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Picture Perfect - April
Published On: Apr 03 2013 04:14:28 PM CDT Updated On: May 03 2013 12:52:06 PM CDT
Check out your "Picture Perfect" photos that appear on News 8 at Noon.
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Comedian Ron White coming to Riverside
"Blue Collar Comedy" star Ron White is returning to the Riverside Theater April 12.
Last time White was in town was February 2012, when he performed stand-up at a sold-out Riverside. That's a typical accomplishment for White: he's sold more than 10 million CDs and DVDs and has been one of the top three grossing touring comedians in the U.S. over the past five years. »Read Full Article
Scrap between Time Warner Cable, WTMJ-TV shows in November numbers
The first ratings sweeps period since the two-month blackout of WTMJ-TV (Channel 4) on Time Warner Cable sees the ratings playing field returned to nearly normal. But if WTMJ suffered residual damage, so did Time Warner.
WISN-TV (Channel 12) won its sixth consecutive 10 p.m. news sweeps ratings race; WITI-TV (Channel 6) won the 6 a.m. news slot; the WTMJ news won at 5 p.m.; and WDJT- TV (Channel 58) beat all newscasts at 6 p.m. with "Jeopardy" and is inching toward third at 10 p.m. »Read Full Article(4)
Chance the Rapper is playing by his own #NewRules
This past Saturday, 20-year-old Chicagoan Chance the Rapper stopped through Milwaukee on his "Social Experiment" Tour. I expected the show at The Rave to be packed with tons of young fans eager to hear him perform songs from his critically acclaimed 2013 mixtape Acid Rap, especially since those under 21 couldn't get into his first Milwaukee show at Harley Davidson's 110th Anniversary this summer. And yeah, it was packed. What I did not expect was the live band, original video production, full light set up, three separate videographers or his complete command of the stage from beginning to end. »Read Full Blog Post
New Glarus Wild Sour Ale the only Wisconsin beer included in Top 25 beers of 2013
Let the end-of-the-year lists begin. And let it begin with beer.
DRAFT Magazine posts its list of top 25 beers of 2013. Author Christopher Statem lauds the flexibility of IPA and says research helped him discover that "for every flawless traditional style, there was a mind-blowingly weird beer counterpoint." »Read Full Article
Time Warner Cable lost subscribers during WTMJ blackout
Media and communications financial monitoring firm SNL Kagan estimates that Time Warner Cable lost 10,350 subscribers in the Milwaukee market during the third quarter of 2013.
Based, conservatively, on an average cable bill of $100 per month that figure represents a loss of about $12.4 million per year. (100 x 12 x 10,350) »Read Full Blog Post(48)
Milwaukee radio ratings for November: WMIL is champ, WTMJ strong
Below is the audience share for Milwaukee radio stations among listeners 6 and older - also known as total audience - between 6 a.m. and midnight in November.
Clear Channel country music station WMIL-FM (106.1) again is the market leader; it has won every ratings period in 2013. Journal Broadcast Group news, sports and conservative talk WTMJ-AM (620) jumps from third to second, and does so without Milwaukee Brewers baseball. »Read Full Blog Post(8)
Frankly Music crew shapes Barber, Schonberg work beautifully
Apparently, the Frankly Music concert series is not just about instrumental music.
Baritone Kelly Markgraf joined violinist Frank Almond and a roster of instrumentalists that shifted with each piece at the Wisconsin Conservatory of Music Monday evening to present a stirring, fascinating evening of music just slightly off the proverbial beaten path. »Read Full Article
Suburban Bourbon restaurant-bar in the works in Muskego
A restaurant and bar called Suburban Bourbon -- specializing in bourbon, whiskey and Scotch on the drinks side and slow-cooked meats on the food side -- is planned in Muskego.
Remodeling has begun at S76-W17745 Janesville Road, formerly High Tide pub and, before that, Williams Supper Club. It could open as soon as late January. »Read Full Blog Post
On Tap Today: Nicholas Lampert discusses 'A People's Art History of the United States'
If you possess the (misguided) perception that art doesn't bring about social change, Nicholas Lampert has a new book to prove you wrong.
The local artist and University of Wisconsin-Milwaukee faculty member has a new book out, "A People's Art History of the United States: 250 Years of Activist Art and Artists Working in Social Justice Movements." Journal Sentinel arts writer Mary Louise Schumacher recently described the book as "ambitious" and "richly illustrated," saying it "puts art history and the worlds of politics and social justice back together where they belong." »Read Full Blog Post

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On this day: April 19
Published On: Apr 17 2013 02:37:03 PM CDT Updated On: Apr 19 2016 01:00:00 AM CDT
The American Revolutionary War breaks out, the Soviet Union launches the first space station, the Waco siege ends in a deadly blaze, and homegrown terrorists strike Oklahoma City, all on this day.
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A healthy lifestyle is the first defense against high cholesterol. But sometimes diet and exercise aren't enough, and you may need to take cholesterol medications. Cholesterol medications may help:
- Decrease your low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol that increases the risk of heart disease
- Decrease your triglycerides, a type of fat in the blood that also increases the risk of heart disease
- Increase your high-density lipoprotein (HDL) cholesterol, the "good" cholesterol that offers protection from heart disease
Your doctor may suggest a single drug or a combination of cholesterol medications. Here's an overview of benefits, cautions and possible side effects for common classes of cholesterol medications.
|Drug class and drug names
|Possible side effects and cautions
Altoprev (lovastatin)
Crestor (rosuvastatin)
Lescol (fluvastatin)
Lipitor (atorvastatin)
Mevacor (lovastatin)
Pitavastatin (Livalo)
Pravachol (pravastatin)
Zocor (simvastatin)
|Decrease LDL and triglycerides; slightly increase HDL
|Constipation, nausea, diarrhea, stomach pain, cramps, muscle soreness, pain and weakness; possible interaction with grapefruit juice
|Bile acid binding resins
Colestid (colestipol)
Questran (cholestyramine/ sucrose)
Welchol (colesevelam)
|Decrease LDL
|Constipation, bloating, nausea, gas; may increase triglycerides
|Cholesterol absorption inhibitor
Zetia (ezetimibe)
|Decreases LDL; slightly decrease triglycerides; slightly increase HDL
|Stomach pain, fatigue, muscle soreness
|Combination cholesterol absorption inhibitor and statin
Vytorin (ezetimibe-simvastatin)
|Decreases LDL and triglycerides; increases HDL
|Stomach pain, fatigue, gas, constipation, abdominal pain, cramps, muscle soreness, pain and weakness; possible interaction with grapefruit juice
Lofibra (fenofibrate)
Lopid (gemfibrozil)
TriCor (fenofibrate)
|Decrease triglycerides; increase HDL
|Nausea, stomach pain, gallstones
Niaspan (prescription niacin)
|Decreases LDL and triglycerides; increases HDL
|Facial and neck flushing, nausea, vomiting, diarrhea, gout, high blood sugar, peptic ulcers
|Combination statin and niacin
Advicor (niacin-lovastatin)
|Decreases LDL and triglycerides; increases HDL
|Facial and neck flushing, dizziness, heart palpitations, shortness of breath, sweating, chills; possible interaction with grapefruit juice
|Omega-3 fatty acids
Lovaza (prescription omega-3 fatty acid supplement)
Vascepa (Icosapent ethyl)
|Decrease triglycerides
|Belching, fishy taste, increased infection risk
Most cholesterol medications lower cholesterol with few side effects, but effectiveness varies from person to person. If you decide to take cholesterol medication, your doctor may recommend periodic liver function tests to monitor the medication's effect on your liver. Also remember the importance of healthy lifestyle choices. Medication can help control your cholesterol — but lifestyle matters, too.
Source: http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/cholesterol-medications/art-20050958


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A man and a woman got into "a physical altercation" over what was on their television Sunday evening, state police in Armstrong County said.
Darren Lutheran and Shelli Craig were at home in Pine Township at about 6:40 p.m., and a visitor was watching "SpongeBob SquarePants" instead of the Steelers game, police said.
Nobody was injured during the incident on Rupp Lane, police said.
Lutheran, 43, and Craig, 44, were each cited for harassment via summons from District Judge Sam Goldstrohm's office, police said.


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Radiation is usually given to relieve symptoms caused by melanoma that has spread to the bone or brain. It generally does not cure melanoma. In certain circumstances, radiation therapy may be offered in a more curative approach. When radiation therapy is given after surgery, it may help reduce the chances of the cancer coming back and/or spreading to the nearby lymph nodes. Radiation also may be used when melanoma has come back after surgery. In any case, the successful treatment of melanoma is a multi-modality approach and surgeons, dermatologists, medical and radiation oncologists should be involved in your care and should work together from the beginning to plan your best course of treatment.
External Radiation Therapy
In external beam radiation therapy, radiation is produced by a machine called a linear accelerator. Short bursts of x-rays are fired from the machine at your cancer. The x-rays come out in a square-shaped manner, and the radiation oncologist designs special blocks to shape the radiation beam so that it treats the cancer and as little normal tissue as possible.
Like chemotherapy, the side effects from radiation result from injury to the normal tissues. There are many new ways that the radiation oncologist can customize your treatment to try to kill as much cancer while sparing as much normal tissue as possible. The radiation oncologist will determine how many treatments you will receive.
You may experience side effects common to radiation therapy, including:
- Fatigue
- Skin changes, like redness or irritation
- Nausea and vomiting
There are treatments to reduce side effects. Talk to your doctor before you start treatment or as soon as side effects appear.
Revision Information
- Reviewer: Mohei Abouzied, MD
- Review Date: 03/2016 -
- Update Date: 03/15/2015 -


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Chicago Bulls Autographed Memorabilia and Collectibles
With six NBA championships to boast from, the Chicago Bulls are one of the winningest franchises the NBA has ever seen. The franchise enjoyed one of the most successful runs by any NBA team during a stretch from 1991 to 1998 as they won six titles and claimed seven division crowns. The Bulls' legacy is spearheaded by Hall of Famers, Michael Jordan and Scottie Pippen, who led the team to their six titles during the 1990s.
Behind the stellar play of Michael Jordan, who is widely regarded as the best basketball player ever, and Scottie Pippen, the Bulls established themselves as one of the most dominant teams ever. Chicago is the only NBA franchise to win multiple titles and never lose an NBA Finals in their history.
The history of the Chicago Bulls begins and ends with the story of Michael Jordan. The Bulls drafted Jordan with the third overall pick in the 1984 NBA Draft and that move eventually changed the franchise forever. Jordan went on to win five NBA MVP awards, was named an All-Star 14 times, claimed ten scoring titles, and led the team to six NBA championships. During his tenure, Jordan recorded many iconic moments that will be celebrated forever, including his legendary jump from the free-throw line to throw down one of the best dunks ever during the 1988 Dunk Contest. Michael Jordan is not only the greatest player to wear a Bulls jersey, but is quite possibly the best athlete of all time.
Despite having a do-it-all player in Jordan, the Bulls were regularly bounced out of the playoffs until the team acquired Scottie Pippen in a trade prior to the 1987 season. With Pippen and Jordan, the Bulls finally broke through and won a title in an easy five games over the Los Angeles Lakers and Hall of Famer Magic Johnson. Chicago won 67 games the following season and repeated as champions with a series win over Clyde Drexler and the Portland Trail Blazers. The Bulls concluded their first three-peat with a six-game victory over Charles Barkley and the Phoenix Suns in 1993.
After Jordan retired from the NBA in 1993 to play minor league baseball, the Bulls still won 55 games behind Pippen in 1994 but eventually lost in the second round of the playoffs. Jordan returned to the Bulls during the 1995 season, but at times seemed to have lost his All-Star status and the Bulls were once again bounced out of the playoffs early. The 1996 season marked the reemergence of Jordan and the Bulls. The star led the team to a record 72-10 record and the Bulls eventually claimed their fourth title with a NBA Finals win over the Seattle SuperSonics. Jordan's Bulls went on to win two more consecutive titles and claimed their second three-peat in franchise history.
The franchise struggled after losing Jordan and Pippen, but has since regained relevance with a young core of players, including Derrick Rose, Joakim Noah and Jimmy Butler. The Bulls drafted Noah and Rose with first round picks in the 2007 and 2008 NBA Draft's, respectively. Rose has already won an MVP title and Noah has established himself as one of the best defensive players in the league after winning the Defensive Player of the Year Award in 2014.
The Chicago Bulls have represented winning like few other franchises in the NBA have been able to do. While on dominating the league in the 1990s, the Bulls placed themselves next to the Boston Celtics and Los Angeles Lakers as some of the teams to win at least six titles in franchise history. It's easy to see why the Chicago franchise has a worldwide following and why Bulls memorabilia is some of the most coveted on the sports collectibles market. No team comes close to the success Chicago enjoyed during the 1990s and as a team that continues to be a power player every NBA season, investing in Bulls memorabilia is always a smart move.
- Derrick Rose Autographed Basketballs: Derrick Rose is one of the best young players in the NBA and is the leading force on the Bulls current roster. The Bulls selected Rose with the top overall pick in the 2008 NBA Draft and he served as the face of the franchise ever since. Rose didn't waste any time before taking the NBA by storm, winning the 2009 NBA Rookie of the Year award after averaging 16.8 points per game while dishing out 6.3 assists. Rose continued to elevate his game and during the 2011 season he was named NBA MVP after dominating the league to the tune of 25 points per game and 7.7 assists. Investing in Derrick Rose memorabilia is a fantastic move for any NBA collector because his career will only continue to provide iconic moments to preserve. With a Derrick Rose signed basketball, fans and collectors can commemorate the epic start to his career and show their support for one of the game's most up-and-coming players.
- Michael Jordan Signed Jerseys: Michael Jordan is the greatest basketball player to ever grace the NBA hardwood, period. Jordan played the majority of his iconic career with the Chicago Bullsand as a six-time NBA champion, five-time NBA MVP, and 14-time All-Star, Jordan is one of the most decorated players in NBA history and was enshrined in the Hall of Fame in 2009. A signed Michael Jordan jersey is simply the utmost iconic piece of sports memorabilia that anyone can own. Since he is revered as the best player ever, Michael Jordan memorabilia is very difficult to come across and among the most valuable items on the sports collectibles market. An autographed Michael Jordan jersey is the perfect addition to any sports collection due to his iconic place among the world's top athletes and can also serve as a fantastic gift for any long-time Jordan admirer.
- Autographed Scottie Pippen Photos: A six-time NBA champion, Scottie Pippen helped Michael Jordan lead the Chicago Bulls to a level of success the franchise had never thought possible. A lockdown small forward, Pippen enjoyed a huge amount of success in the NBA and enough so that he earned seven trips to the All-Star game. Pippen's stellar defense helped Jordan and the Bulls to three-consecutive titles on two separate occasions during his tenure with the team. Scottie Pippen was one of the most talented players in NBA history, fans and collectors admired his game because it complemented that of Michael Jordan's so well. Due to high-demand and worth, Scottie Pippen signed photos are a perfect addition to any basketball collection and preserve some of the most memorable moments in NBA history. Fans and collectors can take home a piece of history with an autographed Scottie Pippen photo. Considering his legacy, no Bulls collection is complete without a piece dedicated to Scottie Pippen.
- Jimmy Butler Memorabilia: An elite defender at just a young age, Jimmy Butler is one of the most premier, upcoming players in basketball. The Bulls snagged Butler late in the first round of the 2011 NBA Draft and have quickly inserted him into their starting lineup because of his defensive prowess. Standing at 6-foot-7, Butler is long and versatile enough to disrupt the best offensive players in the NBA. Butler's impact on the court is not going unrecognized, he was voted to the NBA All-Defensive Second Team this past season, which is a feat reserved for the best defenders in the league. Items with a Jimmy Butler autograph are a great investment as the young star will continue to excel on the court and write his name in NBA history. Capture one of the many highlights of his young career and add to your Bulls collection with Jimmy Butler memorabilia, such as an autographed ball or signed photo.
- Joakim Noah Signed Basketballs: A two-time All-Star, Joakim Noah is an elite defender who has played his entire NBA career for the Chicago Bulls. The Bulls selected Noah out of the University of Florida with the ninth overall pick in the 2007 NBA Draft. The franchise is enjoying a huge amount of success since it teamed up Noah with another young superstar in Derrick Rose. Noah has solidified himself as one of the top defensive players in the NBA as a two-time All-Defensive First Team member and winning the 2014 NBA Defensive Player of the Year award. Chicago fans can highlight his remarkable career and many memorable achievements with a Joakim Noah autographed basketball. Being a part of the next generation of Bulls megastars, any item with a Joakim Noah autograph is sure to acquire value over the years as he continues to dominate the court.


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Winter storm barrels across U.S.
Published On: Feb 21 2013 08:22:37 AM PST Updated On: Feb 23 2013 02:14:22 AM PST
A deadly winter storm dumps snow, ice and rain as it moves eastward from the Rocky Mountains.
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"I have been listening to you on EWTN for about a year now. I left the Catholic Church 42 years ago. After many struggles during this last year, I finally went to confession on Sunday. I cannot begin to explain how excited I am to be home. Thank you so much for helping me on my journey home."
"The laws of Caesar are one thing, the laws of Christ another."


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Please use this identifier to cite or link to this item: http://hdl.handle.net/1959.3/224593
|Download PDF (24 pages) (Adobe Acrobat PDF, 576 KB)
- Title
- The 2011 Swinburne National Technology and Society Monitor
- Author(s)
- Social Psychology Research Unit
- Abstract
- Information and life science technologies have profound social, political, psychological and ethical implications. Public perceptions of such technologies are potentially volatile. The Swinburne National Technology and Society Monitor was developed in 2003 at Swinburne University of Technology. It involves a representative nationwide survey of Australians, and provides an annual 'snapshot' of public perceptions regarding new technologies in Australia. The 2011 Monitor is the ninth edition of the Swinburne National Technology and Society Monitor. It provides a general account of public perceptions about new technologies in Australia, including trust in institutions that provide information about new technologies
- Publication type
- Report
- Research centre
- Swinburne University of Technology. Faculty of Life and Social Sciences
- Source
- Swinburne National Technology and Society Monitor, 2011 survey
- Publication year
- 2011
- Keyword(s)
- Australia; Controversial science; Demographics; Genetic modification; GM; Health; Internet; Nanotechnology; New technologies; Nuclear power; Public attitudes; Social Psychology Research Unit; Society; Technological change; Trust
- Publisher
- Swinburne University of Technology
- Publisher URL
- Copyright
- Copyright © 2011.
- Full text


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Love at first fright: Rutland Halloween Parade rouses spiritsBy KEVIN OCONNOR
CORRESPONDENT | October 27,2013Think marriage is scary? Meet Barbara and Gary Spaulding, Rutland newlyweds who as shown at Rutlands 54th annual Halloween Parade on Saturday take commitment to a whole new level.
Ten Halloweens ago, Barbara turned her Bellevue Avenue home into a haunted house a tradition she continues each Oct. 31. Just married this month, she had reason to take a break this year. Instead, the ghoulishly dressed bride and groom recreated their vows on a graveyard float in anticipation of decorating their residence for an expected 300 trick-or-treaters Thursday.
Its our wedding, postmortem, said Barbara, an 18-year employee of the Rutland Redevelopment Authority. We took it very seriously til death do us part.
The two werent the only ones in the spirit when almost 100 costumed bands and bulb-blazing floats wound through a downtown crowd of thousands in New Englands oldest haunted-holiday march.
The city Recreation and Parks Department event kicked off at 6:30 p.m. with Drum Journeys of Earth skeleton drummers and dancers ushering in Pumpkin Princess Olivia Cacciatore, a Fair Haven Union High School senior who accessorized her crown with a 1976 Corvette Stingray convertible and umbrella to ward off scattered raindrops.
Dozens of area businesses and organizations presented floats ranging from a green-skinned Frankenstein (Community Health Centers of the Rutland Region) to blue-faced Smurfs (Rutland Regional Medical Center).
Fabian Earth Moving of West Rutland illuminated a 42-foot-long Witch Doctor island complete with flaming torches based on a suggestion by the owners 10-year-old granddaughter, Katelyn Schutt.
The citys Loretto Home the last residence of the parades late, longtime leader, Tom Fagan and neighboring St. Joseph Kervick facility participated for the first time, creating Monsters University with help of students from nearby Mount Saint Joseph Academy.
Proctor High School band members dressed as crocodiles make that Proctor-diles to perform Elton Johns Crocodile Rock as freshman classmate Steven Goodhue, in rhinestone-white sunglasses, jumpsuit and boa, played a baby grand piano atop a 25-foot-long animated crocodile.
Nine other student bands played everything from The Phantom of the Opera (Rutland High School) to Blue Oyster Cults Dont Fear The Reaper (Castleton State College), all while escorting a Pumpkin Princess court that included Lina Bergamini of Long Trail School in Dorset, Rebecca Elrick of Proctor High, Grace Giancola of Mount Saint Joseph Academy in Rutland, Alexis Hill of Poultney High, Tegan Waite of West Rutland High and Kyle Weatherhogg of Mill River Union High in Clarendon.
Amid the heights and frights, a few units aimed to comfort people. The Rutland County Democratic Committee, for example, wore scrubs and lab coats as they carried a message about the Affordable Care Act, known as Obamacare: The ACA its not a scary thing.
The NeighborWorks Home Energy Assistance Team welcomed The Logger Rusty DeWees, who broadcast his own sound bite to the local cable PEG-TV crew airing the parade live: Save a mountain of green and be warmer in the winter. (An average of $1,400 a year, the accompanying publicity people specified.)
The Making Strides Against Breast Cancer Boo Bees, for their part, hoped humor would promote a serious cause: Get regular checkups and mammograms.
Halloween wasnt the only holiday on marchers minds. Costumed characters walking alongside the Vermont Backroad Christmas Light Tour Bus handed out 5,000 candy canes to spectators in anticipation of driving about the region this December.
The Killington and Pico resort promoted the upcoming ski season by rolling out snowmaking zombies riding on one of their mountains gargantuan groomers and gondola cars (equipment valued at more than $500,000, a handler estimated).
Bigger dollar signs still, the American Cancer Society promoted its 25th anniversary Rutland County Relay For Life next June 21 and 22, noting this years event raised $200,000 to bring the fundraisers quarter-century total to $2 million.
The parades masked Jack OLantern mystery guest ended the event by revealing herself to be Rutland Middle School instructor Bianca McKeen, Vermonts most recent Science Teacher of the Year.
Ive always wanted to be Jack OLantern, she said. For me, its a dream come true.
And for wide-eyed students lining the sidewalk, inspiration for marching into the future.
email@example.com IN This Just InMONTPELIER A new report from a commission that studied the cost, availability and quality of... Full StoryVermont fish hatchery changes focus, looks inland
BETHEL, Vt. Full StoryHONOLULU (AP) A group of Hawaii musicians and a Hawaiian Airlines flight attendant provided... Full Story
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Wordsmith Talk
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#210064 - 03/19/13 03:46 PM Re: Tuesday: PERUSE [Re: Tromboniator]
Carpal Tunnel
Registered: 08/06/01
Posts: 6943
Loc: Worcester, MA
Originally Posted By: TromboniatorPERUSS (peh-RUSH): to read with great care in Cyrillic, and rather quickly.
Not to be confused with its near-homonym PERUSH, (pee-rush), meaning "Ooh! Ooh! Teacher! I really have to go to the bathroom!"
#210066 - 03/19/13 04:28 PM Re: Tuesday: PERUSE [Re: wofahulicodoc]
Carpal Tunnel
Registered: 06/23/08
Posts: 8541
Loc: Land of the Flat Water
Originally Posted By: wofahulicodocOriginally Posted By: LukeJavan8I hope these infections stay in your office
and that you are inoculated.
You want me to get an infection in my eye?
Sorry Doc, I don't speak MDese. I hope you have had what
ever shot you need so you don't get the disease you mentioned._________________________
----please, draw me a sheep----
#210067 - 03/19/13 04:30 PM Re: Tuesday: PERUSE [Re: LukeJavan8]
Carpal Tunnel
Registered: 06/23/08
Posts: 8541
Loc: Land of the Flat Water
Toilet bowl cleaner._________________________
----please, draw me a sheep----
#210068 - 03/19/13 09:30 PM Re: Tuesday: PERUSE [Re: LukeJavan8]
Registered: 06/05/10
Posts: 1554
Loc: Lower Aberdeen, Mississippi
r > n
penuse - the projected life of a Bic ballpoint pen less fifty percent.
#210069 - 03/19/13 09:51 PM School of Useless Knowledge [Re: LukeJavan8]
Carpal Tunnel
Registered: 08/06/01
Posts: 6943
Loc: Worcester, MA
"Ocular" means related to the eye, as in oculist who makes lenses, and binoculars (two lenses, one for each eye - and they also make monocles for one eye.)
Actually, "inoculate" really does mean "stick it in your eye." That's the way the first smallpox immunizations were administered. Serum was made from victims of vaccinia (a related viral disease, cowpox. As one might suspect, since ''vaca" is cow. Smallpox is "variola.") and it was instilled into the eye of the protectee after the doctor pulled the lower lid down to make a sac to drip a drop or two into. So it was literally an "in-ocul-ation," and then the word got generalized to mean any immunization against you-name-it disease, no matter where it was given.
And "pertussis" is whooping cough. ("Tussive" is coughing. RobiTussin is A H Robins' brand of cough syrup. Tussionex is somebody else's.) Pertussis is the P of the DPT shot your kids got when they were infants: Diphtheria, Pertussis, Tetanus. Never heard of 'em? It's because the shots became almost universal, and the diseases almost unheard of. Except that whooping cough is coming back, because...but that's another story.
(Apologies for droning on. Occasionally this does somehow turn into a word Board, all our intentions to the contrary notwithstanding...)
#210070 - 03/19/13 10:00 PM Go Back Three Weeks [Re: jenny jenny]
Carpal Tunnel
Registered: 08/06/01
Posts: 6943
Loc: Worcester, MA
TACTYLOGRAPHY - handwriting in Braille
#210071 - 03/20/13 10:24 AM Very Interesting medical wordings, Wofa, thanks. [Re: wofahulicodoc]
Registered: 06/05/10
Posts: 1554
Loc: Lower Aberdeen, Mississippi
with Anu Garg
PRONUNCIATION:(SEK-uhnd GES)
MEANING: verb tr.:
1. To criticize an event with the benefit of hindsight.
2. To guess or predict.
Probably a back-formation from second-guesser (in baseball, one who criticizes a play after the fact). Earliest documented use: 1941.
S to R
recond-guess- a recond-ed guess. As in...
Do you recond? Well, shoot, I recond.
#210072 - 03/20/13 10:32 AM Re: School of Useless Knowledge [Re: wofahulicodoc]
Carpal Tunnel
Registered: 06/23/08
Posts: 8541
Loc: Land of the Flat Water
I thought I was using 'inoculation' correctly, but only in
the sense you mention, generalization for any immunization
and I appreciate the comments. I had enough Latin to know
'oculis' is eye, but I was hoping you were protected from
all the other diseases you were specifying - and since
JJ is back I appreciate your taking up her mantle for the
time being._________________________
----please, draw me a sheep----
#210073 - 03/20/13 12:28 PM Darned if I'm gonna be the first one to show up [Re: jenny jenny]
Carpal Tunnel
Registered: 08/06/01
Posts: 6943
Loc: Worcester, MA
SECOND-GUEST - v.i. - to wait in the car until you see someone else ring the doorbell ahead of you
#210077 - 03/21/13 11:02 AM Re: Darned if I'm gonna be the first one to show up [Re: wofahulicodoc]
Registered: 06/05/10
Posts: 1554
Loc: Lower Aberdeen, Mississippi
A.Thursday.Word.A.Day with Anu Garg
MEANING: adjective:
1. Jumping from topic to topic; rambling.
2. Proceeding logically, using reason or argument rather than emotion.
From Latin discurrere (to run about), from dis- (apart) + currere (to run). Ultimately from the Indo-European root kers- (to run), which is also the source of car, career, carpenter, occur, discharge, succor, and caricature. Earliest documented use: 1599.
add T
discursitive- a meaning that can mean either extreme of diametrical opposite meanings. EX: discursive.
Edited by jenny jenny (03/21/13 01:22 PM)
Edit Reason: spelling error
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Three women face charges after bus assault
WHITE RIVER JUNCTION Three Rutland-area women who were part of a larger group taking their daily bus ride to a New Hampshire methadone clinic are facing charges in the wake of an assault a month ago that landed one of their fellow riders in the hospital.
Vermont State Police Sgt. Craig Gardner said he was called to the parking lot of a methadone clinic in Lebanon, N.H., on the morning of April 22 after an ambulance met the shuttle operated by Marble Valley Regional Transit District to take victim Jennifer DeCicco to Dartmouth-Hitchcock Medical Center, also in Lebanon.
DeCicco told police that she was punched multiple times in the head as The Bus was traveling through Quechee on its daily run to the clinic.
Gardner said that when he initially interviewed the 10 other women who were on the bus, they all advised they were actually sleeping at the time of the argument but would have woken up if any fight had occurred.
Gardner added that Jennifer Bell, 24, of Castleton, was identified by DeCicco as the woman whod hit her repeatedly, but he said Bell was adamant that she never got out of her seat and said she merely argued with DeCicco from several rows back.
After the bus driver mentioned that the bus was equipped with a video surveillance camera, Gardner said he requested a copy of the tape which he said clearly showed Bell get up and punch DeCicco five times in the head and, the trooper said, it also showed Shari Cabral, 36, of Mendon, grab DeCiccos notebook during the assault and toss it to Annie Thompson, 33, of Rutland ,who then could be seen opening her bus window and tossing the notebook outside.
Gardner said that when he visited DeCicco in the emergency room at Dartmouth-Hitchcock Medical Center she described her level of pain from the attack as a 10 on a scale of 1 to 10.
Bell pleaded innocent Tuesday to a single misdemeanor count of simple assault while Cabral and Thompson each ended up charged with a felony in regard to the notebook. Cabral pleaded innocent to a felony count of larceny from a person and Thompson pleaded innocent to a felony count of being an accessory after the fact.
Cabral and Thompson told police that they had actually gone back after the incident on their own accord and found DeCiccos notebook, an account which Gardner said was later confirmed by the driver of the bus who was the person to whom they had turned over the notebook.MORE IN This Just InMONTPELIER A new report from a commission that studied the cost, availability and quality of... Full StoryVermont fish hatchery changes focus, looks inland
BETHEL, Vt. Full StoryHONOLULU (AP) A group of Hawaii musicians and a Hawaiian Airlines flight attendant provided... Full Story
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Talk about decking the halls.
An Indiana man has managed to cram 86 Christmas trees into his 1,400-square-foot home, Indianapolis TV station WRTV reported.
It started as a hobby more than 10 years ago, but has now turned into Brandon Smith's obsession.
"Christmas was a big German holiday for my family," Smith, 31, told "Good Morning America." "My parents always put up a pretty good display and I just have grown and expanded on it over the years."
Smith said many of his trees are donated.
They fill nearly every inch of his house. Some are even crammed in the bathroom.
Smith decorated this year's trees with an estimated 52,000 lights.
It takes him four weeks to set up each year's display, but he said he doesn't mind.
"We love Christmas," Smith said. "There's no denying that."


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Music Review: Holiday pops much more than the same oldBy Jim LoweJim Lowe / Staff Photo
Dawn Willis leads the audience in a carol singalong at the VSO Holiday Pops concert at the Barre Opera House on Friday. The program will be repeated at 3 p.m. today at Rutlands Paramount Theatre.
For the occasional concertgoer, holiday music programs are a joy, reminding us of everything we hold dear about the time of Christmas and Hanukkah.
But, for the music aficionado, these same programs become the dreary same old, same old, same old.
That is, unless the program is created and directed by Robert De Cormier, founding director of the Vermont Symphony Orchestra Chorus. On Friday at the Barre Opera House, De Cormier led the VSO and VSO Chorus in a program that was full of the familiar, new takes on the familiar and some new traditions to celebrate.
(The same program was presented on Saturday at Burlingtons Flynn Center and will be performed at 3 p.m. today at Rutlands Paramount Theatre.)
At 90 years old, De Cormier, still one of this countrys foremost choral conductors, is at no loss for ideas and the ability to execute them. It was in the more classic prologue to Vaughan Williams Hodie that he led the chorus and orchestra in its most beautiful performance. The complex and spicy orchestration complemented the rich choral sound and message, beautifully delivered.
More novel, De Cormier led the chorus and orchestra in what is thought to be Grubers original Silent Night, familiar but more elegant and lyrical than what we are accustomed to. De Cormier juxtaposed Mozarts and Leroy Andersons Sleigh Ride. Although it was filled with appropriate sleigh bells, the Mozart (from his German Dances) was light and elegant. The Anderson, well, it wasnt but it was lots of fun.
De Cormier introduced an impressive work by 18-year-old Jacob Morton-Black, a Colchester High School senior and a product of Vermonts Music-COMP, a high school composition mentoring program. Morton-Blacks Danse Slav et Valse for orchestra proved a lively work based on Russian themes. The simple themes belied the works complex harmonic language and colorful orchestration. It was a real pleasure.
After The 12 Days of Christmas, Louise De Cormier, Roberts wife and a former Weston Playhouse actress, read letters from the unhappy girl receiving the gifts hilarious.
You cant get more traditional than Messiah, and Dawn Willis, the VSO Choruss assistant conductor, led the chorus and orchestra in a 10-minute version of Handels masterpiece. Willis led a performance that was not only spirited but clean and clear you could actually understand the words of Unto Us a Child Is Born, Pifa and Glory to God. And, of course, it closed with the audience rising for the Hallelujah Chorus.
Truly charming were two Hanukkah songs by Woody Guthrie, arranged and orchestrated by De Cormier. Intriguing and fun were Tintinabulations, variations for orchestra on Jingle Bells in multiple recognizable styles. Just as fascinating was the complex orchestral work, Pat-a-pan, a Fantasy, by Hershy Kay, originally written for the Cleveland Orchestra.
The carol sing-along, led by Willis, had even the aficionados lending their voices enthusiastically. And De Cormier closed the program most appropriately with Why Cant We Have Christmas the Whole Year Around?
VSO Holiday Pops
Robert De Cormier will lead the Vermont Symphony Orchestra and Chorus in the VSO Holiday Pops at 3 p.m. today (Dec. 9) at the Paramount Theatre, 30 Center St. in Rutland. Tickets are $20-$30, or $16-$24 for seniors, or $9 for students. Call 775-0903, or go online to www.paramountlive.org. For information about upcoming VSO programs, go online to www.vso.org.MORE IN Central VermontMIDDLEBURY According to WebMD, Dystonia is a movement disorder that causes a persons muscles ... Full StoryTiffany Briggs and Kayla Jackson eyed each other across the table, clasped hands, and then it was... Full StoryMARLBORO Police are investigating a burglary on Higley Hill Road. Full Story
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A Connecticut man named Noel was arrested after scaling a Christmas tree in a public park.
Police cut electricity to the tree in New Haven Green, a 16-acre park in New Haven near Yale University, and talked with Noel Delgado to persuade him to come down, The Associated Press reported.
Delgado was carrying two banners and shouting about various causes.
He was charged with breach of the peace and refused medical treatment at the scene, the AP reported.


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This week's concerts
5 p.m. Friday and noon Saturday, 2013 Paramount Blues Festival, Lime Kiln Park, 800 S. Green Bay Road, Grafton. $10 in advance for the weekend, $20 at the gate; single day tickets $10 at the gate. See graftonblues.org. »Read Full Article
The Malt Shoppe, a beer store with growler filling station, planned for Wauwatosa
A store called the Malt Shoppe that's dedicated strictly to beer -- bottled beer, beer in growlers, and items like specialty glassware -- is planned for 813 N. Mayfair Road in Wauwatosa.
Owner Patrick Lafferty said his idea for the shop came from the Four Firkins, a beer-focused store he's visited in Minneapolis. "There's nothing like that here," Lafferty said. »Read Full Blog Post
Milwaukee Symphony inspires with reworked program
The Milwaukee Symphony Orchestra made lemonade out of lemons Friday with some inspired programming.
Financial concerns earlier this season led to the removal of Mahler's Symphony No. 6 from this weekend's program. »Read Full Article(1)
Roz Chast's memoir speaks truth about aging parents
Roz Chast'snew memoir about the decline and death of her parents, "Can't We Talk About Something More Pleasant?," is both gut-wrenching and laugh-aloud funny. I want to recommend it to everyone I know who has elderly parents, or might have them someday.
If you're in the middle of the worst part of a late-life scenario, you might not want to read Chast's book right now. But when you're ready, she'll be there for you. »Read Full Article(1)
'I Hear America Singing': Skylight Music Theatre remixes a century of music
Skylight Music Theatre is singing an old song ... no, wait, that's a new song ... no, it's an old one.
Actually, the folks over at the Skylight are whipping up a mix of show tunes, arias and art songs, mixed with songs from the Civil War to World War I that have been reworked by composer Daron Hagen for his new show, "I Hear America Singing." The show, which opens Friday, uses the tunes to support a plot in which three music-school friends reunite for a show a few decades into their careers. »Read Full Article
Entire cast of superheroine opera 'Fortuna' returns to Milwaukee Opera Theatre
If you left "Captain America: The Winter Soldier" thinking it was pretty good but would be better if were an opera, Milwaukee Opera Theatre has just the thing for you.
Milwaukee Opera Theatre is reviving its 2012 word-of-mouth hit, "Fortuna the Time Bender vs. The Schoolgirls of Doom!," which reviewer Elaine Schmidt described as "a loopy musical romp that borrows from operetta, musical theater, pop music, television, comic book superheroes and pop culture in general." »Read Full Article
Talk brews familiarity, insight at Milwaukee Beer Week
Talking beer always comes back to Wisconsin.
Even though his Surly Brewing products won't be available in Wisconsin until next year, owner Omar Ansari said Surly — in the middle of construction on a new $20 million brewery — is tied to Milwaukee. »Read Full Article
'The Confabulist' depicts Houdini's ultimate disappearing act
Meditating in "Ragtime" on the Hungarian Jew named Ehrich Weiss, who spent part of his youth in Appleton and Milwaukee before morphing into Harry Houdini, E.L. Doctorow writes that Houdini "could not reason from his own hurt feelings. To the end he would be almost totally unaware of the design of his career, the great map of revolution laid out by his life."
In "The Confabulist," novelist Steven Gallowaytakes that idea and runs with it, telling the story of an artist whose meticulously crafted persona — what Galloway refers to as "a shell to show the world" — led to the eventual disappearance of the underlying man, who vanished as fully as Houdini himself seemed to do when on stage. »Read Full Article
Florentine performing Puccini's much-loved 'La Bohème'
As operas go, "La Bohème" pretty much has it all.
The combination of Puccini's gorgeous melodies, an engaging backstory of four bohemians living in the Latin Quarter of Paris and a heartbreaking love story have made it, globally, one of the most often performed pieces of the opera repertoire. »Read Full Article
WWJD: What would Jack Bauer do?
The world is full of problems, personal, local and global. And if you're like me - and I hope for your sake you're not - when a crises arise you wonder "What would Jack Bauer Do?"
Bauer, of course, is the action hero played by Kiefer Sutherland, who battled terrorists, international and domestic, for 8 seasons on the Fox series "24." »Read Full Blog Post
Listening to Lou Reed: 'Ecstasy'
On Fridays I'm posting my thoughts on Lou Reed's solo albums, one album at a time in chronological order of release.
When he recorded "Ecstasy" (2000), Lou Reed had been playing for some years with the tightest, most versatile rhythm section he'd ever had: bassist Fernando Saunders and drummer Tony (Thunder) Smith. Second guitarist Mike Rathke had been Lou's simpatico foil for more than a decade. Lou's albums with these musicians, which also include "Set the Twilight Reeling" and "Perfect Night: Live in London," were recorded about as well it was possible to record rock music. »Read Full Blog Post(1)
Milwaukee Rep gets $500,000 grant to repair sinking theater complex
The Milwaukee Repertory Theater is nearly halfway toward getting the funding it needs to shore up its sinking home on the Milwaukee River, thanks to a $500,000 grant from the Richard and Ethel Herzfeld Foundation.
Announcing the grant Friday, the Rep said that, combined with a $250,000 grant from the United Performing Arts Fund and a $75,000 grant from the Bert L. and Patricia S. Steigleder Charitable Trust, the Herzfeld Foundation gift gives the theater company almost 50% of the estimated $1.75 million needed to repair its settling theater complex at 108 E. Wells St. »Read Full Article
Milwaukee Art Museum's best decision might be not to build an addition
No one would have designed the Milwaukee Art Museum site as it exists today with three buildings uncomfortably joined: Eero Saarinen's sober War Memorial, Santiago Calatrava's curvy addition and David Kahler's work horse.
I don't know of a more convoluted museum site, the product of a generation of piecemeal development that has been more focused on fashionable architecture and the museum's near-term needs than the long-term impact on the lakefront. »Read Full Article(16)
Wild Space dancers tackle big questions in 'All About Life'
Sometimes the best way to tackle a big topic is to go at it one small bit at a time.
Wild Space Dance Company did just that with Thursday's opening of "All About Life," in the Milwaukee Repertory Theater's Stiemke Studio. »Read Full Article
Stuff to do in Milwaukee this weekend
Are you ready for some FootGolf? At 10 a.m. Friday, Milwaukee County Parks opens its first 18-hole course for FootGolf — a cross between soccer and golf — at Lincoln Park, 1000 W. Hampton Ave., and its first 9-hole course at Doyne Park, 5300 W. Wells St. Fees are $15 at Lincoln and $5 at Doyne; playing the Lincoln course requires a reservation, either online at countyparks.com or by calling (414) 475-6222. Bonus: You can rent soccer balls at both courses.
Milwaukee Dining: What it takes to be selected as a Top 30 restaurant
What makes a great restaurant?
It's a timely question: Spring is when I step up visits for the annual Top 30 list in September, weaving those dinners into my regular schedule of new restaurants being reviewed for the first time. »Read Full Article(4)
Fried bologna sandwiches pop up on menus
Bologna might conjure memories of lunchbox sandwiches, but it's moved beyond that these days: No fewer than three restaurants around Milwaukee have fried bologna sandwiches on their menus now.
They've been appearing on more menus around the country — not corner taps, but places like Au Cheval in Chicago — and New York chef David Chang this year declared his love for the sandwich in GQ magazine, theorizing craft bologna could be the next big thing in food. »Read Full Article(1)
On Tap Today: Beer, Spider-Man and dueling rooftop fiddlers
Welcome to Friday. This is the last time you have to read the schedule for Milwaukee Beer Week here. But that comes with this warning: American Craft Beer Week begins May 12.
Today "The Amazing Spider-Man 2" opens. »Read Full Blog Post
The Neighbourhood, Jake Bugg among U.S. Cellular stage headliners
Gloomy newcomer the Neighbourhood, buzz-generating genre-blender Jake Bugg and electronic rock duo Phantogram are among the headliners at Summerfest's alternative rock-heavy U.S. Cellular Connection Stage for 2014.
The stage will be the place to see some of the most talked about up-and-coming rock bands of the year, including Kongos, a South African band of brothers with the alt-rock chart-topping hit "Come With Me Now," as well as Bleachers, a new pop-rock side project fronted by fun. guitarist Jack Antonoff. There'll also be a few more seasoned headliners, including Switchfoot and Neon Trees. »Read Full Article


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Shumlin lawyer: Land deal offers on the table this week
MONTPELIER The saga of Peter Shumlin and his land deal gone sour could reach its denouement as early as this week, when the embattled governor is expected to find out whether a resolution is finally in the offing.
Its been more than a month since Shumlin and Jeremy Dodge enlisted a pair of well-known lawyers to mediate a high-profile dispute over their real estate transaction. Shumlin last fall bought for $58,000 an East Montpelier homestead later valued by town listers at $140,000; the terms of the deal fell under a microscope in May when Dodge went public with his sellers remorse. The property had been assessed at $233,000 at the time of the sale.
Both sides have since gone quiet as lawyers try to negotiate a resolution. Jerry Diamond, the former three-term attorney general hired by Shumlin to handle the dispute on his behalf, said that resolution could be arriving very soon.
We have reviewed a number of options, Diamond said Monday. And we should know something by the middle of this week as to whether any of those options are going to be acceptable.
Diamond wouldnt specify what those options included, other than to say both sides have put proposals on the table. Dodges lawyer, Brady Toensing, a longtime political operative with close ties to Republicans both in Vermont and Washington, D.C., declined to comment for this story.
People close to the talks say one option would see Dodge reclaim ownership of his home, and a large portion of his land, without having to repay any of the approximately $30,000 Shumlin has paid out so far.
Shumlin had previously offered to void the purchase-and-sale agreement only if Dodge agreed to repay the money over time.
Shumlin continues to defend the deal as a fair one for both buyer and seller. Dodge owed more than $17,000 in back taxes at the time of the sale, and Shumlin said he spared his neighbor from a looming tax sale at which the property could have been auctioned off for far less than what he was willing to pay for it.
Critics, meanwhile, accuse the governor of exploiting a desperate neighbor for his own personal gain. Dodges children say their father, 54, was mentally unfit to understand the terms of the deal offered by Shumlin. Dodge did not have a lawyer representing him in the transaction, something for which Shumlin has come under especially pointed criticism.
Under the original purchase-and-sale agreement, Dodge was obligated to be out of the property by July 15. Diamond said Monday that the date has since been changed to Aug. 15. Diamond declined to speculate about what might happen next if the parties cant negotiate a mutually agreeable settlement.
peter.hirschfeld @timesargus.com
email@example.com IN Vermont NewsMONTPELIER Rep. Peter Welch, D-Vt. Full StoryVermont Attorney General Bill Sorrell plans to join the U.S. Full StoryAs Rutland prepares to welcome Syrian refugees to its community, some are continuing to voice... Full Story
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|Boat Ramp with LOTS of Parking
Contributed by TrailerClub1 - This blog has been viewed 7715 times and there are 0 comments
|... Read More
|February Trailering and Water Music
Contributed by TrailerClub1 - This blog has been viewed 7613 times and there are 0 comments
While I must agree with your selections of water music, "The River" and "Sailing", I felt the need to write. Kenny Chesney's "Boats" hits it out of the park to the feelings one has owning, captaining, as well as life on the water.
Thank you for your informative and fun-read magazine!
|Cape May YES!
Contributed by TrailerClub1 - This blog has been viewed 7913 times and there are 0 comments
|I thoroughly enjoyed the article on Cape May in the February issue. I was stationed at the Coast Guard base there for boot camp in the summer of 1957. It is a beautiful area and I would love to boat there sometime.
BoatUS Trailering is a great magazine for boaters. I moved from North East Alabama to Wilmington, NC last year and the article on checking out the boat trailer was excellent. I did what I could and had the rest done professionally where necessary. The 600 mile trip was smooth as silk!
Many thanks,
Doug Tounsley
Wilmington, NC
|February Trailering Issue and Navigation
Contributed by TrailerClub1 - This blog has been viewed 7993 times and there are 0 comments
|Just a note to say what a fine issue this is. As a trailerboater myself, I'm always on the lookout for good, practical information. (And as a frequent visitor to Cape May, I especially enjoyed your piece on that town.)
One mild suggestion: If you're approaching another boat nose-to-nose, a horn signal is most likely to elicit one of two reactions. A friendly skipper will just wave and smile; most will give you an interdigital gesture that translates to "Who you beepin' at, Jack?"
Better to swing your bow 45 degrees to starboard or port, slow down, and wait for the other boat to re...... Read More


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A teen on spring break with friends was arrested after allegedly urinating on a deputy's lunch inside his cruiser, according to a report.
The Fort Myers News-Press reported that Chris Brennan was among a few partiers causing a ruckus outside a hotel at Fort Myers Beach early Monday morning.
MUGSHOTS: Who Got Arrested In South Florida?
When deputies arrived, they put Brennan in the back seat of a cruiser while they interviewed his friends, the News-Press reported.
That's when the teen starting "banging his head on the window bars and screaming," even telling a deputy "I will **ss in your car," according to the News-Press.
Brennan then began urinating "through the screen cage in the deputy's car and on several of the deputy's personal items," including his lunch and cellphone, the report said.
The suspect was charged with resisting arrest and taken to the Lee County Jail.


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Richard Childress Racing
Recent News
RCR Crew Member Spotlight: Tyler Rader
July 17, 2013
"That was all Rader! Everyone thank Rader!" Crew chief Danny Stockman exclaimed over the team radio directly after Austin Dillon survived three green-white-checkered restarts in Saturday's NASCAR Nationwide Series race at New Hampshire Motor Speedway to finish third and clinch the Dash 4 Cash $100,000 bonus.
The "Rader" Stockman was referring to is team gasman Tyler Rader, who spent the final harrowing moments of the race, along with his crew chief and team engineer, crunching numbers. Dillon was extremely close to running out of fuel in the No. 3 AdvoCare Chevrolet Camaro in a race that was extended 13 laps past its advertised distance.
With a little bit of luck, excellent fuel mileage thanks to Sunoco Green E15 American Ethanol fuel, Dillon's fuel conservation skills and Rader's ability to properly fuel RCR's Chevrolets during pit stops, everything played into the team's favor on race day and Dillon left New Hampshire Motor Speedway $100,000 richer. The team also jumped from fifth to third in the point standings, just 12 markers shy of the lead.
Rader, a former football star at West Virginia University, is no stranger to the high pressure world of sports. He won two BCS games during his five years as a football star at WVU. In high school, he excelled in football, baseball and track.
So, how exactly did a college star athlete end up on the NASCAR circuit? Rader grew up as the "ultimate" Kyle Petty fan and attended several races as a child with his father. One of his earliest racing memories was sitting in the grand stands at Myrtle Beach Speedway in 1996 to watch Dale Earnhardt Jr.'s NASCAR Nationwide Series debut. Last year, Rader received a phone call from his father, who had heard about RCR's pit crew combine.
The combine drew more than 100 applicants from all over the country and gave participants the opportunity to showcase their athletic talents and learn the necessary skills to help them develop into a well-rounded teammate.
Rader and one of his friends drove from West Virginia to Welcome, N.C. and participated in a series of rigorous agility workouts and physically demanding tests, including real-time simulated pit stops in high-pressure scenarios. Shortly after the combine, Rader was offered the opportunity of a lifetime and made the move to N.C.
"I love it here," said Rader. "I feel like RCR is home."


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Welcome to Hyperion Records, an independent British classical label devoted to presenting high-quality recordings of music of all styles and from all periods from the twelfth century to the twenty-first.
Hyperion offers both CDs, and downloads in a number of formats. The site is also available in several languages.
Please use the dropdown buttons to set your preferred options, or use the checkbox to accept the defaults.
|Schütz: The Christmas Story; Gabrieli: Christmas Motets
'Ravishing… the sheer beauty of the sound, immeasurably enhanced by a warm, sonorous recording, sweeps us into the narration of the familiar story' (B ...» More
|Christmas through the ages
'Other than to assure you that it works for me, need I say more?' (Fanfare, USA)» More


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Two women got into a fight over the sale of beauty products during a game of bingo for seniors at a senior living community, police said.
According to Seacoastonline.com, officers in Portsmouth, N.H. responded to the community room at the apartment building after taking a report of "some pushing and shoving" due to a disagreement over the sale of Avon products.
One woman got upset at another for setting up a table to sell her cosmetics during the regularly scheduled bingo game.
Officers cleared the scene of the initial call, only to be called back two hours later by a person who insisted on pressing charges after the fact.
Police are still investigating whether an assault actually occurred during the altercation.


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Roger Chou, MD; Amir Qaseem, MD, PhD, MHA; Douglas K. Owens, MD, MS; Paul Shekelle, MD, PhD; for the Clinical Guidelines Committee of the American College of Physicians
Acknowledgment: The authors thank Paul Dallas, Thomas D. Denberg, Mary Ann Forciea, Robert H. Hopkins, Linda L. Humphrey, Holger J. Schünemann, and Donna E. Sweet of ACP's Clinical Guidelines Committee and Vincenza Snow and Steven Weinberger at ACP for reviewing the manuscript and providing suggestions for revisions, and Rongwei Fu for statistical assistance.
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations.
Financial Support: Financial support for the development of this guideline comes exclusively from the American College of Physicians' operating budget.
Potential Conflicts of Interest: Dr. Chou: Consulting fee or honorarium: Wellpoint, Palladian Health, Consumers Union, Blue Cross Blue Shield Association; Grants/grants pending: American Pain Society; Payment for manuscript preparation: American College of Physicians. Dr. Owens: Support for travel to meetings for the study or other purposes: American College of Physicians; Consultancy: Anthem/Wellpoint. Dr. Shekelle: Grants/grants pending: Agency for Healthcare Research and Quality; Royalties: UptoDate; Other: Unpaid advisor for a Wellpoint project that seeks to identify and certify high-quality back pain centers of excellence. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1394. Any conflict of interest of the Clinical Guidelines Committee members was declared, discussed, and resolved.
Requests for Single Reprints: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, firstname.lastname@example.com.
Current Author Addresses: Dr. Chou: Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Mailcode BICC, Portland, OR 97239.
Dr. Qaseem: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Owens: Veterans Affairs Palo Alto Healthcare System, 3801 Miranda Avenue, Palo Alto, CA 94304.
Dr. Shekelle: Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073.
Author Contributions: Conception and design: R. Chou, A. Qaseem, D. Owens, P. Shekelle.
Analysis and interpretation of the data: R. Chou, A. Qaseem, D. Owens.
Drafting of the article: R. Chou, A. Qaseem, D. Owens.
Critical revision of the article for important intellectual content: R. Chou, A. Qaseem, D. Owens, P. Shekelle.
Final approval of the article: R. Chou, A. Qaseem, D. Owens, P. Shekelle.
Administrative, technical, or logistic support: A. Qaseem.
Collection and assembly of data: R. Chou.
This paper, written by Roger Chou, MD; Amir Qaseem, MD, PhD, MHA; Douglas K. Owens, MD, MS; and Paul Shekelle, MD, PhD, was developed for the Clinical Guidelines Committee of the American College of Physicians: Paul Shekelle, MD, PhD (Chair); Roger Chou, MD; Paul Dallas, MD; Thomas D. Denberg, MD, PhD: Nick Fitterman, MD; Mary Ann Forciea, MD; Robert H. Hopkins Jr., MD; Linda L. Humphrey, MD, MPH; Tanvir P. Mir, MD; Douglas K. Owens, MD, MS; Holger J. Schünemann, MD, PhD; Donna E. Sweet, MD; and David S. Weinberg, MD, MSc. Approved by the ACP Board of Regents on 20 November 2010.
Chou R, Qaseem A, Owens DK, Shekelle P, for the Clinical Guidelines Committee of the American College of Physicians. Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care From the American College of Physicians. Ann Intern Med. 2011;154:181-189. doi: 10.7326/0003-4819-154-3-201102010-00008
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© 2016
Published: Ann Intern Med. 2011;154(3):181-189.
Diagnostic imaging is indicated for patients with low back pain only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition. In other patients, evidence indicates that routine imaging is not associated with clinically meaningful benefits but can lead to harms. Addressing inefficiencies in diagnostic testing could minimize potential harms to patients and have a large effect on use of resources by reducing both direct and downstream costs. In this area, more testing does not equate to better care. Implementing a selective approach to low back imaging, as suggested by the American College of Physicians and American Pain Society guideline on low back pain, would provide better care to patients, improve outcomes, and reduce costs.
Low back pain is very common (1, 2), and many patients with low back pain receive routine spinal imaging (lumbar radiography, computed tomography [CT], or magnetic resonance imaging [MRI]) (3, 4), despite evidence-based recommendations from the American College of Physicians (ACP) and the American Pain Society (APS) that call for imaging only for patients who have severe or progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition (5). This is problematic, because routine imaging does not seem to improve clinical outcomes and exposes patients to unnecessary harms (6, 7).
The overuse of imaging also contributes to the high and growing costs associated with low back pain. In 1998, total U.S. health care expenditures for low back pain were estimated at $90 billion (8). Average total health expenditures for patients with back and neck problems increased from $4795 per year in 1997 to about $6096 per year in 2005, an inflation-adjusted increase of 65% (in 2005 U.S. dollars) (9). This rate was higher than that observed for overall health expenditures. Low back pain also incurs high indirect costs due to lost productivity (10). Reducing unnecessary tests or ineffective treatments (11) is an obvious way to decrease the costs associated with low back pain.
Imaging is an important driver of low back pain costs, not only because of the direct costs of the procedures (Table 1) (12, 13) but also the downstream effects (14). Imaging can lead to additional tests, follow-up, and referrals and may result in an invasive procedure of limited or questionable benefit. Of note, the rate of spine MRI increased sharply at the same time as that of lumbar surgeries (7, 15).
Table 1.
Despite increased spending on low back pain, U.S. adults with spine problems reported similar or worse scores for mental health, physical functioning, work or school limitations, and social limitations in 2005 than in 1997 (9). In North Carolina, the proportion of persons who reported chronic low back pain that impaired activity more than doubled between 1992 and 2006, from 3.9% to 10.2% (16).
The appropriateness of many of the low back imaging studies obtained in clinical practice has long been questioned (17), but clinicians are subject to many pressures that promote excessive imaging. This report, based on a systematic review (18) conducted for the 2007 ACP/APS low back pain guideline and a subsequent meta-analysis (6), aims to help clinicians practice high-value health care by following a more rational and cost-conscious diagnostic approach.
The ACP/APS low back pain guideline (5) recommends selective imaging for patients in whom it is clinically indicated. Appropriateness criteria from the American College of Radiology (19) are consistent with this guideline. The evidence supporting these recommendations includes the findings of randomized trials of spine imaging strategies; this is one of the relatively few areas of diagnostic imaging for which data are available from multiple randomized trials that reported clinical outcomes. Most studies of diagnostic tests estimate their accuracy at identifying a disease or condition, but even accurate tests may not improve patient outcomes. Well-conducted, randomized trials of diagnostic studies that evaluate patient outcomes provide the most direct information about the benefits and harms of alternative testing strategies (Table 2) (20–23).
Table 2.
A meta-analysis of 6 randomized trials (6), which comprised 1804 patients with primarily acute or subacute low back pain and no clinical or historical features that suggested a specific underlying condition, found no differences between routine lumbar imaging (radiography, MRI, or CT) and usual care without routine imaging in terms of pain, function, quality of life, or overall patient-rated improvement (Table 3). For short-term outcomes (<3 months), trends slightly favored usual care without routine imaging. Routine imaging was also not associated with psychological benefits (6), despite the perception that it can help alleviate patient anxiety about back pain (24). These results can probably be generalized to some degree to patients with or without radiculopathy, because most of the trials enrolled at least some patients with radiculopathy. The conclusions of the meta-analysis did not seem to be affected by whether radiography or advanced imaging (MRI or CT) was evaluated. On the basis of the systematic review, routine imaging can be considered a low-value health care intervention; because it is more costly than usual care without routine imaging and offers no clear clinical advantages, it cannot be cost-effective (11, 25).
Table 3.
Several factors may explain why routine imaging does not seem beneficial. Most lumbar imaging abnormalities are common in persons without low back pain and are only loosely associated with back symptoms. One systematic review (26) reported odds ratios that ranged from 1.2 to 3.3 for the association between low back pain and disc degeneration on radiography and no association with spondylosis or spondylolisthesis. A randomized trial (27) showed no incremental value of rapid MRI over radiography for evaluating low back pain, which suggests that although advanced imaging can detect more and smaller abnormalities, these abnormalities are not necessarily clinically relevant. Many abnormalities detected with advanced imaging are so common in asymptomatic persons that they could be viewed as normal signs of aging (28–30). In a cross-sectional study (31), 36% of asymptomatic persons aged 60 years or older had a herniated disc, 21% had spinal stenosis, and more than 90% had a degenerated or bulging disc. A prospective study (32) found that among patients with lumbar imaging abnormalities before the onset of low back pain, 84% had unchanged or improved findings after symptoms developed. Thus, it is important to understand that the presence of imaging abnormalities need not mean that the abnormalities are responsible for symptoms.
Routine imaging might also be ineffective because acute low back pain has such a favorable natural history and because the expected yield of routine imaging is low. Most patients with acute back pain, with or without radiculopathy, have substantial improvements in pain and function in the first 4 weeks (33, 34); routine imaging is unlikely to improve on this. About 0.7% of patients with low back pain in primary care settings have metastatic cancer, 0.01% have spinal infection, and 0.04% have the cauda equina syndrome (35, 36). Vertebral compression fractures (4%) and inflammatory back disease (≤5%) may also cause back pain, but these conditions typically carry lower diagnostic urgency (36, 37). Of the small proportion of patients with any of these conditions, almost all have an identifiable risk factor. In a retrospective study of 963 patients with acute low back pain (38), the 8 patients with tumors or fractures all had clinical risk factors. A prospective study (39) found no cases of cancer in 1170 patients younger than 50 years with acute low back pain and no history of cancer, weight loss, other sign of systemic illness, or lack of improvement. Similarly, 4 trials that enrolled 399 patients without risk factors found no missed serious conditions (6).
Routine imaging may have little effect on clinical outcomes because imaging results rarely affect treatment plans. A review of 68 000 lumbar radiographs (40) estimated that clinically unsuspected findings occurred in 1 of every 2500 patients between 20 and 50 years of age. In 2 studies of about 100 patients each (41, 42), lumbar radiography affected management in only 1 or 2 patients. Similarly, a randomized trial of routine advanced imaging versus no imaging (43) found no differences in diagnoses or treatment plans. The limited therapeutic effect could be due to the largely unknown clinical significance of most imaging abnormalities. No evidence suggests that selecting therapies on the basis of the presence of the most common imaging findings improves outcomes compared with a generalized approach (5).
Any potential benefits of routine imaging may also be offset by potential harms. Lumbar radiography and CT contribute to cumulative low-level radiation exposure, which could promote carcinogenesis. Lumbar spine CT is associated with an average effective radiation dose of 6 mSv (44). On the basis of the 2.2 million lumbar CT scans performed in the United States in 2007, 1 study (45) projected 1200 additional future cases of cancer. Another study (46) estimated 1 additional case of cancer for every 270 women aged 40 years who had coronary angiography, a procedure associated with a radiation dose similar to that of lumbar spine CT (44). A woman aged 20 years would have an approximately doubled risk. Lumbar CT also involves the use of iodinated contrast, which is associated with hypersensitivity reactions and nephropathy.
Because lumbar radiography is performed much more frequently than lumbar CT, it accounts for a greater proportion of the total radiation dose from medical imaging procedures in the United States (3.3% vs. 0.7%), despite having a lower average effective radiation dose (1.5 mSv) (44). The average radiation exposure from lumbar radiography is 75 times higher than for chest radiography (44). This is of particular concern in young women because of the proximity to the gonads, which are difficult to effectively shield. The amount of female gonadal irradiation from lumbar radiography has been estimated as equivalent to having chest radiography daily for several years (36).
Telling patients that they have a back imaging abnormality could result in unintended harms related to labeling (47). In an acute low back pain trial that performed lumbar spine MRI on all patients (48), patients randomly assigned to routinely receive their results reported smaller improvements in general health than those who were blinded to their results. In another trial (49), patients with back pain of at least 6 weeks' duration who had routine radiography reported more pain and worse overall health status after 3 months than those who did not have radiography and were more likely to seek follow-up care. Knowledge of clinically irrelevant imaging findings might hinder recovery by causing patients to worry more, focus excessively on minor back symptoms, or avoid exercise or other recommended activities because of the fear that they could cause more structural damage (47).
Imaging might also lead to unnecessary procedures. Visual evidence can be very compelling, despite the uncertainties related to interpretation of most spinal imaging abnormalities, and imaging abnormalities may be viewed as targets for surgery or other interventions (50). The association between rates of advanced spinal imaging and rates of spinal surgery seems strong (15), although causality is difficult to establish. In a randomized trial, patients with low back pain who had rapid MRI had spine surgery about twice as often as those who had radiography, although the difference did not reach statistical significance (risk difference, 0.34 [95% CI, −0.06 to 0.73]) (27). One observational study (7) showed that variation in rates of spinal MRI accounted for 22% of the variability in overall spinal surgery rates among Medicare beneficiaries, or more than double the variability accounted for by differences in patient characteristics. Another study (51) found that for work-related acute low back pain, MRI within the first month was associated with more than an 8-fold increase in risk for surgery and more than a 5-fold increase in subsequent total medical costs compared with propensity-matched control patients who did not have early MRI.
Although clinicians vary substantially in how frequently they obtain low back pain imaging (7, 52), some continue to order imaging routinely or without a clear clinical indication. In a survey (3), about 40% of family practice and 13% of internal medicine physicians reported ordering routine diagnostic imaging for acute low back pain. Another survey (4) found that in the absence of any worrisome features, 22% of physicians would obtain lumbar spine radiography for acute low back pain without sciatica and 62% would do so for low back pain with sciatica. Data on actual imaging practices support these survey results. Among 35 000 Medicare beneficiaries with acute low back pain and no diagnostic code indicating a serious underlying condition, nearly 30% had lumbar radiography within 28 days (53), even though the ACP/APS guideline (5) suggests a trial of management without imaging in adults with no risk factors other than older age. An Australian study (54) showed a slight increase in imaging rates in general practice for patients with new low back pain, despite the publication of guidelines that recommend against routine imaging.
Use of advanced spinal imaging, which is far more expensive than lumbar radiography (Table 1), is increasing rapidly. Among Medicare Part B beneficiaries, lumbar MRI scans increased by about 4-fold between 1994 and 2005 (55). Similarly, the rate of MRI tripled between 1997 and 2006 in a large health care organization (46). In North Carolina, more than one third of patients with chronic low back pain received either MRI or CT in the past year (56), and other studies show even higher rates (57).
Patient expectations and preferences about diagnostic testing, when communicated to physicians, can affect clinical decisions (24). Patients expect a clear diagnosis for their low back pain (58). They want to know what is causing their symptoms and may equate a decision to not obtain imaging or provide a precise diagnosis with low-quality care (59) or as a message that their pain is not legitimate or important (50). Wanting diagnostic testing is a frequent reason for repeated office visits for chronic back pain (60). In 1 study (61), use of low back pain imaging was strongly associated with how intensely patients believed imaging was necessary. A survey of U.S. physicians (62) found that more than one third would order lumbar MRI for uncomplicated acute low back pain if a patient insisted on it even after the physician explained that it was unnecessary.
Linking financial performance incentives to patient satisfaction could augment such tendencies. In randomized trials, patients expressed more satisfaction when they received routine lumbar imaging (49) or advanced imaging instead of radiography (27), even when their clinical outcomes were no better. A study of Medicare beneficiaries found earlier use of imaging and more advanced imaging when clinician incentives were based on patient satisfaction (53). A trial showed that patients randomly assigned to receive routine imaging became more likely to believe it was necessary, despite experiencing no clinical benefit (63).
Greater availability of imaging resources seems to correlate with increased use. One study (64) found a strong correlation between the number of MRI units added in a geographic area and the number of MRI scans performed, with about 40 additional lumbar MRI scans for each new unit over a 5-year period. The number of MRI scanners in the United States tripled from 2000 to 2005, from 7.6 to 26.6 per million persons (64). In 2006, about 7000 U.S. sites offered MRI (65), almost twice as many per capita as any other industrialized country and more than 4 times as many as Canada or the United Kingdom (65). In 2006, western Pennsylvania had almost as many MRI machines (140 units) as all of Canada (151 units) (66).
Financial incentives can also influence imaging decisions. Top-of-the-line MRI units can cost at least $2 million to purchase and about $800 000 a year to operate (64, 66). However, advanced imaging offers a high profit margin. Relative to actual costs, Medicare provides far greater reimbursement for MRI than for conventional radiography (reimbursement–cost ratio, 2.3 vs. 0.9) (67). A 2009 report from the Medicare Payment Advisory Commission (68) reported an association between physician ownership or investment in imaging facilities and rates of use. An earlier study of worker's compensation cases (69) found more inappropriate imaging requests from physicians who self-referred.
In addition, the overuse of back imaging could be related to the perceived risk for missing a serious diagnosis. Defensive medicine refers to alteration of clinical behavior owing to concerns over malpractice liability. In 1 study (70), more than 90% of Pennsylvania physicians from 6 specialties reported defensive medicine practices, and almost one half of those with positive responses reported unnecessary imaging as their most recent defensive act. When a legal claim related to the back pain is more likely or when patients express dissatisfaction, the likelihood of such practices probably increases. Low back pain imaging is a typical part of the evaluation in worker's compensation and disability cases, despite the absence of evidence that it improves outcomes in these situations.
Finally, clinicians are pressed for time. Ordering an imaging test may be viewed as more expedient than explaining to a patient why imaging is not necessary (23, 71).
Adhering to the ACP/APS recommendations on use of imaging could reduce overuse. Most patients do not need immediate imaging, and an initial trial of therapy before imaging is warranted in many cases (Table 4). A key principle of the guideline is that a thorough history and physical examination are necessary to guide imaging decisions. No randomized trial data are available to guide optimal diagnostic strategies for patients with clinical risk factors. However, imaging is recommended when features suggest the cauda equina syndrome or vertebral infection. Although these conditions are rare and the prevalence of risk factors is low (72), timely diagnosis may prevent serious sequelae related to compression of the spinal cord or cauda equina. Key clinical features include new urine retention, saddle anesthesia, fecal incontinence, or fever (especially in patients with risk factors for bacteremia). Imaging is also indicated for severe or progressive neurologic deficits (such as objective or progressive motor weakness at a single level or deficits at multiple spinal levels).
Table 4.
Other risk factors are associated with specific conditions, such as cancer, vertebral compression fracture, ankylosing spondylitis, herniated disc, or symptomatic spinal stenosis (Table 4). The traditional approach has been to use imaging to act on all clinical risk factors. However, this would result in high imaging rates with low positive predictive values (38, 73). One study of 1172 patients with acute back pain in primary care (73) found that one quarter were older than 55 years, about one quarter had morning back stiffness, and about one third had pain that improved with exercise. All are considered risk factors for cancer or ankylosing spondylitis, but no cases of either condition were identified.
A more efficient strategy would be to use likelihood ratios to inform imaging decisions. For instance, the prevalence, or pretest probability, of cancer in a primary care population is about 0.7% (39). A history of cancer is the strongest risk factor for a spinal tumor (positive likelihood ratio, 15) (39). Unexplained weight loss, lack of improvement after 1 month, and age older than 50 years are weaker risk factors (positive likelihood ratio, 2.7 to 3.0). On the basis of these likelihood ratios, the probability of cancer in a patient with a history of cancer would increase to approximately 9%, or high enough to warrant immediate imaging (a strong clinical suspicion for cancer would give a similar result [72]). In patients with any of the other 3 risk factors, the posttest probability increases only marginally, to 1.2%. Imaging could be reasonably deferred in most cases unless symptoms did not improve after several weeks (38, 74). For patients with no signs of neurologic compromise who have risk factors for vertebral compression fracture, ankylosing spondylitis, herniated disc, or spinal stenosis, a trial of therapy before imaging would also be warranted. Diagnostic rules based on the evaluation of multiple risk factors could help better inform imaging decisions, but they are in the early stages of development (72).
Advanced imaging should be reserved for situations in which findings are more likely to affect clinical decision making, such as major trauma, severe neurologic compromise, or vertebral infection (5). If available, MRI is usually preferred over CT because it involves less radiation exposure and has better soft-tissue visualization. In cases in which only weak risk factors for cancer and no neurologic signs are present, initial imaging with lumbar radiography and evaluation of erythrocyte sedimentation rate is a reasonable approach (74). For persistent radicular symptoms or spinal stenosis without severe neurologic compromise, advanced imaging should be performed after a 1-month trial of therapy in candidates for surgery or an epidural steroid injection (5). For suspected vertebral compression fracture or ankylosing spondylitis, lumbar radiography is recommended. Decisions regarding repeated imaging should be based on the development of new or changed clinical features, such as new or progressive neurologic symptoms or recent trauma.
Although patient expectations regarding back imaging are frequently at odds with the evidence (58), this need not be the case. Most patients do not want unnecessary or potentially harmful tests. Patient education could help bring expectations more in line with the evidence. In addition, effective education may be less burdensome than assumed. One randomized trial (63) found that a brief educational intervention regarding back imaging took fewer than 5 minutes and resulted in similar satisfaction with overall care (and similar clinical outcomes) to that of routine radiography. Supplementing face-to-face information with patient handouts, self-care education books (75), online materials (76, 77), mass media educational campaigns (78), or other methods could be an efficient strategy for reinforcing or expanding on key points.
Efforts to decrease imaging overuse should also address external barriers to change. For example, clinician incentives based on patient satisfaction could reward unnecessary testing and be counterproductive (53). Incentives should instead be based on whether clinicians deliver appropriate care. Efforts are under way to curb overuse related to physician self-referral and to revise reimbursement schedules to provide fair compensation without excessive incentives for advanced imaging (65, 68, 79).
Active and individualized methods will probably be more effective at changing clinician behavior than passive ones, such as distributing guidelines (80, 81). Many health insurers have imposed authorization requirements for advanced imaging, but these are often viewed as onerous (65). As a potential alternative, a randomized trial (82) found that an educational session by local clinical leaders followed by individualized clinician audit and feedback was more effective than no intervention for reducing inappropriate lumbar imaging. Another promising method is a computer-based decision support tool (65) that provides information at the time of ordering, such as whether the patient has had a recent imaging study, and compares a physician's ordering patterns with that of his or her peers.
Health care practices associated with high costs and limited or no benefits provide little value (11). Good evidence indicates that routine back imaging is not associated with clinically meaningful benefits and exposes patients to unnecessary harms, but imaging remains overused. Implementation of the ACP/APS recommendations on judicious and selective low back imaging would improve patient care while reducing costs. To be most effective, efforts to reduce use of imaging should be multifocal and address clinician behaviors, patient expectations, and financial incentives. The mindset that more testing means better care must be abandoned in favor of a more evidence-based approach.
The ACP has found strong evidence that routine imaging for low back pain by using radiography or advanced imaging methods is not associated with a clinically meaningful effect on patient outcomes. Unnecessary imaging exposes patients to preventable harms, may lead to additional unnecessary interventions, and results in unnecessary costs. Diagnostic imaging studies should be performed only in selected, higher-risk patients who have severe or progressive neurologic deficits or are suspected of having a serious or specific underlying condition. Advanced imaging with MRI or CT should be reserved for patients with a suspected serious underlying condition or neurologic deficits, or who are candidates for invasive interventions. Decisions about repeated imaging should be based on development of new symptoms or changes in current symptoms. Patient education strategies should be used to inform patients about current and effective standards of care. The Figure summarizes this advice.
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