text:
Download citation file:
*For a list of the members of the U.S. Preventive Services Task Force, see the Appendix.
From the U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, Maryland
Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Financial Support: The USPSTF is an independent, voluntary body. The U.S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF.
Requests for Single Reprints: Reprints are available from the Agency for Healthcare Research and Quality Web site (www.preventiveservices.ahrq.gov).
Description: Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for colorectal cancer.
Methods: To update its recommendation, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review on 4 selected questions relating to test characteristics and benefits and harms of screening technologies, and 2) a decision analytic modeling analysis using population modeling techniques to compare the expected health outcomes and resource requirements of available screening modalities when used in a programmatic way over time.
Recommendations: The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary. (A recommendation)
The USPSTF recommends against routine screening for colorectal cancer in adults 76 to 85 years of age. There may be considerations that support colorectal cancer screening in an individual patient. (C recommendation)
The USPSTF recommends against screening for colorectal cancer in adults older than age 85 years. (D recommendation)
The USPSTF concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal cancer. (I statement)
The U.S. Preventive Services Task Force (USPSTF) makes recommendations about preventive care services for patients without recognized signs or symptoms of the target condition.
It bases its recommendations on a systematic review of the evidence of the benefits and harms and an assessment of the net benefit of the service.
The USPSTF recognizes that clinical or policy decisions involve more considerations than this body of evidence alone. Clinicians and policymakers should understand the evidence but individualize decision-making to the specific patient or situation.
The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years.
The risks and benefits of these screening methods vary. See the Rationale and Clinical Considerations sections for comparisons of the risks and benefits of different screening regimens, as well as the specific intervals for different recommended tests.
This is an A recommendation.
The USPSTF recommends against routine screening for colorectal cancer in adults age 76 to 85 years. There may be considerations that support colorectal cancer screening in an individual patient. This is a C recommendation.
The USPSTF recommends against screening for colorectal cancer in adults older than age 85 years. This is a D recommendation.
The USPSTF concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic (CT) colonography and fecal DNA testing as screening modalities for colorectal cancer. This is an I statement.
See the Figure for a summary of the recommendations and suggestions for clinical practice.
Screening for colorectal cancer: clinical summary of a U.S. Preventive Services Task Force (USPSTF) recommendation.
For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement, and supporting documents, please go to www.preventiveservices.ahrq.gov. FOBT= fecal occult blood testing.
*These recommendations do not apply to individuals with specific inherited syndromes (the Lynch syndrome or familial adenomatous polyposis) or those with inflammatory bowel disease.
See Table 1 for a description of the USPSTF grades and Table 2 for a description of the USPSTF classification of levels of certainty about net benefit.
Colorectal cancer is the third most common type of cancer and the second leading cause of cancer death in the United States. Current levels of screening in this country lag behind those of other effective cancer screening tests; it has been estimated that attainment of goals for population colorectal cancer screening could save 18800 lives per year (1). Colorectal cancer incidence and mortality show health disparities, with a disproportionate burden occurring in certain minority populations, including African Americans and Alaska Natives (2–3).
The evidence is convincing that screening for colorectal cancer with fecal occult blood testing, sigmoidoscopy, or colonoscopy detects early-stage cancer and adenomatous polyps.
Although colonoscopy is considered to be the reference standard against which the sensitivity of other colorectal cancer screening tests are compared, it is not perfect. Two types of studies to assess the sensitivity of colonoscopytandem colonoscopy studies, in which the same patient is studied twice, and studies comparing colonoscopy and CT colonographyshow that colonoscopy may miss even polyps larger than 10 mm and colorectal cancer. In addition, most of the evidence about the sensitivity of colonoscopy comes from experienced examiners in research settings. The evidence is inadequate to estimate the sensitivity in community practice; however, it is likely to be lower than in research settings.
Although single test performance is an important issue in the detection of colorectal neoplasia, the sensitivity of the test over time is more important in an ongoing screening program. Unfortunately, data that permit assessment and comparison of screening methods to detect colorectal neoplasia in a testing program over time from a population perspective are limited to data from analytic modeling.
There is convincing evidence that screening with any of the 3 recommended tests reduces colorectal cancer mortality in adults age 50 to 75 years. Follow-up of positive screening test results requires colonoscopy regardless of the screening test used. Because of the harms of colonoscopy described below, the chief benefit of less invasive screening tests is that they may reduce the number of colonoscopies required and their attendant risks.
There is adequate evidence that the benefits of detection and early intervention decline after age 75 years. The lead time between the detection and treatment of colorectal neoplasia and a mortality benefit is substantial, and competing causes of mortality make it progressively less likely that this benefit will be realized with advancing age.
The primary established harms of colorectal cancer screening are due to the use of invasive procedures initially or in the evaluation sequence. Harms may arise from the preparation the patient undergoes to have the procedure, the sedation used during the procedure, and the procedure itself.
Evidence is adequate to estimate the harms of colonoscopy. In the United States, perforation of the colon occurs in an estimated 3.8 per 10000 procedures (4). Serious complicationsdefined as deaths attributable to colonoscopy or adverse events requiring hospital admission, including perforation, major bleeding, diverticulitis, severe abdominal pain, and cardiovascular eventsare significantly more common, occurring in an estimated 25 per 10000 procedures (5).
Evidence is adequate that serious complications occur in approximately 3.4 per 10000 procedures (5).
Evidence about the harms of fecal tests is lacking (inadequate), but the USPSTF assesses them to be no greater than small.
Computed tomographic colonography images more than the colon. Up to 16% of people having their first CT colonography are found to have extracolonic abnormalities that require further testing (6). Evidence is inadequate to assess the clinical consequences of identifying these abnormalities, but there is potential for both benefit and harm. Potential harms arise from additional diagnostic testing and procedures for lesions found incidentally, which may have no clinical significance. This additional testing also has the potential to burden the patient and adversely impact the health system.
The risks for perforation associated with screening CT colonography in research settings are estimated to be 0 to 6 per 10000 CT colonography studies (4). However, these estimates may be higher than what can be expected in screened populations because the studies included symptomatic populations.
Radiation exposure resulting from CT colonography is reported to be 10 mSv per examination. The harms of radiation at this dose are not certain, but the linear no-threshold model predicts that 1 additional individual per 1000 would develop cancer in his or her lifetime at this level of exposure (7). The lifetime cumulative radiation risk from the use of CT colonography to screen for colorectal cancer should be considered in the context of the growing cumulative radiation exposure from the use of other diagnostic and screening tests that involve radiation exposure. On the other hand, improvements in CT colonography technology and practice are lowering this radiation dose.
The USPSTF concludes that, for fecal occult blood testing, flexible sigmoidoscopy, and colonoscopy to screen for colorectal cancer, there is high certainty that the net benefit is substantial for adults age 50 to 75 years. See Clinical Considerations for a comparison of the regimens for each of these tests.
The USPSTF concludes that, for adults age 76 to 85 years, there is moderate certainty that the net benefits of screening are small.
The USPSTF concludes that, for adults older than age 85 years, there is moderate certainty that the benefits of screening do not outweigh the harms.
The USPSTF concludes that there is insufficient evidence to assess the sensitivity and specificity of fecal DNA testing for colorectal neoplasia, and that therefore the balance of benefits and harms cannot be determined for this test.
The USPSTF concludes that, for CT colonography, evidence to assess the harms related to extracolonic findings is insufficient, and the balance of benefits and harms cannot be determined.
These recommendations apply to adults 50 years of age and older, excluding those with specific inherited syndromes (the Lynch syndrome or familial adenomatous polyposis) and those with inflammatory bowel disease. The recommendations do apply to those with first-degree relatives who have had colorectal adenomas or cancer, although for those with first-degree relatives who developed cancer at a younger age or those with multiple affected first-degree relatives, an earlier start to screening may be reasonable. Data suggest that colorectal cancer has a higher mortality rate in African Americans. The reasons for this differential are not well known, and the recommendations are intended to apply to all ethnic and racial groups.
When the screening test results in the diagnosis of clinically significant colorectal adenomas or cancer, the patient will be followed by a surveillance regimen and recommendations for screening are no longer applicable. The USPSTF did not address evidence for the effectiveness of any particular surveillance regimen after diagnosis and/or removal of adenomatous polyps.
The relative sensitivity and specificity of the different colorectal screening tests with adequate data to assess cancer detectioncolonoscopy, flexible sigmoidoscopy, and fecal testscan be depicted as follows:
Sensitivity: Hemoccult II < fecal immunochemical tests Hemoccult SENSA flexible sigmoidoscopy < colonoscopy
Specificity: Hemoccult SENSA < fecal immunochemical tests Hemoccult II < flexible sigmoidoscopy= colonoscopy
For the operator-dependent testsflexible sigmoidoscopy, CT colonography, and colonoscopybetter operator training and more experience have a high likelihood of improving sensitivity. Approaches related to certification, such as quality standards and possibly minimum volume requirements, could be used to achieve the goal of improving operator performance and therefore test sensitivity. Assurance of performance of high-quality endoscopy should be part of all screening programs.
Because several screening strategies have similar efficacy, efforts to reduce colon cancer deaths should focus on implementation of strategies that maximize the number of individuals who get screening of some type. The different options for colorectal cancer screening tests are variably acceptable to patients; eliciting patient preferences is one step in improving adherence. Ideally, shared decision making between clinicians and patients would incorporate information on local test availability and quality as well as patient preference.
Screening for colorectal cancer reduces mortality through detection and treatment of early-stage cancer and detection and removal of adenomatous polyps. The degree to which each of these mechanisms contributes to a reduction in mortality is unknown, although it is likely that the largest reduction in colorectal cancer mortality during the 10 years after initial screening comes from the detection and removal of early-stage cancer. Colonoscopy is a necessary step in any screening program that reduces mortality from colorectal cancer. This reduction in mortality does come at the expense of significant morbidity associated with colonoscopy. Evidence does not currently allow a differential estimate of colonoscopy-related morbidity for different age groups or for examinations done with or without biopsy.
In this context, the best measure for the morbidity that results from any screening program for colorectal cancer is the number of colonoscopies required to achieve a reduction in mortality. Although improvements in mortality will generally be associated with increasing morbidity that results from the screening and surveillance program, the goal of a screening program should be to maximize the number of life-years gained while minimizing the harms.
In a report prepared for the USPSTF by 2 groups in the Cancer Intervention and Surveillance Modeling Network (CISNET), investigators conducted microsimulation analyses that applied programs of screening to standard populations of adults in the United States (5). These analyses permitted a comparison of expected outcomes among testing strategies involving the fecal tests, flexible sigmoidoscopy, or colonoscopy (as noted below). In the models, the predicted total number of colonoscopies included those resulting from surveillance after detection of colorectal neoplasia. The models assumed lifetime monitoring by colonoscopy every 3 to 5 years depending on the number and size of the adenomas detected. It is not the intent of the USPSTF to endorse this particular approach to surveillance, but standardizing the approach to surveillance is necessary to compare screening strategies in the models.
For all screening modalities, starting screening at age 50 resulted in a balance between life-years gained and colonoscopy risks that was more favorable than commencing screening earlier. Despite the increasing incidence of colorectal adenomas with age, for individuals previously screened the gain in life-years associated with extending screening from age 75 years to 85 years was small in comparison to the risks of screening people in this decade. For adults who have not previously been screened, decisions about first-time screening in this age group should be made in the context of the individual's health status and competing risks, given that the benefit of screening is not seen in trials until at least 7 years later. For persons older than 85 years, competing causes of mortality preclude a mortality benefit that outweighs the harms.
Screening programs incorporating fecal occult blood testing, sigmoidoscopy, or colonoscopy will all be effective in reducing mortality. Modeling evidence suggests that population screening programs between the ages of 50 and 75 years using any of the following 3 regimens will be approximately equally effective in life-years gained, assuming 100% adherence to the same regimen for that period (8): 1) annual high-sensitivity fecal occult blood testing, 2) sigmoidoscopy every 5 years combined with high-sensitivity fecal occult blood testing every 3 years, and 3) screening colonoscopy at intervals of 10 years.
The strategies differ in the total number of colonoscopies that would be required to gain similar numbers of life-years. The first strategy, use of annual high-sensitivity fecal occult blood testing (sensitivity for cancer70%) that has a false-positive rate less than 10% (that is, specificity>90%), is estimated to require the fewest colonoscopies while achieving a gain in life-years similar to that seen with screening colonoscopy every 10 years. Currently available tests that meet both specifications include SENSA guaiac testing (Beckman Coulter, Fullerton, California) and fecal immunochemical tests with characteristics similar to those of the Magstream quantitative test (Fujirebio, Tokyo, Japan).
Although use of an annual fecal occult blood screening test with a lower sensitivity has been demonstrated to reduce colorectal cancer mortality in randomized, controlled trials, modeling suggests that the number of life-years gained will be greater with the strategies using higher-sensitivity tests.
For all screening modalities, the effectiveness decreases substantially as adherence to the regimen declines. At the individual level, adherence to a screening regimen will be more important in life-years gained than will the particular regimen selected. Current data are insufficient to predict adherence to any specific screening regimen at the population level.
A screening program that incorporates the option of CT colonography could help reduce colorectal cancer mortality in the population if patients who would otherwise refuse screening found it an acceptable alternative.
The potential harms from evaluation of incidental findings found with CT colonography may be large. The lifetime cumulative radiation risk from use of CT colonography to screen for colorectal cancer should be considered, as well as the growing cumulative radiation exposure from the use of other kinds of diagnostic and screening that involve radiation exposure.
Computed tomographic colonography performed by trained and experienced radiographers may not be currently available in many parts of the United States.
Patient time and burden to participate in colorectal cancer screening using test strategies that require bowel preparation are substantial. A CT colonography screening strategy that did not involve bowel preparation would decrease the burden of adherence. The cost of CT colonography is high.
Fecal DNA has potential as a highly specific test, and it could reduce harms associated with follow-up of false-positive test results.
Fecal DNA tests are evolving, and no test is widely used.
Fecal DNA is likely to have a high monetary cost per test.
Dietary approaches, such as avoidance of red meat and alcohol or consumption of diets very high in fiber, have been suggested to protect against the risk for colorectal adenomas, but these claims are based on associations present in observational studies that have thus far not been substantiated in trials. Certain nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with regression and decreased incidence of colonic adenomas, but the harms of daily NSAID use in asymptomatic persons led the USPSTF to recommend against this use in persons not at increased risk (see below.)
In 2007, the USPSTF recommended against the use of aspirin or NSAIDs for prevention of colorectal cancer (D recommendation, available at www.ahrq.gov/clinic/uspstf/uspsasco.htm).
Our understanding of optimal screening strategies would be significantly enhanced if higher-quality data were available about the natural history of small adenomas. Also, the importance of detecting flat adenomas is controversial, and there is a pressing need for further research on the natural history of these lesions.
Information is needed about the age-specific and biopsy-related harms of colonoscopy. Also needed are studies of the benefits and risks of detection and subsequent evaluation of extracolonic lesions through CT colonography. Finally, randomized trials are needed to compare screening programs using different modalities in order to define more clearly their relative benefits and harms.
Ultimately, all screening tests are merely tools, and the most important step is their actual use by patients; as such, further research into systems approaches to promoting the use of colorectal cancer screening could have a large impact on increasing the use of the tools that are available.
As noted earlier, colorectal cancer is the third most common type of cancer in both men and women in the United States (9). Progress has been achieved in reducing the cancer burden in the United States with declining rates in overall cancer deaths since the 1990s (3). However, the increasing proportion of the population older than 65 years has contributed to the increasing absolute total number of cancer deaths (2, 10). For 2008, it is estimated that 148810 individuals will be diagnosed and that 49960 will die of colorectal cancer (11).
More than 80% of diagnosed cases of colorectal cancer occur in patients older than 55 years. The age-adjusted incidence for colorectal cancer is 51.6 per 100000 persons, with a lifetime risk of diagnosis of 5.7% for men and 5.1% for women. Increased age, along with male sex and black race, are associated with increasing colorectal cancer incidence (11). Despite these disparities, the incidence rate for colorectal cancer has declined over the past 20 years among men of all racial and ethnic groups except for Hispanics/Latinos and Alaska Natives, and has stabilized among women of all racial and ethnic groups except Alaska Natives (3, 9).
In 2002, the USPSTF released a strong recommendation on colorectal cancer screening for average-risk adults age 50 years or older (12). To update this recommendation, the scope of the current review was determined to encompass 2 parts: a targeted systematic evidence review (5) to update information on selected questions from the prior review (13), and a decision analytic modeling analysis commissioned by the USPSTF to use population modeling techniques (8, 14).
The targeted systematic evidence review focused on the following key questions:
Do colorectal cancer screening programs have demonstrated benefit in reducing colorectal cancer mortality?
What is the efficacy of newer screening technologiesthe high-sensitivity guaiac fecal occult blood test, the fecal immunochemical test, the fecal DNA test, and CT colonography?
What is the effectiveness of optical colonoscopy and flexible sigmoidoscopy in community practice?
What are the harms of newer screening technologies and optical colonoscopy and flexible sigmoidoscopy in community practice?
The USPSTF also requested a report from 2 decision analytic modeling groups to offer guidance on the optimal ages at which to start and stop screening, as well as the optimal intervals for different screening modalities. The analyses were carried out by using 2 microsimulation population models, both parts of the larger CISNET collaboration funded by the National Cancer Institute.
As each individual ages, there is a chance that an adenomatous lesionthe benign precursor to colorectal cancerwill develop. Because the time between the development of an adenoma and the occurrence of a clinically observable cancer is unknown, the models incorporate different assumptions about the adenomacarcinoma sequence that yield different estimates of the average time between adenoma development and cancer diagnosis among cancer cases: a 10-year average in one model and a 22-year average in the other. Life expectancy was calculated for different screening strategies, including no screening given a 40-year-old cohort of asymptomatic individuals in the United States. The primary outcome was life-years gained relative to no screening, relative to the number of colonoscopies (4).
This update of the 2002 recommendation did not consider barium enema because it has substantially lower sensitivity than modern test strategies, it has not been subjected to screening trials, and its use as a screening test for colorectal cancer is declining.
Currently, there are 2 recognized approaches for colorectal cancer screening: assessment of stool for blood or DNA and visual inspection of the colon and rectum to find precancerous adenomas or early cancer. Since the 2002 review, several new stool-based screening modalities have become available: immunochemical fecal occult blood testing and fecal DNA testing. Certain fecal immunochemical tests have shown gains in sensitivity without excess loss of specificity when compared with established stool tests (15–16). Screening with fecal DNA is still an evolving technology, with only 1 fair-quality study in average-risk patients providing data on sensitivity (better than Hemoccult II) and on the proportion of all tests that have positive results (higher than Hemoccult II) (17).
Direct visualization techniques offer substantial benefit over fecal tests, with greater sensitivity, when considered as a single test (5). Reduced screening accuracy in the community setting, due to inadequate bowel preparation or provider skill level, may decrease the sensitivity of optical colonoscopy and flexible sigmoidoscopy. Despite these operational constraints, these screening modalities remain an important means for detecting and treating colorectal cancer and its precursor lesions.
Recent clinical studies of CT colonography suggest that this screening method may be at least as sensitive as optical colonoscopy at identifying colorectal cancer and large adenomas in the community setting (18–20).
In 2002, the USPSTF concluded that there was fair-to-good evidence that several screening methods were effective in reducing mortality from colorectal cancer (12). The only method with direct evidence for reduction of mortality is a program that tests for blood-positive stools over several years. Since the last recommendation in 2002, the mortality reduction previously reported in FUBT trials was maintained in longer-term follow-up, and a recent meta-analysis estimates the overall colorectal cancer morality reduction at 15% for biennial fecal occult blood testing (21).
There are no new trials that report on mortality for the other optical screening modalities (colonoscopy and sigmoidoscopy) or newer screening methods, such as fecal DNA and fecal immunochemical testing. The decision analytic modeling analysis performed for the USPSTF projected a comparative benefit to screening with colonoscopy, high-sensitivity fecal blood test, or flexible sigmoidoscopy every 5 years in combination with fecal testing every 3 years or mid-interval screening, relative to the other techniques studied (8). Despite the lack of direct evidence from clinical trials to ascertain which is the most effective strategy, any of the recommended screening methods is effective compared with no screening (22).
The USPSTF found evidence of harms associated with different colorectal screening programs. With all colorectal cancer screening modalities, a positive test result leads to follow-up testing, specifically colonoscopy, to resolve the diagnosis. This invasive procedure can result in serious morbidity as well as anxiety, inconvenience, discomfort, and additional medical expenses. Below, we first report known harms of each modality in single-use scenarios, and, at the end of this section, we describe the use of the accompanying decision model report to project the accumulated harms (that is, the number of colonoscopies) resulting from each program of screening over the lifetime of a hypothetical cohort of people.
No current studies adequately address any adverse effects of high-sensitivity stool tests for blood (SENSA, fecal immunochemical testing) (23).
Perforation from colonoscopy occurs in an estimated 3.8 per 10000 procedures in the United States; major bleeding is estimated to occur in 12.3 per 10000 procedures (95% CI, 7.8 to 19.3 per 10000 procedures) (4). Serious complicationsdeaths from colonoscopies in asymptomatic populations or events requiring hospital admission, including perforation, major bleeding, diverticulitis, severe abdominal pain, and cardiovascular eventsare estimated at 25 per 10000 procedures (CI, 12 to 76 per 10000 procedures) (5).
Serious complicationsdeaths from flexible sigmoidoscopy in asymptomatic populations or events requiring hospital admission, including perforation, major bleeding, severe abdominal symptoms, and syncopewere fewer than with colonoscopy. The rate of serious complications is estimated at 3.4 per 10000 procedures (CI, 0.6 to 19 per 10000 procedures) (4). Perforation from flexible sigmoidoscopy was relatively uncommon, with a point estimate of 4.6 per 100000 procedures (CI, 0.36 to 59 per 100000 procedures) (4). Proportions for other complications were not calculated because of a lack of reliable data.
Information on harms from fecal DNA testing is limited at this time. Popular misunderstandings could occur about genetic profiling and insurability, but these are without basis because fecal DNA testing relies on the detection of de novo or somatic mutation in the mucosal lining of the bowel and is not related to hereditary (germ-line) mutations (24). Despite this distinction, general acceptability may limit the use of this test.
The risk for perforation, as studied in both symptomatic and asymptomatic populations, from CT colonography is estimated at 0 to 6 per 10000 procedures (4). Because rates of perforation are higher for symptomatic persons undergoing CT colonography, the actual risk in a screening population would be expected to be on the low end of this range.
Computed tomographic colonography involves a wider area of examination than just the interior of the colon. Extracolonic findings of potential clinical significance are common and range from 7% to 16% of studies (4). It is not known whether the serendipitous discovery of these lesions results in better outcomes for patients; it is possible that they result in extra follow-up testing without associated benefit.
No studies directly addressed cancer-causing effects from CT colonographyassociated radiation exposure. The ionizing radiation from a single CT colonography examination ranges from 1.2 to 23.4 mSv, with the median exposure at 10 mSv. The average radiation dose of 2-view chest radiography is 0.06 mSv (25), and the background radiation experienced by living in the United States is 3 mSv per year (7). However, the potential risk from this low-dose exposure remains uncertain. It is not yet possible to quantify accurately the potential harms of extracolonic findings or radiation exposure associated with CT colonography (4).
As mentioned above, the risks or harms from a single administration of a screening test must be considered in the framework of how often that test will be repeated in a patient's lifetime, as well as how many invasive procedures (that is, colonoscopies) will be required to follow up on abnormal screening test results. The model commissioned for this evidence review estimates that the USPSTF-recommended strategies would result in 3756 total colonoscopies per 1000 people for the colonoscopy every 10 years strategy, 2654 total colonoscopies for the annual SENSA strategy, 2295 for the annual fecal immunochemical testing strategy, and 1655 for the flexible sigmoidoscopy every 5 years with SENSA every 3 years strategy (14). Through the lens of minimizing harms associated with colonoscopy, the flexible sigmoidoscopy plus SENSA and the fecal immunochemical testing strategies are most successful.
In considering the magnitude of benefit from a colorectal cancer screening program, the USPSTF noted with high certainty that there are substantial benefits to screening asymptomatic adults. Given the substantial benefit and small harms, the USPSTF recommends screening for colorectal cancer in all asymptomatic adults from 50 to 75 years of age. Balancing the small benefit and potential increased harms, the USPSTF does not recommend routine screening in asymptomatic adults from 75 to 85 years of age and recommends against screening in asymptomatic adults older than 85 years of age who have previously been adequately screened.
The decision modeling analysis prepared for the USPSTF used a microsimulation approach to compare the life-year gains and the total colonoscopy burden expected with various strategies (14). The number of colonoscopies expected per 1000 individuals is a proxy for harm and burden of testing because colonoscopy is the final evaluative pathway for all the screening methods, with the highest risks for morbidity, hospitalization, and (rarely) death. The models generated outcomes for 1) no screening, 2) colonoscopy, 3) Hemoccult II, 4) Hemoccult SENSA, 5) fecal immunochemical testing, 6) flexible sigmoidoscopy with biopsy, and 7) flexible sigmoidoscopy with biopsy plus Hemoccult SENSA. This decision modeling analysis did not include colonography.
The modeling analysis used life-years gained relative to the number of colonoscopies required for each strategy to calculate the net benefit, where the number of colonoscopies represents a proxy for resource utilization as well as adverse events from screening. The life-years gained relative to the number of colonoscopies for the scenarios allowed for an ordinal ranking of the different screening modalities (14) as follows: 1) colonoscopy (associated with 271 life-years gained for every 1000 persons screened); 2) SENSA, fecal immunochemical testing, and flexible sigmoidoscopy/SENSA (associated with 259, 256, and 257 life-years gained, respectively, for every 1000 persons screened); and 3) Hemoccult II and flexible sigmoidoscopy (218 and 199 life-years gained, respectively, per 1000 persons screened).
Our knowledge about the development of colorectal cancer currently builds on the concept of an adenomacarcinoma sequence, wherein it is expected that some adenomas will develop into carcinomas. The progression from a precursor lesion to colorectal cancer is a multistep process accompanied by alteration in several suppression genes over a period of 10 to 15 years (26). The long preclinical phase from the development of adenomas to colorectal cancer allows for opportunities to successfully screen, intervene, and save lives. The efficacy of screening with stool-based methods relies on the detection of bleeding or shedding of genetic material from adenomas or carcinomas. Compared with the older stool tests (for example, Hemoccult II), the newer stool-based tests are more sensitive but less specific. All optical methods rely on visual recognition of surface alterations, either texture or shape changes in the mucosa of the colorectum. Adequate preparation of the colorectum is critical to ensure visualization of these changes. The impetus for a noninvasive optical technique (that is, CT colonography) was to permit visualization with a much lower risk for perforation and other complications. However, because the field of exposure, both in terms of radiation and scrutiny, is broad with CT colonography, more studies are required to determine all the risks and benefits associated with its use. Fecal DNA technology (that is, detection of particular gene loci) may advance significantly in the coming years; data on sensitivity and accuracy of this testing are needed. This type of technology may radically alter diagnosis, risk stratification, and surveillance of a wide range of cancerous and non-cancerous gastrointestinal conditions (27).
In contrast to the 2002 USPSTF recommendation, which applied to all adults 50 years of age or older without regard to an age at which to stop screening, routine colorectal cancer screening is now recommended in adults beginning at age 50 and continuing only until age 75 (in people with adequate screening histories). The following screening modalities are recommended: high-sensitivity FOBT, sigmoidoscopy with interval FOBT, or colonoscopy. The USPSTF does not recommend routine screening for adults 75 to 85 years of age and recommends against screening adults older than 85 years of age. With this statement, the USPSTF concludes that for CT colonography and fecal DNA, there is insufficient evidence to permit a recommendation.
In March 2008, the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology (28) jointly recommended screening for colorectal cancer beginning at 50 years of age by 1) high-sensitivity FOBT or fecal immunochemical testing annually, 2) flexible sigmoidoscopy every 5 years, 3) double-contrast barium enema every 5 years, 4) CT colonography (virtual colonoscopy) every 5 years, 5) colonoscopy every 10 years, or 6) fecal DNA at an unspecified interval. The report stated that approaches offering visualization of the colon were preferred to indirect methods (available at caonline.amcancersoc.org/cgi/reprint/58/3/130). The American College of Obstetricians and Gynecologists recommends colonoscopy as the preferred method (29). In 2001, the Canadian Task Force on Preventive Health Care (30) concluded that there is good evidence for annual or biannual FOBT and fair evidence to include flexible sigmoidoscopy in periodic health examinations of asymptomatic people older than 50 years of age (available at www.cmaj.ca/cgi/reprint/165/2/206). The American College of Physicians, American Academy of Family Physicians, American College of Preventive Medicine, and Centers for Disease Control and Prevention have issued similar recommendations or endorsed the USPSTF recommendation.
Members of the U.S. Preventive Services Task Force are Ned Calonge, MD, MPH, Chair (Colorado Department of Public Health and Environment, Denver, Colorado); Diana B. Petitti, MD, MPH, Vice-Chair (Keck School of Medicine, University of Southern California, Sierra Madre, California); Thomas G. DeWitt, MD (Children's Hospital Medical Center, Cincinnati, Ohio); Allen J. Dietrich, MD (Dartmouth Medical School, Hanover, New Hampshire); Kimberly D. Gregory, MD, MPH (Cedars-Sinai Medical Center, Los Angeles, California); Russell Harris, MD, MPH (University of North Carolina School of Medicine, Chapel Hill, North Carolina); George Isham, MD, MS (HealthPartners Inc., Minneapolis, Minnesota); Michael L. LeFevre, MD, MSPH (University of Missouri School of Medicine, Columbia, Missouri); Roseanne M. Leipzig, MD, PhD (Mount Sinai School of Medicine, New York, New York): Carol Loveland-Cherry, PhD, RN (University of Michigan School of Nursing, Ann Arbor, Michigan); Lucy N. Marion, PhD, RN (School of Nursing, Medical College of Georgia, Augusta, Georgia); Bernadette Melnyk, PhD, RN (Arizona State University College of Nursing & Healthcare Innovation, Phoenix, Arizona); Virginia A. Moyer, MD, MPH (University of Texas Health Science Center, Houston, Texas); Judith K. Ockene, PhD (University of Massachusetts Medical School, Worcester, Massachusetts); George F. Sawaya, MD (University of California, San Francisco, California); and Barbara P. Yawn, MD, MSPH, MSc (Olmsted Medical Center, Rochester, Minnesota).
Members of the Task Force at the time this recommendation was finalized. For a list of current Task Force members, go to www.ahrq.gov/clinic/uspstfab.htm.
Please read the other comments before posting. Contributors must reveal any conflict
of interest.
Comments are moderated and will appear on the site at the discretion of The American
College of Physicians editorial staff. Please be sure your email address is
updated in your account, otherwise the American College of Physicians will not be
able to contact you about your comment.
Anyone can submit a comment any time after publication, but only those submitted within 4 weeks of an article's publication will be considered for print publication. One month after publication, editors review all posted comments and select some for publication in the Letters section of the print version of Annals. (Not peer reviewed)
Authors: No more than 5
Text: Word Limit 400 (excludes references), 5 references, no figures or tables
* = Required Field
Disclosure of Any Conflicts of Interest*
(applies to the past 5 years and foreseeable future) Indicate any potential conflicts
of interest of each author below, including specific financial interests and relationships
and affiliations relevant to the subject matter or materials discussed in the manuscript
(eg, employment/affiliation, grants or funding, consultancies, honoraria, speakers
bureau, stock ownership or options, expert testimony, royalties, donation of medical
equipment, or patents filed, received, or pending). If all authors have none, check
"No potential conflicts or relevant financial interests" in the box below. Please
also indicate any funding received in support of this work. The information will
be posted with your response.
Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation
The summary below is from the full reports titled Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement, Screening for Colorectal Cancer: A Targeted, Updated Systematic Review for the U.S. Preventive Services Task Force, and Evaluating Test Strategies for Colorectal Cancer Screening: A Decision Analysis for the U.S. Preventive Services Task Force. They are in the 4 November 2008 issue of Annals of Internal Medicine (volume 149, pages 627-637, pages 638-658, and pages 659-669). The first report was written by the U.S. Preventive Services Task Force; the second report was written by E.P. Whitlock, J.S. Lin, E. Liles, T.L. Beil, and R. Fu; and the third report was written by A.G. Zauber, I. Lansdorp-Vogelaar, A.B. Knudsen, J. Wilschut, M. van Ballegooijen, and K.M. Kuntz.
Read More...
Terms of Use
The In the Clinic® slide sets are owned and copyrighted by the American College
of Physicians (ACP). All text, graphics, trademarks, and other intellectual property
incorporated into the slide sets remain the sole and exclusive property of the ACP.
The slide sets may be used only by the person who downloads or purchases them and
only for the purpose of presenting them during not-for-profit educational activities.
Users may incorporate the entire slide set or selected individual slides into their
own teaching presentations but may not alter the content of the slides in any way
or remove the ACP copyright notice. Users may make print copies for use as hand-outs
for the audience the user is personally addressing but may not otherwise reproduce
or distribute the slides by any means or media, including but not limited to sending
them as e-mail attachments, posting them on Internet or Intranet sites, publishing
them in meeting proceedings, or making them available for sale or distribution in
any unauthorized form, without the express written permission of the ACP. Unauthorized
use of the In the Clinic slide sets will constitute copyright infringement.


text:
Game 6 was more of the same for the St. Louis Blues. The Blues controlled a large chunk of the game, working hard and creating numerous chances in LA's zone. Like we've seen in the last three games, it was all for naught as no one could put a puck on a collision course with the net. On the defensive side of things, the Blues made a handful of major mistakes and the Kings pounced.
Need a microcosm of this series and the Blues' season? Look at how the second period ended. The Blues had several opportunities to skate the puck out of their zone and end the period tied 1-1. Instead, they gave it away a couple times, ultimately handing it to Dustin Penner who fired a puck from the blueline past Brian Elliott with 0.2 left on the clock. The Blues were halfway to the dressing room while Penner was winding up and giving LA a 2-1 lead. The Blues quit with time left on the clock and they paid dearly for it.
The Blues lose this series 4-2 and the long summer questioning what went wrong and what needs to be fixed for 2013-14 begins.
I'll have an extensive look at the Blues and their playoff exit in the coming days. This will include player grades and my thoughts on how their play will impact any pending contract situations. I'll also try to touch on which players I think won't be returning.
For now, I leave you with what many of you are probably thinking. The Blues played some outstanding hockey against LA, but remarkably fell short in four straight games. A few pucks find their way in and a few mental errors removed and this might be a very different series.
Some players gave it their all. Some coasted even in the dying minutes of Game 6. Some players deserve to wear the Note, some don't. I'll offer up my thoughts in the next few days after everyone has had time to digest another playoff exit.
With that, I want to thank all of you that followed this blog for the 2013 season. Bring on 2013-14.
Let's Go Blues.

subset: commoncrawl


text:
8:00 am Registration
9:00 Welcome by Session Chairperson
9:15 A SCODA-Based Instrument for Nucleic Acid Extraction from Challenging SamplesAndre Marziali, Ph.D., Director, Engineering Physics, University of British Columbia
We have developed a high performance instrument based on SCODA, a novel electrophoretic concentration technology, for efficiently purifying and concentrating nucleic acids. SCODA excels in applications where common extraction techniques can fail by offering unique advantages including exceptional contaminant rejection, an unparalleled ability to enrich for low abundance nucleic acids, and minimal mechanical disturbance of samples enabling reduced cell lysis or recovery of high molecular weight DNA when desired. Due to the flexibility of the SCODA system, we are able to process samples in a variety of complex matrices, including samples that contain particulates or strong PCR inhibitors. We are also able to recover nucleic acids from extremely dilute samples, with successful concentration from starting DNA concentrations in the zeptomolar range. The non-mechanical nature of the process has allowed recovery of intact high molecular weight DNA over 1Mb. We are currently working towards extraction of circulating nucleic acids from blood and other fluid samples, selective enrichment particularly for short RNA molecules, and metagenomic sample preparation from unique sources.
9:45 Two-Dimensional Electrophoresis for the Analysis and Optimization of Complex Nucleic Acid ManipulationsPeter Estibeiro, Ph.D., Commercial Director, Lifeind ehf (BioCule)The manipulation of highly complex mixtures of nucleic acids is, in practice, a cumulative error-prone process. Low quality or damaged input material and inefficient processing reactions all contribute to loss of fidelity and compromise the biological integrity of the output data. We have developed two-dimensional electrophoresis technology that can separate complex nucleic acid mixtures on the basis of size, chemistry (DNA or RNA) and strandness. We will demonstrate how these technologies can be applied in a 10-minute step to the population-scale analysis of DNA lesions (input material quality) and used to monitor the efficiency of all stages of complex genomic manipulations to optimize the biological fidelity of the processes and thus the integrity of the ultimate output data.
10:15 Technology Focus
Use of Conventional qPCR for Sensitive DNA Methylation AssaysJohn Langmore, Ph.D., VP Commercial Development, Rubicon Genomics, Inc.Conventional research and diagnostic assays for DNA methylation involve multiple pre-analytical steps including bisulfite conversion of unmethylated cytosines to uracil, in conjunction with proprietary analytical assays such as MS-PCR and MethyLight. An enzymatic amplification method (MethylPlex) will be described that avoids bisulfite conversion, and enables hundreds of methylation assays to be performed on ng amounts of FFPE tissue or plasma/serum. The analyte-specific MethylPlex assays are non-proprietary, simple to design and employ conventional SYBRgreen QPCR. MethylPlex enables a much greater number of biomarkers to be discovered, validated, and used for patient tests.
10:30 Networking Coffee Break
11:00 Evaluation of Bead Array-Based DNA Methylation Profiling AssaysJoseph Hacia, Ph.D., Associate Professor, Biochemistry and Molecular Biology, University of Southern California
Here, we will describe the application of Illumina bead-based DNA methylation assays for the epigenetic profiling of lymphomas. This exciting new technology allows for the evaluation of over 500 CpG islands in the human genome. We uncovered a series of CpG islands that are frequently methylated in lymphoma as well as CpG islands whose methylation status is associated with clinical outcomes. Lastly, we demonstrate the excellent specificity and sensitivity of the Illumina platform through confirmatory quantitative PCR and bisulfite sequencing analysis. Overall, the bead-based DNA methylation assays show outstanding promise for genome-wide DNA methylation profiling.
11:30 Resequencing Pathogen Microarrays (RPM) for Simultaneous Detection and Definitive Identification of Known and Unknown PathogensClark Tibbetts, Ph.D., Executive Vice President and CTO, Corporate and R&D, Tessarae, LLCTessArae's Resequencing Pathogen Microarray (RPM) simultaneously detects and identifies hundreds of strains of pathogens. RPM results are gene sequences of detected pathogen(s) that distinguish between known and previously unknown variants. Two clinical studies conducted in 2005 and 2007 demonstrated superior sensitivity and specificity, with zero false positives, compared to benchmark microbial cultures and PCR tests. In a three-month interval of the 2005 study, thirteen new H3N2 influenza strains were identified on detection with RPM-generated, nearly full-length HA and NA gene sequences, different from vaccine and field strains known to be in circulation. TessArray™ RPM distinguishes human serotypes and strains of Type A Influenza as well as all combinations of Type A avian influenza (HA 1-16/NA 1-9). The RPM is the only platform that unequivocally detects and identifies any avian influenza isolates in 100% concordance with de novo gene sequencing analysis. The single RPM assay of each specimen can also detect most other viral and bacterial respiratory pathogens that can cause flu-like illness and symptoms. RPM provides single-specimen, single-test, same-day results for real-time global epidemiology.
12:00 Microarray-Based Analysis of Whole Blood Specimens as a Sequel to Globin mRNA ReductionNalini Raghavachari, Ph.D., Director, NHLBI Genomics Core, NIHGlobal transcriptome analysis of whole blood RNA using microarrays has been proven to be challenging due to the high abundance of globin transcripts that constitute 70% of whole blood mRNA in the blood. Hence, there is a critical need in multi-center clinical trials for a standardized methodology that would hone in techniques to stabilize RNA in collected specimens and increase the sensitivity and reproducibility of gene expression data generated from whole blood RNA. Addressing these issues, we undertook this study to evaluate the efficacy of reducing globin transcripts in paxgene stabilized whole-blood RNA samples for genome-wide transcriptome analyses using oligonucleotide arrays. We demonstrate here by both microarrays and q-PCR that the globin mRNA depletion method resulted in 50-60% reduction in globin transcripts in whole blood collected from healthy volunteers and sickle cell disease patients. This ultimately led to a significant improvement in microarray data quality with increased detection rate of expressed genes which overlapped to a large extent with the expression profile of PBMCs
Sponsored by
Natasha Paul, Ph.D., Senior Staff Scientist, TriLink Biotechnologies, Inc.The polymerase chain reaction (PCR) is a powerful technique used to amplify a nucleic acid region of interest, where the essential reaction components are the DNA polymerase, two short oligonucleotide primers, and the nucleoside 5'-triphosphates (dNTPs). The need for greater PCR specificity has prompted the development of "Hot Start" strategies. Herein, we describe the conceptualization and development of a unique approach to "Hot Start" activation in PCR, which involves the use of modified dNTPs containing thermolabile protecting groups. These modified dNTPs are intended to block DNA polymerase-mediated primer extension at the lower, less stringent temperatures of reaction assembly. Once assembled, "Hot Start" activation at elevated temperature induces deprotection to the corresponding unmodified dNTP, which is now a suitable DNA polymerase substrate. The envisioned advantages of the proposed new technology for improved PCR performance include its general application for use with any DNA polymerase or amplification system.
12:45 Luncheon Technology Workshop (Sponsorship Available) or Lunch on your Own
2:00 Comments by Session Chairperson
2:10 Rapid Detection and Characterization of Staphylococci Directly from Positive Blood CulturesYi-Wei Tang, Ph.D., Associate Professor, Medicine/Pathology, Vanderbilt University HospitalPhenotypic methods take several days for identification and antimicrobial susceptibility testing of staphylococcal isolates after gram-positive cocci in clusters (GPCC) are observed in positive blood cultures. We developed and validated a StaphPlex system for species-level identification of staphylococci, detection of genes encoding Panton-Valentine leukocidin (PVL), and antimicrobial resistance determinants of staphylococci. The StaphPlex system was compared to phenotypic methods for organism identification and antimicrobial resistance detection for positive blood culture specimens in which GPCC were observed. Among a total of 360 GPCC specimens, 273 (75.8%), 37 (10.3%), 37 (10.3%), 1 (0.3%), 3 (0.8%), and 9 (2.5%) were identified by StaphPlex as coagulase-negative Staphylococcus (CoNS), methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible S. aureus (MSSA), or mixed infections of CoNS and MRSA, CoNS and MSSA, or nonstaphylococci, respectively, with an overall accuracy of 91.7%. The 277 CoNS-containing specimens were further identified to the species level with an overall accuracy of 80.1% compared to a combined reference identification. High very major errors were noticed when detection of aacA, ermA, ermC, tetM, and tetK was used to predict in vitro antimicrobial resistance, but relatively few major errors were observed when the absence of these genes was used to predict susceptibility. The StaphPlex system demonstrated high sensitivity and specificity when used for staphylococcal cassette chromosome mec typing and PVL detection. StaphPlex provides simultaneous staphylococcal identification and detection of PVL and antimicrobial resistance determinants within 5 h, significantly shortening the time needed for phenotypic identification and antimicrobial susceptibility testing.
2:40 LATE-PCR and the BioSeeq: Maximum Information from a Field Based InstrumentLawrence Wangh, Ph.D., Associate Professor, Biology, Brandeis UniversityLATE-PCR and PrimeSafe™, two technologies invented in my laboratory, make it easier to construct multi-plexed single-tube assays which can be probed at low temperature with either sequence specific or mis-match tolerant probes. We are now using these methods to construct highly informative assays for several infectious diseases of global importance, including Foot and Mouth Disease (FMDV) and Avian Influenza (AI). These assays are designed to run on either standard laboratory equipment or a sophisticated portable instrument from Smiths Detection, Inc., known as the BioSeeq Portable Veterinary Laboratory. The FMDV is assay is a duplex assay designed to detect virtually all strains of this RNA virus. It includes both an external RNA control and an internal DNA control to guard against both false negatives. All targets are detected at end-point. The AI assay is a highly multi-plex assay composed of seven pairs of primers and ten fluorescent probes. It tests for both low/high pathogenic variants of Avian Influenza subtypes H5 and H7, together with their N subtypes and also detects Newcastle Virus, if Avian Influenza is not present. An internal DNA standard and an external RNA control are included to guard against false negatives. Depending on which virus is present, sets of 1-3 single-stranded DNA target sequences are amplified and detected via hybridization to their specific probes. Four colors are read at end-point by dropping the temperature to 70°, 50°, and 35° degrees C. The BioSeeq Portable Veterinary Laboratory is a light weight thermal cycler which can carry out up to five independent reactions in parallel. Each reaction is controlled by insertion of a sample preparation device that contains all of the protocols, reagents, and mechanisms needed for automated nucleic acid extraction, purification, reverse transcription, and amplification with minimum user training or bias. Several forms of telecommunications guarantee the resulting information can be relayed from virtually anywhere on earth to virtually anywhere on earth as needed.
3:10 Technology Focus
Dark Quencher Dyes Useful for Hyper-Sensitive Fluorescent Molecular Sensors: A New Versatile Approach in Probe DesignAndrei Laikhter, Ph.D., Vice President, Chemistry, Chemistry Research, Integrated DNA Technologies, Inc.The novel efficient quencher dyes for use in real-time PCR probes have been synthesized. Those dyes were incorporated into oligonucleotides either by corresponding phosphoramidite building blocks or by using suitable solid support. A number of dual labeled DNA probes were evaluated by signal to noise assays and by quantitative real-time PCR assay. We demonstrated that antraquinone type dyes quench very broad spectra of fluorescent dyes with fluorescent emission between 500 and 700 nm. And new azo quenchers are very efficient with fluorescein reporter dye.
3:25 Networking Refreshment break, Poster and Exhibit Viewing
3:55 Tech Talk: Problem-Solving Roundtables
5:10 Networking Reception, Poster and Exhibit Viewing
6:10 Close of Conference Day One
250 First Avenue, Suite 300
Needham, MA 02494
E: email@example.com
Innovation Portals
Biological Therapeutic Products
Biomarkers & Diagnostics
Biopharma Strategy
Bioprocess & Manufacturing
Clinical Trials & Translational Medicine
Drug & Device Safety
Drug Discovery & Development
Drug Targets
IT & Informatics
Technology & Tools For Life Science
Therapeutic Indications
CII Divisions
Cambridge Healthtech Institute
Cambridge EnerTech
Business Development
Corporate Information
Cambridge Innovation Institute
Executive Team
Mailing List
Request Information
Privacy Policy


text:
Get FREE Advice
Subscribe today and discover:
- 2 Home Remedies For Better Skin TOMORROW!
- Why Traditional Methods FAIL Again, and Again. And What to Do Instead
- How To Quickly Restore Your Skin's Natural Healing Powers
- And Much More...
Simple Steps to Calm Acne Inflammation in Your Skin
Having a breakout in itself can be inconvenient and embarrassing, but the whole ordeal becomes even worse when your acne becomes inflamed and painful to the touch.
This inflammation is actually caused by an infection in the breakout, triggered by the spread of p. acnes bacteria in the skin. Depending upon the severity of your acne, your acne inflammation could range from mild to moderate to highly painful. No matter how serious the inflammation and swelling in your skin may be, there are a few simple steps that you can take to calm and soothe your skin to treat your acne for good.
What Causes Acne Inflammation in the Skin?
In the basic chain of events that leads to acne inflammation, the oil glands will begin to produce excess oil, normally stimulated by stress or hormones, which will mix with dead skin on the surface of the complexion to clog the pores. As if that wasn't bad enough, the p. acnes bacteria will enter the scene by triggering infection, leading to irritation and inflammation around the acne lesion.
This acne inflammation is exhibited in symptoms of swelling, redness, discomfort, and warmth, and it is actually the result of your immune system naturally fighting against a foreign invader. In essence, inflammation is necessary to keep your skin protected from outside damage, but you can stop these painful problems before they start by attacking your inflammatory acne at its source.
Acne Inflammation Dietary Triggers
If you have tried product after product, cream after cream, and treatment after treatment, it may be time to look to a simpler solution to alleviate your acne: your diet. Many common acne products and treatments can provide temporary relief, yet the acne returns again in a few weeks or months later. What gives? The truth is that severely inflamed acne is linked to inflammation caused by the diet, which is often triggered by a food allergy, according to research from the Center for Food Allergies. [2] In a recent study they conducted on a 25-year-old male suffering from acne inflammation, the patient had been struggling with facial and back acne since he was a teenager. He also had a series of digestive issues, as well as itchy skin and chronic fatigue. After discovering his food allergies to dairy and gluten, the young man then altered his diet and experienced immediate relief from acne inflammation and his other digestive issues.
To further illustrate my point, check out what several sufferers of acne inflammation had to say about how their diet affected their skin at the acne.org forums:
I've been lowering my meat intake altogether, and despite being a 6'5″ guy, I'm only eating about 1200 calories per day. Nonetheless, I've always found when I'm eating the most red meat to be when I break out the most, by far.
I've been vegetarian for the past three years. Before becoming vegetarian at age 15, I had acne all over my face, red scarring everywhere, and I had awful combination skin. Every acne product would dry out my skin. Nothing worked. I became vegetarian for ethical reasons, and was shocked to find that my diet not only made me feel healthier, but also cleared up my skin a lot. My skin isn't totally clear, and I've had some help from a dermatologist, but the diet I'm on has made a noticeable difference.
I am a big believer in treating things the natural way, including acne. I think that we would all be healthier if we started incorporating the things that you mentioned into our lives. I notice that when I'm eating well and working out my skin generally looks much better than when I'm eating junk.
I'm 28 and my acne has just gotten worse over the years which of course takes a big toll on my self-image, confidence, etc.. I have recently gone back to school and am in holistic nutrition and can I tell you how right on you!?!? Seriously- for the past 2 months I have tripled the amount of green vegetables (kale, spinach, dandelion, chard, etc..) I have eaten. Truth be told, 3 months ago I didn't even know what half that stuff was! Well, so far, my skin has really improved. I'm shocked.
So what can you do today to reduce your acne inflammation? Here are a few steps to get you moving in the right direction:
- Use a daily skin care regimen with products that are appropriate to your skin type, containing only natural or organic ingredients. Remember that the chemical ingredients that you put on your skin can easily be absorbed into your bloodstream to affect your circulatory system for the worse!
- Cleanse only with lukewarm water. If you cleanse with water that is too hot, it will dry out your skin and trigger even more oil production to result in acne breakouts and inflammation.
- Examine your diet! As soon as you start to balance your diet and eliminate any trigger foods causing inflammation, you will see a noticeable difference in the quality and health of your skin. Happy eating!
There's more you should know. . .
We've really only touched the surface of what you should know about this debilitating disease that we've all grown to hate. Here at Focus:Acne, we have started an information revolution – where we put all misconceptions aside, and inform the "motivated-to-cure" on the true nature of this disease. Stop buying acne medications, stop visiting the dermatologist, and simply enter your name and e-mail below – it's time to be inspired and officially put acne in the past…
- "Acne: How Food Can Cause It." Center for Food Allergies. Web. 03 Jan. 2011. <http://www.centerforfoodallergies.com/acne.htm>.
- "What Causes Acne?" EHealthMD.com. Web. 03 Jan. 2011. <http://www.ehealthmd.com/library/acne/acn_causes.html>.
About the Author: Bethany Ramos is an aesthetician and makeup artist with a special interest in using nutrition to heal and alleviate a number of conditions in the skin. You can find out more skin care and makeup tips by visiting her blog at FacebyBethany.
FOCUS! Your Ultimate Guide to Clear Skin
Are you ready to throw away those nasty chemical lotions and creams… never pay for another expensive, worthless prescription ever again… and discover the "hushed up" truth about so-called acne cures and the 100% natural secret that's WAY MORE POWERFUL?


text:
|Girls, Infant/Baby
Im just a southern girl, born and raised in Louisiana. About 10 years ago, I was diagnosed with Multiple Sclerosis. For physical therapy and because of boredom, I took up crocheting. Right now I ...
Im just a southern girl, born and raised in Louisiana. About 10 years ago, I was diagnosed with Multiple Sclerosis. For physical therapy and because of boredom, I took up crocheting. Right now I just make all items from other peoples patterns. I have a couple of items I have recently designed, so I will be attempting writing my own patterns soon. More to come...
Well, here is the more :) I am finally releasing my first pattern! Kind of nervous, scared and excited all at the same time. I hope everyone enjoys it as much as I enjoy writing and creating it. Hugs & Best Stitches JEN
I am so glad that you decided to even check out my first pattern! This is an exciting yet nervous feeling. I hope you enjoy it as much as I do.
I had several requests for this pattern as I have made a lot of these hats for sweet little girls everywhere. The pattern has been in my head and I finally decided to write it down. The testers say it is very easy to understand and works up very quickly.
Little girls love this hat, especially ages 3-5 years. It is great for dress up, Halloween accessory, or just a cool fall hat. All little girls have dreamed of being a Disney Princess. This hat will help them feel special and so princess like.
I was inspired by the movie Tangled! Everyone always brags about Rapunzel's beautiful long hair and braids so I decided to try and recreate it! If you have any questions, please email me at firstname.lastname@example.com
*****The $1.99 Price is introductory and ONLY good until September 9th at 10:00 am CST. The regular price will be $2.99.
All patterns are copyright protected but you are welcome to sell finished products made from my patterns. However, please mention my company name along with my Craftsy shop link on your page or pictures of your work with my pattern!
Debutant Designs
See Pattern for Gauge


text:
Transfer admission is an important component of our admission process and transfer students are important members of our community. There are many reasons students are transfer candidates—sometimes financial, sometimes academic, sometimes they have refocused their interests and educational path. Some transfer applicants were unsuccessful in our freshmen admission process, but would like another chance to be considered for admission to Hamilton. Regardless of the reason, the unique perspective and appreciation for their education that transfer students bring to Hamilton is welcomed into our community.
Each year we seek to enroll approximately 10-20 transfer students in the fall, and an additional 5-10 transfer students in the spring. Occasionally, we are over or under-subscribed with our freshmen enrollment and will adjust these targets accordingly.
Students who wish to be considered for financial aid must apply by the posted deadlines. Financial aid applications for transfers candidates will not be considered after admission decisions have been made and, barring unforeseen financial hardship, those who do not qualify at the point of admission will not be eligible for financial aid while enrolled at Hamilton.
General guidelines for credit transfer are as follows:


text:
Hey you know what would be nice, if somebody could record that interview and share it to all of us somehow... I'm sure that a lot of people would appreciate that
Ellen DeGeneres, Josh Hutcherson and Betty White are among the celebrities scheduled to attend the Gay and Lesbian Alliance Against Defamation's (GLAAD) Media Awards in Los Angeles, where Chaz Bono will be honored.
At the April 21 event, Bono, an outspoken advocate for transgender rights, will receive the group's Stephen F. Kolzak Award.
Read more at : http://ohnotheydidnt.livejournal.com/68117696.html
"And when the rest of the world walks away ... I'll still be here".
I hope Ellen and Portia will attend GLAAD awards in persons this weekend and walk the red carpet
. They need to get out of the house more so we can see their beautiful faces.
Hope so too
But they don't tend to do the red carpet thing anymore.
Especially when Ellen opens a show and takes off soon afterwards. Which will probably happen.
Portia did go with her to the Peoples' Choice Awards though, so it is a possibility we see them both.
EDIT: You can sign up on the GLAAD website to watch the red carpet livestream to see if she appears:
Not sure why you have to sign up, maybe it's so they know the numbers?
And on Sunday they will have a video of Ellen opening the show.
It's a nice article on her: http://www.glaad.org/blog/ellen-dege...-show-april-21
Last edited by Bolt; 04-21-2012 at 04:47 AM.
I am watching the red carpet now using this link.
Ellen doesn't always walk the red carpet so we might not see her.
awsome thanks for the new never get a chance to get on here
Ellen DeGeneres is one of a kind Portia is one of a kind
Thanks to @LICKIucroj !! posted this tweet :
I see you @TheEllenShow. But really. #glaadawards http://pic.twitter.com/WydbxYyC
Thanks to @YMandCharlie !! @ellendegeneres starting off the night #glaadawards http://instagr.am/p/JtKac0iWE3/
Thanks to @MillaJovovich !! Check it! Ellen at the #GLAADAWARDS! http://tweetreel.com/?9gmef
Last edited by Clau_17; 04-21-2012 at 09:13 PM.
"And when the rest of the world walks away ... I'll still be here".
There are pictures of Ellen and Portia at the GLAAD Awards on wireimage.com
"You know I'm close, I'll always keep my promises. I'll always listen when you talk to me, And I'll always hear you. Yeah" Ellen Theme Song


text:
Shop b-glowing's Cult Classic Beauty Picks.
We love introducing devotees to new brands and products, especially those that have a strong cult following. In our Cult Classic Beauty Picks boutiques, we've taken the guesswork out of trying new lines by hand-selecting our favorite products in Skincare, Makeup, Fragrance, Hair Care, Bath + Body, and Men's.
For unpredictable skin, we love the Tanda Zap! It's lightweight, inexpensive and serves dual purposes. Not only is it great for acne prevention, but it also works to speed up the healing process of existing blemishes. Talk about a miracle worker!
The specialized blue light is used to target the specific type of bacteria that causes acne, so you end up giving your skin an actual fighting chance and a head start before skin-clogging bacteria can do its damage. Once a blemish has occurred, the light still works against the active bacteria, destroying it and significantly reducing the irritation and inflammation.
Some tips on use:
-Make sure your hands and skin are clean. Never touch your face with dirty hands: the golden rule!
-Make sure the device is clean, as bacteria can build on it between use. Simply wipe it down with warm water and antibacterial soap. Do not submerge device in water.
-For preventive measures, think of your face as four quadrants and spend some time on each area by moving the device around slowly.
-For existing blemishes, place the device close to, but not directly over, the area and treat as necessary. It's very important to clean device between uses.
Golden Globes Inspired Mani » -
As per usual, Zooey Deschanel had some of the best nails on the red carpet at this year's Golden Globes, which gave us some serious nail inspiration. We loved the femininity and simplicity of her nails, plus the added glamour of the gold, so our resident nail artist got to work on a Zooey D-style mani.
Step 1: Apply Your Base
Always start with clean, buffed nails, and apply a base coat for mani longevity, and to protect your nails. We used a sheer beige/pink base to keep the nail look natural and clean. For this we used Tenoverten's Houston. Two coats will do just fine, and don't worry about slight transparency.
Step 2: Dots
Once the base color dried for about 5 minutes, we added our gold dots for the centers of the daisies. The tip of the polish brush is quite perfect for making the small, slightly raised dots. Just a few dabs on the nail with the brush will give the desired effect. Make sure to spread them out so you have room to paint the petals of the daisies.
For this we used Lushington, new from butter LONDON's Boho Rock Collection. Zooey's manicure has bigger and fewer daises, but we opted for a smaller flower. The choice is yours! These will take longer to completely dry, but after a few minutes you can move on to your next step.
Step 3: Petals
To create the petals we used a small pointed nail brush. For those of you without these tools around, a steady hand and the tip of a bobby pin will work, too. We chose a light blue, instead of white, just to add a pop of color; we used Blue Orchid from Deborah Lippmann's spring 2014 line.
The easiest way to dip your brush into the polish is to pour a small amount onto a dish. Starting from the gold dot, lightly drag the brush with your petal polish outward. Try to keep them the same length, and don't crowd too many petals on one dot. Your brush will start to accumulate polish, so be sure to wipe the brush periodically.
Step 4: Gloss
Give your mani sufficient time to dry before applying your top coat—a good 15 minutes, just to be safe. Once dry, apply a top coat of your choice to seal the look and create a high shine. Now you, too, have sweet and sophisticated red carpet nails!
We want to see your red carpet looks! Follow us on Instagram and Facebook and tag #awardshowglow on your hair, nail, and makeup pics.
Get your best skin this winter by taking care with five essential steps.
Pre-cleanse: loosens and breaks down makeup to pull impurities to the surface.
• Apply your pre-cleanser to the forehead, cheeks, nose, and chin and add a little water to help with distribution. Using the tips of fingers, work the pre-cleanser over the skin in small circles making sure to get the side of the nose and hairline. Work over the face twice and lightly rinse with water. You do not need to completely remove pre-cleanser. This is also a good time to remove any eye makeup. An eye makeup remover may be necessary for waterproof mascaras, but a pre-cleanser will loosen most eyeliners and shadows.
Cleanse: Effectively remove makeup, debris, and environmental build up.
• Apply your cleanser in the same manner you would your pre-cleanser and work in the same directions. Work over the face twice and rinse thoroughly. If you still feel like you have excess makeup a second cleanse can be done. Some people only need to wash their face once a day, and if you are a makeup wearer, do this at night, as you never want to sleep in your makeup.
Masks/Exfoliators: Exfoliate to keep pores from clogging with dead skin cells. Masks can be treatment-based to help fight signs of aging, prevent acne, or help treat other problems.
• There are a few types of exfoliators; some are mechanical (beads, sugar, etc), and some are chemical (typically mild safe acids, such as salicylic), and some are even both. Sensitive skin types will usually benefit most from one or the other but not a combination.
Most exfoliators should be worked over the face in the same manner as a cleanser, but spend extra time on problem areas, such as the sides of the nose and the middle of the forehead, between the brows. These areas tend to accumulate dead skin and oil-causing blackheads.
Pay attention to your skin, and go at your own pace. If you feel that something is irritating, or your skin appears redder than usual, maybe skip a day of exfoliating.
• Masks are pretty fool proof, as you apply them evenly to the face or problem area, leave them on for recommended time, and the remove thoroughly with a damp cloth.
Toner: Works to balance skin's pH levels and refine pores.
• Some toners are mists, while others are applied with a cotton pad or ball. Whichever you choose, make sure you are covering all areas of the face and neck so that the skin is balanced and ready for any serums and moisturizers.
Serum: These active treatments penetrate the skin's top layer to combat various concerns.
• Serums are generally used to target a concern, such as anti-aging, dark spots, acne or others, so they should be used in your problem areas. Apply liberally, but also make sure you are concentrating the product to the area needed. Allow serums to dry and settle before applying your moisturizer.
Moisturizer: Lastly, provide appropriate lubrication to ensure healthy and happy skin!
• Moisturizers should be applied evenly over the face and the neck. If you are looking to add sun protection to your regimen, now is the time to do it! Moisturizer should be set and dry before applying any makeup.


text:
Created using this Craftsy indie pattern
This project was made from an independent Craftsy designer's pattern:
CinderElla Graph Pattern »
by Holliday Crafts
Recent projects from Craftsy Crocheting classes:
CrochetingCrocheted Baby Cardigan
Offer some kudos...
Join the conversation...
Ask a question...
Add your comment...
Love it!
09/03/2012 Flag
Did you make it with sc?
01/22/2013 Flag
Afghan stitch
04/26/2013 Flag
very pretty I'm considering purchasing your pattern I'd like to know what yarns you used though
04/21/2013 Flag
I used 4 ply Red Heart. Thanks
04/26/2013 Flag


text:
Los Angeles Treat: Giveaway of Free Admission to the Sassy City Chicks Fashion Bash
This is a little Halloween treat for my Los Angeles/Southern California readers. I'm giving away up to 50 free tickets/ Free passes to a the Sassy City Chick shopping event in Los Angeles, on Thursday, Nov. 4th at the Petersen Auto Museum. Click here to see a list of some of the designers offered at past Sassy City Chick events, and I think you might want to check out the shopping. 🙂 To get the free tickets, click on this link, then:
1) Go to the Ticket Info tab across the top of the invite picture on the website, and select a Sassy City Chicks Tote Ticket (the $25 ticket).
2) At checkout just enter the code CHEVROLET and type in the name THE RECESSIONISTA in the "How did you hear about us?" space and you''ll receive the ticket for free.
If you like to shop, and want to see the Petersen Auto Museum (which is a very cool place) , plus get a little swag bag for free, this is a good deal! Thanks to Chevrolet for sponsoring this and offering the tickets. I'll be there on Thursday night and hope to see some of you there.


text:
manly men's soaps
Move over Old Spice, Axe, and other guy-focused products. Manhands Soap is here.
Soaps made to actually smell like a real man, in scents like bonfire, beer, and top soil, not coconut-pheremone-infused silky body washes. MMMmmmmm...smell the manliness.
Available for purchase here.
posted by a_blodder @ 8:05 AM
0 comments
<< Home


text:
Dust: An Elysian Tale Screenshots for Xbox 360On: Xbox 360, PC
Winner of the 2009 Microsoft Dream. Build. Play. challenge, Dust: An Elysian Tale is a 2D action-RPG set in the beautiful fantasy world of Falana.
Review Verdict Read Review
7Out of 10Back to game info
Latest Articles for Dust: An Elysian Tale
May 2014 Games With Gold titles are Dust and Saints Row: The Third
Dust set for May 1, followed by Saints Row: The Third on May 16.
Summer of Arcade 2012 titles priced and dated
The Xbox LIVE Summer of Arcade 2012 begins July 18 with the release of Activision's Tony Hawk's Pro Skater HD, priced 1200 MS Points.


text:
Home Page | List Your Yacht | Help | Members Login | Add Your Site | About Us | Disclaimer
|Sabre Yachts manufactures luxury sailboats to the certification levels of the National Marine Manufacturers Association, the American Boat and Yacht Council, and the European CE. The yachts have been hand-built in South Casco, Maine since 1971. Sabre yachts have customization ability on various levels, and Sabre uses concepts that reflect agile manufacturing in order to provide this flexibility. The sailing yachts produced by Sabre are a combination of a cruising yacht with a racing yacht, from 38 feet to 42 feet in length. They are designed to carry a heavy or high load. Sabre keels are formed to achieve maximum lift for the yacht, while maintaining solid performance. The sail plans are created with both light winds and harsh weather in mind. The Sabre 426 won Sail Magazine's Top Ten award.
Yachts .com - The #1 Resource For Yacht Enthusiasts
Yachts .com is a publication and trademark of MediaInsights.com
©1997-2016 Rights Reserved
|Page views this month: 114
|Page views this year: 1076
|Page views since 10/9/2003: 19263


text:
Image: Twilight Tours, 2005
One of the 'Fabulous Fishes' Twilight Tour groups in the tank area, 3 August 2005.
- Photographer:
- Mark McGrouther
- Rights:
- © Australian Museum
On the evening of 3 August 2005, Museum staff ran behind the scenes tours through many of its collections. The Fish Department participated as usual.
Members of the public were taken on two 'fabulous fishes tours' through the Spirit House and Tank Area. Tour participants were shown through the main collection area where 'adult' specimens are stored in jars and drums on moveable compactor units. Also stored in the Spirit House are thousands of vials containing the tiny fishes that make up the huge larval fish collection. Deepsea fishes are always of interest. Tour participants examined the toothy Murray's Abyssal Anglerfish and the 'reproductively-bizarre' Haplophryne mollis.
In the tank area visitors saw the strange Goblin Shark specimens and were able to touch a juvenile White Shark.
Last Updated:
Tags Twilight Tours 3 August 2005, fishes, ichthyology,


text:
Bart Inman Air Heating & Cooling
Bart Inman Air Heating & Cooling is the most trusted St. Louis heating and cooling repair company. As a full service heating and air conditioning company in St. Louis, Bart Inman Air offers a complete range of services for both residential and commercial properties. Bart Inman Air has been serving the St. Louis area for years, and we have become the name that people trust for heating and cooling needs. Bart Inman Air specializes in heating and cooling repairs, maintenance, sales, and installation services for all makes and models of heating and cooling systems.
As for our expert HVAC technicians, they are all trained and certified professionals that will treat you and your home with courtesy and respect.
If you are looking for an affordable solution to making your living or work environment more comfortable, have the job done right the first time with the expert HVAC technicians at Bart Inman Air!
Heating & Cooling Services
- Heating services
- Furnace repair & maintenance
- Furnace installation
- Air conditioning services
- Air conditioner repair & maintenance
- Air conditioner installation
- Commercial heating and air conditioning
- Emergency heating and air conditioning repair
- Technicians available 24/7 for emergency services
- Energy audits
Proudly Serving the St. Louis Metro Area
Special Offers & Incentives
At Bart Inman Air, we offer our clients a number of special incentives and discounts throughout the year on new purchases or repairs. Our expert HVAC technicians can help you take advantage of any available special rebates, incentives, or programs.


text:
Ally Bank Still Offering 0.25% Certificate of Deposit Loyalty Bonus
|Email Print
I had a 11-month No Penalty certificate of deposit maturing this month and was pleased to learn that Ally Bank was still offering a 0.25% interest rate loyalty bonus if you renew the CD. When you renew, you can change the maturity of the CD and even increase or reduce how much you are saving. I took the opportunity to make the 11-month no penalty CD into a whole year regular CD, juicing the interest rate up a few fractions of a percent, and called it a day.
If you wanted to take advantage of this bonus as quickly as possible (and if you don't already have a CD there), I think you're can just open a CD for 3 months for $1 and then renew it with more money and for a longer period. (and I bet Ally Bank wouldn't really care!)
The best part was that the whole process took just a few minutes using their online chat. I was logged in before I started the chat and all I had to do was confirm my phone number and address. Not bad for a day's work!{ 1 comments, please add your thoughts now! }


text:
|Version 15 (modified by davidh, 9 years ago) (diff)
Getting Started
Project.net is a web-based application for planning and coordinating projects. It groups your organization into businesses and sub-businesses containing projects and, optionally, sub-projects. A project consists of tasks, schedules, deliverables, milestones, resources, and documents. Project.net helps project teams and project managers control and monitor these essential items.
- For teams - Project.net makes it easy to manage schedules, track deliverables and milestones, store documents, share calendars, create discussion groups, route items through workflows, and leverage repeatable processes.
- For project managers - Project.net enables at-a-glance access to the health of a complete project portfolio or an individual project. It will track schedules, budgets, and deliverables employing summaries, status reports, and emailed alerts.
This Getting Started document is designed to give a quick overview of Project.net, allowing you to start utilizing the application quickly.
Project managers have access to a Project Outline that will help guide you through the project management process. For more information or further details, please refer to the Project.net User's Guide.
Accepting an invitation
To join a project, the project manager will send an email invitation from Project.net. Click the project URL link in the message (Figure 1), which will take you to the Project.net Registration screen.
Figure 1. Email invitation
Registration is an easy process:
- First, read and accept the End User License Agreement. Click Next .
- Select your registration Domain. For most, this is Global Domain . Click the Next button.
- You may be prompted to enter a license key, given to you by your administrator. If so, enter the key, and then click Next.
- Now, complete the registration fields (Figure 2). Note, required fields are marked with bolded text.
NOTE: Remember your login name and password. You will need this information each time you log into Project.net.
- Click the Register button. A verification code will be emailed to you.
- Finally, retrieve the email and click the URL link to return to the final registration page. Enter your email address and verification code. Click Verify Now to complete registration and go to the Login screen.
Figure 2. Registration screen
Logging in to Project.net
- Open a web browser and go to prm.project.net.
- From the Login screen (Figure 3), enter your Login
Name and Password.
- Click the Login button.
Oops! I forgot my password
- Open a web browser and go to prm.project.net.
- From the Login screen, select Forgotten Password
or Login Name.
- Select your registration Domain. For most users, this
is Global Domain. Click the Next button.
- The Login Name / Password wizard appears (Figure
- Enter your email address in the email field, and
select either Forgot your password? or Forgot your login name? Click the Next button.
- Enter your current user name and answer the jog
question you created when you registered.
- Click the Next button. Project.net automatically
sends an email to you with a new verification code.
- Retrieve the email and click the URL link. The
Forgotten Password or Login Name screen appears.
- Complete the password fields.
- Click the Finish button.
- From the Login screen, enter your login name and new password and then click the Login button.
Logging out of Project.net
- From any screen, click on the Log Out link located at
the top of the screen, as shown in Figure 5.
- You are returned to the Project.net login screen.
3.Understanding the Components
After you login to the Project.net application, you will arrive at your Personal workspace page. A workspace is a visual area where you can review and work on project activities. Project.net has three workspaces (Personal, Business,and Project) that are designed for different functions. You will always enter the Personal workspace page after logging in to Project.net.
The Personal workspace is YOUR page, unique to you. Think of it as your privatevirtual office. The Personal workspace provides information about all the projects and businesses of which you are a member. This section is color coded in yellow (Figure 6). The Navigation toolbar on the left links to the other available features for the workspace. This navigation menu changes based on which workspace you are working in. The Action toolbar appears at the top right of the page. Channel bars (Site Status, My Projects, New Items, etc.) divide the workspace NOTE: You can personalize your workspace by clicking the Personalize this Page link at the bottom of the page.
The Business workspace is similar to an office building containing people and projects. Business workspaces are used to group projects and people by company, business unit, department, and customer. This section is color coded in green (Figure 7).
NOTE: The navigation toolbar for the Business workspace appears AFTER you click a Business link. Figure 7. Business workspace The Project workspace is similar to a team room or project war room. The Project workspace is where all team members share and manage projects. This section is color coded in blue (Figure 8). NOTE: The navigation toolbar for the Project workspace appears AFTER you click a Project link. The Project workspace contains a Search feature that allows you to search for information quickly. Figure 8. Project workspace 4 Understanding Screen Elements Let's break down the elements that appear on a Project.Net screen further. Please refer to Figure 9. Figure 9. Project.net elements The content area contains three workspaces: Personal Business Projects . More details about each workspace can be found in Understanding the Components. The Personal workspace is shown in Figure 9. The navigation menu on the left is the Toolbar. Use it to move through the different modules within a workspace. See The Toolbar section of this document for more information. NOTE: The toolbar features change with each workspace. For the Business and Projects workspaces, you will need to click a particular business or project to view the navigation toolbar. At the top of the content area is a set of icons called the Action bar. These icons change depending upon the workspace you are in and where you are in that specific workspace. See the Action bar section of this document for more information. The Help feature offers assistance for a particular page. NOTE: Currently, Help does not include an index or search feature. Channel bars divide the workspace. Think of channel bars as another way to display topics visually. The channel bars differ depending upon your workspace. Click the or buttons to collapse or expand each channel bar. View any projects you have accepted under the My Projects channel bar. You can also see any new items that have been added in the New Items channel bar. Your can respond to a request by using the Accept or Decline buttons. If you do not want a channel to appear in your content area, click on the to remove it. To have the channel bar reappear on your workspace, select the Personalize this Page link at the bottom of the screen. From the Channel Manager, select the channels that you want to appear on your workspace, and then click the Submit button. 5 Action Bar The Action bar is available in all three workspaces (Personal, Business, and Project). This bar appears in the upper right section of each page (Figure 9, Item 3). The Action bar is tailored to a workspace and page, and provides a fast method to complete tasks. When an action is not available for a page, that icon is disabled (grayed out). Below is a list of the most common icons in the toolbar. NOTE: Action bar functions can vary from page to page, with certain actions limited to specific pages. For more information on the Action Bar, refer to the Project.net User's Guide. Icon Action Description Create Creates a new item. Depending on the page, this will create a new project, document, discussion post, and so forth. Modify Modifies the selected/current item. Delete Deletes the selected/current item. Refresh Refreshes the information on the current page. NOTE: If the page is a form, selecting this icon will reset all form values to their original values. Properties Displays the properties of the selected/current item. Link Links other information to this item. For example, you can link documents or issues to a task. Workflow Adds the selected item to a workflow envelope and launches the Workflow Envelope Wizard to route the item through a workflow. Search Searches for information within the project workspace. Notify Indicates that you would like to be notified when the selected document or object is modified. Help Displays Help for the current page. Security Shows the current security level or the required security needed to view, modify, or perform other functions on the selected object. Special icons for the Documents module Icon Action Description Check out Checks out a document from the Document vault. Check in Checks in a document to the Document vault. View Opens a document so you can view it. Undo Checkout Cancels a check out. New Folder Adds a new folder. Move Moves a document or folder. 6 The Toolbar Like the Action bar, the Toolbar changes depending on what workspace you are in and what you are doing. Two example toolbars are shown to the left. The most common Toolbar options are described below. The icons on the right indicate the workspaces where you will see these options. Dashboard Gives an overview of the current workspace. It is essentially the "home page" of each workspace. Directory Provides information about the workspace participants, their roles, and their assignments. Documents Stores and tracks project-related documents. Discussions Provides threaded discussion groups within a workspace. Forms Offers customizable forms to collect and track specific information. Once created, a form can be used repeatedly. Projects Gives an overview and list of all the projects in a business. Calendar Displays at-a-glance all events, tasks, meetings, and milestones for all workspaces you are a member of. Workflow Allows you to define a series of tasks as a Workflow. Using a Workflow, you can automatically route items to and from other users. Templates Enables you to create templates, or reusable components, from existing projects. Templates are used to create new projects quickly. News Allows easy access to read and post project-related news items. It is like a virtual bulletin board. Workplan Shows current tasks, milestones, and other project metrics. This view allows you to track detailed project status quickly. Setup Stores personal, business, and project related information, and allows you to personalize some aspects of Project.net. Other Project.net terms Process – The Project Process Module is essentially the Lifecycle of the project. This is the area where tasks and deliverables are defined. It is the heart of the project. Phase – Phases are the different parts of the process. Projects are divided into phases, ending in gates. Each phase consists of deliverables, tasks, and milestones. Phase-Gate – A review of the past phase. Usually a meeting to decide if a phase's goals have been met and whether to go forward with the project. Roles – The Project Team is divided into Roles. Roles are a convenient way of structuring projects. Users can use roles to organize tasks and to set security. Workflow Envelope – An envelope contains specific items, such as a form or document, which are being routed through a workflow.
Attachments (1)
- Figure 2.gif (28.0 KB) - added by davidh 9 years ago.
Download all attachments as: .zip