtering options to make smiles look brighter and skin look clearer.
"You can present a glorious life, a glorious relationship, the look of glorious parenting and you may or may not be living any of that," said Jennifer Siciliani, a psychology professor at the University of Missouri-St. Louis.
What selfies ultimately say about us was a hot topic at the Midwestern Psychological Association annual meeting in Chicago last year.
"We don't have research on this yet, but there are people who are in the middle of studying it, looking at how people choose to present themselves," Siciliani said.
Hitchcock, who runs an art gallery, says the inundation of selfies in our culture led him to his latest exhibit, which opens next month featuring the cellphone self-portraits taken by about 50 people.
Hitchcock sees the selfie as more than a photo.
"It's not only taking it but also disseminating it almost immediately. It's almost not complete until it has been transmitted because it's not just about who I think I am and how I want to be seen but who I think is seeing me," he said.
Cyndi Frisby, a strategic communication professor at the University of Missouri-Columbia, said that with selfies, "you're your own public relations firm and can control the image of yourself." The photo is often posted to elicit a response.
"A certain number of likes or comments can translate into a massive increase in self-esteem" Frisby said.
Frisby admits to using photos to gauge public opinion. Earlier this month, she posted a photo of herself on Facebook taken at a hair salon where she just got out of the stylist's chair.
"I wanted to know how people were going to respond when they saw me at school," Frisby said. She quickly got about 70 likes as well as a string of positive comments.
" 'So I must look OK,' I thought," Frisby said. "And I don't see myself with self-esteem issues."
Stanley Strembicki, a photography professor at Washington University, started posting one self-portrait a day on a blog five years ago. Some of them are selfies. They reflect his everyday life as an artist, a husband, a grandfather.
He just finished teaching a class called Cellphones, Snapshots and the Social Network. The first assignment was to take a selfie.
"The class gets into not only using cellphones to make art but using them as a means of distribution for the artists," Strembicki said. "What does it mean in the larger context of the selfie movement?"
In addition, he and his wife, Rosemary, a psycho-dynamic social worker, have taught a class called The Artist and the Sense of Self at Wash U.


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Simard, Edgar P.a,b; Pfeiffer, Ruth M.a; Engels, Eric A.a
aDivision of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
bSurveillance Research Program, American Cancer Society, Atlanta, Georgia, USA.
Correspondence to Eric A. Engels, Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, 6120 Executive Boulevard, EPS 7076, Rockville, MD 20892, USA. E-mail: email@example.com
Received 12 December, 2011
Revised 12 March, 2012
Accepted 21 March, 2012
Objective: Deaths related to HIV/AIDS have declined due to improved HIV therapies. However, people with AIDS remain at elevated risk for cancer and cancer deaths. Prior studies evaluated cancer deaths using death certificates, which may be inaccurate. We utilized population attributable risk methods (which do not rely on death certificates) to assess cancer mortality.
Design: Data from a US population-based record linkage study were used to identify incident cancers and deaths in 372 364 people with AIDS (1980–2006) followed for up to 5 years after AIDS onset. We utilized Cox regression to compare mortality in individuals with and without cancer and to calculate cancer-attributable mortality across calendar periods (AIDS onset in 1980–1989, 1990–1995, and 1996–2006).
Results: Mortality declined across calendar periods for all people with AIDS but remained higher among those with cancer relative to those without. During 1996–2006, among individuals with an AIDS-defining cancer (ADC) who died, 88.3% of deaths were attributable to their ADC; likewise, among individuals with a non-AIDS-defining cancer (NADC), 87.1% of deaths were attributable to their NADC. The fraction of all deaths in people with AIDS attributable to ADC (i.e. population-attributable risk) decreased significantly from 6.3% (1980–1990) to 3.9% (1996–2006), but NADC population attributable mortality increased significantly over time from 0.5% (1980–1989) to 2.3% (1996–2006).
Conclusion: Among individuals with AIDS and cancer who subsequently die, most deaths are attributable to cancer. With a decline in overall mortality, the proportion of all deaths attributable to NADCs has increased. These results highlight the need for improved cancer prevention and treatment.
Following the widespread use of HAART in 1996, survival improved dramatically among people infected with HIV [1,2]. These changes in the mortality experience of people with HIV infection are largely due to steep declines in deaths from complications, such as opportunistic infections associated with advanced immunosuppression (i.e., AIDS). Despite improved overall survival, people with HIV infection, and particularly those with AIDS, remain at elevated risk for cancer and cancer-related death [3–5]. There are three AIDS-defining cancers (ADCs) that occur at elevated rates in HIV-infected people, each of which is caused by an oncogenic virus: Kaposi sarcoma (caused by Kaposi sarcoma herpesvirus), non-Hodgkin lymphoma (NHL, wherein the major AIDS-defining subtypes are due to Epstein–Barr virus), and cervical cancer (due to human papillomavirus) [6]. People with HIV/AIDS are also at increased risk for other cancers [i.e., non-AIDS-defining cancers (NADCs)], such as Hodgkin lymphoma (caused by Epstein–Barr virus infection) and lung cancer (related to tobacco exposure), for which HIV-related immunosuppression or inflammation may also contribute [7].
As deaths among HIV-infected people decline, especially those due to AIDS-related opportunistic infections, a larger fraction of the remaining deaths may be attributable to cancer. Indeed, studies that have reviewed causes of death among HIV-infected people have signaled that the crude fraction of deaths due to cancer (i.e. the number of deaths with cancer as the underlying cause divided by the total number of deaths) may be increasing in the HAART era [8–10]. Notably, however, it can be difficult to determine a single cause of death in people with HIV/AIDS, many of whom have multiple serious medical conditions. Clinicians may inaccurately ascribe death to cancer, when AIDS or another illness is actually responsible, or vice versa.
An alternate approach to assigning a proportion of deaths to cancer is premised on a calculated estimate of cancer-attributable mortality [11,12]. This method is, in principle, based on a simple comparison of the all-cause mortality experience of people with cancer to people without cancer, that is, it assumes that the extra deaths in people with cancer are due to the cancer. Because the attributable mortality framework uses only the total number of deaths, an advantage is that it does not require specified causes of death from death certificates, which can be inaccurate. However, no previous study of HIV-infected people has utilized this methodology.
We used population-based data from a large cohort of people with AIDS in the United States to determine trends in mortality and applied statistical models to determine the fraction of deaths attributable to cancer over time.
The HIV/AIDS Cancer Match Study links registry data on persons with HIV or AIDS diagnosed between 1980 and 2008 to cancer registries in 15 US states and metropolitan regions (http://hivmatch.cancer.gov) [13]. Following linkage, only deidentified data are retained for analyses. Institutional review boards at participating sites approved the study.
Our goal was to determine mortality attributable to incident cancer among an immunosuppressed population. We, therefore, constructed a cohort of people with AIDS who were initially cancer free. AIDS was defined according to the 1993 Centers for Disease Control and Prevention surveillance case definition [6]. We required individuals to be cancer-free before and at AIDS diagnosis, as cancer prior to AIDS onset might have artifactually accelerated the development of AIDS, and because three cancers are themselves AIDS-defining conditions. Importantly, Kaposi sarcoma can occur as an initial AIDS-defining event but has lower mortality than other AIDS-defining conditions [14]. Therefore, our exclusion of people with ADCs as their AIDS-defining event precludes the possibility of findings which would suggest ADCs as protective for mortality.
Follow-up for cancer and mortality began 4 months after AIDS onset. Of 574 242 potentially eligible people with AIDS, we excluded those who had any cancer reported to the cancer registry, or an ADC reported to the HIV/AIDS registry, before 4 months after AIDS onset (N = 33 374 and N = 18 107, respectively) and those whose observation time ended before month 4 (N = 128 831). We also excluded those whose follow-up for cancer began after month 4 (N = 16 743) in order to make the cohort uniform at baseline. In addition, people diagnosed with AIDS prior to 1980 (N = 7) and children aged less than 14 years (N = 4816) were excluded, yielding a cohort of adults and adolescents with AIDS who were cancer-free at the start of month 4 after AIDS onset (N = 372 364). The exclusions used in the current study of people with AIDS are the same used in a prior analysis of underlying causes of death reported on death certificates [10], allowing for a direct comparison of findings between the two methods.
Information on invasive cancers was obtained using the linked data from cancer registries, and malignancies were coded according to the third edition of the International Classification for Diseases for Oncology [15]. Cancers were categorized as ADCs and NADCs using a modification of the Surveillance, Epidemiology, and End Results program's 'Site recode with Kaposi sarcoma and mesothelioma' [16]. Only first cancers were considered, and vital status was obtained from HIV/AIDS registries at the time of the linkage.
Individuals were classified according to calendar year of AIDS onset: 1980–1989 (no or limited availability of antiretroviral therapy), 1990–1995 (monotherapy and/or dual therapy), and 1996–2006 (HAART). Person-time was measured from month 4 after AIDS onset until last follow-up for cancer from the cancer registry, death, or a maximum follow-up of 5 years, whichever occurred first. Mortality rates among people with AIDS and cancer, and among those with AIDS alone who were cancer-free (the reference group), were calculated with people contributing person-time to the cancer-free group until they developed cancer, then contributing person-time the group with cancer subsequently.
To determine the proportion of mortality due to cancer over this 5-year (60-month) period following AIDS onset, we calculated the fraction of deaths attributable to cancer among persons with cancer (attributable risk) and the fraction of deaths attributable to cancer among all persons with AIDS [population attributable risk (PAR)]. Analyses were conducted separately to assess mortality attributable to ADC, NADC, and any cancer combined.
The attributable mortality method assigns a proportion of deaths to an exposure or condition (e.g. cancer) based on the relative difference in mortality rates among exposed and unexposed groups. A difficulty in applying standard formulae for attributable risk and PAR is that they evaluate individuals at a single time point, when all individuals can be unambiguously classified with respect to the exposure and outcome. To account for the fact that cancers and deaths both continued to occur throughout 5 years of observation, we divided the person-time into 10 intervals of 6-month duration. Individuals were then classified according to their cancer status at the start of each interval. Next, for each interval, we fitted a Cox regression model to measure the association between presence of cancer on or before the start of the interval with death during the interval, adjusted for sex, race/ethnicity, and age group. For each interval, we then calculated attributable risk and PAR as,
wherein Pe was the proportion of individuals with cancer (i.e. exposed) on or before the start of the interval [11,12]. We derived overall attributable risk and PAR estimates for the entire 60 months of follow-up by multiplying the interval-specific attributable risk and PAR estimates with the interval-specific number of deaths in persons with cancer or the interval-specific total deaths, respectively; summing these interval-specific attributable deaths across the intervals, and expressing the total attributable deaths as a fraction of all deaths in persons with cancer (attributable risk) or all deaths in the cohort (PAR). Variances for attributable risk and PAR estimates were derived using the delta method [17], and pairwise estimates were compared for individuals diagnosed with AIDS during 1980–1989, 1990–1995, and 1996–2006 using a two-sided Student's t-test. Finally, in addition to these proportional measures, we report cancer-attributable mortality as rates per 1000 person-years. We calculated attributable mortality rates by dividing the number of deaths in people with cancer that were attributable to their cancer by the person-time contributed by people with cancer. Likewise, we calculated population attributable mortality rates by dividing the number of deaths in the entire population attributable to cancer by the person-time contributed by all people regardless of cancer status. These rates are presented by AIDS onset calendar periods.
P values less than 0.05 were considered significant. All analyses were conducted in SAS version 9.2 (SAS Institute, Cary, North Carolina, USA) and R version 2.1 (R Foundation for Statistical Computing, Vienna, Austria).
Demographic characteristics of the 372 364 people with AIDS included in the study are presented in Table 1. Across calendar periods, the proportion of males declined (88% in 1980–1989 to 74.7% in 1996–2006) and the median age at AIDS onset increased (35 years in 1980–1989 to 38 years in 1996–2006). The proportion of non-Hispanic whites decreased from 50.4% in 1980–1989 to 28.6% in 1996–2006. The proportion of men reporting male-to-male sexual contact as their mode of HIV exposure declined, whereas the proportion with injection drug use or heterosexual exposure increased over time (Table 1). During 5 years of follow-up, 19 126 people developed an ADC, 4137 developed a NADC, and 170 712 died.
Mortality following an ADC, NADC, or any cancer was highest among those with AIDS onset in 1980–1989 and declined over time (Fig. 1). Overall, mortality rates among people who were cancer-free were markedly lower and also declined more steeply with AIDS calendar time. The mortality attributable to cancer (in relative or absolute terms) reflects the excess deaths in people with cancer compared with those without cancer. As a result of the temporal changes in mortality rates, we found that among people with cancer who subsequently died, the proportion of deaths attributable to their cancer increased over time (i.e. attributable risk, Table 2). For example, the proportion of deaths among people with an ADC that were attributable to their ADC increased significantly across AIDS calendar periods from 68.6% during 1980–1989 to 77.8% during 1990–1995 to 88.3% during 1996–2006. Similar patterns were observed for NADCs and all cancers combined. Nonetheless, the pattern was different when attributable mortality was viewed as a rate, as a result of the overall decline in mortality rates: attributable mortality rates due to ADC, NADC, and any cancer overall each exhibited a more than 60% decrease across the study period (Table 2).
Table 2 also presents information on deaths among the entire AIDS population attributable to cancer. These results incorporate the population proportion of people with cancer as well as mortality rates. When expressed as a rate, population attributable mortality declined over time. For example, the population mortality rates attributable to any cancer were 34, 16, and 3.8 per 1000 person-years for AIDS onset in 1980–1989, 1990–1995, and 1996–2006, respectively. Similar patterns were seen for ADCs and NADCs separately. Likewise, when expressed as a proportion of all deaths, population mortality attributable to ADCs (i.e. PAR) declined significantly over time, from 6.3% of all deaths in 1980–1989 to 3.9% in 1996–2006. In contrast, however, the population mortality attributable to NADCs increased significantly over time, rising from 0.5% of all deaths in 1980–1989 to 2.3% in 1996–2006. Finally, the decline in deaths attributable to ADCs led to a modest decline in population mortality attributable to any cancer, from a peak of 6.9% of deaths in 1990–1995 to 6.0% in 1996–2006.
In this large and nationally representative cohort of people with AIDS in the United States, we noted significant declines in mortality among those with and without cancer, which we interpret to reflect the impact of increasingly effective antiretroviral therapies in decreasing deaths related to HIV infection. With these improvements in overall mortality, a significantly growing fraction of deaths in people with an ADC or NADC were attributable to their cancer. Furthermore, the fraction of all deaths among people with AIDS that were attributable to a NADC (i.e. PAR) increased significantly in the HAART era.
An important feature of this analysis was our evaluation of the contribution of cancer mortality among people with AIDS on multiple scales. In absolute terms, attributable mortality rates (ADC and NADC) declined over the study period. This increased survival after cancer diagnosis may be related to improvements in cancer treatment. However, on the relative scale, our attributable risk estimates demonstrated the persisting importance of cancer-related mortality among people with AIDS and cancer. For those with any cancer who died, the fraction of deaths attributable to that cancer increased from 68.7 to 87.6% in the HAART era.
These results suggest that, although deaths from noncancer causes have decreased dramatically, cancer-specific mortality has not improved as rapidly. We, therefore, emphasize that successful cancer treatment among people with AIDS will become increasingly important and should address both clinical issues (e.g. immunosuppression, comorbid conditions, chemotherapeutic drug interactions with HAART) and social barriers (e.g. limited access to healthcare, societal marginalization and stigma) [18–20]. Further, as a single cancer treatment center is unlikely to see many HIV-infected people with a given cancer type, coordinated multicenter trials are needed to determine optimized therapeutic regimens. It has also been argued that HIV-infected people should be included in cancer treatment trials open to the general population [18].
Our population attributable mortality rate findings demonstrate that ADC-related mortality among people with AIDS has declined dramatically. This population-level decrease is partly due to steep declines in the incidence of these cancers [3,5], which have resulted from improved HIV therapies and better immune control of cancer-causing viruses (e.g., Epstein–Barr virus for NHL). Population attributable mortality rates for NADC also declined, albeit more slowly than for ADCs. In contrast to ADCs, the incidence of NADCs among people with AIDS has remained stable [3,5,21]. At the population level, the mortality attributable to NADCs increased from 0.5% of all deaths in 1980–1989 to 2.3% in 1996–2006. This increase in population attributable mortality should be considered in the context of declines in mortality from other causes; as mortality due to opportunistic infections and ADCs decreased over time, a greater fraction of all deaths were attributed to NADCs.
Our findings are consistent with those of other reports describing cancer-related mortality among people with AIDS. One study among people with AIDS in New York City (1999–2004) found 5% of deaths had cancer listed as the underlying cause [8], similar to our PAR estimate of 6.0% during 1996–2006. An analysis of deaths among HIV-infected people in Europe found 8% of deaths were due to NADC [22]. This estimate was substantially higher than ours, perhaps because it was based on a population that included people without AIDS, who likely had fewer AIDS-related deaths (and therefore proportionally more cancer-related deaths). A recent collaborative analysis of causes of death among people with HIV in Europe and North America reported a NADC mortality rate of 1.2 per 1000 person-years in 1996–2006, very similar to our population attributable mortality rate of 1.4 per 1000 person-years [23]. The same study showed no decline in NADC mortality in the most recent calendar period (2003–2006 vs. 1996–1997), emphasizing the continuing importance of cancer in this population.
A potential source of heterogeneity in findings across studies is the challenge in accurately determining a single cause of death in people with multiple medical problems [24]. Based on the underlying cause of death (UCOD) recorded on death certificates, we previously reported the fraction of deaths among people with AIDS related to cancer [10]. For NADCs, the results were largely similar to those we report here. However, the results differed for ADCs, especially for people diagnosed with AIDS before the availability of HAART. For example, for people diagnosed with AIDS in the 1980s and who subsequently died, only 1.05% had an ADC listed as their UCOD [10], whereas herein we estimated a PAR of 6.3%. These estimates were more similar for people diagnosed with AIDS in the HAART era (2.47% of deaths due to ADCs based on UCODs vs. 3.9% based on the calculated PAR). We suspect that in the pre-HAART era, when AIDS-related mortality was very high, clinicians were more likely to attribute any death in a person with an ADC to AIDS rather than to cancer, but with improved HIV treatment, this tendency may have reversed. The sensitivity of death certificates for detecting deaths related to cancer (ADCs in particular) may, therefore, be low and somewhat variable. In an additional analysis, we found that most people included in the current study who died from cancer (according to the UCOD on their death certificate) also had a prior cancer diagnosis in the cancer registry (68% for ADCs and 62% for NADCs during 1980–2006), suggesting UCODs on death certificates have moderate positive predictive value. Nonetheless, differences between the present study and our prior study [10] underscore the difficulties in attributing a single cause when deaths involve multiple disease processes, and they demonstrate how different methods of counting and classifying deaths can lead to different conclusions. Similar challenges in correctly classifying cancer-related deaths from UCODs reported on death certificates arise in the general population [25]. Taken together, these findings support our use of an attributable mortality framework, which is not limited by the accuracy of information included on death certificates and not subject to changes in diagnostic patterns or death certificate coding over time.
Strengths of our study include its large size and representative inclusion of major cities and states affected by the HIV epidemic, making our cancer-attributable death results applicable to the US AIDS population. An additional strength was our novel analytic approach, which accurately accounted for incident cancers and deaths occurring throughout the follow-up period. Others have recently proposed a piece-wise constant hazards model to estimate population attributable mortality [26], which appears similar to our method, although the variance estimation procedures are more computationally intensive. Of note, the attributable mortality framework is based on a causal relationship between exposure (i.e. cancer) and the outcome of interest (i.e. death), which assumes there are no unmeasured confounders. Although our multivariate models adjusted for sex, race/ethnicity and age group, we lacked information on individual-level risk factors, such as tobacco and alcohol use, comorbid conditions, and HAART use. Thus, our mortality estimates reflect the combined effects of both cancer and these unmeasured factors.
We chose to evaluate mortality at 5 years because longer follow-up would require adjustments to account for potential outmigration of people with AIDS [5,27]. In addition, from a clinical standpoint, estimating mortality due to cancer at 5 years after AIDS onset is appropriate for a disease such as AIDS for which survival was previously poor (measured in months) but has subsequently improved (now measured in years). Future studies with longer periods of follow-up and into more recent calendar periods may also be informative as mortality among people with AIDS continues to change over time. Also, cohorts of individuals with HIV but not AIDS should be evaluated, especially as the number of HIV-infected people on HAART increases and AIDS becomes a less common condition.
As the spectrum of HIV/AIDS-related sequelae continues to change in the HAART era, accurate monitoring of cancer-related deaths will remain necessary to inform clinicians treating people with HIV and cancer, epidemiology researchers, and public health officials. To our knowledge, this is the first study to use attributable mortality methods to evaluate cancer deaths among an AIDS cohort. Although mortality due to NADCs has declined in the HAART era, these malignancies account for an increasing proportion of all deaths. Our results highlight the importance of improved cancer screening, prevention, and treatment among people with AIDS.
We thank the staff at the HIV/AIDS and cancer registries at the following locations: Colorado; Connecticut; Florida; Illinois; Georgia; Massachusetts; Michigan; New Jersey; New York, New York; Los Angeles, San Diego and San Francisco, California; Seattle, Washington; Texas and Washington, D.C. We also thank Mr. Tim McNeel (Information Management Systems, Rockville, Maryland) for database management.
This study was supported by the Intramural Research Program of the National Cancer Institute. All authors declare no conflicts of interest.
This article has been cited 1 time(s).
AIDS; attributable risk; cancer; HIV; mortality
© 2012 Lippincott Williams & Wilkins, Inc.
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Get an overview of this hotelBoardwalk Jeju hostel in Jeju City with free parking
Situated on the boardwalk, this hostel is close to Jeju Waterworld, Jeju Mokgwana, and Jejuhyanggyo Confucian School. Also nearby are Yongduam Rock and Jeju Ferry Terminal.
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A coffee shop/café, a sauna, and coffee/tea in the lobby are available at this smoke-free hostel. Free WiFi in public areas and free self parking are also provided. Additionally, a computer station, tour/ticket assistance, and multilingual staff are onsite.
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All 28 rooms offer coffee makers, LCD TVs with cable channels, and free bottled water.Information missing or incorrect? Tell us!
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Hotel Amenities
The hostel offers a coffee shop/café. A computer station is located on site and high-speed wireless Internet access is complimentary. This Jeju hostel also offers a sauna, tour/ticket assistance, and barbecue grills. Complimentary self parking is available on site.
HKjeju I is a smoke-free property.
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- Number of buildings/towers - 1
- Number of floors - 4
- Sauna
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- Total number of rooms - 28
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Available in some public areas: Free WiFi
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- Cable TV service
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- Free bottled water
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Up to 2 children 6 years old and younger stay free when occupying the parent or guardian's room, using existing bedding. Alcohol is not served at this property.