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Articles tagged dubstep
5 May 2016 // 11:01 AM
Joker's "Only You" is one of the few songs that showcases trap music's true potential.READ more
14 Apr 2016 // 11:38 AM
Katy B's "I Wanna Be" is one of the reasons why pop music is considered by many to be generic and bland.READ more
12 Apr 2016 // 2:20 AM
Ital Tek releases this year's best album to date.READ more
11 Apr 2016 // 2:53 PM
This is a "big" sound, full of reverb and beats that make your chest vibrate. Pretty amazing.READ more
17 Feb 2016 // 3:22 PM
Tension building never sounded so gracefully constructed.READ more
3 Dec 2015 // 3:30 AM
How many pixie sticks can you eat before you puke? How amped can you get before you're just depleted? Is hi-end the new bass? How does it feel to live inside a Lisa Frank coloring book?READ more
1 Oct 2015 // 2:20 AM
As writer Rory Gibb once asked himself, "What on earth is this music?"READ more
25 Nov 2014 // 3:06 AM
With an astonishing lead single and an enveloping album besides, the Manchester producer offers the most vivid expression of his ghostly, brooding vision yet.READ more
17 Nov 2014 // 3:02 AM
This collection of songs are serviceable tracks that would fit well on any EDM-lovers playlist, but it lacks a certain something: experimentation.READ more
10 Nov 2014 // 4:00 AM
- //Features
James Muschler, drummer for EDM and dubstep infused jazz trio Moon Hooch, discusses his group's new record, being shut down by the cops, and finding happiness in jazz.READ more
25 Aug 2013 // 11:04 PM
With eight singles and his two City Limits albums released on the DEEP MEDi label to date, Silkie is truly a stalwart in Mala's army of bass pressure junkies.READ more
8 Aug 2013 // 11:05 PM
Commodo, resident DJ for Sheffield via Nottingham's mighty '20Hz/RubberDub Soundsystem' drops his impressive new EP $pace Cash in a flurry of experimental, grime infused dubstep madness for Mala's seminal bass music label, DEEP MEDi.READ more
18 Jul 2013 // 11:03 PM
Has Emika, the Native Instruments sound designer and Ninja Tune stalwart, lived up to the hype and the promise shown on her experimental, laptop-driven self-titled debut, a work that joined the dots between hypnotic German techno and the sub-heavy styling of London's underground dubstep scene?READ more
17 Jun 2013 // 11:00 PM
I've come to know it as a grower -- a curiosity I wouldn't dream of playing for a friend but a secret I might keep, locked within my music player.READ more
16 Jun 2013 // 11:03 PM
While there's nothing wrong with an artist exploring new avenues and using diverse styles, it seems Benga is possibly being carried by the tide and not forging his own paths and directions.READ more
2 May 2013 // 11:04 PM
Each bar straddles rapid snares that pop and snap like firecrackers rippling on a waterbed mattress of liquid bass. Is this starting to sound like dirty talk? Then you're starting to get it.READ more
11 Apr 2013 // 6:00 AM
Harmony Korine's film plays games with both the audience's and the character's perception of reality, fantasy, and familiarity. The various ways the music is employed throughout the film helps confuse, disorient, or ground us, and the play between diegetic and non-diegetic music brings us in and out of the characters' perspective.READ more
10 Jan 2013 // 8:30 AM
- //Music
From genre-bending to sonic spoon-bending, Vlad Kudryavtsev's fidgety and melodious album throws some real whimsy and majesty at what might loosely be called dubstep.READ more
4 Sep 2012 // 7:56 AM
Spacek producer and one half of the Shining, Morgan Zarate has a second single release coming from Hyperdub on 2 October. On "Broken Heart Collector", Zarate teams with upcoming singer-songwriter Stevie Neale for a hook-filled R&B/pop tune with dubstep roots.READ more
17 Oct 2011 // 10:00 PM
The German electronic musician and erstwhile member of Moderat returns with a warmer, softer edge than contemporaries like James Blake.READ more
Shabazz Palaces "Dawn in Luxor" (Singles Going Steady) // Music
Randy Rogers and Wade Bowen "West Texas Rain" (audio) (premiere) // Music
Kaytranada "Lite Spots" (Singles Going Steady) // Music
Rachael Sage "I Don't Believe It" (video) (premiere) // Music
Cage the Elephant Ignite Central Park with Kickoff for Summerstage Season
// Notes from the Road
"Cage the Elephant rocked two sold-out nights at Summerstage and return to NYC for a free show May 29th. Info on that and a preview of the full Summerstage schedule is here.READ the article


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National Practice Recommendations for Hematuria: How to Evaluate in the Absence of Strong Evidence?
Loo, Ronald
Whittaker, Joel
Rabrenivich, Violeta
The Permanente Journal
Hematuria is one of the most common conditions confronting clinical urologists and is present in many genitourinary pathology conditions. Although researchers have studied hematuria symptoms in an effort to determine the best diagnostic pathway, the existing lack of scientific evidence has created variations in clinical practice. The literature does not provide enough evidence to significantly alter the need to assess these patients. Consequently, many patients with microscopic or gross hematuria undergo low-yield workups that include invasive testing and imaging with radiation. In 2007, a national group of Kaiser Permanente (KP) urology chiefs agreed that national practice recommendations were needed to address existing variations in the management and workup of hematuria. Using a KP guideline methodology, the group reached a consensus agreement on the following recommendations: 1) referral to urology is recommended for all people with gross hematuria or high-grade hematuria (>50 red blood cells per high-power field [RBCs/HPF]) on a single urinalysis (UA); 2) referral to urology and urologic evaluation is recommended for men or women with asymptomatic microscopic hematuria or symptomatic hematuria that produces >3 RBCs/HPF on two of three properly performed and collected urinalyses; and 3) voided urinary cytology should be eliminated from asymptomatic hematuria screening protocol. The test is not sensitive enough to obviate further workup if findings are negative, and elimination of this screening test is estimated to save millions of dollars across the US. Hematuria on a UA should be reported as 0 to 3 RBC/HPF, 4 to 10 RBC/HPF, 11 to 25 RBC/HPF, 26 to 50 RBC/HPF, >50 RBC/HPF, or gross hematuria. This approach will also reduce radiation exposure.
Related Articles
High Risk Patients with Hematuria Are Not Evaluated According to Guideline Recommendations
Elias, Keren
Svatek, Robert S.
Gupta, Samir
Ho, Richard
Lotan, Yair
To determine whether high risk patients with hematuria receive evaluation according to guideline recommendations.
Materials and Methods
We recently performed a screening study for bladder cancer using a urine-based tumor marker in 1502 subjects at high risk based on age over 50, ≥10-year smoking history, and/or a 15 year or more environmental exposure. We evaluated use of urinalysis (UA) within 3 years preceding the screening study. Chart review was performed to determine if this subset with microhematuria received any additional evaluation.
Of 1502 study participants, routine urinalysis was performed in 73.2% and 164 (14.9%) subjects had documented hematuria (>3 RBCs/HPF) prior to inclusion. Of these, 42.1% had no further evaluation. Additional testing included repeat urinalysis (36%), urine culture (15.2%), cytology (10.4%), imaging (22.6% overall: 15.9% CT, 4.3% IVP; 2.4% MRI) and cystoscopy (12.8%).
Three subjects with microscopic hematuria (2%) were subsequently found to have bladder cancer during the screening study but were not referred for evaluation based on their hematuria. The source of hematuria was unknown in 65%, infection in 22%, benign prostatic enlargement in 10% and renal stone disease in 4% but these results are based on incomplete evaluation since only 12.8% underwent cystoscopy.
Subjects at high risk for bladder cancer based on ≥10 years of smoking or environmental exposure with microscopic hematuria are rarely evaluated thoroughly and only 12.8% were referred for urologic evaluation. Further studies are needed to evaluate both the utilization and effectiveness of guidelines for hematuria.
Hematuria; Guidelines Recommendations; bladder cancer
Related Articles
Accurate Risk Assessment of Patients with Asymptomatic Hematuria for the Presence of Bladder Cancer
Cha, Eugene K.
Tirsar, Lenuta-Ancuta
Schwentner, Christian
Hennenlotter, Joerg
Christos, Paul J.
Stenzl, Arnulf
Mian, Christine
Martini, Thomas
Pycha, Armin
Shariat, Shahrokh F.
Schmitz-Dräger, Bernd J.
World journal of urology
Bladder cancer is frequently diagnosed during a workup for hematuria. However, most patients with microscopic hematuria and many with gross hematuria are not appropriately referred to urologists. We hypothesized that in patients presenting with asymptomatic hematuria, the risk of having bladder cancer can be predicted with high accuracy. Towards this end, we analyzed risk factors in patients with asymptomatic hematuria and developed a nomogram for the prediction of bladder cancer presence.
Data from 1,182 consecutive subjects without a history of bladder cancer undergoing initial evaluation for asymptomatic hematuria were collected at three centers. Clinical risk factors including age, gender, smoking status, and degree of hematuria were recorded. All subjects underwent standard workup including voided cytology, upper tract imaging, and cystourethroscopy. Factors associated with the presence of bladder cancer were evaluated by univariable and multivariable logistic regression analyses. The multivariable analysis was used to construct a nomogram. Internal validation was performed using 200 bootstrap samples.
Of the 1,182 subjects who presented with asymptomatic hematuria, 245 (20.7%) had bladder cancer. Increasing age (OR=1.03, p<0.0001), smoking history (OR=3.72, p<0.0001), gross hematuria (OR=1.71, p=0.002), and positive cytology (OR=14.71, p<0.0001) were independent predictors of bladder cancer presence. The multivariable model achieved 83.1% accuracy for predicting the presence of bladder cancer.
Bladder cancer presence can be predicted with high accuracy in patients who present with asymptomatic hematuria. We developed a nomogram to help optimize referral patterns (i.e., timing and prioritization) of patients with asymptomatic hematuria.
urinary bladder neoplasms; hematuria; nomograms; early detection of cancer; carcinoma
Related Articles
Thin glomerular basement membrane disease: light microscopic and electron microscopic studies.
Suh, K. S.
Kim, J. O.
Kang, G. H.
Journal of Korean Medical Science
Benign recurrent hematuria usually indicates a good prognosis. This condition is associated with abnormally thin glomerular basement membranes. Of 680 renal biopsy cases in which lower urinary tract disease had been excluded by careful study, 25 cases from seven children and eighteen adults met the criteria for thin glomerular basement membrane disease, placing the incidence of the disease at 3.7%. The mean patient age was 32.4 years and the male to female ratio was 1 to 5.3. The primary finding was microscopic hematuria in eighteen patients and gross hematuria in five patients. Among eighteen patients who had microscopic hematuria, one patient also exhibited proteinuria and one patient suffered from acute renal failure due to acute drug-induced interstitial nephritis. Proteinuria was only found in one patient. All of the patients had normal renal function, with the exception of one who suffered from acute renal failure. The duration of hematuria from the time of detection to the date of biopsy ranged from 3 months to 30 years with a mean interval of 56.6 months. No apparent evidence of familial hematuria in any patient was noted. Under light microscopy most glomeruli were normal. However, five cases showed focal global sclerosis. Under immunofluorescence microscopy seventeen cases were negative for all immunoglobulins, for complement, and for fibrinogen. Eight cases showed nonspecific mesangial deposition of fibrinogen and/or IgM. Ultrastructurally, extensive diffuse thinning of the GBM was a constant finding. The mean thickness of the GBM was 203.2 +/- 28.3 nm (n = 25); the thickness in adult (201.4 +/- 27.5 nm; n = 18) did not differ from that in children (208.1 +/- 32.0 nm; n = 7).
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Commentary: the role of cytologic analysis of voided urine in the work-up of asymptomatic microhematuria
Trivedi, Deep
Messing, Edward M
BMC Urology
Microscopic hematuria is a common finding in patients presenting to both primary care doctors as well as urologists. Sources of microscopic hematuria include infection, stones, inflammatory disorders as well as cancer of the genitourinary tract, particularly urothelial cancer. A primary focus in the urologic workup of hematuria is to rule out cancer. This is done using radiographic studies as well as procedures such as cystoscopy and bladder biopsy. As the authors state in their article titled "The utility of serial urinary cytology in the initial evaluation of the patient with microscopic hematuria", cytologic analysis of voided urine, though attractive due to its noninvasive nature, has been found to have the neither the sensitivity, cost-effectiveness, nor the ease of administration necessary to replace more invasive diagnostics in the evaluation of microscopic hematuria.
Related Articles
Macroscopic Hematuria—A Leading Urological Problem in Patients on Anticoagulant Therapy: Is the Common Diagnostic Standard Still Advisable?
Antoniewicz, Artur A.
Zapała, Łukasz
Poletajew, Sławomir
Borówka, Andrzej
ISRN Urology
All urological standards of care are based on the past definition of the clinical importance of macroscopic hematuria. The aim of the study was to assess the phenomenon of iatrogenic hematuria in current clinical practice and analyze its origins in patients receiving anticoagulant drugs. Retrospective analysis of clinical documentation of 238 patients that were consulted for hematuria in 2007–2009 by 5 consultant urologists was performed. In the group of 238 patients with hematuria, 155 (65%) received anticoagulants. Abnormalities of urinary tract were found in 45 (19%) patients. Estimated cost of a single neoplasm detection reached the value of 3252 Euro (mean 3-day hospitalization). The strong correlation between the presence of hematuria and anticoagulant treatment was observed. Authors suggest to redefine the present and future role of hematuria from a standard manifestation of serious urological disease to a common result of a long-term anticoagulant therapy.
Related Articles
Hemoglobinuria Misidentified as Hematuria: Review of Discolored Urine and Paroxysmal Nocturnal Hemoglobinuria
Veerreddy, Prashant
Clinical Medicine Insights
Discolored urine is a common reason for office visits to a primary care physician and urology referral. Early differentiation of the type or cause of discolored urine is necessary for accurate diagnosis and prompt management.
Paroxysmal nocturnal hemoglobinuria is a clonal disorder caused by acquired somatic mutations in the PIG-A gene on the X- chromosome of hemopoietic stem cells and leads to deficiency of surface membrane anchor proteins. The deficiency of these proteins leads to an increased risk of hemolysis of erythrocytes and structural damage of platelets, resulting in a clinical syndrome characterized by complement-mediated intravascular hemolytic anemia, bone marrow failure, and venous thrombosis. Patients with this clinical syndrome present with paroxysms of hemolysis, causing hemoglobinuria manifesting as discolored urine. This can be easily confused with other common causes of discolored urine and result in extensive urologic work-up. Three commonly confused entities of discolored urine include hematuria, hemoglobinuria, and myoglobinuria. Specific characteristics in a dipstick test or urinalysis can guide differentiation of these three causes of discolored urine.
This article begins with a case summary of a woman presenting with cranberry-colored urine and a final delayed diagnosis of paryxysmal nocturnal hemoglobinuria. Her hemoglobinuria was misdiagnosed as hematuria, leading to extensive urologic work-up. The article also gives an overview of the approach to diagnosing and treating discolored urine.
discolored urine; hematuria; hemoglobinuria; myoglobinuria; paroxysmal nocturnal hemoglobinuria; GPI-AP (glycosylphosphatidylionositol—anchor proteins); CD55; CD59
Related Articles
The Clinical Significance of a Retroaortic Left Renal Vein
Nam, Jong Kil
Park, Sung Woo
Lee, Sang Don
Chung, Moon Kee
Korean Journal of Urology
A retroaortic left renal vein (RLRV) is located between the aorta and the vertebra and drains into the inferior vena cava. Urological symptoms can be caused by increased pressure in the renal vein. To evaluate the clinical importance of RLRV, we reviewed patients' medical records and radiologic findings.
Materials and Methods
Nine patients who were studied with multidetector computed tomography at our institution from January 2003 to December 2009 had urologic symptoms with RLRV. We retrospectively reviewed these patients' medical records and analyzed their clinical characteristics.
The patients' mean age was 46.0±20.1 years (range, 17-65 years) and the male to female ratio was 5 to 4. The urologic symptoms of the initial diagnosis were various (hematuria: 5 of the 9 patients; left flank pain: 4 of the 9 patients; inguinal pain: 1 of the 5 male patients; and gross hematuria: 1 of the 9 patients). The distribution among the type I, II, III, and IV of RLRV was 6, 2, 1, and 0 patients, respectively. The concomitant diseases were ureteropelvic junction obstruction (UPJO; 2 of the 9 patients) and varicocele (2 of the 5 male patients). One patient with UPJO underwent pyeloplasty and the other patient with UPJO underwent nephrectomy due to a nonfunctional atrophied kidney. The microscopic hematuria was not resolved with conservative management for long-term follow-up.
Hematuria and inguinal or flank pain seem to be common in patients with RLRV. The most common type of RLRV was type I. It appeared that the microscopic hematuria continued in the long-term follow-up.
Abnormalities; Renal veins; Tomography
Related Articles
Interactions between Non-Physician Clinicians and Industry: A Systematic Review
Grundy, Quinn
Bero, Lisa
Malone, Ruth
PLoS Medicine
In a systematic review of studies of interactions between non-physician clinicians and industry, Quinn Grundy and colleagues found that many of the issues identified for physicians' industry interactions exist for non-physician clinicians.
Please see later in the article for the Editors' Summary
With increasing restrictions placed on physician–industry interactions, industry marketing may target other health professionals. Recent health policy developments confer even greater importance on the decision making of non-physician clinicians. The purpose of this systematic review is to examine the types and implications of non-physician clinician–industry interactions in clinical practice.
Methods and Findings
We searched MEDLINE and Web of Science from January 1, 1946, through June 24, 2013, according to PRISMA guidelines. Non-physician clinicians eligible for inclusion were: Registered Nurses, nurse prescribers, Physician Assistants, pharmacists, dieticians, and physical or occupational therapists; trainee samples were excluded. Fifteen studies met inclusion criteria. Data were synthesized qualitatively into eight outcome domains: nature and frequency of industry interactions; attitudes toward industry; perceived ethical acceptability of interactions; perceived marketing influence; perceived reliability of industry information; preparation for industry interactions; reactions to industry relations policy; and management of industry interactions. Non-physician clinicians reported interacting with the pharmaceutical and infant formula industries. Clinicians across disciplines met with pharmaceutical representatives regularly and relied on them for practice information. Clinicians frequently received industry "information," attended sponsored "education," and acted as distributors for similar materials targeted at patients. Clinicians generally regarded this as an ethical use of industry resources, and felt they could detect "promotion" while benefiting from industry "information." Free samples were among the most approved and common ways that clinicians interacted with industry. Included studies were observational and of varying methodological rigor; thus, these findings may not be generalizable. This review is, however, the first to our knowledge to provide a descriptive analysis of this literature.
Non-physician clinicians' generally positive attitudes toward industry interactions, despite their recognition of issues related to bias, suggest that industry interactions are normalized in clinical practice across non-physician disciplines. Industry relations policy should address all disciplines and be implemented consistently in order to mitigate conflicts of interest and address such interactions' potential to affect patient care.
Please see later in the article for the Editors' Summary
Editors' Summary
Making and selling health care goods (including drugs and devices) and services is big business. To maximize the profits they make for their shareholders, companies involved in health care build relationships with physicians by providing information on new drugs, organizing educational meetings, providing samples of their products, giving gifts, and holding sponsored events. These relationships help to keep physicians informed about new developments in health care but also create the potential for causing harm to patients and health care systems. These relationships may, for example, result in increased prescription rates of new, heavily marketed medications, which are often more expensive than their generic counterparts (similar unbranded drugs) and that are more likely to be recalled for safety reasons than long-established drugs. They may also affect the provision of health care services. Industry is providing an increasingly large proportion of routine health care services in many countries, so relationships built up with physicians have the potential to influence the commissioning of the services that are central to the treatment and well-being of patients.
Why Was This Study Done?
As a result of concerns about the tension between industry's need to make profits and the ethics underlying professional practice, restrictions are increasingly being placed on physician–industry interactions. In the US, for example, the Physician Payments Sunshine Act now requires US manufacturers of drugs, devices, and medical supplies that participate in federal health care programs to disclose all payments and gifts made to physicians and teaching hospitals. However, other health professionals, including those with authority to prescribe drugs such as pharmacists, Physician Assistants, and nurse practitioners are not covered by this legislation or by similar legislation in other settings, even though the restructuring of health care to prioritize primary care and multidisciplinary care models means that "non-physician clinicians" are becoming more numerous and more involved in decision-making and medication management. In this systematic review (a study that uses predefined criteria to identify all the research on a given topic), the researchers examine the nature and implications of the interactions between non-physician clinicians and industry.
What Did the Researchers Do and Find?
The researchers identified 15 published studies that examined interactions between non-physician clinicians (Registered Nurses, nurse prescribers, midwives, pharmacists, Physician Assistants, and dieticians) and industry (corporations that produce health care goods and services). They extracted the data from 16 publications (representing 15 different studies) and synthesized them qualitatively (combined the data and reached word-based, rather than numerical, conclusions) into eight outcome domains, including the nature and frequency of interactions, non-physician clinicians' attitudes toward industry, and the perceived ethical acceptability of interactions. In the research the authors identified, non-physician clinicians reported frequent interactions with the pharmaceutical and infant formula industries. Most non-physician clinicians met industry representatives regularly, received gifts and samples, and attended educational events or received educational materials (some of which they distributed to patients). In these studies, non-physician clinicians generally regarded these interactions positively and felt they were an ethical and appropriate use of industry resources. Only a minority of non-physician clinicians felt that marketing influenced their own practice, although a larger percentage felt that their colleagues would be influenced. A sizeable proportion of non-physician clinicians questioned the reliability of industry information, but most were confident that they could detect biased information and therefore rated this information as reliable, valuable, or useful.
What Do These Findings Mean?
These and other findings suggest that non-physician clinicians generally have positive attitudes toward industry interactions but recognize issues related to bias and conflict of interest. Because these findings are based on a small number of studies, most of which were undertaken in the US, they may not be generalizable to other countries. Moreover, they provide no quantitative assessment of the interaction between non-physician clinicians and industry and no information about whether industry interactions affect patient care outcomes. Nevertheless, these findings suggest that industry interactions are normalized (seen as standard) in clinical practice across non-physician disciplines. This normalization creates the potential for serious risks to patients and health care systems. The researchers suggest that it may be unrealistic to expect that non-physician clinicians can be taught individually how to interact with industry ethically or how to detect and avert bias, particularly given the ubiquitous nature of marketing and promotional materials. Instead, they suggest, the environment in which non-physician clinicians practice should be structured to mitigate the potentially harmful effects of interactions with industry.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001561.
This study is further discussed in a PLOS Medicine Perspective by James S. Yeh and Aaron S. Kesselheim
The American Medical Association provides guidance for physicians on interactions with pharmaceutical industry representatives, information about the Physician Payments Sunshine Act, and a toolkit for preparing Physician Payments Sunshine Act reports
The International Council of Nurses provides some guidance on industry interactions in its position statement on nurse-industry relations
The UK General Medical Council provides guidance on financial and commercial arrangements and conflicts of interest as part of its good medical practice website, which describes what is required of all registered doctors in the UK
Understanding and Responding to Pharmaceutical Promotion: A Practical Guide is a manual prepared by Health Action International and the World Health Organization that schools of medicine and pharmacy can use to train students how to recognize and respond to pharmaceutical promotion.
The Institute of Medicine's Report on Conflict of Interest in Medical Research, Education, and Practice recommends steps to identify, limit, and manage conflicts of interest
The University of California, San Francisco, Office of Continuing Medical Education offers a course called Marketing of Medicines
Related Articles
High-grade microscopic hematuria in adult men can predict urothelial malignancy
Kotb, Ahmed Fouad
Attia, Doaa
Canadian Urological Association Journal
Microscopic hematuria in men younger than 40 is a confusing issue to urologists, especially when these men have normal radiological findings. We report our experience in looking for urologic malignancy in this group of patients.
We conducted a prospective study for men with vague urological symptoms. We included men under 40 years old, men with microscopic hematuria greater than 25 red blood cells/high power field in 2 properly collected mid-stream urine samples, and men with free urine culture and normal multiphasic computed tomography abdomen and pelvis studies. All patients underwent diagnostic cystoscurethroscopy. If there were no lesions, multiple random biopsies were taken. In cases of apparently normal cystoscopic findings and associated renal colic, uretroscopy was done to the suspected side.
Only 20 patients fulfilled our inclusion criteria. The mean age of the patients were 34; 2 patients presented with pain. The other 18 patients were presenting with mild recurrent lower urinary tract symptoms. Cystoscopy showed small papillary low-grade tumour in 3 patients. All random biopsies were free of malignancy. Unilateral uretroscopy for the 2 cases presented with pain detected carcinoma in situ in one of them.
Cystoscopy is highly recommended for young adult men, with significant levels of microscopic hematuria, due to the 20% incidence rate of associated urological malignancy. Random bladder biopsies, in the absence of suspicious lesions, have no diagnostic role, and should not be done. Uretroscopy is advised for patients with microscopic hematuria and loin pain, even in the absence of suspicious radiological findings.
Related Articles
Dipstick urine analysis screening among asymptomatic school children
Hajar, Farah
Taleb, Mohamad
Aoun, Bilal
Shatila, Ahmad
North American Journal of Medical Sciences
Mass urinary screening is a useful tool to identify children with asymptomatic progressive renal diseases. A dipstick urinalysis screening was conducted to detect such prevalence and to set up a more effective screening program for children.
Patients and Methods:
A cross sectional study was carried out in seven nurseries and primary schools in different regions of Lebanon (Beirut, North Lebanon, and Valley of Bekaa) between February 2010 and March 2010. Eight hundred seventy asymptomatic children were enrolled in this study. First morning mid steam urine samples were obtained from students and were tested by dipstick method. Children with abnormal findings were re-tested after fifteen days.
Twenty five (2.9%) children had urinary abnormalities at the first screening; Eighteen (72%) of them still had abnormal results at the second screening. Among all the students, hematuria was the most common abnormality found with a prevalence of 1.5%, followed by nitrituria (0.45%), combined hematuria and nitrituria (0.45%) and proteinuria (0.1%). Urinary abnormalities were more common in females than in males. With respect to age, most positive results were detected at 6 years of age. Hematuria and proteinuria were mainly present in the North of Lebanon.
Asymptomatic urinary abnormalities might be detected by urine screening program at school age. Further work-up should be offered to define the exact etiology of any abnormal finding and to determine whether early detection of renal disorders in childhood will lead to effective interventions and reduction in the number of individuals who develop end-stage renal disease.
Dipstick urine analysis; renal failure in school aged children; urine analysis screening
Related Articles
Test Characteristics of Urinalysis to Predict Urologic Injury in Children
Thorp, Andrea W.
Young, Timothy P.
Brown, Lance
Western Journal of Emergency Medicine
To use receiver operator characteristic curve methodology to determine the test characteristics of microscopic hematuria for identifying urologic injuries in children who underwent computed tomography (CT) of the abdomen and pelvis as part of a trauma evaluation.
We performed a retrospective medical record review of all children from 0 to 12 years of age who presented to our pediatric emergency department within a Level 1 trauma center, had an abdominal and pelvic CT and a microscopic urinalysis as part of an initial evaluation for trauma. Urologic injury was defined as any injury to the kidneys, ureters or bladder. We defined hematuria from the microscopic urinalysis and reported by the clinical laboratory as the exact number of red blood cells per high power field (RBC/hpf).
Of the 502 children in the study group, 17 (3%; 95% CI [2%–5.4%]) had evidence of urologic injury on the abdominal or pelvic CT. Microscopic urinalysis for those children with urologic injury ranged from 0 to15,544 RBC/hpf. The remaining 485 children without urologic injury had a range of hematuria from 0 to 20,596 RBC/hpf. A receiver operating characteristic curve was generated and the area under the curve is 0.796 (95% CI [0.666–0.925]).
If the abdominal and pelvic CT is used as the criterion standard for identifying urologic trauma, the microscopic urinalysis has moderate discriminatory power to predict urologic injury.
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Asymptomatic Microscopic Hematuria Revisited
Livingstone, Verity
Canadian Family Physician
The literature states that asymptomatic microscopic hematuria (AMH) is a sensitive indicator of underlying pathology and deserves investigation. However, studies to date have been done on urological outpatients and, because of referral and sampling bias, the findings may not be applicable to a family practice population. The positive predictive value of AMH may be very low in a family practice. The recommended investigations are invasive, expensive, and cause morbidity and mortality. Further studies must examine the significance of AMH in the general population. Such studies would help to identify at risk patients and, perhaps, allow investigations to be tailored to these patients, while the physician maintains a high degree of suspicion and keeps a watchful eye on the others.
Asymptomatic microscopic hematuria; family practice; urology
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The Use of Molecular Analyses in Voided Urine for the Assessment of Patients with Hematuria
Beukers, Willemien
Kandimalla, Raju
van Houwelingen, Diandra
Kovacic, Hrvoje
Chin, Jie-Fen D.
Lingsma, Hester F.
Dyrskjot, Lars
Zwarthoff, Ellen C.
PLoS ONE
Patients presenting with painless hematuria form a large part of the urological patient population. In many cases, especially in younger patients, the cause of hematuria is harmless. Nonetheless, hematuria could be a symptom of malignant disease and hence most patients will be subject to cystoscopy. In this study, we aimed to develop a prediction model based on methylation markers in combination with clinical variables, in order to stratify patients with high risk for bladder cancer.
Material and Methods
Patients (n=169) presenting with painless hematuria were included. 54 patients were diagnosed with bladder cancer. In the remaining 115 patients, the cause of hematuria was non-malignant. Urine samples were collected prior to cystoscopy. Urine DNA was analyzed for methylation of OSR1, SIM2, OTX1, MEIS1 and ONECUT2. Methylation percentages were calculated and were combined with clinical variables into a logistic regression model.
Logistic regression analysis based on the five methylation markers, age, gender and type of hematuria resulted in an area under the curve (AUC) of 0.88 and an optimism corrected AUC of 0.84 after internal validation by bootstrapping. Using a cut-off value of 0.307 allowed stratification of patients in a low-risk and high-risk group, resulting in a sensitivity of 82% (44/54) and a specificity of 82% (94/115). Most aggressive tumors were found in patients in the high-risk group. The addition of cytology to the prediction model, improved the AUC from 0.88 to 0.89, with a sensitivity and specificity of 85% (39/46) and 87% (80/92), retrospectively.
This newly developed prediction model could be a helpful tool in risk stratification of patients presenting with painless hematuria. Accurate risk prediction might result in less extensive examination of low risk patients and thereby, reducing patient burden and costs. Further validation in a large prospective patient cohort is necessary to prove the true clinical value of this model.
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Primary Localized Amyloidosis of Urinary Bladder: A Case Report and Review of Literature
Raja, Kapeel
Ahmed, Ejaz
Mubarak, Muhammed
Iqbal, Tanveer
Hassan, Syed Mujahid
Nephro-urology Monthly
Amyloidosis is a disorder of protein metabolism characterized by extracellular deposition of abnormal protein fibrils. It may either be localized to any organ or systematically distributed throughout the body. The biochemical nature of proteins varies but the physical and tinctorial properties are shared by all the amyloidogenic proteins. In the West, it is mainly composed of amyloid light (AL) type immunoglobulin (Ig) light chains. Amyloidosis of the genitourinary tract is rare except for the kidney and isolated primary amyloidosis of the urinary bladder is even rarer. It mainly presents as intermittent painless gross hematuria. It mimics transitional cell carcinoma on imaging and endoscopic examination. We herein present a case of fifty six-years-old male with history of painless hematuria for three months. Cystoscopy revealed a 1 cm hyperemic area on the posterior wall of urinary bladder. The biopsy showed features of amyloidosis and amyloid A (AA) immunostaining was negative. Extensive workup was done to exclude other sites of involvement and a final diagnosis of primary localized amyloidosis of the urinary bladder was made. The patient is on regular follow-up.
Amyloidosis; Urogenital System; Urinary Bladder
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Immunocytology Is Strong Predictor of Bladder Cancer Presence in Patients With Painless Hematuria: A Multicentre Study
Cha, Eugene K.
Tirsar, Lenuta-Ancuta
Schwentner, Christian
Christos, Paul J.
Mian, Christine
Hennenlotter, Joerg
Martini, Thomas
Stenzl, Arnulf
Pycha, Armin
Shariat, Shahrokh F.
Schmitz-Dräger, Bernd J.
European urology
Although the performance of immunocytology has been established in the surveillance of patients with urothelial carcinoma of the bladder (UCB), its value in the initial detection of UCB in patients with painless hematuria remains unclear.
To determine whether immunocytology improves our ability to predict the likelihood of UCB in patients with painless hematuria. Further, to test the clinical benefit of immunocytology in this setting using decision curve analysis.
Design, setting, and participants
The subjects were 1182 consecutive patients without a history of UCB presenting with painless hematuria and were enrolled at three centres.
All patients underwent upper-tract imaging, cystourethroscopy, voided urine cytology, and immunocytology analysis. Bladder tumors were biopsied and histologically confirmed as UCB.
Multivariable regression models were developed. Area under the curve was measured and compared using the DeLong test. A nomogram was constructed from the full multivariable model. Decision curve analysis was performed to evaluate the clinical benefit associated with use of the multivariable models including immunocytology.
Results and limitations
Immunocytology had the largest contribution to a multivariable model for the prediction of UCB (odds ratio: 18.3; p < 0.0001), which achieved a 90.8% predictive accuracy. Decision curve analysis revealed that models incorporating immunocytology achieved the highest net benefit at all threshold probabilities.
Immunocytology is a strong predictor of the presence of UCB in patients who present with painless hematuria. Incorporation of immunocytology into predictive models improves diagnostic accuracy by a statistically and clinically significant margin. The use of immunocytology in the diagnostic workup of patients with hematuria appears promising and should be further evaluated.
Cystoscopy; Decision curve analysis; Early detection of cancer; Hematuria; Immunocytology; Nomograms; Urinary bladder neoplasms
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Renal Trauma from Recreational Accidents Manifests Different Injury Patterns than Urban Renal Trauma
Lloyd, Granville L.
Slack, Sean
McWilliams, Kelly L.
Black, Aaron
Nicholson, Tristan M.
The Journal of urology
The majority of blunt renal trauma is a consequence of motor vehicle collisions and falls. Prior publications based on urban series have shown that significant renal injuries are almost always accompanied by gross hematuria alone or microscopic hematuria with concomitant hypotension. We present a series of blunt renal trauma sustained during recreational pursuits, and describe the mechanisms, injury patterns and management.
Materials and Methods
Database review from 1996 to 2009 identified 145 renal injuries. Children younger than age 16 years, and trauma involving licensable motor vehicles, penetrating injuries and work related injuries were excluded from analysis. Grade, hematuria, hypotension, age, gender, laterality, mechanism, management, injury severity score and associated injuries were recorded.
We identified 106 patients meeting the criteria and 85% of the injuries were snow sport related. Age range was 16 to 76 years and 92.5% of patients were male. There were 39 grade 1 injuries, 30 grade 2, 22 grade 3, 12 grade 4 and 3 grade 5 injuries. Gross hematuria was present in 56.7%, 77.2% and 83.3% of grade 2, grade 3 and grade 4 injuries, respectively. None of the patients with grade 2 or greater injuries and microscopic hematuria had hypotension except 1 grade 5 pedicle injury. The nephrectomy and renorrhaphy rate for grade 1 to grade 4 injuries was 0%.
Compared to urban series of blunt renal trauma, recreationally acquired injuries appear to follow different patterns, including a paucity of associated injuries or hypotension. If imaging were limited to the presence of gross hematuria, or microscopic hematuria with hypotension, 23% of grade 2 to grade 4 injuries would be missed. Men are at higher risk than women. However, operative intervention is rarely helpful.
kidney; multiple trauma; retrospective studies; wounds; nonpenetrating; injury severity score
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Diagnosis and Treatment of Benign Prostatic Hyperplasia
Collins, Mary McNaughton
Barry, Michael J
Bin, Lin
Roberts, Richard G
Oesterling, Joseph E
Fowler, Floyd J
Journal of General Internal Medicine
To define primary care physicians' (PCPs) practices in managing patients with benign prostatic hyperplasia (BPH), and to compare these practices to portions of the Agency for Health Care Policy and Research BPH guideline and urologists' practices.
Mail survey.
Nationwide random sample of PCPs and urologists, selected from the American Medical Association Registry.
Initial mailing, postcard reminder, second mailing, telephone reminder, final mailing.
Primary care physicians (n = 444, response = 51%) reported seeing a median of 35 patients with BPH over the preceding year, in contrast to 240 for urologists (n = 394, response = 68%). Regarding tests recommended by the guideline, two thirds of PCPs reported rarely or never using the American Urological Association (AUA) symptom index, nearly all reported routinely performing digital rectal examinations, and many (66%) reported routinely ordering tests to determine the serum creatinine level. Although considered "optional" by the guideline, more than 90% of PCPs reported routinely ordering a prostate-specific antigen test, while infrequently using other optional tests. Regarding "not recommended" studies, a substantial minority reported selectively or routinely ordering intravenous pyelography (34%) and renal ultrasound (33%), while two thirds reported rarely or never ordering these tests. Eighty-six percent of PCPs reported prescribing medications for BPH over the preceding year; α blockers to a median of 12 patients, and finasteride to a median of 2. Variation in urology referral thresholds was suggested in responses to two patient scenarios.
Primary care physicians are actively managing patients with BPH. Some of their diagnostic evaluations vary from the recommendations of a national guideline and urologists' practices. Referral thresholds appear to vary considerably.
prostatic hyperplasia; primary care physicians; practice patterns; practice guideline
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Cytological findings in routine voided urine samples with hematuria from a tertiary care center in south India
Siddappa, Sujatha
Mythri, KM
Kowsalya, R
Journal of Cytology / Indian Academy of Cytologists
Regardless of the availability of newer and more sophisticated modalities of investigation, urinary tract cytology still remains the most commonly used non-invasive test for the diagnosis of bladder cancer.
As hematuria is the commonest presenting symptom in patients with malignancy of urinary tract, we undertook this study to know the usefulness of urine cytology in evaluation of the hematuric patients for malignancy.
Materials and Methods:
A total of 21,557 fresh voided urine samples received at our tertiary care referral centre over a period of three years were included in the study. Of these, 1428 cases had hematuria, criteria of either gross or microscopic.
Among these hematuric cases included in the study, 32.5% (464 cases) were found to have positive finding of atypical cells. In these cases with atypia, 9.5% (136 cases) were proved to have malignancy both with the histopathological biopsy and cystoscopic findings. Other cases of atypia were found to be of reactive origin, either due to instrumentation or foreign body. A large number of hematuric cases, that is, 964 cases (67.5%) were negative for atypical cells.
The limited ability of urine cytology to detect low grade bladder tumors, its subjectivity and lack of uniformity in reporting, all render urine cytology a less than perfect tool. With added collaboration between clinician and cytopathologist, urine cytology can be used an adjunct tool in evaluation of patients with hematuria.
Atypical cells; hematuria; urine cytology
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The value of cystoscopy as an initial diagnostic modality for asymptomatic microscopic hematuria.
Hong, S. K.
Ahn, C.
Kim, H. H.
Journal of Korean Medical Science
For the patients who visit outpatient clinics due to asymptomatic microscopic hematuria, cystoscopy has been looked upon as rather invasive compared to other diagnostic methods. We tried to elucidate the actual diagnostic value of cystoscopy in the initial evaluation of asymptomatic microscopic hematuria. We reviewed the results of cystoscopic examinations in 213 patients who visited our hospital due to asymptomatic microscopic hematuria. No definite lesion that could explain the microscopic hematuria was detected by means of IVP, urine cytology, and other nephrologic evaluations for all the patients. Among the abnormal cystoscopic findings in 55 patients, the lesions suspected to be directly related to microscopic hematuria were classified as 'significant lesions' (31 patients, 17.6%) which include entities such as bladder cancer (1.31%). 27 of 31 patients with significant lesions (85.2%) were over 50 yr old, and furthermore, 3 patients who were diagnosed as bladder tumor by cystoscopy were over 60 yr. Cystoscopy should be utilized as initial diagnostic modality in older patients with asymptomatic microscopic hematuria to rule out any possibility of bladder cancer occurrence. Further studies are needed to justify implementation of cystoscopy as an initial diagnostic modality in younger patients with asymptomatic microscopic hematuria.
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The pitfalls of electronic health orders: development of an enhanced institutional protocol after a preventable patient death
Manley, Brandon J
Gericke, Rebecca K
Brockman, John A
Robles, Jennifer
Raup, Valary T
Bhayani, Sam B
Patient Safety in Surgery
Continuous bladder irrigation (CBI) is a long-standing treatment used in the setting of gross hematuria and other acute bladder issues. Its use has traditionally been reserved for patients under direct urologic care, but with the constraints of modern large-hospital healthcare, many patients have CBI administered by providers unfamiliar with its use and potential complications.
There were 136 CBI orders placed in 2013 by non-urologic providers. The biggest hazard found in our analysis was the requirement for entering a rate of irrigation administration. Nurses with no experience with CBI viewed this order as an indication to administer via an infusion pump, which can easily exceed the mechanical integrity of the bladder and increase the risk of bladder perforation. Our panel also found that due to lack of experience by nurses and non-urologic providers, that signs and symptoms of CBI dysfunction were not common knowledge. Also we found that non-urologic providers were unfamiliar with administration and dosing of medications for CBI patients to help with the intrinsic discomfort with CBI administration.
In our revised order set we found that removing the requirement for an infusion rate, along with placing warnings in the CPOE, helped staff better understand this possible complication. We created a best practice alert in our CPOE to strongly recommend the urology service be consulted. Communication text boxes were added to the order set to help staff be aware of the signs and symptoms of CBI dysfunction, along with a guide for trouble shooting.
MeSH; Hematuria; Communication; Delivery of health care; Urinary bladder; Consultants
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Management of the early and late presentations of rheumatoid arthritis: a survey of Ontario primary care physicians.
Glazier, R H
Dalby, D M
Badley, E M
Hawker, G A
Bell, M J
Buchbinder, R
Lineker, S C
CMAJ: Canadian Medical Association Journal
OBJECTIVE: To examine primary care physicians' management of rheumatoid arthritis, ascertain the determinants of management and compare management with that recommended by a current practice panel. DESIGN: Mail survey (self-administered questionnaire). SETTING: Ontario. PARTICIPANTS: A stratified computer-generated random sample of 798 members of the College of Family Physicians of Canada. OUTCOME MEASURES: Proportions of respondents who chose various items in the management of two hypothetical patients, one with early rheumatoid arthritis and one with late rheumatoid arthritis. Scores for investigations, interventions and referrals for each scenario were generated by summing the recommended items chosen by respondents and then dividing by the total number of items recommended in that category. The scores were examined for their association with physician and practice characteristics and physician attitudes. RESULTS: The response rate was 68.3% (529/775 eligible physicians). Recommended investigations were chosen by more than two thirds of the respondents for both scenarios. Referrals to physiotherapy, occupational therapy and rheumatology, all recommended by the panel, were chosen by 206 (38.9%), 72 (13.6%) and 309 (58.4%) physicians respectively for early rheumatoid arthritis. These proportions were significantly higher for late rheumatoid arthritis (p < 0.01). In multiple regression analysis, for early rheumatoid arthritis, internship or residency training in rheumatology was associated with higher investigation and intervention scores, for late rheumatoid arthritis, older physicians had higher intervention scores and female physicians had higher referral scores. CONCLUSIONS: Primary care physicians' investigation of rheumatoid arthritis was in accord with panel recommendations. However, rates of referral to rheumatologists and other health care professionals were very low, especially for the early presentation of rheumatoid arthritis. More exposure to rheumatology and to the role of physiotherapy, occupational therapy and social work during primary care training is strongly recommended.
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Relationships between family physicians' referral for palliative radiotherapy, knowledge of indications for radiotherapy, and prior training: a survey of rural and urban family physicians
Olson, Robert A
Lengoc, Sonca
Tyldesley, Scott
French, John
McGahan, Colleen
Soo, Jenny
Radiation Oncology (London, England)
The primary objective of this research was to assess the relationship between FPs' knowledge of palliative radiotherapy (RT) and referral for palliative RT.
1001 surveys were sent to FPs who work in urban, suburban, and rural practices. Respondents were tested on their knowledge of palliative radiotherapy effectiveness and asked to report their self-assessed knowledge.
The response rate was 33%. FPs mean score testing their knowledge of palliative radiotherapy effectiveness was 68% (SD = 26%). The majority of FPs correctly identified that painful bone metastases (91%), airway obstruction (77%), painful local disease (85%), brain metastases (76%) and spinal cord compression (79%) can be effectively treated with RT, though few were aware that hemoptysis (42%) and hematuria (31%) can be effectively treated. There was a linear relationship between increasing involvement in palliative care and both self-assessed (p < 0.001) and tested (p = 0.02) knowledge. FPs had higher mean knowledge scores if they received post-MD training in palliative care (12% higher; p < 0.001) or radiotherapy (15% higher; p = 0.002). There was a strong relationship between FPs referral for palliative radiotherapy and both self-assessed knowledge (p < 0.001) and tested knowledge (p = 0.01).
Self-assessed and tested knowledge of palliative RT is positively associated with referral for palliative RT. Since palliative RT is underutilized, further research is needed to assess whether family physician educational interventions improve palliative RT referrals. The current study suggests that studies could target family physicians already in practice, with educational interventions focusing on hemostatic and other less commonly known indications for palliative RT.
Cancer; Palliative radiotherapy; Family physician; Education; Knowledge; Palliative care
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Management of common musculoskeletal problems: a survey of Ontario primary care physicians.
Glazier, R H
Dalby, D M
Badley, E M
Hawker, G A
Bell, M J
Buchbinder, R
Lineker, S C
CMAJ: Canadian Medical Association Journal
BACKGROUND: In Canada, primary care physicians manage most musculoskeletal problems. However, their training in this area is limited, and some aspects of management may be suboptimal. This study was conducted to examine primary care physicians' management of 3 common musculoskeletal problems, ascertain the determinants of management and compare management with that recommended by a current practice panel. METHODS: A stratified computer-generated random sample of 798 Ontario members of the College of Family Physicians of Canada received a self-administered questionnaire by mail. Respondents selected various items in the management of 3 hypothetical patients: a 77-year-old woman with a shoulder problem, a 64-year-old man with osteoarthritis of the knee and a 30-year-old man with an acutely hot, swollen knee. Scores reflecting the proportion of recommended investigations, interventions and referrals selected for each scenario were calculated and examined for their association with physician and practice characteristics and physician attitudes. RESULTS: The response rate was 68.3% (529/775 eligible physicians). For the shoulder problem, all of the recommended items were chosen by the majority of respondents. However, of the items not recommended, ordering blood tests was selected by almost half (242 [45.7%]) as was prescribing an NSAID (236 [44.7%]). For the knee osteoarthritis the majority of respondents chose the recommended items except exercise (selected by only 175 [33.1%]). Of the items not recommended, tests were chosen by about half of the respondents and inappropriate referrals (chiefly for orthopedic surgery) were chosen by a quarter. For the acutely hot knee, the majority of physicians chose all of the recommended items except use of ice or heat (selected by only 188 [35.6%]). Although most (415 [78.5%]) of the respondents selected the recommended joint aspiration for this scenario, 84 (15.9%) omitted this investigation or referral to a specialist. The selection of recommended items was strongly associated with training in musculoskeletal specialties during medical school and residency. INTERPRETATION: Primary care physicians' management of 3 common musculoskeletal problems was for the most part in accord with panel recommendations. However, the unnecessary use of diagnostic tests, inappropriate prescribing of NSAIDs, low use of patient-centred options such as exercise, and lack of diagnostic suspicion of infectious arthritis are cause for concern. The results point to the need for increased exposure to musculoskeletal problems during undergraduate and residency training and in continuing medical education.
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Utility of serial urinary cytology in the initial evaluation of the patient with microscopic hematuria
Nakamura, Kogenta
Kasraeian, Ali
Iczkowski, Kenneth A
Chang, Myron
Pendleton, John
Anai, Satoshi
Rosser, Charles J
BMC Urology
We determine the utility of serial urinary cytologies in patients presenting with microscopic hematuria who were evaluated with upper and lower urinary tract studies to rule out a malignancy.
Two hundred and thirty-seven patients with the diagnosis of microscopic hematuria were evaluated at an inner-city tertiary care hospital. Of these 239 patients, 182 patients had 405 cytologies obtained as part of their evaluation for hematuria. In addition, all patients had their lower urinary tract and upper tract thoroughly evaluated.
Two hundred and seventy four cytology samples were read as normal, 104 (26%) as atypia, 7 (2%) as suspicious/malignant, and 20 (5%) as unsatisfactory. Seventeen patients (9.3%) had biopsy confirmed bladder cancer. Of these 17 patients, 2 had normal cytology, 11 had atypia, and 5 had suspicious/malignant. No patient had a positive cytology and a negative biopsy. Overall the number of hematuric patients harboring bladder cancer was small (7%). Cytology #1 detected 4 cases of cancer, cytology #2 detected an additional case and cytology #3 did not detect any additional cancers.
Because of this low prevalence of bladder cancer in patients presenting with microscopic hematuria and the low sensitivity of detecting bladder cancers, the utility of urinary cytology in the initial evaluation of patients with hematuria may be minimal. The exact role of urinary cytology in the evaluation of hematuria is unknown.
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Location: Acton, MA Type: Full Time Apply Virsec is looking for a software engineer with strong background in C/C++. Do you see yourself in a role that will help reshape the world of cyber security? We?re building the future of cyber security, and we?re looking for talented,4/12/2016 Acton, MA Save This Job
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San Bruno Principal Engineer Nomis is looking for a phenomenal Principal Engineer to help evolve our best-in-class price optimization product and help take it to the next level. Preferred candidates have strong service-oriented architecture experience and have a track record of4/12/2016 San Bruno, CA Save This Job
Los Angeles, CA Boingo Wireless ? one of the Best Places to Work in Los Angeles! ? LA Business Journal, 2015 Software Engineer Entrepreneurial-Minded Senior Software Engineer Wanted: Boingo Wireless offers a ?buffet for technologist?! Choose from a smorgasbord of tools &4/16/2016 Los Angeles, CA Save This Job
Job Summary: Work with a dynamic team of engineers and architects to build enterprise solutions using the very latest PaaS technologies. The Senior Salesforce Engineer needs to be capable of working alone or within a team atmosphere to convert functional and architectural3/27/2016 Portsmouth, NH Save This Job
Los Angeles, CA Boingo Wireless ? one of the Best Places to Work in Los Angeles! ? LA Business Journal, 2015 Entrepreneurial-Minded Software Engineer Wanted: Boingo Wireless offers a ?buffet for technologist?! Choose from a smorgasbord of tools & technologies to build your4/16/2016 Los Angeles, CA Save This Job
Solutions Engineer Do you live in a world between sales and solutions delivery? Are you a dynamic, hard-working ?geek that can speak? with demonstrated ability to lead based on experience, knowledge and competence? Are you an ambitious consultant with a passion for technology4/9/2016 Sunnyvale, CA Save This Job
Location: Reston, VA About the Job At the Reston office, you?ll be joining a talented group of engineers building Echo360?s media capture and processing systems. As a Software Engineer on the Capture Team, you will work on products from inception, through development, and4/6/2016 Reston, VA Save This Job
Please fill in the information below and use the navigational buttons to continue. Warning: Using your browser's Back and Forward buttons may produce undesirable results. Job Summary: Work with a dynamic team of engineers and architects to build enterprise solutions using the3/27/2016 Portsmouth, NH Save This Job
at Twilio (View all jobs) San Francisco About the job: Twilio's customers send millions of communications every day. These communications become a firehose of micro-transactions, processed at a fraction of a penny at a time. As a pay-as-you-go service, it's critical to5/23/2016 San Francisco, CA Save This Job


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HYDERABAD: The BJP government has put an end to the policy paralysis created by UPA government in its 10 year rule and has given the nation a... ...http://www.newindianexpress.com/states/telangana/We-have-given-India-a-speaking-PM-Shah/2016/05/30/article3457574.ece
PEP TALK: Telangana State BJP president K. Laxman, BJP National President Amit Shah, Union Minister Bandaru Dattatreya at the BJP workers meeting... ...http://www.thehindu.com/news/cities/Hyderabad/trs-did-not-approach-us-amit-shah/article8663485.ece?utm_source=RSS_Feed&utm_medium=RSS&utm_campaign=RSS_Syndication
VARANASI, May 28: Union minister JP Nadda has said the country's borders are highly-secured and the Government has given full permission to... ...http://www.dailyexcelsior.com/forces-told-to-respond-first-then-seek-permission-nadda/
In economic policy, an often unremarked aspect has been the consolidation of the banking system. Prime Minister Narendra Modi's achievements... ...http://www.sundayguardianlive.com/news/4967-pm-modi-poised-speed-change
The death of a college student and the death of democracy. The naked truth of Ishrat Jahan encounter is yet to be unravelled completely, but it is... ...http://www.oneindia.com/feature/ishrat-jahan-encounter-the-ugly-face-of-politics-2111970.html
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Rhode Island Trailers & RVs for Sale! Buy or sell used trailers in Rhode Island – we have used RVs, used horse trailers, used camper travel trailers, used heavy equipment trailers, used dump trailers, used livestock trailers, etc… AllUsedTrailers.com brings Rhhode Island safe, easy transactions of buying used near you!
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Customer Experiences
I would strongly advise anyone wanting to sell equipment to use the services of USEDvending.com. I had listed my unit on another well known web site and had to deal with lots of crazy offers and look -y- loos. Once I listed with USEDvending, Cristina, my service agent, did all of the work. She notified me only when she had a serious buyer lined up. She did all the work and I took the check to the bank! Do yourself a favor and use this company to sell your equipment and rest easy that they will do a great job for you. Thank you USEDvending and Cristina for all you did for me!
Houston, TX
I signed up with 4Vendingtips.com to get locations for my machines and have gotten several good accounts. April Hurd is the best. She is so nice and helpful. Thank you.
Jeff L.
Oceanside CA
I really enjoyed working with Used Vending. I tried other sites, but always had unqualified people wanting to purchase. Melissa called me with a buyer who was looking for a food truck and was very qualified and after looking at my truck, brought it. I would highly recommend Melissa and Used Vending.
Chester, VA
I listed my machine on Craig's List and Ebay and got absolutely nothing out of it for almost a year. When I first listed my machine with usedvending.com they actually provided feedback on my pricing as compared to the market. Once I adjusted my price the inquiries started to come in. My customer service rep, April Hurd, is awesome and very punctual. I had one customer ready to buy but would not respond to her persistent communications. It all worked out as within a week she had another customer ready to buy and closed the deal that same week.
Ron Teicher,
New Jersey
Mellissa and staff were great to work with and prompt to respond to questions as we progressed through this transaction. We would recommend them to prospective clients and hope to do further business!
Barbara and Jay Buckert
10/20/2009It was a pleasure dealing with April.I thought I was dealing with a person I've known my whole life.She was extremly helpful and I thought I was buying a vending machine from a family friend.
When I needed a secong machine I called april only, because I knew she would give me the best price.
It was a real pleasure to deal with April.
Boston, Massachusetts
I have to admit, I was very skeptical when I made the decision to list our trailer on this site. Melissa made contact with us immediately. She offered suggestions about info to post and offered to help us post more info (pics).
When Melissa informed us about a potential buyer, my questions began pouring in to her. She contacted me via phone, e-mail, and text (as it was convenient for me!). Melissa guided us through the entire process and made us feel like we had no worries about selling on the internet! Melissa closed the deal for us. We are happy with the entire process. For Melissa's sake, I hope not all customers need hand holding like we did! She was GREAT! The entire process was a great experience and we would use this company again and we recommend it to everyone!!!
Ken & Janet
Tifton, GA
Stacy was prompt and very attentive to our needs. Would definitely recommend him and the company to anyone. We think the Mega snack/drink machine is awesome! Thanks!
Debbie, Universal Chevy
Wendell, NC
I'm not sure why you would want to sell your stuff on any other site because UsedVending.com sold my Food Truck in less than a month. The process was professional, friendly and quick. They help you throughout and build a relationship with you. I will definitely use them again, everything was just that easy. My point of contact was Stacy. He was great, friendly and just amazing.
Thanks Stacy Sweet, What a sweet experience!
Deonne, MD
10/15/2009Melissa was just the BEST person/middleperson for the job of finally getting rid of my machines! She was persistant and consistent and I truly appreciated all her efforts!
Thanks Melissa!
Gainesville, Virginia
I have worked with Melissa Powers in the past when purchasing equipment through your website. She always makes things fun...but, I had no idea how fast Stacy Sweet works his magic, because my unit literally flew out the door once I priced it ready to sell. Not only that, but he somehow came up with a buyer only 45 minutes away! I am completely satisfied once again with UsedVending.com and would recommend Stacy Sweet anytime. Well done.
Santa Rose, CA
It was a pleasure to work with April, she always kept me in the loop and never had a problem. Things went very smoothly. Thanks for the help.
Rick LoChirco
Henderson, NV
I think Melissa was the first to help. I think she did a great job and was very professional in dealing with the public. Sometime that can be hectic.
April Hurd was very helpful when I contacted her for some information. She didnt hestitate to help. Keep up the GOOD WORK. I would recommend you to other people.
USEDvending is GREAT! They sold my Food Truck in less than a week! They were SUPER friendly, SUPER easy, SUPER helpful, & SUPER to work with!
Kyle, TX
Hi! Sorry Cristina! (this is Traci, Kyle has no time to do anything lol), and we meant to get back with you sooner than this! but we got the food trailer and everything went really smooth. Thank you for all your help and patience with everything! We hope you get a raise (if that's how it works! don't know if your paid by the hour or commission lol but you done A GREAT JOB!) we would recommend Usedvending.com to others. God Bless.
West Virginia
02/10/2011It has been a pleasurable experience working with Melissa. The sale process was quick, well organized and hassle free.
We appreciate your help and will utilize your services in the futuer.
Michelle Vervaeke
06/15/2009Here you go April! I just wanted you to know that I had a very good experience working with you. This was my first time and now I am ready to go any other time because thanks to you I know what I'm doing. All transactions were easy and whenever I needed you, you were there. Not only were you there ready to go, but you were there with an AMAZING attitude and OUTSTANDING service. Even when you were sick you came in and took care of me and who knows what else. Also the day before that you were too sick to come in, other people stepped up and helped me out with great service.
Last but for sure not least, it was great to work with someone else in THE Faith. Ha I keep reading your email signatures. Anybody reading this, just know that if you get to work with April, you are very lucky!
01/01/2009Thanks for all your efforts- you have been a real professional to work with and there is a good possiblity that we may make a second purchase from you within the next 90 days.
Jay Higgins
To whom it may concern - Hands Across The Water Inc would like to thank Ms April Hurd, of Mega-vending for her assistance with obtaining a combo machine for our office. We had a number of issues that Ms hurd was able to guide us through such as finding an realistic machine for an office of 30, locating a delivery service that would bring the machine all the into our area, although there was three sets doors to pass through and none being double doors. Ms Hurd was always polite, helpful and professional. When we decide to add vending in our other offices Ms Hurd will be the one we contact. Thank you.
James C. Nelson - Board of Directors, Hands Across The Water Inc.
Ann Arbor, MI
awesome service despite the miles. my wife and I live in NH,our vending trailer for sale was in FL,the buyer from TN and Mellisa taking care of the whole deal fom MS.Things could'nt have gone better if we were all sitting at the same table.Great communication,smooth transaction.Thankyou so much Mellisa!
01/27/2009April, it seems that it is hard to find someone who is honest and trustworthy in the world today and it makes people leery of buying things online, especially when you have to give personal financial information. Our experience with Usedvending.com was awesome. The person that we bought our machine from was very helpful even after the purchase. I was so pleased to see that the machine I purchased was like new and operates the same. Thank you for being a company of integrity, offering money back guarantees if the machine is not as specified. This was the best experience I have had online.
Thank you so very much for everything you've done for Greg & I. Where do I email a letter of how well we were treated!
Greg & Colleen
Thank you so much for your speedy reply and consistent follow up! We were in need of a vendor and you provided that service and answered all of our questions. You made our move to a new location and getting set up for business a smooth transaction. We initially only wanted 1 vending machine but ended up getting 3! Again, Great Job!
07/21/2011We had a great experience using 4VendingTips.com. The response was prompt, and we are pleased with the outcome. I'd recommend them to anyone seeking a vending machine or vending services.
-John Evans
Edwin Watts Golf
Arlington, TX
12/07/2009Dear USEDVending-
I thought I would let you know that everything went REALLY smooth for our purchase of our new business adventure. The machine that we bought works great and the customer service we received from our representative, April, was OUTSTANDING. In the future we will always check with April before purchasing elsewhere. Thanks again for everything.
Columbus, Ohio
Outstanding customer serivice! Great communication skills! April Hurd was able to help me 100% with all my concerns about the product I purchased today. I couldn't be happier with my experience over all. What an amazing job, April! Thanks for all your help.
Guillermo H.
McHenry IL
10/13/2009Working with April to locate and secure new vending machines for our company was an absolute pleasure.
She exceeded all of my expectations and was able to find me new machines at a fantastic price! The new machines that she found for me were actually less than other companies wanted for used machines!
I would and will recommend usedvending.com and April Hurd to anyone looking for new or used vending equipment!
Lake Geneva, Wisconsin
I am very happy with the service Gini gave me, as she was upfront and asked me to provide some basic information. In a few days I was able to have a vendor come out and view my Office. I had tried on my own to get a machine out here, but had no luck. The efficiency in matching and doing all the leg work is impressive. I will refer many others to your site. Thank you.
Milpitas, California.
It was pleasure doing business with your company. The transaction was smooth from the beginning until we drove away with the vending machine we purchased in the end. It was easy working with the Broker and we were ready to buy the item from seller ALL the leg work had been done. We will definitely use your company again should the need arise. Happy Customer!!!!
Dorothy Meadows,
Greensboro, NC
06/09/2011I would like to thank Stacy Sweet and his staff for their professionalism and and timely help in securely a vendor for our business. I was unable to get anyone to supply us with a snack / pop machine.I had all but given up when I came across 4MEGA-Vending.com. I was contacted within 1 hour of submitting my request or information. Stacy was able to secure us a vendor and our snack machine was installed 5 days later. Now that's customer service!! Kudos to Stacy and his staff. I will be recommending his service to the surounding businesses in my area.
Thanks Stacy !!!
Dan Shishkowsky
Maaco of Puyallup
I would recommend usedvending.com to anyone! The customer service was exceptional! If you are in the market to buy or sell new or used vending, this is definitely the place for you. Jennifer was an absolute pleasure to work with and I thank you kindly for helping me sell my concession trailer!
Wonderful wonderful!!Not only was the product delivered in 30 minutes flat, they helped move out our old machine that our past vendor has not moved. So professional and extremely exceptional service!!!
South Bend, Indiana
It was a very helpful and easy way to sold my food truck. Melissa did a nice job, I will recommend it.
M. Navarro, Ohio
Melissa , everything went great we are pleased with our purchase and we thank you for making it easy for everyone
Kane, Pennsylvania
Good Morning Stacy, I would like to tell how pleased I am with the way everything went with the purchase I made through Usedvending.com . Connie was awesome and even threw in a few items I could use in starting up my new food truck business. I would also like to thank you Stacy, you were very cordial and professional through the whole transaction.I would recommend your company without hesitation...
Skandia, MI
Purchased some machines, working with Calice made the purchase easy and enjoyable. I will be buying again. Thanks Calice for a job well done!
Venice, FL
Thanks "usedvending.com" and especially Ms. Calice! My client needed a specific type of vending machine and usedvending had it listed. Calice helped put both buyer and seller together and all went according to plan. My client is now one Happy Camper! Thanks again Calice!
James Bastrop, Tx
I recently purchased a 32-selection vending machine from Megavending.com (my 2nd purchase in as many years). I have been extremely pleased with both my purchases and customer service. April was unbelievably nice and helpful. All of my future purchases will be done using Megavending.com. They truly are top-notch!
Houma, LA
10/18/2009I was very pleased with Usedvending services and very please with April she did a very good job and I would recommend her to my friends. I hope to do business with her again soon.
Arnita Williams
Colonial Heights, Virginia
Absolutely it was a real pleasure working with you and your company. You guys made it easy and smooth all the way through the entire transition. I'll definitely spread the word if I ever come across anyone looking to buy or sell a food truck. Thanks again and take care and talk to you when I need my second one.
Chris Innes - The Salt Water Truck
Albuquerque, NM
Thanks!! I appreciate Stacy Sweet's help in negotiating the sale of my machines ... he made it quick and simple. Great site, great service.
Mobile, Alabama
Hello Melissa, I know it's a bit late but I wanted to say Thank YOU !!! for all the work you did for us on the last transaction. The machines are in great condition and working great. Excellent buy!!! Thanks Again!!!
C. Velez
Jacksonville, FL
Hi Wendy, Selling my food truck was an arduous task for the past several months. I had scammers and totally unqualified people wasting my time. However, when I decided to list my truck with Used Vending, the leads were much more viable. And, it finally sold last week with your wonderful help and assistance! Although I would have sold the truck to anyone, I'm very pleased with the buyers. They really love the truck and are planning to keep it as is. You made the entire transaction easy, quick and smooth. I really appreciate your availability and patience answering all my questions. The entire transaction was virtually worry free! I would recommend Used Vending to anyone with a food truck to sell!
Hilary Boslet,
Boulder, CO
Great machines very fast and smooth transaction. Stacy Sweet was very helpful in making sure that all parties were in contact in a fast manner. This was one of the easiest and fastest transaction that I have made buying vending machines. Thanks again for the great efforts. uesedvending.com and Stacy Sweet are #1 in my book.
Charles, MS
We were very impressed with Mellisa and all the hard work she put into selling out conssesion trailer for us, she was very easy to work with and took care of all our needs, I will defenitly contact her for any future needs.
Thank you so much.
Meagan, Texas
10/07/2010I received my best location from you guys. Connie was very personable and easy to talk to. I look forward to working with her in the future.
Melissa, Thank you for everything. You were great and got everything done when you said you would. You really made it easy. I would use you again.
Doug Martindale,
Austin, TX
Hi Melissa! Crazy day!!! But we got everything sorted! I just wanted to say thank you so much for all your help in making the purchase as fluid & effortless as it possibly could have been. So excited about my new business venture!!!! :) You were wonderful to work with. Hope you have a fantastic evening! I know I will (so much planning left to do)!!!!! :D
Lois Willis,
Austin, TX


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Respond to Review of Grasshopper Restaurant
by kevin.schneider
Review: Reliably good vegan fare, I've been coming here for years. There's a good variety on the menu, decent prices, and the staff is friendly. They also host interesting speaking events and put on cheap buffets every third Sunday or so, awesome! One odd thing, they have a large fish tank... never quite got that, but the fishies seem content enough. Check it out, for sure!
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Home :: Bridal Ring Sets :: Bridal 2-Piece Antique Sets :: Diamond Bridal Ring Set
14K White Gold
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Wedding Band
The wedding band I ordered is beautiful. I love it! My future husband is so excited to wear the ring. The quality is excellent! I was very impressed with...
Men's Wedding Band!!
We were thrilled when we received the ring with such prompt service! I was very impressed on how we were kept informed on the status of the ring and look...
Thanks! 3mm Plain Band
The ring arrived today (Friday 11/23). Thank you so much for being able to get the ring here on time. All of the stores we visited were unable to...
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Home > News > World
Wednesday, 23 July 2014 | MYT 6:40 AM
COTONOU (Reuters) - Benin has detained 10 people on suspicions of child-trafficking just weeks after a group in neighbouring Niger was held for links to a "baby factory" ring, police sources said on Tuesday.
While it was not immediately clear if there was a connection between the two cases, the latest detentions point to the persistence of human trafficking across West Africa.
"There have been around 10 people detained in the civil prison since last week," said Ghislaine Bokovo, director of the Benin police force's central office for child protection.
Bokovo did not give further details of this case, such as the age of the children, citing judicial secrecy for an ongoing investigation.
But she said trafficked children in the region were typically sold either for use in voodoo practices or to crooked adoption agencies.
Martial Degbessou, from the Porto-Novo police division, said people operating in trafficking networks often purported to be holding children on behalf of a nongovernmental organisation.
He said his division was familiar with the problem of child sales since his town is a stopover point for traffickers on the way to next-door Nigeria.
"Once they (the children) arrive in Nigeria, they are sold at a very high price, often between 20 million CFA Francs ($41,000) (24033 pounds) and 30 million CFA Francs ($62,000)(36343 pounds) per child," he said in a telephone interview on Tuesday.
Authorities in Niger have detained 17 people, including wives of senior politicians, after an investigation by Niger's police into 30 people suspected of acquiring new-born babies from "baby factories" in Nigeria, two legal sources said last month.
(Reporting by Samuel Elijah; Writing by Emma Farge; Editing by Mohammad Zargham)
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