text:
Interlaken Aqua Boutique Hotel Shenzhen
- Location:
- Address: Huaqiaocheng Canyon, Dameisha East, Yantian District, Shenzhen
- Tel: 0755-25289999//总部0755-888 (Book this hotel, call 800-2682918)
- Hotel Name in Chinese: Interlaken Aqua Boutique Hotel Shenzhen
- Lowest Price: $114
Opened in 2009, Interlaken Aqua Boutique Hotel Shenzhen is located in Ecoadventure Valley with "man and nature" as the theme, and the hotel is just located between the largest artificial waterfall of China and tremendous rocks. It boasts 94 guest rooms and 4 themed dining halls and beer bars, as well as Seafield Theater with the audio and video mix an ultra modern dinner hall.
The hotel employs the world famous designer team and have it built with 'water' as elements and for artistic creation for indoors and other aspects, and finally have it integrated into the contemporary art works with 'water' as the them. With the daring conception by the designers, guests have to pass the corridor in air at the length of 300 meters, to cross the waterfall and step over the drifting river as if they were walking in a crystal palace hotel. The designers make the most of modern high technologies and apply videos, sense of smell and sense of touch to the design of the hotel.
- Prices not include 18% service fee and tax.
- Payment Method: pay using our secure online payment service or pay at the hotel at some hotels.
- Triple/quad occupancy may require an extra bed at extra cost.
Hotel Amenities
|Hotel Services
|Luggage service, Car rentals, Laundry service, Child care, Room service, Express check-in/check-out, Medical clinic service, Currency Exchange, Wake Up Call, Parking Service, Airport Shuttle, 24hr Reception, Permanent English-speaking staff, Business Centre, Copy Service, E-mail, Fax Service, Typing Service
|Room Amenities
|Air conditioning, AM/FM radio, Alarm clock, Color Television, Cable/satellite TV, Complimentary newspaper, Coffee/tea maker, Telephone, Hair dryer, In-room safe, Electronic Lock, Iron and ironing board, Refrigerator, Mini Bar, Bath and Shower, Non-smoking rooms available, In-house movies, Internet access,
Hotel Amenities: Elevator, Parking, Business Floor or Executive Floor, Air-Conditioned Facilities, Indoor Swimming Pool, Beauty Salon, Sauna, Business Center, Gift Shop, Gymnasium , Suitable for wheelchairs, Meeting Room, Ballroom, Deposit Box at Front Desk, Airline Desk, Fire Detector, KTV, Chess & Playing Cards Room
Dining Facilities: Chinese Restaurant, Western Restaurant, Cafe, Bar, Lounge Bar
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- Address: Huaqiaocheng Canyon, Dameisha East, Yantian District, Shenzhen
- 地址: Huaqiaocheng Canyon, Dameisha East, Yantian District, Shenzhen
- Tel: 0755-25289999//总部0755-888
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|Tehran, Iran
|High School:
Did not play.
Played in four games … averaged 0.5 points and 0.3 rebounds per game … earned the team's Faculty Athletic Representative Award, bestowed upon the player with highest academic achievement and team contribution … totaled two points, one rebound, one assist and one block in seven minutes … made his first and only field goal attempt of the season on a jump shot against Cal State Northridge (Nov. 28) … grabbed one rebound in three minutes against Prairie View A&M (Dec. 15).
Before UCLA
Two-year varsity basketball letterwinner at Glendale Community College (Glendale, Calif.) under head coach Brian Beauchemin (2010-11, 2011-12) ... secured first-team All-Western State Conference honors (South Division) as a sophomore, averaging 9.1 points and 8.1 rebounds per game in 27 total contests ... led Glendale CC in rebounds as a sophomore, recording at least 10 or more boards in 20 consecutive games ... shot 65.1 percent from the free throw line as a sophomore and had a streak of 22 consecutive free throws made ... shot 54.0 percent from the field, connecting on 101 of 187 shots ... as a freshman at Glendale CC (2010-11), averaged 4.5 points and 3.7 rebounds per game ... shot 50 percent from the field and 81 percent at the free throw line during his freshman season ... as a freshman in 2010-11, helped Glendale CC qualify for the Southern California Regionals for the first time since 2008.
High School
Attended Sahakian in Tehran, Iran for four years and majored in math and physics ... played in the Iranian national basketball program from the under-14 through the under-20 age group teams.
National Team
Competed at multiple levels in the Iranian national basketball program from the under-14 age group division through the under-20 division … was invited to compete for the Iranian National Team at the Asian Cup for the 2014 World Cup (did not participate due to academic and athletic conflicts at UCLA) … in 2009, participated in the U-19 World Cup in Auckland, New Zealand … in 2008, helped Iran's U-18 team win the title game at the FIBA Asia Championship in Tehran, Iran … won titles at the 2007 and 2008 West Junior Asian Championship … participated in Basketball Without Borders Asia, playing in New Delhi, India, in 2008 … Basketball Without Borders (BWB) is the NBA and FIBA's global basketball and community outreach program aimed to unite young basketball players and promote the sport around the world … was invited to participate at Iran's Olympics Qualification Camp, but did not attend due to academic conflicts (fall semester) … also competed for Ararat Basketball Club in the Iran Superleague.
Full name: Sooren Derboghosian Pakajaki (pronounced SOO-ren dair-boh-GHO-see-uhn) ... born in Tehran, Iran, on Feb. 20, 1990 ... parents are Hovakom Derboghoskian Pakajaki and Diana Taroian ... is the middle of three children ... has one older sister, Sarineh, and one younger sister, Christine ... international development studies major.

subset: commoncrawl


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This article was published online first at www.annals.org on 24 December 2013.
From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, and Providence Cancer Center, Providence Health and Services, Portland, Oregon.
Disclaimer: The findings and conclusions in this review are those of the authors, who are responsible for its content, and do not necessarily represent the views of the AHRQ. No statement in this review should be construed as an official position of the AHRQ or of the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Andrew Hamilton, MLS, MS, who conducted literature searches, and Amanda Brunton, BS, who provided assistance; both are affiliated with Oregon Health & Science University.
Financial Support: By the AHRQ under contract HHSA-290-2007-10057-1-EPC3.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1684.
Requests for Single Reprints: Heidi D. Nelson, MD, MPH, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Mailcode BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098; e-mail, email@example.com.
Current Author Addresses: Drs. Nelson, Zakher, Okinaka-Hu, and Fu and Ms. Pappas and Ms. Mitchell: Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Mailcode BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098.
Author Contributions: Conception and design: H.D. Nelson, M. Pappas, B. Zakher.
Analysis and interpretation of the data: H.D. Nelson, M. Pappas, B. Zakher, J.P. Mitchell, L. Okinaka-Hu, R. Fu.
Drafting of the article: H.D. Nelson, M. Pappas, B. Zakher, J.P. Mitchell, L. Okinaka-Hu, R. Fu.
Critical revision of the article for important intellectual content: H.D. Nelson, M. Pappas, B. Zakher, L. Okinaka-Hu, R. Fu.
Final approval of the article: H.D. Nelson, M. Pappas, B. Zakher, R. Fu.
Provision of study materials or patients: H.D. Nelson.
Statistical expertise: H.D. Nelson, R. Fu.
Obtaining of funding: H.D. Nelson.
Administrative, technical, or logistic support: H.D. Nelson, M. Pappas, J.P. Mitchell.
Collection and assembly of data: H.D. Nelson, M. Pappas, B. Zakher, J.P. Mitchell.
Background: Mutations in breast cancer susceptibility genes (BRCA1 and BRCA2) are associated with increased risks for breast, ovarian, and other types of cancer.
Purpose: To review new evidence on the benefits and harms of risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women.
Data Sources: MEDLINE and PsycINFO between 2004 and 30 July 2013, the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews from 2004 through the second quarter of 2013, Health Technology Assessment during the fourth quarter of 2012, Scopus, and reference lists.
Study Selection: English-language studies about accuracy of risk assessment and benefits and harms of genetic counseling, genetic testing, and interventions to reduce cancer incidence and mortality.
Data Extraction: Individual investigators extracted data on participants, study design, analysis, follow-up, and results, and a second investigator confirmed key data. Investigators independently dual-rated study quality and applicability by using established criteria.
Data Synthesis: Five referral models accurately estimated individual risk for BRCA mutations. Genetic counseling increased the accuracy of risk perception and decreases the intention for genetic testing among unlikely carriers and cancer-related worry, anxiety, and depression. No trials evaluated the effectiveness of intensive screening or risk-reducing medications in mutation carriers, although false-positive rates, unneeded imaging, and unneeded surgeries were higher with screening. Among high-risk women and mutation carriers, risk-reducing mastectomy decreased breast cancer by 85% to 100% and breast cancer mortality by 81% to 100% compared with women without surgery; risk-reducing salpingo-oophorectomy decreased breast cancer incidence by 37% to 100%, ovarian cancer by 69% to 100%, and all-cause mortality by 55% to 100%.
Limitation: The analysis included only English-language articles; efficacy trials in mutation carriers were lacking.
Conclusion: Studies of risk assessment, genetic counseling, genetic testing, and interventions to reduce cancer and mortality indicate potential benefits and harms that vary according to risk.
Primary Funding Source: Agency for Healthcare Research and Quality.
The U.S. Preventive Services Task Force (USPSTF) recommended in 2005 that women whose family histories are associated with increased risks for clinically significant, or deleterious, mutations in the BRCA1 or BRCA2 gene be referred for genetic counseling and evaluation for mutation testing (1). This recommendation was intended for primary prevention of cancer and applies to women without previous diagnoses of breast or ovarian cancer.
Deleterious mutations in the BRCA1 and BRCA2 genes are associated with increased risks for breast, ovarian, fallopian tube, and peritoneal cancer in women and breast cancer in men (2). They are also, to a lesser degree, associated with pancreatic and early-onset prostate cancer, and BRCA2 mutations are associated with melanoma. Mutations in BRCA genes cluster in families exhibiting an autosomal dominant pattern of transmission and account for 5% to 10% of cases of breast cancer overall (3–4).
Specific BRCA mutations, known as founder mutations, occur among certain ethnic groups, including Ashkenazi Jewish (5–7), black (8), and Hispanic persons (9–10), and in identified families (11–15). Other genes are associated with hereditary susceptibility to breast and ovarian cancer but are not commonly tested, such as PTEN (the Cowden syndrome) and TP53 (the Li–Fraumeni syndrome) (2, 16).
Genetic risk assessment and testing involve determining individual risk for BRCA mutations, followed by selective testing of high-risk persons. Characteristics associated with an increased likelihood ofBRCA mutations (17–20) include breast and ovarian cancer in relatives and young age at onset. These and other individual and family characteristics can be used to assess personal mutation risk and the need for referral for additional evaluation. Genetic counseling is the process of identifying and counseling persons at risk for familial or inherited cancer and is recommended before testing (21–22).
Guidelines recommend testing for mutations only when an individual has a personal or family history of cancer suggestive of inherited cancer susceptibility and the results can be adequately interpreted and will aid in management (23). The type of mutation analysis that is required depends on family history. Persons without links to families or groups with known mutations (5–10, 12–14) generally have direct DNA sequencing. For appropriate candidates, interventions to reduce cancer risk include earlier, more frequent, or intensive cancer screening; risk-reducing medications; and risk-reducing surgery, including bilateral mastectomy and salpingo-oophorectomy.
This systematic review is an update of a prior review (1, 24–25) for the USPSTF on the effectiveness and adverse effects of risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women. Its purpose is to evaluate and summarize research addressing specific key questions important to the USPSTF as it considers new recommendations for primary care practice.
This research is part of a comprehensive systematic review that includes an additional analysis of studies of the prevalence and penetrance of BRCA mutations that is not included in this manuscript (26). We followed a standard protocol consistent with the Agency for Healthcare Research and Quality (AHRQ) methods for systematic reviews (27). On the basis of evidence gaps identified from a prior review (24–25), the USPSTF and AHRQ determined the key questions for this update by using the methods of the USPSTF (28). Investigators created an analytic framework incorporating the key questions and outlining the patient populations, interventions, outcomes, and potential adverse effects (Appendix Figure 1). A work plan was externally reviewed and modified.
Analytic framework and key questions.
KQ = key question; MRI = magnetic resonance imaging.
* Clinically significant mutations of the BRCA1 or BRCA2 gene or related syndromes.
† Testing may be done on the unaffected woman, the relative with cancer, or the relative with the highest risk, as appropriate.
‡ No known mutation in relatives and none detected in the patient.
§ Known mutation in relatives but none detected in the patient.
|| Interventions include increased early detection through intensive screening (e.g., earlier and more frequent mammography and breast MRI), risk-reducing medications (tamoxifen and raloxifene), and risk-reducing surgery (mastectomy and salpingo-oophorectomy).
The target population includes women without cancer or known BRCA mutations who are seen in clinical settings applicable to U.S. primary care practice, although the ideal candidate for mutation testing could be a male or female relative withcancer. The conditions of interest are mutation carrier status and BRCA-related cancer (predominantly breast, ovarian, fallopian tube, and peritoneal). Although other types of cancer are also considered during familial risk assessment, studies with these cancer outcomes are outside the scope of this review.
We searched MEDLINE from 2004 to 30 July 2013, the Cochrane Central Register of Controlled Trials and Cochrane Databaseof Systematic Reviews from 2004 through the second quarter of 2013, and Health Technology Assessment during the fourth quarter of 2012 for relevant English-language studies, systematic reviews, and meta-analyses. We manually reviewed reference lists of articles and reviewed citations of key studies by using Scopus.
Research published in 2004 or later and done in the United States or in populations that receive services and interventions applicable to medical practice in the United States was reviewed. Randomized, controlled trials (RCTs); systematic reviews; prospective and retrospective cohort studies; case–control studies; and diagnostic accuracy evaluations were included if they addressed the accuracy of risk assessment methods, outcomes of genetic counseling and testing, and the effectiveness of interventions to reduce BRCA-related cancer and mortality among mutation carriers.
Risk assessment methods were included if they were designed to guide referrals to genetic counselors or other genetic specialists and could be used by nonspecialists in genetics in clinical settings (that is, methods that were brief and nontechnical and did not require special training to administer or interpret). Evaluation of comprehensive models used in the practice of genetic counseling was outside the scope of this review, which focuses on primary care practice. Interventions included intensive screening, risk-reducing medications, and risk-reducing surgery. Only risk-reducing medications approved by the U.S. Food and Drug Administration (that is, tamoxifen and raloxifene) were considered, consistent with the scope of the USPSTF.
Studies of any design were included if they described potential adverse effects, including inaccurate risk assessment; inappropriate testing; false-positive and false-negative results; false reassurance; incomplete testing; misinterpretation of results; anxiety; cancer-related worry; immediate and long-term harms associated with interventions; and ethical, legal, and social implications. For adverse effects of interventions, studies were included that enrolled women at high risk for BRCA-related cancer regardless of their mutation status.
After an initial review of abstracts, we reviewed full-text articles by using additional inclusion criteria. Studies from the prior review that met inclusion criteria for the update were included to build on previous relevant research. Appendix Figure 2 shows the results of the search and selection process.
Summary of evidence search and selection.
* Identified from reference lists, hand-searching, suggestions from experts, and other methods.
† Results are provided in an additional publication (26).
‡ Studies that provided data and contributed to the body of evidence were considered to be "included." Studies may contribute data to >1 key question. This number includes studies from the prior review as well as studies published since 2004.
An investigator abstracted data about the study design and setting; participant characteristics; procedures for data collection; number of participants enrolled and lost to follow-up; methods of exposure and outcome ascertainment; analytic methods, including adjustment for confounders; and outcomes. A second investigator confirmed the accuracy of key data. Two investigators used predefined criteria for RCTs; systematic reviews; and cohort, case–control, and diagnostic accuracy studies developed by the USPSTF (28–29) to rate the quality of studies (good, fair, or poor) and resolved discrepancies by consensus.
Quality could not be assessed for many studies with designs that did not have predefined criteria, such as descriptive, cross-sectional, and pre–post studies and case series. The applicability of studies was determined using the population, intervention, comparator, outcomes, timing of outcomes measurement, and setting format adapted to this topic (30).
Because of heterogeneity across studies, results were not combined in a quantitative meta-analysis. We assessed the aggregate quality of the body of evidence (good, fair, or poor) by using methods that the USPSTF developed on the basis of the number, quality, and size of studies and consistency of results between studies (28). Studies were considered consistent if outcomes were generally in the same direction of effect and ranges of effect sizes were narrow.
This research was funded by the AHRQ. Investigators worked with AHRQ staff and USPSTF members to define the scope, analytic framework, and key questions; resolve issues arising during the project; and review the final report to ensure that it met basic methodological standards for systematic reviews. The draft report was reviewed by content experts, USPSTF members, AHRQ program officers, and collaborative partners and was posted for public comment for 4 weeks during April 2013. The funding source had no role in the selection, critical appraisal, or synthesis of evidence. The investigators were solely responsible for the content and the decision to submit the manuscript for publication.
Risk models estimate the likelihood of BRCA mutations in individual persons, and some were developed to guide patient referrals to genetic counselors or other genetic specialists for more comprehensive evaluations. Ten studies describing performance characteristics of the Ontario Family History Assessment Tool (FHAT) (31–33), Manchester scoring system (33–36), Referral Screening Tool (RST) (37–38), Pedigree Assessment Tool (PAT) (39), and Family History Screen-7 (FHS-7) (40) met inclusion criteria for this review (Appendix Table 1). Included studies met criteria for fair or good quality and determined the sensitivity and specificity of models by comparing results of mutation carriers versus noncarriers or referral models versus more complex models, such as the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) (41–42), BRCAPRO (43–45), and Myriad II (18) (Appendix Table 2). No studies described adverse effects of the risk models. Studies of the RST, PAT, and FHS-7 were published after the prior USPSTF systematic review.
Models were evaluated in patient populations in the United States (RST and PAT), Canada (FHAT), the United Kingdom (Manchester scoring system), and Brazil (FHS-7). Most studies defined the referral threshold as 10% estimated probability of a BRCA mutation. The FHAT and Manchester scoring system were evaluated in selected populations of known mutation carriers and noncarriers. Sensitivity was high for both models in most studies (94% for the FHAT [31–32] and 87% to 93% for the Manchester scoring system [34–36]). Lower sensitivity estimates (70% for the FHAT and 58% for the Manchester scoring system) came from a study of both models that included 200 mutation carriers and 100 noncarriers (33), which represented a patient spectrum different from that of the other studies.
The RST, PAT, and FHS-7 were evaluated in large samples of women having screening mammography or visiting primary care clinics. The sensitivity of the RST was high compared with that of the BOADICEA (89%), BRCAPRO (91%), and Myriad II (91%) (37). A revised Web-based version that includes more information on family history reported slightly higher sensitivity values (38). The PAT had 100% sensitivity compared with Myriad II (39), and the FHS-7 had 88% sensitivity compared with a genetic evaluation that included kindred analysis, risk estimates using multiple models, and clinical criteria (40).
Twenty-seven studies met inclusion criteria, including 16 published since the prior review (46–63) and 11 included previously (64–74) (Appendix Table 3). Studies provided data about accuracy of risk perception; intention for genetic testing; and distress, measured as breast cancer–related worry, anxiety, or depression.
Although studies included in the prior USPSTF review were inconclusive (64, 66–69, 71–74), 8 new studies consistently reported improved accuracy of the perception of risk for breast cancer after genetic counseling (50, 54–56, 58–59, 61, 72). A single study reported decreased accuracy (51). Only 1 study evaluated perception of risk for ovarian cancer and reported decreased accuracy after counseling (57). A fair-quality systematic review of 19 studies published before February 2007 indicated that risk perception was accurate for 42% of women before counseling and for 58% after (63). Accuracy improved when counseling provided information about family history, heredity, and personal risk estimates and facilitated informed decision making and adaptation to personal risk.
Two new studies reported decreased intention to have genetic testing after genetic counseling among women unlikely to be carriers (50, 55), which is consistent with prior studies (64, 67, 70). These include a study comparing telephone counseling, in-person counseling, and no counseling that indicated that women in the 2 counseling groups were less likely to pursue genetic testing than those in the noncounseling group (55). A fair-quality RCT reported decreased interest in genetic testing 6 months after group and individual counseling compared with no counseling (50).
No new studies reported increased breast cancer–related worry among women who received genetic counseling, and 8 studies reported decreases (48, 50–53, 55–56, 60); 1 poor-quality RCT reported no changes (49). These results are consistent with prior studies indicating that breast cancer–related worry usually decreases after genetic counseling (65–67, 69–71, 73–74). No studies reported statistically significant increases in anxiety and depression after genetic counseling; 3 reported statistically significant decreases (52, 61–62), and 3 reported no changes (48, 56, 60). Studies in the prior review also indicated that measures of anxiety and depression generally decreased or did not differ with counseling (65–66, 68–69, 72–74).
Thirteen new observational studies (75–89) and 1 included previously (90) (Appendix Table 4) provided data about distress due to BRCA testing, measured as breast cancer–related worry, anxiety, or depression or other psychosocial outcomes. No studies described other adverse effects of testing, such as false-positive or false-negative results or unneeded risk-reducing interventions.
Five studies reported statistically significant increases in breast cancer–related worry after receipt of BRCA test results (76, 87–90). These findings were confined to mutation carriers before versus after testing (88), mutation carriers compared with noncarriers (87, 89) or compared with women who were not tested (90), and women with family histories that indicate high risk for breast cancer compared with untested low-risk women (76). One study reported a decrease in breast cancer–related worry for both carriers and noncarriers (78).
Although some studies reported decreased anxiety scores after testing regardless of mutation status (75) and among noncarriers only (82), others studies found statistically significantly higher anxiety scores for mutation carriers versus noncarriers (83, 87), women with family histories of breast cancer who were not tested versus mutation carriers (79–80), and mutation carriers and noncarriers (78). Although all women in 1 study had high anxiety scores, noncarriers had lower anxiety scores at 1-week follow-up than carriers and women who were not tested (90). Four studies reported no differences in anxiety over 1 year (77, 85) or among carriers, noncarriers, and age-matched control participants (76, 84).
Women with family histories of breast cancer who did not have genetic testing had higher depression scores than mutation carriers in 1 study, although scores did not reach the threshold for clinical depression (80). Noncarriers had lower depression scores at 4-month follow-up than carriers and women who were not tested in another study (90). Four studies reported no differences in depression over time (75, 85) or among carriers, noncarriers, and age-matched control participants (76, 84), with all scores below the case threshold.
Mutation carriers had more subjective sleep problems than noncarriers and age-matched control participants, although actual sleep duration, latency, and wakefulness, as measured by a wrist monitor, showed no differences among groups (86).
No studies of the effectiveness of intensive screening met inclusion criteria. Five studies that enrolled mutation carriers and other high-risk women described adverse effects (91–95). The Dutch MRISC (Magnetic Resonance Imaging [MRI] Screening) study reported statistically significantly higher false-positive rates with MRI than with mammography on the first and subsequent screening rounds (first, 14.0% vs. 5.5%; subsequent, 8.2% vs. 4.6%; P < 0.001 for both comparisons) (91). False-negative rates for MRI were lower than those for mammography, although numbers were small (91). A study of every-6-month screening found similar false-positive rates for MRI (11%) and mammography (15%) (92). Recall rates for annual MRI were higher than those for annual mammography in a descriptive study conducted in the United Kingdom (MRI, 11.0% per woman-year; mammography, 3.9%; combined, 13.0%) (93). In that study, 245 of 279 total recalls were for benign findings, amounting to 8.5 recalls per cancer case detected.
These studies also reported additional imaging procedures or biopsies that may have been unnecessary because final results were benign and women may never have had these procedures if the original screening test had not been done (92, 96). In the Dutch MRISC study, 43% of women with unneeded biopsies had preceding screening MRIs and 28% had mammography (96). Alternating MRI with mammography screening every 6 months yielded a greater proportion of unneeded imaging (targeted ultrasonography) in women screened with mammography than with MRI (mammography, 8 of 11; MRI, 4 of 8), although rates of unneeded biopsies were similar (mammography, 3 of 11; MRI, 2 of 8) (92).
Discomfort, pain, and anxiety of women having intensive screening with annual mammography, MRI, and biannual clinical breast examination were similar to those of women having only biannual clinical breast examination in a fair-quality prospective cohort study (94). Most women had no anxiety after each type of screening. In a pre–post study of screening with MRI, mammography, ultrasonography, and clinical breast examination, women who were recalled reported higher anxiety scores approximately 1 month after screening than those who were not recalled (8.8 vs. 5.9; P = 0.03) (95), although differences were not statistically significant after 6 months.
No studies of the effectiveness of intensive screening met inclusion criteria. Adverse effects were described in a study of annual measurements of serum cancer antigen-125 (CA-125) and transvaginal ultrasonography in 459 BRCA mutation carriers (mean, 2.4 screening visits [1.6 per year]) (97). Abnormalities were detected in 3% (38 of 1116) of screening visits. Of 26 diagnostic procedures, cancer was not detected in 67% (4 of 6) after abnormal serum CA-125 measurement compared with 100% (9 of 9) after abnormal transvaginal ultrasonography. Combined methods resulted in an unneeded rate of diagnostic surgery of 55% (6 of 11) (97). In a study of screening with annual serum CA-125 measurements and transvaginal ultrasonography, women with abnormal results had statistically significantly higher cancer-related distress 1 week after receiving results than those with normal results, although long-term distress, anxiety, and depression scores were not higher (98).
No trials evaluated the efficacy of risk-reducing medications in BRCA mutation carriers specifically, although placebo-controlled trials of tamoxifen and raloxifene indicated reduced risk for estrogen receptor–positive breast cancer for women at various risk levels (26, 99–100).
Adverse effects for participants are of placebo-controlled trials relevant to mutation carriers. Women using tamoxifen and raloxifene had more thromboembolic events than women using placebo (tamoxifen risk ratio [RR], 1.93 [95% CI, 1.41 to 2.64]; 4 trials and raloxifene RR, 1.60 [CI, 1.15 to 2.23]; 2 trials) (99–100). Coronary heart disease events and stroke were not increased in placebo-controlled trials, although women randomly assigned to raloxifene had higher stroke mortality than placebo recipients in the RUTH (Raloxifene Use for the Heart) trial (RR, 1.49 [CI, 1.00 to 2.24]) (101). Tamoxifen caused more cases of endometrial cancer (RR, 2.13 [CI, 1.36 to 3.32]; 3 trials) and was related to more benign gynecologic conditions; surgical procedures, including hysterectomy; and uterine bleeding than placebo (99–100). Women receiving tamoxifen had more cataract surgeries than those receiving placebo in the NSABP (National Surgical Adjuvant Breast and Bowel Project) P-1 trial (102). The most common adverse effects were vasomotor symptoms and vaginal discharge, itching, or dryness for tamoxifen and vasomotor symptoms and leg cramps for raloxifene (99–100).
A prospective cohort study of women with BRCA mutations indicated that none of 75 women with risk-reducing mastectomies was diagnosed with breast cancer during follow-up compared with 34 of 585 (5.8%) without mastectomies (103). A cohort study of mutation carriers in Denmark found that 3 of 96 women who had mastectomies were diagnosed with breast cancer versus 16 of 211 who did not (hazard ratio [HR], 0.39 [CI, 0.12 to 1.36]), although the study was inadequately powered for this outcome (104). A descriptive study found that none of 307 women who had BRCA mutations or were otherwise considered to be at high risk and had mastectomies was diagnosed with breast cancer during follow-up, whereas 21.3 were expected (105), consistent with results of an earlier study of 18 mutation carriers (106–107).
Adverse effects include surgical complications, long-term physical effects, and distress. In a case series of 122 women who had risk-reducing mastectomy, 64.4% reported postsurgical numbness, pain, tingling, infection, swelling, breast hardness, bleeding, organizing hematoma, failed reconstruction, breathing problems, thrombosis, and pulmonary embolism (108). Most women (87.3%) reported postmastectomy pain and discomfort, and 21.8% reported that pain affected their daily lives in a follow-up study of 59 high-risk women (109). In another study, women's pain scores did not statistically significantly differ before mastectomy, 6 months after mastectomy, or 1 year after mastectomy (110).
In a study of 90 high-risk women with risk-reducing bilateral mastectomies, including 50 mutation carriers, anxiety scores statistically significantly decreased after surgery (mean Hospital Anxiety and Depression Scale scores: before surgery, 5.59; 6 months after surgery, 3.80; 1 year after surgery, 3.83; P < 0.001) (110–111). Women also reported less pleasure in sexual activity 1 year after surgery than 6 months after surgery and before surgery (mean Sexual Activity Questionnaire scores: before surgery, 12.28; 6 months after surgery, 12.21; 1 year after surgery, 11.18; P = 0.005). Depression scores, body image, and other concerns did not change. Other studies indicated no statistically significant changes in psychological or sexual activity measures after mastectomy (108–109, 112).
In a prospective study of 1557 BRCA mutation carriers, salpingo-oophorectomy was statistically significantly associated with reduced incidence of ovarian or primary peritoneal cancer (1.3% vs. 5.8%; HR, 0.28 [CI, 0.12 to 0.69]), breast cancer (11.6% vs. 21.6%; HR, 0.54 [CI, 0.37 to 0.79]), and all-cause mortality (1.8% vs. 5.9%; HR, 0.45 [CI, 0.21 to 0.95]) (103). In this study, salpingo-oophorectomy did not reduce breast cancer– and ovarian cancer–specific mortality, although the study may have been underpowered for these outcomes. Oophorectomy was also associated with reduced breast cancer incidence in a prospective study of women from families with known BRCA1 mutation carriers (18% vs. 42%; HR, 0.38 [CI, 0.15 to 0.97]) (113). Risk reduction was most pronounced for women who had the procedure at younger ages in this study, as well as in a retrospective study of risk-reducing oophorectomy (114).
Few studies described adverse effects. Most women reported worse vasomotor symptoms and sexual function after risk-reducing salpingo-oophorectomy in a small pre–post study of mutation carriers (115). In another small pre–post study, mutation carriers reported an increase in somatization; a decrease in cancer-related distress; and no change in health-related quality of life, anxiety, or depression after salpingo-oophorectomy (116).
No studies directly addressed the effectiveness of risk assessment, genetic counseling, and genetic testing in reducing cancer incidence and mortality (Table). Five referral models accurately estimated individual risk for BRCA mutations, with most sensitivity measures greater than 85%. However, reference standards and study designs varied, and some models have been evaluated only in single studies. Risk was based on self-reported information, which potentially compromises model accuracy. The sensitivity and specificity of self-reported history of cancer in first-degree relatives have been estimated as 65% and 99% for breast cancer (117) and 50% and 99% for ovarian cancer, respectively (118).
Genetic counseling increases the accuracy of risk perception; decreases intention for mutation testing among women who are unlikely carriers; and decreases cancer-related worry, anxiety, and depression. Limitations of studies included differences in designs and measures, dissimilar comparison groups, and small sizes. Risk perception improved after receipt of test results, and breast cancer–related worry and anxiety increased for women with positive results and decreased for others, although results were inconsistent. Studies were limited by high loss to follow-up and differences between comparison groups. Other relevant adverse effects of genetic testing were not studied, including false-positive or false-negative results, genetic discrimination, and insurability.
No trials evaluated the effectiveness of intensive screening in reducing the incidence of BRCA-related cancer and mortality. Higher rates of false-positive test results, unneeded imaging, and unneeded surgeries with screening were reported. No trials of risk-reducing medications provided results for BRCA mutation carriers, and whether efficacy in carriers differs from that in noncarriers is unclear. In trials, tamoxifen and raloxifene increased thromboembolic events and tamoxifen increased endometrial cancer and cataracts. Both caused undesirable effects for some women, such as vasomotor symptoms.
For high-risk women and mutation carriers, risk-reducing bilateral mastectomy reduced breast cancer incidence and mortality and oophorectomy or salpingo-oophorectomy reduced breast and ovarian cancer incidence and all-cause mortality. Comparison groups varied among studies, although results were consistent. Some women had physical complications of risk-reducing surgery, postsurgical symptoms, or changes in body image, whereas some women had less anxiety. Studies were descriptive and lacked important outcomes, and the few available studies had small numbers of participants and no comparison groups.
Limitations of this review include the use of only English-language articles and studies applicable to the United States, although these studies are most relevant to the USPSTF. The review focused on 5 key questions that restricted its scope, and men were not explicitly included except as family members of the women under evaluation. The number, quality, and applicability of included studies varied widely. Data were not available to determine the optimum age for testing and how the age at testing influences benefits and harms. Whether testing for BRCA mutations reduces cause-specific or all-cause mortality and improves quality of life has not been studied. The harms associated with receiving a false-negative result or a result indicating mutations of unknown significance are unknown. Evidence of harms often relied on small descriptive studies with brief follow-up, and the long-term effects are unknown.
Several factors not evaluated in studies influence treatment effects. Effectiveness of salpingo-oophorectomy for reducing breast cancer risk depends on the age at which the procedure is done and decreases after menopause. However, how and when the benefit–harm ratio shifts for women facing this decision is uncertain. Also, the type of risk-reducing intervention that a mutation carrier selects may depend on her specific mutation. For example, women with BRCA1 mutations have higher risks for ovarian cancer than those with BRCA2 mutations (119–120) and may consider their surgical options differently. Medications reduce risk for estrogen receptor–positive breast cancer (100) and consequently may be a more favorable choice for women with BRCA2 mutations, for whom 77% of breast cancer cases are estrogen receptor–positive (121). How these factors influence patient decision making and eventual clinical outcomes is unknown.
To determine the appropriateness of risk assessment and testing for BRCA mutations in primary care, research on access to testing; effectiveness of screening approaches, including risk stratification; use of system supports; and patient acceptance and education is needed. Trials comparing types of providers and protocols could address who should perform these services, how they should be done, and what skills are required. The consequences of identifying women as high-risk, as well as genetic testing of women and their relatives, require more study. Well-designed investigations using standardized measures and enrolling participants that reflect the general population, including women from minority groups, are needed.
An expanded database or registry of patients receiving genetic counseling and testing for BRCA mutations would provide essential information about predictors of cancer, response to interventions, and other modifying factors. Traditionally, all patients clinically tested through direct DNA sequencing in the United States used a single private laboratory and patient data were inaccessible. Developing a centralized accessible database with key variables to address these issues as testing practices change in the wake of the recent U.S. Supreme Court decision on DNA patents (122) would be a major advance in this field.
Additional research on interventions is needed. Practice standards for screening have preceded supporting evidence despite known harms of overscreening. For example, although intensive screening with annual transvaginal ultrasonography and serum CA-125 measurement is recommended for high-risk women (21), no efficacy trials are available. The PLCO (Prostate, Lung, Colorectal, and Ovarian) Cancer Screening Trial reported no mortality benefit of screening average-risk women by using transvaginal ultrasonography and serum CA-125 measurement compared with usual care after 12 years of follow-up (123) and did not report outcomes for high-risk women, including BRCA mutation carriers. Also, a study of 3532 European women who were at increased risk for ovarian cancer, had unknown BRCA status, received transvaginal ultrasonography and CA-125 measurement, and were followed for up to 16 years indicated no stage shifts in disease incidence (124).
Trials of risk-reducing medications in mutation carriers, including aromatase inhibitors, and measurement of long-term outcomes are also needed. Comparisons of salpingo-oophorectomy versus more limited surgeries, such as salpingectomy alone, would inform current practice. Studies of factors related to acceptance of risk-reducing interventions based on genetic information would be useful, such as determining whether cancer incidence in relatives is reduced because they adopt risk-reducing interventions. This information could improve patient decision making and lead to better health outcomes.
The process of risk assessment and referral, evaluation by genetic counselors, genetic testing, and use of intensive screening and risk-reducing medications and surgeries is complex. Each step requires careful interpretation of information, consideration of risks, weighing of benefits and harms, and shared decision making before moving to the next step. Services must be well-integrated and highly personalized to optimize benefits and minimize harms for women as well as their families. Additional studies are necessary to better inform practice.
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text:
The worst day as your own boss beats
the best day in a cubicle, but no one would ever
say that it's easy.
You've been downsized, right-sized, overworked, overlooked, laid off, paid off, guilt-tripped and pink-slipped. You're mad as hell, and you're not going to take it anymore!
Ready to kick corporate?
It may not be as easy as you think. Get
ready for an emotional roller-coaster ride. It's going
to shake your paradigm but good. A few of you may even
end up returning to the mother ship.
But if you're like most budding entrepreneurs
who have fled the world of Dilbert, you're going to
keep on walking and never look back. Because, to paraphrase
the popular bumper sticker, the worst day as your own
boss beats the best day in a cubicle.
"There's an intriguing thing about
independent venturing, which is that people are almost
never sorry that they did it, even if they failed,"
says Karl Vesper, professor of business administration
at the University of Washington School of Business.
"It carries benefits -- freedom and independence
-- that are very addictive."
Are you a corpaholic?
How well and how quickly you'll take to entrepreneurship may depend in part on your relationship with your corporate job.
Those who have spent their corporate years consumed with amassing power within a corporation are the least prepared for the real small-business world, according to Leonard Lodish, professor at the Wharton School of Business and author of "Entrepreneurial Marketing: Lessons from Wharton's Pioneering MBA Course."
"People who have been in organizations where it's all about how big your silo was and how much power you have don't do very well in the entrepreneurial setting because they have a different value system," he says. "If you've done that long enough, it's very hard to change."
Three corporate types
David Paradise of the Family Business Resource Center
in Boston says there are three types of corporate workers.
Obviously the first two groups are going to kick corporate easier than the third, which tends to face an uphill struggle.
"They are not prepared in their minds,"
he says. "Psychologically, they have wanted to
be with the corporation out of protection, out of identification,
because 'The corporation knows more than I do' or that
'They'll take care of me.'
"When suddenly the corporation says we don't need your services anymore, they get thrown into entrepreneurship by default."
* Mortgage rate may include points. See rate tables
for details. Click
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text:
** The S7 coat size is a larger coat, but made with the smaller 'V' inset at the front shoulders, unlike the S8 to S10. It is the in- between fitting, for dogs that are longer , but do not have the bulky muscles .This coat has the buckle closure.
We designed a special Patented pattern for the larger dogs, S8, S9 & S10. Instead of just an inset-- these have a fuller 'sleeve' area and a larger curved lycra inset. The 'sleeve' is designed, so the dogs have movement room from their shoulders. The chest piece wraps through the dogs' front legs, and up around the dogs rib cage. The larger dogs have a wider chest strap that closes with velcro. The coat is stabilized with two side velcro pieces on the straps. These are all reasons, we patented the coat. Coats are water resistant, both cooling in the summer and warming in the winter. These are very special coats.
There are few large dog coats, and no others that will keep your dog comfortable in the summer or winter. These coats do not slide from side to side. These coats will last 10 years.Wash cool with detergent, and no fabric softeners. hang to dry. Enjoy the peace of mind that Zentek provides.
|Border Collie
|German Shepherd
|Black Russian Terrier
|Neck to tail
|45-60 lbs
|60-80 lbs
|75-90 lbs.
|80-110 lbs
|Neck Collar
* Please refrain from dry-cleaning this item
(Posted by Cathy Glasner on 21st Apr 2014)
I am using the coat for an elderly dog. It is a smooth and comforting fabric and fastens together thoughtfully and easily.
Customer service is outstanding: prompt, thorough, accomodating.
(Posted by Unknown on 1st Mar 2011)
Hi Janice,
I wanted to tell you about yesterday.
Rain was dressed in her beautiful ZenTek coat as we headed off on errands. It was +15 degrees out and a few days past a big snow fall when I got a flat tire...bead broke and tire was nearly off the rim. I managed to get my minivan into a parking lot and called my road side assistance that specializes in road service for folks using wheelchairs and who have Service Dogs.
I kept the van turned off so as not to use up all my gasoline as I didn't know how long I was going to be "broken down". The building, in whose lot I had parked, was locked and no one around. With all the snow and me using an electric wheelchair, I had no place to go to get us into a warm building while we waited for help to arrive. I covered myself with a warm blanket and Rain curled up on her seat, front passenger seat, though I did unhook her seat belt to give her total freedom to get comfortable. I have a blanket for Rain but she didn't need it at all. Rain stayed toasty warm as we waited. It took a little over an hour for road service to arrive to change the flat tire.
Thank you so much for Rainy's coat! It served her well :D


text:
– The WWE Performance Center is celebrating its first birthday in Orlando, Florida. Dot com has a new article on the milestone featuring quotes from Triple H. Click here to read it.
– Speaking of dot com, free preview week of WWE Network continues as the official website looks at "10 hidden gems on WWE Network." Check that piece out at this link.
– The weekend is here, something celebrated each Friday afternoon with a new episode of The JBL & Cole Show. Watch this week's show at this link or embedded below:
– John Cena thanked Chikara Crossfit for an overseas workout. Here's a pic:
The language of effort is globally understood. Thanks Chikara #crossfit for giving me a chance to #dothework pic.twitter.com/xsku2URzRV
— John Cena (@JohnCena) July 10, 2014


text:
Read what our writers around the world are saying about climate change.
...or have your own say in the Celsias Lounge »
The Chinese government is pushing manufacturers, and in particular, steelmakers, to be more energy efficient, reducing demand for Australian coal. Image: Johannes 'volty' Hemmerlein Rapid increases in energy efficiency in Chinese manufacturing, especially in the steel production sector, will temper demand for Australian coal exports and put billions of dollars ... keep reading
Written by Kylar Loussikian- The Conversation in December 2013, about Carbon Trading, Coal & Oil, Economics, Emissions, Energy Saving, Finance & Money, Industry & Business
Vancouver, CANADA – The 13th edition of the GLOBE Series of events, a leading sustainable business summit, has unveiled its keynote speakers for the upcoming event being held March 26-28, 2014 in Vancouver, Canada. Framed around the thematic concept of 'Building Business Resilience through Sustainability Strategies & Innovation', the GLOBE 2014 agenda ... keep reading
Written by Lindsey Horne in December 2013, about Biofuels & Alternative Energy, Carbon Trading, Clean Technologies, Climate Change, Consumerism, Economics, Emissions, Energy Saving, Events, Green energy, Industry & Business, Smart Growth, Water
A new wool and rice straw blended upholstery fabric, which has been developed by a Wellington company, goes into commercial production next year with the potential to create significant demand for New Zealand crossbred wool, while helping solve a massive air pollution problem in China. The Formary is a Wellington ... keep reading
Written by PR in December 2013, about Air Quality, Design, Emissions, Industry & Business, Pollution
IKEA is now offering 'off the shelf' solar power packages to UK consumers, in a move that could help to mainstream domestic solar power systems. It is the first major retailer to offer a comprehensive home photovoltaic installation service, having teamed up with Hanergy, a thin-film PV supplier, to produce ... keep reading
Written by Sejal Patel in November 2013, about Alternative, Cohousing, & Off-Grid Living, Clean Technologies, Energy Saving, Industry & Business, Solar
The National Renewable Energy Laboratory (NREL) has released the 2012 Renewable Energy Data Book on behalf of the Energy Department's Office of Energy Efficiency and Renewable Energy. The annual report is an important assessment of U.S. energy statistics for 2012, including renewable electricity, worldwide renewable energy development, clean ... keep reading
Written by Lindsey Horne in November 2013, about Biofuels & Alternative Energy, Clean Technologies, Climate Change, Energy Saving, Green energy, Industry & Business, Smart Growth
The power generation industry is demanding smarter solutions around water supply and wastewater strategies, according to new research. Tighter environmental regulations and water scarcity are pushing power plant operators to rethink how they use this resource, as water and power generation are inseparable. Fossil fuel-fired power stations require a reliable ... keep reading
Written by Maxine Perella- edieWater in November 2013, about Energy Saving, Industry & Business, Rivers, Lakes, and Oceans, Water
France's constitutional court has upheld a ban on hydraulic fracturing, ruling that the law against the energy-exploration technique known as fracking is a valid means of protecting the environment. The 2011 law "conforms to the constitution" and is not "disproportionate," the court in Paris said in a decision posted ... keep reading
Written by Celsias in October 2013, about Coal & Oil, Industry & Business, Water
A group of cafes in Brno, the Czech Republic's second-largest city, has begun offering a sort of micro Citibike program to patrons. Buy a cup of coffee and, with a 300 Crown ($16 USD) deposit, they'll lend you a bike. Simply return the bike by end of day ... keep reading
Written by PSFK in October 2013, about Food, Industry & Business, Lifestyle & Behavior, Transport, Travel
The Intergovernmental Panel on Climate Change states that scientists are now 95 percent sure that global warming has been set in motion as a direct result of human actions, and the planet has already begun to feel these effects. The United States experienced the hottest year on record in 2012 ... keep reading
Written by PSFK in October 2013, about Children and Families, Climate Change, Industry & Business, Lifestyle & Behavior, Water, Weather
A very thorough study from the University of Oxford has found that a campaign to persuade investors to take their money out of the fossil fuel sector is growing faster than any previous divestment campaign and could cause significant damage to coal, oil and gas companies. As the Guardian reports ... keep reading
Written by Celsias in October 2013, about Action, Protest, & Activism, Climate Change, Coal & Oil, Economics, Education, Finance & Money, Industry & Business
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Join the conversation in the Celsias Lounge.


text:
Wayne Foundation
this wiki
The idea for a large scale holding company that operates as a foundation was first conceived by Bruce Wayne after his faithful butler, Alfred saved the lives of Bruce and Dick Grayson and sacrificed himself in the process. To honor the memory of the late butler, Wayne decided to start the "Alfred Foundation", of which he became the chairman.[1] The first institution backed by the Alfred Foundation was the Gotham Wax Museum.[2]
New Earth
The Wayne Foundation is the holding company for the Thomas Wayne Foundation and the Martha Wayne Foundation. The Wayne Foundation funds scientific research and helps people with research by providing facilities and training.
The foundation has its own building, called the Wayne Foundation Building, which includes a penthouse apartment where Batman lived for a period of time. It also has a secret elevator that leads to a matching Batcave in a secret sub-basement under the building.
Through the Wayne Foundation and the organizations underneath, Wayne not only addresses social problems encouraging crime and assists victims in a way that his Batman persona cannot, but the arrangement also provides a large network of connections in the world of charities. He finds out about the newest trends and newest arts, and at the same time maintains connections to the streets through the soup kitchens and social services groups, which augments his crime fighting efforts.
Thomas Wayne Foundation
The Thomas Wayne Foundation is a foundation for medicine and medical help. This foundation gives annual awards for medical breakthroughs and lifelong commitment, similar to the Nobel Foundation. The Thomas Wayne Foundation is also responsible for funding the Thomas Wayne Memorial Clinic in Park Row, Gotham's infamous Crime Alley. The foundation funds and runs dozens of clinics in Gotham. Bruce Wayne's surrogate mother, Dr. Leslie Thompkins, runs the Memorial Clinic in Crime Alley and governed the other clinics until she left Gotham.
Martha Wayne Foundation
The Martha Wayne Foundation is a patron and supporter of arts, families, education, and tolerance. The foundation supports and helps to run a number of orphanages and free schools, and provides teachers for those who have learning difficulties. Artists can apply for grants from the foundation to help support them in furthering the arts. The foundation sponsors companies like Family Finders. Family Finders is an organization directed at finding lost people and uniting families. The Martha Wayne Foundation also sponsors and runs dozens of soup kitchens within the city.
Equipment: None known.
Transportation: None known.
Weapons: None known.
- No special notes.
- No trivia.
See Also
- 151 Appearances of Wayne Foundation
- 1 Images that include Wayne Foundation
- Organization Gallery: Wayne Foundation


text:
Join us for a walking tour, with a Shepherd Guide thru 6 walk-thru scenes, including the live animals at the manager. Hear the story of Jesus' birth as narrated by your Shepherd Guide. Then join us for refreshments, music and children's crafts inside. All of this is free, as it is our gift to the community. Visit cedarvilleumc.org or call 610-326-4173 with any questions. This event is handicapped accessible.
Cedarville UMC – Live Nativity« Back to Events
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text:
April 22, 1998
STANFORD, Calif. - Stanford will host four playoff games for the Western Women's Lacrosse League this weekend. All games are played on New Maloney Field on Stanford's campus and are free to the public.
The two winners of Sunday's games will advance to the WWLL Final Four in San Diego next weekend. Additionally, the United States Women's Lacrosse League will host tryouts for a Northern California team on Saturday, followed by the first open practice on Sunday at 4:00 pm.
Here is the complete schedule:
Western Women's Lacrosse League Playoffs
April 25 & 26 @ New Maloney Field, Stanford University
Admission is Free
Saturday, April 25 11:00 am #4 Santa Clara vs. #5 Saint Mary's 2:00 pm #3 UC Davis vs. #6 UC Santa Cruz 4:00 pm USWLA Northern California Tryouts
Sunday, April 26 11:00 am #1 Stanford vs. winner of Santa Clara/Saint Mary's 2:00 pm #2 Cal vs. winner of UC Davis/UC Santa Cruz 4:00 pm USWLA First Practice


text:
Cool and breezy conditions are left in Central Indiana after Halloween's record rain and severe storms.
Wind gusts up to 75mph were recorded. Here are some of the highest.
Rain was also a big part of the weather story. 2013 will be the wettest on record for Indianapolis.
Some spots picked up more than 3″ of rain!
Today winds will gust up to 25mph with temps topping out in the low to mid 50s.
Trick or treating weather will be cool and breezy, but much better than it would have been last night!
Good luck to all of the Monumental Marathon runners Saturday. There's a slight chance for a shower, but the wind gusts out of the NW will be more of an issue for you.
Average highs for November start in the upper 50s, but tumble into the 40s by the end of the month.
The 7 day forecast shows temps below normal, then popping up just above.


text:
March 22, 2003
Arizona Head Coach Joan Bonvicini
Opening comment... "We are very glad to be back in the NCAA Tournament. We've worked very hard to get here. Obviously, that was one of our goals, to come here. When you get this far there are no easy games. Notre Dame for our first-round opponent is a very good team. It's interesting because it's the third time we've played them in three years. They are only two years removed from winning the NCAA Title. They are extremely well coached. It's going to be a really great game. They have one of the best three-point shooters in NCAA history in Alicia Ratay. And the freshman of the year from a year ago, Jacqueline Batteast. I'm very impressed with their team. And with Courtney LaVere coming off the bench, I think that she is one of the top freshman in the country. We are in for a tough ball game tomorrow."
On playing up to their competition... "In the beginning of the year a lot of teams didn't know a lot about us. We were coming off of a difficult season for us, a .500 season. I knew that we were much better than people, prognosticators thought, but you don't do a whole lot of talking when you're .500. We started off with LSU. We had a very good opportunity to win that game and I know that was quite a while ago, but we had a very tough non-conference schedule. I was pleased with our team from the very beginning. I think that we gained confidence throughout the year. My big thing is to be consistent. The last 10 games I think that we have gone 8-2 against very good quality teams. This team has learned and understand what it means to win. I think in the beginning there were a couple of games we probably shouldn't have lost, if you look at our record and some of the closeness of the game. I think our team understands that. We'll really see the benefit next year. We're a young team. We've learned a lot. We will be ready to play. We are very excited to be here. I think we've prepared ourselves well from our non-conference schedule and obviously in the Pac-10. When you go on the road in the Pac-10 you're really on the road, the only bus trip we make is to Arizona State. We feel that our conference has really prepared us for the NCAA Tournament."
On the predetermination of the sites... "I think it will continue this way for the next few years until the NCAA can evaluate the crowds, how much of an advantage is it to the host team and is women's basketball ready to move to the next level. Maybe going to eight-team sites as the men do. That's what I see as a progression. I think the next wave, the NCAA will let us play like this for a few years and then next go to eight sites of eight teams. They will probably have a home-court team there and then eventually go to neutral sites. That's the way I see it. But I think that right now we are very excited. It has obviously helped the teams that are hosting that they can have a year to sell tickets, to advertise and market those games. I'm excited I think that we've come a long way since the first one I believe was in 1982. We've grown incredibly. I know Kansas State has done an excellent job. A year ago they had a great home attendance for the first and second rounds and I'm sure they will do the same this year. I'm excited to be here."
On her personal feelings on the predetermination of the sites.. "I think that it's good for women's basketball to have predetermined sites. I know that some people don't agree. But I do. I think that it's very hard to host and find out six, seven days before and sell tickets and get everything set-up the way it needs to be with hotels. I think that we are going in the right direction. I think that the hard thing for next year is that the teams that are hosting this year may not be hosting next year. I think that women's basketball is going through some growing pains. I think those things are helping."
On seeing other games played today... "I haven't been playing attention to the scores. The only team I'm concerned about right now is (Arizona). And as I said, we are just excited to be here."
Arizona players
Sophomore, guard, Dee-Dee Wheeler
On forcing turnovers, rattling the opponents and the Wildcats' defense ... "I would say it is the goal of my defense. It's not just me, it's my teammates, too. I'm quick, but my other teammates also play a role in forcing turnovers."
On playing in the Pac-10 and tough competition... "I think we played well against our better opponents, the ranked teams. As you can see, we played LSU and went to overtime with them and played Georgia. I think we played up to the level of our opponent. If we can continue to do that, we'll have a great game against Notre Dame."
On Shawntinice Polk this season... "I think she's made the transition well from high school to college ball. She started practicing with us last January, although she wasn't able to play. I really think she's adjusted well. When she's double- and triple-teamed, I think she's taken it well. She's a great passer, a very unselfish player. By double- and triple-teaming her, she's able to see the court with her vision. I think she's handled it well."
Senior, guard/forward, Krista Warren
On playing in the NCAA Tournament... "My initial (reaction) was that I was a little shocked at first for us going all of the way to the East (Region). I'm excited and we're hoping to meet UConn - that'd be a real big achievement for our team. We're going to take it one game at a time just to get there."
Freshman, center, Shawntinice Polk
On playing in the Pac-10 and tough competition... "The Stanford game, them being a top-ranked team, playing at their home court and in front of their fan support will definitely, I think, help us out a lot, especially for us playing on the road."
On the Stanford game... "The Stanford game was a hard loss. We played hard so I can't knock the team or knock myself for that. I don't think I'll be triple-teamed again ... I hope not. To be back playing, after being off for so long, I'm really excited about that." On her learning curve as a freshman post player...
"It's been frustrating at times. The refs let a lot more go, there's a lot more banging inside, that all posts have to get used to. You have to be ready mentally. I think that's a big part of adjusting to the game. For myself, it hasn't been easy but I've done all right with the players I have around me. They've helped me out a lot. I'm adjusting pretty well."


text:
Hospice of Davidson County will offer volunteer training
Published: Monday, May 13, 2013 at 10:48 a.m.
Last Modified: Monday, May 13, 2013 at 10:48 a.m.
Hospice of Davidson County will offer a volunteer training session for new volunteers from 1-5 p.m. May 21-23 at the Administrative Building on the Hospice of Davidson County campus.
Volunteers at Hospice of Davidson County perform a variety of functions, ranging from providing direct patient care to completing administrative tasks. Volunteers receive specialized training, enabling them to provide companionship and caregiver support to those experiencing a life-limiting illness. Hospice of Davidson County encourages volunteers to consider a commitment for one to three hours a week.
Volunteer applications are available online at www.hospiceofdavidson.org. For more information, call 475-5444.
Reader comments posted to this article may be published in our print edition. All rights reserved. This copyrighted material may not be re-published without permission. Links are encouraged.


text:
The Kiwanis Club of Lynchburg Serving the Central Virginia community since 1920.
We take on various projects, all with one purpose: to improve our community and serve its youth. That includes helping to finance and construct children's playgrounds and camps; beautifying our community; bringing fun to children via the Teddy Bear Parade; and building confidence, character, and interpersonal skills, providing recognition, and teaching leadership, in our schools.
Kiwanis partners with area civic groups to maximize service efforts.
Join Us!
Join Kiwanis today to enrich your own life and the lives of those in need.
Kiwanis offers many opportunities for fun and exciting social events.
We sponsor several unique fundraisers, including annual lobster and shrimp sales.
Kiwanis Interclub Social
Kiwanis of Lynchburg joins with other Kiwanis clubs for food, fun and fellowship. The next Capital District Interclub will be July 17 at Hunting Hills Country Club and will be hosted by the Kiwanis Club of Roanoke. Golf tee times start at 11:30am. Greens fees are $35 including cart. Register by calling 540-774-4429. The dinner will begin with a cash bar at 5:30pm, dinner begins at 6:30pm. The cost is $34 per person. To make reservations for dinner email Lloyd Enoch firstname.lastname@example.com.
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We welcome everyone to join us for a meeting, public event or service project. Please see our calendar of events or feel free to contact our club Membership Committee Chair Ken Kowalski for more information at firstname.lastname@example.com.
Our monthly lunch meeting are held the first and third Fridays of every month on the beautiful Presbyterian Homes and Family Alliance campus. Please consider joining us!.
Membership in the Kiwanis Club of Lynchburg is open to everyone! Our club is growing and we would love to have YOU involved in our efforts to improve the world, one child and one community at a time.


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More New and Used
from Private Sellers
Note: Supplemental materials are not guaranteed with Rental or Used book purchases.
Chronicles of the Strange and Uncanny in Florida
ISBN13:by JENKINS GREG
Ingram Pub Services
Questions About This Book?
What version or edition is this?
This is the edition with a publication date of 10/15/2010.
What is included with this book?
- The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any CDs, lab manuals, study guides, etc.
Chronicles of the Strange and Uncanny in Floridaexplores the unknown for those who wish to look beyond the confines of everyday life to discover the truly unusual. It explores Floridars"s darker avenues for evidence of the extraordinary and the fantastic. Investigate sightings of flying saucers, extraterrestrials, and strange aerial phenomena. Meet skunk apes, chupacabras, and other creatures of the night. And in Floridars"s lakes and seas, meet aquatic abnormalities like sea monsters, the Everglades water serpent, and the three-toed beast of Clearwater Beach.
Author Biography
Greg Jenkins has close to 20 years working in the mental health and medical fields, and is currently a mental health therapist and case manager with several psychiatric and medical facilities. Since an early age, Greg has had a profound interest in the supernatural and fringe science, and after a personal experience with the unknown in 1987, he began his journey into the realms of parapsychology and all things mysterious. Greg is a folklorist and collector of oral traditions and urban legends, and is an associate member of England's Society for Psychical Research.


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Excerpt from page vii.
It's a wonderful thing to step into a friend's kitchen and see a cast iron skillet on the stove. You know right then that you are going to have something good to eat, that you are in the home of a true cook. A cast iron skillet has an heirloom quality about it. Every pan has its own stories to tell, memories of sharing good food with friends and loved ones. No other pan has this kind of history. Passed from generation to generation, old cast iron skillets remind our senses of smells and flavors that make us want to heat them up and hear them sizzle with good food again
The cast iron skillet is one of the most important pans in your kitchen. It is the key to good cooking. We'll admit up front that a cast iron skillet is heavy and a bit more difficult to clean and maintain than a skillet coated with Teflon or other nonstick material. So why use it? For browning, searing, roasting, and caramelizing, we have greater success with cast iron than with any other kind of pan. Certain recipes require an iron skillet; others just taste better when cooked in one. Cast iron's unique characteristic of producing dry, even heat makes it ideal for baking as well. Baked goods come out moist on the inside with a crisp, golden crust on the outside. Vegetables roast and caramelize perfectly. Meats sear and brown just as they should and don't seize up or stew, because cast iron doesn't cause additional moisture to form.
For four generations the cast iron skillet has played an important role in our family. Sunday mornings always meant peeking into the over to watch the Dutch baby rise, the sautéed apples and powdered sugar waiting on the table. We've included many of our favorite recipes that have been in our family for years. Our well-seasoned cast iron skillets connect our family history with love, one generation to the next.
Copyright © 1995-2016 Lehman Hardware and Appliances Inc, All Rights Reserved. Designated trademarks are the property of their respective owners. Use of this Web site constitutes acceptance of the Lehmans User Agreement and Privacy Policy


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Please pick a language
Please pick a language
As a parent, you are likely to hear children telling on each other: "Mom! Jimmy's picking on me again," or "Sally called me a name." You may brush this off as typical behavior for a child. But, do you know how to recognize when it is more than that? When the name calling and teasing goes too far? Bullying can be a serious issue for young children when it becomes more than the typical sibling rivalry or two friends teasing each other while they play catch.
Bullying is never acceptable. As a parent, it is important to recognize the signs and understand what steps you can take to help your child if you think he is being bullied.
Below is information adapted from the U.S. Department of Health and Human Services, Health Resources and Services Administration's Stop Bullying educational campaign at http://www.stopbullying.gov.
Your child may be a victim of bullying if he:
How you can support your child, or others being bullied:
The behaviors connected to bullying are typically not one-time instances. Rather, they are behaviors that have a tendency to be repeated. As a result, prevention programs are able to focus on some of the patterns that occur and work to minimize bullying that takes place. As a parent, you can contact your child's school to see how you can become involved in their prevention programs.
For additional information and resources, go to:
Stop Bullying (resources for both children and parents)
National Crime Prevention Council
Eyes on Bullying


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Policy Options: Support Physical Activity through Transportation Policy
If your state is one of the 30 states that have a constitutional or statutory restriction on using state gasoline taxes on anything other than highways (see list), work to change the law to allow gas tax funds to be used for transit, bike lanes, trails, sidewalks, and other infrastructure that supports physical activity.
- Example legislation/Constitutional amendment from Maine
Implement programs and policies to make it safe for kids to walk and bike to school
- Model legislation on Safe Routes to Schools from Texas
- National Highway Traffic Safety Administration's Safe Routes to Schools Tool Kit
- Organize a "Walk to School Day"
- "The 2002 Summary of Safe Routes to School Programs in the United States" report by Transportation Alternatives and the Surface Transportation Policy Project. Report includes summaries of model programs that support walking and biking to school and an inventory of programs by location
- The California Safe Routes to School report
- CDC's Kids Walk to School program encourages communities to promote and provide opportunities for children to walk to and from school in groups accompanied by adults.
- Examine your neighborhood and determine how friendly your streets are for walkers using a Walkability Checklist


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Latest News Philippines: 6 PNP officials get new key posts – Journal.com.ph:
AT least six senior Philippine National Police officials have been named to new key posts.
The new appointees are Director Catalino S. Cuy, the erstwhile head of the elite PNP Special Action Force, who has been named as new director of the PNP Directorate for Human Resources and Doctrines Development.
Cuy, a member of Philippine Military Academy Class 1981, will be replaced by his mistah (classmate) Chief Superintendent Cipriano E. Querol Jr., the erstwhile Police Regional Office 6 director in Western Visayas who has been replaced by Chief Supt. Agrimero A. Cruz Jr. of PMA Class 1982.
Cruz, a former PNP spokesman was replaced as director of the Police-Community Relations Group by Chief Supt. Bernardo C. Florece Jr. , a member of PMA Class 1983 who used to be the Secretary to the Directorial Staff of the PNP.
Florece will be replaced as PNP-CDS by Senior Supt. Isagani R. Nerez Jr., a member of PMA Class 1984 who used to be the head of the PNP Anti-Kidnapping Group. Nerez' deputy, Senior Supt. Renato a. Gumban of PMA Class 1985, has been named officer-in-charge of the PNP-AKG. However, sources said that apart from Gumban, another member of PMA Class 1985, Senior Supt. Manuel R. Gaerlan is also being considered to be the new chief of the premier police's anti-kidnapping unit.
PNP chief Director General Nicanor A. Bartolome earlier said that there would be a reorganization of some key offices of the PNP in line with his program to put the right man in the right job.
He said they will include at least 10 officers belonging to the PNP directorial staff, regional offices, national support units and some special staff.
These offices have the rank of Director down to Senior Superintendent.
He said the reshuffle is needed due to the availability of the position and the need to promote some officials who have been occupying the same position for almost two years.
Highly-reliable Journal Group sources said the PNP leadership is already consulting with President Benigno Aquino on the list of contenders for the new PNP Directors for Investigation and Detective Management and Plans.
Another PMA Class 1981 member, Chief Supt. Francisco Don C. Montenegro, who has been the director of the PNP Maritime Group for more than three years now, is reportedly being considered as the next PNP-DIDM director.
A major PNP reshuffle is expected with the retirement of Gen. Bartolome's no. 2 man, PNP deputy chief for administration, Deputy Director General Arturo G. Cacdac Jr., the youngest member of PMA Class 1978 who will retire this coming October 11.
Sources said Cacdac's departure will trigger the designation as the new PNP The Chief Directorial Staff of National Capital Region Police Office chief, Director Alan LM Purisima of PMA Class 1981. Such move will mean there will be a new NCRPO director.
Browse other Latest News Philippines updates.
Incoming search terms:
- PNP List of Officers
- pnp key officers 2013
- pnp key officer 2013
- pcsupt renato gumban pma


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Storm Mountain Lodge & Cabins
Guests will experience delicious Canadian cuisine prepared with a dedication to organic ingredients and naturally raised Alberta meat and wild fish. All of our breads, desserts and breakfast pastries are baked daily on site. Guests can choose lighter selections in the lounge or they can simply relax around a roaring fire and enjoy a moment of kinship with the great explorers of the Canadian Rockies who once passed our way.
Hiker's lunches can be prepared for the trail and in-cabin dining can be arranged with any item off our menu.
Our Chef's are very accommodating to guests with dietary restrictions.Our Wine List is comprised of exclusively Canadian vintages from the internationally acclaimed Okanagan Valley of British Columbia.
Address: Highway 93 South, mid-way between Banff and Lake Louise Townsites PO Box 3249 Banff, AB T1L 1C8
Lat/Lng: 51.252965 / -115.998618
Phone: 403-762-4155
Fax: 403-762-4151
Website: www.stormmountainlodge.com/lodge.html
Email: firstname.lastname@example.com


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The United States is facing a "new threat" that has actually been an ongoing threat throughout the history of terrorism: the female (suicide) bomber. On Sunday, January 19, 2014, at least 14 people were killed and many more wounded by a female suicide bomber at a railway station in Russia. The suspect is a 22 year old woman named Ruzanna Ibragimova (AKA Salima). She is believed to be affiliated with the Caucasus Emirate, a terror group led by Doku Umarov, that has threatened attacks against the Winter Games in Russia.
Female Suicide bomber's motives are the same as male bombers; the purpose of terrorism is to cause fear and apprehension. But they become involved in terrorism and in suicide bombing for different reasons than males.
Females are not normally suspected of terrorism. Many countries are "a man's world;" women have little rights in many areas, in different religions. Violence, cross-culturally, is viewed as a "man thing." Therefor a female terrorist can become a symbol to women, can commit atrocious acts, elevating her own (and female) status, and "make something' of herself. Palestinian terrorist Laila Khaled became a hero to many of her people after a 1969 plane hijacking.
Females cannot be searched as a male suspect can be searched due to religious beliefs and/or social mores. An American woman who grew up in Kuwait explains how she would smuggle drugs into the U.S. in the 1970s: "We hid the (drugs) in tampon boxes, because the minute the (Kuwait) airport police saw them in the luggage, they would literally step away. They wouldn't touch tampon boxes or tampons." "Search" includes physical searches, where a woman may be able to bypass security much more easily as a man will not touch a female, particularly in the breast or genital areas.
Women join terrorist groups usually for revenge of the death of a male family member. If a woman's brother or husband was killed in the "cause," a woman will personally seek revenge by becoming involved in terrorism. Chechen women bombers were named "Black Widows" as many were acting in revenge for the deaths of their husbands, sons, and brothers. Chechen female terrorists have been involved in 22 out of 27 suicide attacks attributed to Chechen rebels, and 43% of 110 bombers were female, between 2000-2005. Ruzanna Ibragimova is the widow of a militant reportedly killed in a shoot-out with police last year in Dagestan.
A woman often has much more emotional investment than a man. Where a man will go fight in the name of a cause, because of idealism, or it is the "correct thing to do," or because his father and grandfather were "freedom fighters," a woman will join for reasons such as symbolism and/or revenge, which ingrains the cause much more deeply into her soul. Therefor she may be easier to recruit and train, and volunteer to become a suicide bomber. Ulrike Meinhof is considered one of history's most dangerous terrorist. Meinhof was a leftist activist from youth and eventually founded the RAF (Rote Armee Fraction) organization. She was responsible for suicide attacks across Germany. In the 1970's she led a series of bombings and attacks.
Females can hide items in their clothing easier. The bulk may appear to be a pregnant belly. Clothing such as burkas hide the bombs and equipment. Wafa el-Bass carried explosives in her undergarments when she attempted to blow up an Israeli hospital in 2005.
Female terrorists are also working in the United States. Consider the SLA, or "Symbionese Liberation Army," the American left-wing revolutionary group that, between 1973 and 1975, kidnapped heiress Patty Hearst, robbed banks, committed murders, and committed other acts of violence. Reports tell us the men of the group were more involved in the ideology and history, where as women were committed to creating change. When the majority of SLA members died in a fiery shootout with Los Angeles Police in May 1974, it was discovered the male leader (Donald DeFreeze) had committed suicide; the women (Angela Atwood, Camilla Hall, Nancy Perry, and Patricia Soltysik) died shooting. All were born and raised in the U.S.
Judith Yates lectures on "Female Terrorists" see more HERE
photo of Judith Yates credit


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Journal of Nanoparticle Research
, Volume 11, Issue 4, pp 785-792
First online:
Calculation of curvature dependent surface plasmon resonance in gold nanospheroid and nanoshell
- Jian ZhuAffiliated withInstitute of Modern Physics, School of Science, Xi'an Jiaotong University Email author
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In this paper, theoretical calculations based on dipole-limit are performed to investigate the effects of curvature on the surface plasmon resonance (SPR) properties of nanometer size gold spheroid and shell. By comparing the aspect ratio with the shell thickness, we demonstrated that the curvature radius is a common better factor that can be used to predict the SPR wavelength and shift fashion. For nanospheroid, increasing the ratio of curvature radius corresponding to the climaxes leads to an increase in the ratio of SPR wavelength, whereas increasing the ratio of curvature radius of outer and inner surface in nanoshell leads to an decrease in the ratio of SPR wavelength. As a morphologic factor, curvature radius plays an important role in affecting the distribution of electron density, and consequently controlling the SPR frequency.
KeywordsCurvature Gold nanospheroid Gold nanoshell Surface plasmon resonance (SPR) Quasi-static Theory Simulation
Reference tools
- Title
- Calculation of curvature dependent surface plasmon resonance in gold nanospheroid and nanoshell
- Journal
Journal of Nanoparticle Research
Volume 11, Issue 4 , pp 785-792
- Cover Date
- 2009-05
- 10.1007/s11051-008-9436-6
- Print ISSN
- 1388-0764
- Online ISSN
- Publisher
- Springer Netherlands
- Additional Links
- Topics
- Keywords
- Curvature
- Gold nanospheroid
- Gold nanoshell
- Surface plasmon resonance (SPR)
- Quasi-static
- Theory
- Simulation
- Industry Sectors
- Authors
- Jian Zhu (1)
- Author Affiliations
- 1. Institute of Modern Physics, School of Science, Xi'an Jiaotong University, Xi'an, 710049, Peoples Republic of China