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Shenzhen Mekede Technology Co., Ltd.
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|Business Type:
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Shenzhen Mekede Technology Co.,Ltd is a high-tech company with expertise in car multimedia systems, ...
Shenzhen Mekede Technology Co.,Ltd is a high-tech company with expertise in car multimedia systems, including Car DVD Players, Car GPS systems and Car monitors. We are proud of our production capabilities and competitive prices. We are confident to bring you advanced products that meet international standards.
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Verizon iPhone Buzz Gets StrongerBy Arnab Ghosh, Gaea News Network
Saturday, January 8, 2011
SAN FRANCISCO (GaeaTimes.com)- The biggest grudge of the iPhone users in USA is not about any particular flaw of the device but about the network it runs on. Ever since the smart phone that started the touch screen revolution in the industry made its debut in 2007 the users have complained about shoddy network coverage affecting the performance of the device. However, this is not a fault of Apple as such, the blame is on the network provider aka AT&T. Despite its claims of improvement AT&T has consistently lagged behind Verizon, its rival and USA's biggest mobile network service provider. Since the launch of the iPhone by Apple it signed an exclusive contract with AT&T which forced the users of iPhone to stick to AT&T. The rumors of Verizon launching iPhone have surfaced several times but it has not materialized so far. Verizon has built its user base selling Android based smart phones and its network has always proved to be better than AT& T.
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Jewel of De Nile
(Page 7 of 7: Viewing Diary Entry 61 to 65)
1 2 3 4 5 6 7
Well, La Da De Da...March 23rd 2007 4:48 pm
[ View A Comments ]
I'm glad I don't belong to snobby groups. I'm better than that anytime. Lots of kittys have told me I'm beautiful or that I'm gorgeous. Who needs some nit wit half brain who can figure out who should belong where EVER try to tell me what group I belong in.
My Coat of Many Color ThatMarch 22nd 2007 6:06 pm
[ View A Comments ]
My MaMa Made For Me...that's my song, and I'm sticking to it. The words are so true, my mama lost lots of babies and I'm the only one, just like her, that has a coat of many colors - so I pay tribute to my mama and my Meowmy says I'm beautiful! Not bad for some poor ol' farm kitty, eh?
I Didn't Do It...Honest I Didn't....March 21st 2007 4:03 pm
[ View A Comments ]
Would you believe this sweet honest face? Good, because Meowmy does, even when Buddy and Friday both look at ME when something happens and Meowmy wants to know who did it.
Did You Hear.....March 20th 2007 6:13 pm
[ View A Comments ]
My brother, Friday's diary is a feature today? Woohoo!! Check it out, maybe he'll be a writer like Meowmy.
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I been waiting to come on here, watching the two boys have all the fun. WooHoo..now it's my turn...OK Meowmy!...I can start to have fun LIKE the boys.
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Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men
Aims There is a significant uncertainty regarding the effect of testosterone replacement therapy (TRT) on cardiovascular (CV) outcomes including myocardial infarction (MI) and stroke. The aim of this study was to examine the relationship between normalization of total testosterone (TT) after TRT and CV events as well as all-cause mortality in patients without previous history of MI and stroke.
Methods and results We retrospectively examined 83 010 male veterans with documented low TT levels. The subjects were categorized into (Gp1: TRT with resulting normalization of TT levels), (Gp2: TRT without normalization of TT levels) and (Gp3: Did not receive TRT). By utilizing propensity score-weighted Cox proportional hazard models, the association of TRT with all-cause mortality, MI, stroke, and a composite endpoint was compared between these groups. The all-cause mortality [hazard ratio (HR): 0.44, confidence interval (CI) 0.42–0.46], risk of MI (HR: 0.76, CI 0.63–0.93), and stroke (HR: 0.64, CI 0.43–0.96) were significantly lower in Gp1 (n = 43 931, median age = 66 years, mean follow-up = 6.2 years) vs. Gp3 (n = 13 378, median age = 66 years, mean follow-up = 4.7 years) in propensity-matched cohort. Similarly, the all-cause mortality (HR: 0.53, CI 0.50–0.55), risk of MI (HR: 0.82, CI 0.71–0.95), and stroke (HR: 0.70, CI 0.51–0.96) were significantly lower in Gp1 vs. Gp2 (n = 25 701, median age = 66 years, mean follow-up = 4.6 years). There was no difference in MI or stroke risk between Gp2 and Gp3.
Conclusion In this large observational cohort with extended follow-up, normalization of TT levels after TRT was associated with a significant reduction in all-cause mortality, MI, and stroke.
- Testosterone replacement therapy
- Myocardial infarction
- Stroke
Professional guidelines recommend testosterone replacement therapy (TRT) in patients with signs and symptoms of hypogonadism and documented evidence of low testosterone (T) levels.1 The diagnosis of late-onset hypogonadism is on the rise with estimates that nearly 2.4 million men aged 40–69 suffer from hypogonadism in the USA.2 Even though late-onset hypogonadism is not a universally accepted concept, and FDA has advised against T supplementation in men on the basis of age alone. However, in the last decade there has been a nearly 400% increase in the number of TRT prescriptions creating a billion dollar market.3 With such widespread and ever increasing use of TRT, there has been growing concern regarding its effect on mortality and cardiovascular (CV) outcomes.
Recent retrospective studies, multiple meta-analyses, and a few small prospective studies have presented conflicting results and contributed to this uncertainty.4–14 Observational studies suggested that low serum T level is associated with increased CV events.4,15,16 Clinical trials examining TRT have been relatively small, and these trials were underpowered to provide conclusive evidence related to CV events.9 For instance, a small prospective study in frail elderly men showed an increased incidence of CV events with TRT and was stopped early.10 Two separate retrospective studies of men in the Veterans Affairs (VA) Health System using two different databases reported opposite effects of TRT on all-cause mortality.11,14 In two very recent studies, Vigen et al.11 using a VA database and Finkle et al.12 using a healthcare database reported that men receiving TRT had an increased risk of myocardial infarction (MI). It is important to note that in many of these studies repeat measurements to document normalization of T levels after TRT were lacking. On the heels of these recently published data, the FDA issued a drug safety alert related to TRT (http://www.fda.gov/Drugs/DrugSafety/ucm383904.htm).
In light of these conflicting results and uncertainty concerning the safety of TRT, we have conducted a large retrospective study with long-term follow-up to address this knowledge gap. The objective of our study was to examine the association between TRT with documented normalization of total testosterone (TT) levels and all-cause mortality and adverse CV events defined by MI and stroke.
This is a retrospective cohort study of male veterans who received their medical care at the Veterans Health Administration (VHA) between December 1999 and May 2014. The data of study patients were retrieved from VHA Veterans Administrations Corporate Data Warehouse (CDW) through the Veterans Administrations Informatics and Computing Infrastructure (VINCI) [http://www.hsrd.research.va.gov/for_researchers/vinci/default.cfm (cited 21 June 2014)]. The study complies with the Declaration of Helsinki, and the Institutional Review Board of Kansas City Veterans Affairs Medical Center, MO, USA, approved the study. Additional details are provided in the Supplementary material online, Appendix.
Study design
This study was designed to examine the effect of TRT on CV outcomes by comparing the incidences of MI, stroke, and all-cause mortality among different sub-populations of treated and untreated patients. All patients' CV events and co-existing conditions were based on the International Classification of Diseases 9th Revision (ICD-9) codes. All of the study patients had TT levels checked at least on two separate occasions as recommended by guideline.1
Ascertainment of testosterone replacement therapy exposure
Use of TRT was ascertained from the medication prescription of patient medical records. For this study, patients who received any form of TRT (injection, gel or patch) were considered as treated.
Determination of total testosterone level
Low TT was determined to be present when TT level was less than the lower limit of normal laboratory reference range (NLRR) reported for that particular test result. This method was adopted to include results from a large number of laboratories in the entire VA Health System over a period of 14 plus years that used different test assays and had different reference ranges and reporting units. Data from position statement of Endocrine Society and several other sources suggest that testosterone levels can vary significantly between different laboratories, even when they use same commercial kits. Moreover, because of assay ambiguities and biological variations, no single cut-off T value can clearly distinguish between hypogonadism and eugonadism17,18 There is also a lack of standardization when it comes to T levels and other tests using the stoichiometric measurements.19,20 Hence, we classified each test result as low or normal based on its respective laboratory reference range reported. This approach permitted inclusion of testosterone values obtained using different assay methods and minimized the investigator bias likely introduced by an arbitrary cut-off value.
Outcome measures
Primary outcome measures were (i) the incidence of MI (ICD-9 410.x0 and 410.x1), (ii) the incidence of ischaemic stroke [ICD-9 433.x1, 434 (excluding 434.x0), or 436], and (iii) the all-cause mortality determined using dates of death in CDW data augmented with vital status files.
Additional details are provided in the Supplementary material online, Appendix.
Study population
Figure 1 presents the patient selection process.
Inclusion criteria
We included patients whose first tested TT level was lower than the respective laboratory NLRR.
Exclusion criteria
We excluded (i) females, (ii) those who received TRT before the first available low TT, (iii) those who had MI or ischaemic stroke before the first day of study, and (iv) those who on repeat testing had normal TT level before any treatment was started.
Eligible study patients were classified into three groups: Gp1: TRT with resulting normalization of TT levels (normalized-TRT); Gp2: TRT without normalization of TT levels (non-normalized-TRT); and Gp3: Did not receive TRT (no-TRT). Additional details are provided in the Supplementary material online, Appendix.
Statistical analysis
Continuous variables were reported as means and standard deviation (SD), categorical variables as percentages. Chi square test and Student's t-test were used to compare normally distributed baseline characteristics of patients. Non-parametric tests were used for non-normally distributed variables. We performed univariate and multivariable Cox proportional hazard regression analyses to assess the differences between groups. Furthermore, propensity scores were used to correct for potential systematic differences between treated and untreated patients. Each study patient's propensity scores for receiving the TRT were computed and adjusted for the covariates in a logistic regression analysis. The covariates included were age, body mass index (BMI), hypertension (HTN), diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), obstructive sleep apnoea (OSA), congestive heart failure (CHF), peripheral vascular disease (PVD), coronary artery disease (CAD), low density lipoprotein (LDL), use of aspirin, beta-blockers, and statins. All individuals with missing data on these matching covariates were excluded from the analysis. For robust analysis of our data, we utilized propensity score-weighted, stabilized inverse probability of treatment weights (IPTW); this allowed us to keep all patients in the study while using the propensity scores to achieve balance between each pair of subgroups we studied.21–23
We also applied the stabilized IPTW to obtain Kaplan–Meier (KM) survival curves and to compare event-free survival time between the groups, along with log-rank P-value. SAS 9.4 was used for statistical analyses while Stata 12 was used to plot KM curves with TRT as a time-varying exposure variable. The study hypotheses were tested at two-sided level of significance with a P-value of <0.05. The use of IPTW effectively controlled for the imbalances in the groups as shown by the P-values (Table 1). Further details regarding how IPTW model was utilized in our study are described in the Supplementary material online, Appendix. Supplementary material online, Figures S5–S7, Appendix show how variations in low and high propensity scores in the unmatched pairs of cohorts were controlled for by IPTW.
|Unmatched cohort
|Propensity-matched cohort (stabilized IPTW)
|Normalized treated vs. untreated
|Normalized treated
|Normalized treated
|Age ≥ 50 years, n (%)
|38 968 (89.4)
|11 998 (90.3)
|36 641 (89.7)
|10 716 (89.6)
|Age, median (Years)
|Body mass index ≥ 30 kg/m2
|28 670 (65.8)
|8117 (63.7)
|26 854 (65.7)
|7871 (65.8)
|Body mass index, kg/m2, mean (SD)
|33.0 (6.6)
|32.8 (6.9)
|33.0 (6.6)
|33.0 (6.8)
|Follow-up time (years), mean (SD)
|6.2 (3.3)
|4.7 (3.1)
|6.0 (3.1)
|4.6 (2.9)
|Hypertension, n (%)
|7465 (17.0)
|2342 (17.5)
|7251 (17.8)
|2128 (17.8)
|Diabetes mellitus, n (%)
|13 318 (30.3)
|4228 (31.6)
|12 826 (31.4)
|3762 (31.5)
|Chronic obstructive pulmonary disease, n (%)
|528 (1.2)
|215 (1.6)
|546 (1.3)
|161 (1.3)
|Obstructive sleep apnoea, n (%)
|801 (1.8)
|279 (2.1)
|814 (2.0)
|240 (2.0)
|Congestive heart failure, n (%)
|713 (1.6)
|353 (2.6)
|779 (1.9)
|228 (1.9)
|Peripheral vascular disease, n (%)
|357 (0.8)
|165 (1.2)
|379 (0.9)
|111 (0.9)
|Coronary artery disease
|2141 (4.9)
|738 (5.5)
|2146 (5.3)
|629 (5.3)
|Depression, n (%)
|3590 (8.2)
|844 (6.3)
|3284 (8.0)
|957 (8.0)
|LDL > 100 mg/dL, n (%)
|21 403 (51.6)
|6085 (48.6)
|20 779 (50.9)
|6087 (50.9)
|Concomitant therapy with
|Antiplatelet agents (ASA), n (%)
|12 410 (28.3)
|3916 (29.3)
|11 904 (29.1)
|3480 (29.1)
|B-blockers, n (%)
|16 022 (36.5)
|5041 (37.7)
|15 439 (37.8)
|4515 (37.8)
|Statins, n (%)
|25 260 (57.5)
|7716 (57.7)
|24 334 (59.6)
|7117 (59.5)
|Normalized treated vs. non-normalized treated
|Normalized treated
|Non-normalized treated
|Normalized treated
|Non-normalized treated
|Age ≥ 50 years, n (%)
|38 968 (89.4)
|22 692 (88.8)
|36 484 (89.3)
|21 389 (89.3)
|Age, median (Years)
|Body mass index ≥ 30 kg/m2
|28 670 (65.8)
|17 460 (69.0)
|27 554 (67.4)
|16 161 (67.5)
|Body mass index, kg/m2, mean (SD)
|33.0 (6.6)
|33.6 (6.9)
|33.2 (6.6)
|33.4 (6.9)
|Follow-up time (years), mean (SD)
|6.2 (3.3)
|4.6 (3.1)
|6.0 (3.1)
|4.5 (3.0)
|Hypertension, n (%)
|7465 (17.0)
|5114 (19.9)
|7655 (18.7)
|4492 (18.8)
|Diabetes mellitus, n (%)
|13 318 (30.3)
|9233 (35.9)
|13 512 (33.1)
|7971 (33.1)
|Chronic obstructive pulmonary disease, n (%)
|528 (1.2)
|460 (1.8)
|608 (1.5)
|358 (1.5)
|Obstructive sleep apnoea, n (%)
|801 (1.8)
|712 (2.8)
|936 (2.3)
|549 (2.3)
|Congestive heart failure, n (%)
|713 (1.6)
|666 (2.6)
|836 (2.1)
|490 (2.0)
|Peripheral vascular disease, n (%)
|357 (0.8)
|291 (1.1)
|386 (1.0)
|227 (1.0)
|Coronary artery disease
|2141 (4.9)
|1623 (6.3)
|2304 (5.6)
|1352 (5.6)
|Depression, n (%)
|3590 (8.2)
|2249 (8.8)
|3539 (8.7)
|2079 (8.7)
|LDL > 100 mg/dL, n (%)
|21 403 (51.6)
|11 676 (47.8)
|20 473 (50.1)
|11 997 (50.1)
|Concomitant therapy with
|Antiplatelet agents (ASA), n (%)
|12 410 (28.3)
|7808 (30.4)
|12 125 (29.7)
|7111 (29.7)
|B-blockers, n (%)
|16 022 (36.5)
|10 532 (41.0)
|15 947 (39.0)
|9350 (39.0)
|Statins, n (%)
|25 260 (57.5)
|15 775 (61.4)
|24 809 (60.7)
|14 541 (60.7)
|Non-normalized treated vs. untreated
|Non-normalized treated
|Non-normalized treated
|Age ≥ 50 years, n (%)
|22 692 (88.8)
|11 998 (90.3)
|21 391 (89.3)
|10 677 (89.3)
|Age, median (Years)
|Body mass index ≥ 30 kg/m2
|17 460 (69.0)
|8117 (63.7)
|16 191 (67.6)
|8086 (67.6)
|Body mass index, kg/m2, mean (SD)
|33.6 (6.9)
|32.8 (6.9)
|33.5 (6.9)
|33.3 (6.9)
|Follow-up time (years), mean (SD)
|4.6 (3.1)
|4.7 (3.1)
|4.5 (2.9)
|4.5 (2.9)
|Hypertension, n (%)
|5114 (19.9)
|2342 (17.5)
|4740 (19.8)
|2370 (19.8)
|Diabetes mellitus, n (%)
|9233 (35.9)
|4228 (31.6)
|8470 (35.4)
|4231 (35.4)
|Chronic obstructive pulmonary disease, n (%)
|460 (1.8)
|215 (1.6)
|431 (1.8)
|214 (1.8)
|Obstructive sleep apnoea, n (%)
|712 (2.8)
|279 (2.1)
|645 (2.7)
|323 (2.7)
|Congestive heart failure, n (%)
|666 (2.6)
|353 (2.6)
|644 (2.7)
|324 (2.7)
|Peripheral vascular disease, n (%)
|291 (1.1)
|165 (1.2)
|288 (1.2)
|145 (1.2)
|Coronary artery disease
|1623 (6.3)
|738 (5.5)
|1510 (6.3)
|756 (6.3)
|Depression, n (%)
|2249 (8.8)
|844 (6.3)
|1966 (8.2)
|984 (8.2)
|LDL > 100 mg/dL, n (%)
|11 676 (47.8)
|6085 (48.6)
|11 489 (48.0)
|5746 (48.1)
|Concomitant therapy with
|Antiplatelet agents (ASA), n (%)
|7808 (30.4)
|3916 (29.3)
|7359 (30.7)
|3676 (30.8)
|B-blockers, n (%)
|10 532 (41.0)
|5041 (37.7)
|9775 (40.8)
|4875 (40.8)
|Statins, n (%)
|15 775 (61.4)
|7716 (57.7)
|14 868 (62.1)
|7419 (62.0)
Cohort description
As shown in Figure 1, the initial cohort consisted of 117 094 patients with low TT. One thousand five hundred and sixty patients were excluded as they had a MI or stroke prior to the assessment of TT levels. These individuals were excluded because our study was focused on incident events. We then excluded 24 522 patients whose pretreatment baseline TT levels could not be ascertained. The remaining 91 012 patients were included in the study and categorized into those who received TRT at any time after they were determined to have low testosterone (81.5%) and those who did not receive TRT (18.5%). Testosterone replacement therapy achieved normalization of TT levels in 43 931 (63.1%) patients while the rest of this group continued to have low TT. Mean duration of treatment for normalized-TRT group was 3.0 ± 2.7 years and for non-normalized group was 1.5 ± 1.9 years.
In the untreated cohort, we identified certain individuals whose TT levels normalized at repeat testing (n = 8002). Though there was no record of treatment for these people, we could not rule out the possibility of non-VA prescriptions which could have been responsible for this finding. To prevent misclassification bias, individuals with these spuriously normalized TT levels were excluded leaving an N of 83 010. The percentage of people showing normal TT levels on repeat testing was around 30%; this number is consistent with the findings from population-based studies in which 1/3 of subjects showed normal TT levels on repeat testing.24
Baseline characteristics of the patients
Table 1 presents the baseline characteristics of the three groups. By means of stabilized IPTW, while performing Cox proportional hazard regression analyses, we controlled for discrepancies related to age, BMI, HTN, DM, COPD, OSA, CHF, PVD, CAD, LDL, use of aspirin, beta-blockers, and statins in the study groups by ensuring the cohorts were well matched (P > 0.05).
Relationship between testosterone replacement therapy and all-cause mortality
All-cause mortality in the three groups was as follows: normalized-TRT (Gp 1) (1654), non-normalized-TRT (Gp2) (3004), and no-TRT (Gp3) (3635) per 100 000 person-years. Normalized-TRT group had significantly fewer deaths than no-TRT (stabilized IPTW, hazard ratio, HR: 0.44, confidence interval, CI 0.42–0.46, P < 0.0001) and non-normalized-TRT (stabilized IPTW, HR: 0.53, CI 0.50–0.55, P < 0.0001) groups (Table 2). Mortality was also significantly lower in the non-normalized-TRT group compared with those in no-TRT group (stabilized IPTW, HR: 0.84, CI 0.80–0.89, P < 0.0001). The KM curves showed that the normalized-TRT group was associated with significantly increased all-cause mortality-free survival (log-rank, P < 0.05) compared with the non-normalized-TRT or no-TRT groups (Figure 2).
|All-cause mortality
|Myocardial infarction
|Hazard ratio
|Hazard ratio
|Hazard ratio
|Comparing normalized treated vs. untreated (ref = untreated)
| Univariate
N = 43 931 vs. 13 378
| Propensity matched (stabilized inverse probability of treatment weights)
N = 40 852 vs. 11 957
|Comparing normalized treated vs. non-normalized treated (ref = non-normalized treated)
| Univariate
N = 43 931 vs. 25 701
| Propensity matched (stabilized inverse probability of treatment weights)
N = 40 852 vs. 23 953
|Comparing non-normalized treated vs. untreated (ref = untreated)
| Univariate
N = 25 701 vs. 13 378
| Propensity matched (stabilized inverse probability of treatment weights)
N = 23 953 vs. 11 957
Relationship between testosterone replacement therapy and myocardial infarction
Table 2 presents result of the unadjusted and adjusted risk of MI in the study groups. Incidence of MI in the three groups was as follows: normalized-TRT group (189), non-normalized-TRT group (261), and no-TRT group (263) per 100 000 person-years. In the stabilized IPTW, normalized-TRT group showed lower risk of MI than non-normalized-TRT (HR: 0.82, CI 0.71–0.95, P = 0.008) and no-TRT (HR: 0.76, CI 0.63–0.93, P = 0.005) groups. However, non-normalized-TRT group was not different from no-TRT group (HR: 0.98, CI 0.80–1.19, P = 0.811). Figure 3 shows a comparison of the probability of MI-free survival among the three groups. The KM curves show that normalized-TRT group was associated with significantly increased MI-free survival (log-rank, P < 0.01) compared with non-normalized-TRT and no-TRT groups. We performed additional analysis for MI-free survival after truncating the follow-up beyond 10 years. Although we lost a significant proportion of the study population, the findings remained fairly consistent after these analyses. See results in Supplementary material online, Table S5 and Figure S8, Appendix.
Relationship between testosterone replacement therapy and ischaemic stroke
The incidence of ischaemic stroke was as follows: normalized-TRT group (43), non-normalized-TRT group (57), and no-TRT group (59) per 100 000 person-years. Stabilized IPTW showed that normalized-TRT group had significantly lower stroke events compared with non-normalized-TRT (HR: 0.70, CI 0.51–0.96, P = 0.028) and no-TRT (HR: 0.64, CI 0.43–0.96, P = 0.031) groups (Table 2). There was no difference in the risk of stroke between non-normalized-TRT group and no-TRT group. Overall, there was a protective effect against stroke in normalized-TRT group, as suggested by KM curves in Supplementary material online, Figure S4, Appendix.
In this study of men with low TT levels and without prior MI or stroke, normalization of TT levels using TRT is associated with lower all-cause mortality, fewer MIs, and ischaemic strokes. This retrospective study describes the largest cohort of such patients and the longest follow-up for TRT to date. It is the first study to demonstrate that significant benefit is observed only if the dose is adequate to normalize the TT levels. Patients who failed to achieve the therapeutic range after TRT did not see a reduction in MI or stroke and had significantly less benefit on mortality. We selected patients without any previous history of MI or stroke prior to initiation of TRT to reduce bias related to CV outcomes. Further, we employed stabilized IPTW to decrease confounders by balancing measurable covariates between the groups. We modelled TRT as a time-varying covariate to account for the interval contributed by the treated individuals between enrollment (first low TT laboratory results) and the onset of TRT. We attempted to overcome the potential limitation of inadequate treatment by using follow-up TT levels as a marker of adequacy of dosing and compliance. We believe that our design criteria permit confidence in interpretation.
Several recent retrospective studies have investigated the association of TRT with CV outcomes. Vigen et al.11 utilized the VA Clinical Assessment Reporting and Tracking (CART-CL) database that collects data from VA cardiac catheterization laboratories.25 Their study enrolled patients who had cardiac catheterization done between 2005 and 2011 and also had low TT. The authors compared those who received TRT with those who did not. In that population, TRT was associated with significantly higher adverse events (MI, strokes, and death; HR: 1.29, 95% CI 1.05–1.58, P = 0.02). Our study differs from this study in several important ways. We included all patients who had their TT level checked, and we divided them into two groups: Gp1, patients who showed a documented appropriate rise in testosterone level post-TRT and Gp2, patients who did not achieve an appropriate rise. In comparison, Vigen et al. only included hypogonadal men who had undergone coronary angiography. This inclusion criterion may have introduced selection bias towards inclusion of a high CV-risk population. In this study, nearly 40% of the cohort had no repeat TT levels checked. Additionally, on the basis of the mean TT levels reported in the study by Vigen et al., a number of patients likely did not achieve normalization of TT levels following TRT and, thus, may have reflected a subsequent risk of non-normalized hypogonadal men rather than a cohort with normalized TT level after TRT. Our study population was relatively healthier with lower average age (∼64.2 years). Furthermore, we assessed hard end points (MI, stroke, and all-cause mortality).
The Testosterone in Older Men (TOM) trial10 was a prospective, randomized placebo controlled study that was designed to determine the effects of TRT on lower extremity strength and physical function in older men with limitations in mobility and low serum levels of TT or free T. This trial was stopped prematurely at 6 months because of increased CV-related events in the TRT group. This trial had a small sample size (209 men), higher than average prevalence of chronic diseases (DM, HTN, and dyslipidaemia) in the cohort, and advanced age (mean age ∼74 years); the adverse CV events were diverse and some were of variable clinical importance such as peripheral oedema, ectopy on ECG, and elevated BP. An additional point worth noting was that early termination of the TOM trial may have contributed to an overestimation of the differences ascribed to treatment. In fact, some previous similar trials did not show an increased risk of adverse CV events with TRT therapy.9,26
A recent study by Finkle et al.12 reported the risk of non-fatal MI in 90 days following a T prescription and compared it with the MI risk in the year preceding the prescription. They found that in older men (≥75 years) and in younger men with pre-existing heart disease, the risk of CV events was higher following a T prescription. However, this study did not take into account T levels. Thus, it is unclear how many people were adequately treated. Testosterone replacement therapy usually is a long-term therapy. These investigators limited the follow-up to 3 months of therapy. It is unknown whether this short duration of follow-up was sufficient to capture the outcomes of interest.
Our results do concur with a previous VA study. Shores et al.14 analysed data from seven VA medical centers. They found that TRT was associated with a significant decrease in all-cause mortality (HR: 0.61, CI 95%, P < 0.0001). While supporting the results of Shores et al., our study adds significantly to its conclusions both due to much larger sample size and also by more accurately identifying those who actually received and responded to the TRT. Shores et al. obtained data from the VA pharmacy records on T prescriptions, and those who received prescription were classified as treated. However, information regarding post-treatment TT level was not available in this study. Our study utilized post-TRT normalization in TT levels as a surrogate for administration of adequate therapy.
While our data found that normalization of TT levels after TRT was beneficial against CV risk and all-cause mortality, the mechanisms for these effects remain speculative. It can be postulated that the beneficial effect of normal T levels on adipose tissue, insulin sensitivity, and lipid profiles or by its anti-inflammatory and anticoagulant properties, as reported by other investigators, might have contributed to our findings.27–29 However, there are other potential mechanisms such as sodium retention, CHF, increased platelet aggregation, or adverse changes in HDL through which T may increase the CV risks.6 Therefore, additional studies will be needed to appropriately identify the mechanisms responsible for the outcomes noted in our study.
Finally, off-label use of TRT remains a concern. Recent FDA analyses suggest that currently only half of the men on TRT had been diagnosed with hypogonadism.30 Furthermore, 25% of users did not have their T concentrations tested prior to initiating therapy, and 21% of those prescribed TRT did not have their levels tested at any time during treatment. Recently, a second advisory from the FDA posted caution about using testosterone products for low T due to ageing and requires labelling change to inform of possible increased risk of heart attack and stroke with use.31 However, two very recent meta-analyses suggested a lack of convincing evidence posed by TRT.32,33 Therefore, for now, to maximize the benefits of TRT and to mitigate potential risks, there is a need for guideline-directed TRT with continuous active surveillance for potential risk in various cohorts of patients.
Study limitations
This was an observational study. Thus, unmeasured confounding or hidden bias might be present. A significant limitation of retrospective studies on TRT has been the inability to fully ascertain whether patients in the treatment arm actually took the medications in an adequate dose. This current study mostly overcomes this limitation by assessing follow-up TT levels. Normalization of follow-up TT levels is in our judgment a reliable surrogate for adequacy of dosing and compliance. Additionally, we could not ascertain the time of the day when the specimens for TT levels were drawn. Blood samples are usually collected during morning hours in the VA healthcare system. If some patients had their blood drawn after the morning hours, their levels would be underestimated. Furthermore, entry criteria and outcomes were determined using ICD-9 codes, and the VA cohort ICD-9 codes have been shown to be valid in determining outcomes.11
Another limitation of our study is that there was no randomization. Also our database does not have all the clinical data regarding indications for initiating TRT and not initiating TRT. Therefore, we cannot rule out the possibility that TRT may have been offered by a physician to healthier subjects and not to men who were less well. In our study, data regarding clinical response to TRT were also not available. Similarly, the available data do not permit us to ascertain the quality of care and/or poor compliance as reason(s) for persistent low testosterone levels observed in some individuals.
Despite the limitations associated with a retrospective study, our study has the advantages of having a large subject population with extensive follow-up. Our findings show that effective TRT is associated with lower rates of CV events in men without previous history of MI or stroke, in whom low TT levels are documented and effective TRT is provided. Safety and outcome of TRT in other populations remain to be determined.
Results from our present study suggest that in men without a history of previous MI or stroke who have low TT levels, TRT might be associated with decreased risks of MI, ischaemic stroke, and all-cause mortality in long-term follow-up. Our study also highlights that TRT should aim for doses resulting in normalization of TT level as this was shown to be associated with reduction in adverse CV events. In the future, adequately powered, prospective, well-designed trials with a long-term follow-up will be needed to reach a conclusive agreement regarding the effect of TRT on CV risk.
Supplementary material
Supplementary material is available at European Heart Journal online.
This study was supported by the Kansas City Veterans Administration Medical Center, Kansas City, MO and the Midwest Biomedical Research Foundation (MBRF), Kansas City, MO. M.S. received support from the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development (VA BX001037 awarded to V.J.S.).
Conflict of interest: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government. None of the authors has any conflict of interest to declare regarding the contents of the paper.
Authors gratefully acknowledge the valuable discussions with Dr Sharad Mathur, M.D., Chief, Pathology and Laboratory Medicine, Kansas City VA Medical center, Kansas City, MO.
- Published by Oxford University Press on behalf of the European Society of Cardiology 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.


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Students say thanks to community
This week's bouquets go to:
From the Escanaba High School project graduation committee:
"We would like to send a huge bouquet to all who helped make our 2013 pasty sale a huge success. Thanks to all who took orders, made pasties and bought pasties. Everyone worked hard and our students will benefit greatly on graduation night from this fundraiser."
From the Webster Elementary Staff:
"We would like to thank Mr. Dave Moyle and Delta County Bukokan staff for coming to the school and giving a martial art lesson to students in the after school club. The students really enjoyed the experience."
From the Webster staff and students from the Wolverine Club:
"We would like to thank Mrs. Gail Rice for coming and sharing her talents. Mrs. Rice shared a story relating to nature and she provided the materials for the students to craft pinecone birdfeeders. Thanks Mrs. Rice for bringing a new activity to us."
Each Saturday the Daily Press salutes individuals and groups from our area who have had a very positive impact on the way we live.
We identify our bouquet recipients in one of two ways: from Daily Press news pages and from nominations sent in by our readers.
Mail us a postcard or letter identifying your nomination and putting into detail what they've done. Include your name, address, and phone number. Send nominations to Saturday Bouquets, The Daily Press, 600 Ludington Street, Escanaba, MI 49829.
They may also be sent to us by going to our Web site, www.dailypress.net, and clicking on the submit news button. Once there, click on "Bouquets" and follow the simple instructions.


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Year in Review: Complex issues impact schools, town, candidates in 2015
Looking back on 2015, some might call it the year of meeting rooms and court rooms.
The fate of Tunica County schools was decided in Jackson meeting rooms in July, when state officials opted to place the district under conservatorship. Dr. Margie Pulley, a native of Greenwood, was dispatched to Tunica in July to help the school system prepare for the coming school year and ultimately correct deficiencies.
In the months leading up to the state takeover, a citizens' group formed and petitioned State Superintendent Dr. Cary Wright to remove Tunica County Superintendent Steve Chandler. The group alleged that Chandler was creating a hostile work environment and organized a sick out for teachers, administrators and staff within days of starting the new semester. They traveled to Jackson in late January to meet with Wright and voice concerns.
In May, the district received a report from an audit conducted by the Mississippi Department of Education's Office of Accountability. The district was deemed "noncompliant" in 25 of 31 areas.
Police urge extra security for homes, cars
A string of residential and auto burglaries that began in early December has Town of Tunica residents on edge.
Nine burglaries of homes and one business along Beat Line Road, Shady Lane, and Edwards Avenue that occurred from December 3 to December 24 are under investigation by the Tunica Police Department.
Police Chief Richard Veazey distributed a map to town aldermen on January 5 showing the location of each incident. Veazey said Koonce, Erwin & Wilkes, at 1246 Edwards in the downtown area, had experienced two burglaries during the three week time frame. Missing were several electronic items and cash, Veazey said. A residence at 1012 Edwards reported three entries or attempted entries, he said. Again, electronics and cash were the targets.
Slow Fall
North Tunica FD in funding crisis
Over a year ago, North Tunica County Fire District commissioner Stanley Jones warned that the fire station in the resort area would be forced to cut staffing if the district continued to be underfunded.
Now, those warnings have proven prophetic. As of January 1, 2016, the district cut the number of firefighters on duty from four to three. The move jeopardizes the district's fire rating, which stands at seven currently but could be revised by the Fire Ratings Bureau within the Mississippi Insurance Commission. Any downgrade to the rating would adversely affect the cost of insurance for property owners in North Tunica County.
"It seems like the county is taking public safety and putting it on the back burner," Jones said in an interview this week.
The North Tunica County Fire Protection District provides emergency services to homes and businesses in a defined section of the county. The district includes all of the casino properties; several large apartment complexes: industrial properties Schulz and GreenTech Automotive, with Feuer about to come on line; the outlet mall; and Tunica National Golf & Tennis Center. North Tunica firefighters also respond to car accidents in the north part of the county. The district has mutual aid agreements with other departments in the area such as the Tunica Fire Department and departments in Eudora and Walls, but assistance from all of those departments is at least 15 minutes away.
More Articles...
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TravelPod Member ReviewsBEST WESTERN PLUS Dallas Hotel & Conference Center
Comfortable bed. Clean room. Fitness center was so so but it did the job.
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Travel Blogs from Dallas
My last day in America!
... easily murdered with our cutlery. Sounds dramatic but her laugh went straight through you like base music!! Once we'd finished lunch we headed back home. I sorted my washing out and packed my cases. I'm leaving America with a massive suitcase full that I didn't turn up with. So my bag I left England with I'm now using as a carry on and I have a massive suitcase. Daphne Taylor's cat has taken a shine to me and that much she was in my ...
The Ez's Treat in Mesquite
... and his family as their 'dream house'. Subsequently sourced as the ideal location for exterior shots (apparently it had perfect views from all sides) the pool and breakfast patio featured often in the programme.
The location became Dallas's leading visitor attraction having been revealed inadvertently on a chat show. The family found it increasingly hard to live privately in such a setting and reluctantly felt the need to move away. ...
Last American Saturday
... Eric and mark headed to a place called 6th street! After a tequila shot it was dance floor time! We had the best night, met some guys along the way to who took us to another bar called the den. Was not impressed with Peter making me walk miles in my heels (well it felt like miles anyway!) was a great bar though! We was there till closing when we then went over the road to rest my poor feet sitting on a bench next to these guys who were playing ...
Day 9: Travel Day
Had to get a really early start since our fight was pretty early. Van came and got us about 6:20 am got to the airport and checked in our selves and bags. Luckily now the exit tax is part of your plan ticket price so we didn't have to worry about that. Only hiccup was they confiscated the dowel for my hammock chair. I think it was the moment they said not and asked to have it that I realized I guess it could be weapon like. Took ...
So much history!
... to recall the events of that day. The cockroach museum lightened things up for us- it was a quick, but memorable stop( wink, wink!). Our drive to Austin was full of exclamations-"Blue Bonnets!! Blue Bonnets on the right!!" The roadside was so colorful. Once in Austin, it was fried chicken at Lucy's- fun to sit out in the cool evening air with a tin bucket of fried chicken- and some FRIED deviled eggs. Yep- gotta get a cholesterol check once we return ...


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The organizer of this afternoon's immigration reform rally outside the Ohio Statehouse in Columbus can take consolation in knowing the event dwarfed OFA's attendee-free climate change rally that wasn't.
Reporter Jesse Hathaway managed to get up close to the action to grab some photos; check Media Trackers Ohio on Tuesday for more angles on this underreported rally, as well as OFA Westerville's same-day press conference with representatives of Mayors of Illegal Guns. We're told that event was actually smaller.


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posted by Roger Halligan on Wed, 04/16/2014 - 08:17
Who Said Mobile Marketing Is Just for the Younger Generations?It has been a common belief among many MarCom Pros that Mobile Marketing is the preferred method of reaching ONLY Gen Y and Gen X shoppers. Conventional wisdom says Boomers are far behind the curve when it comes to mobile phone use, especially for shopping purposes. But surprisingly, a recent study by Thrive Analytics blows that theory out of the water and shows that the older generation isn't far behind the young-uns when it comes to using mobile devices in their path-to-purchase. While 97% of Gen Y shoppers use their Smartphones in-store, a surprising 81% of Young Boomers (44-53 years old) do as well. And when it comes to using their mobile devices in-store to "help make decisions and become better informed", it is pretty much equal across the board - 88% Gen Y, 89% Gen X and 87% Young Boomers. What I also found interesting is that it was also pretty equal regarding "Guilt-free about browsing mobile in-store" - so much for the theory about Boomers being more technology-challenged. If you believe these results, it means marketers need to rethink the use of mobile when marketing to Boomers. But I've got to dash, just got an alert on my iPhone that the local Starbucks is offering a 20% discount on Macchiatos.
posted by Roger Halligan on Fri, 04/11/2014 - 08:31
What Ever Happened To Journalistic Attribution?It used to be a "given" that if a journalist was covering a speaker or session at an event, he or she would always mention the location of the interview and the industry organization sponsoring the event. And that's the way it should be. However, we have coordinated media relations for a variety of conferences recently and some of the business editors would cover the event as media and then write a nice story based on an interview they did or a session they attended. That is all fine and dandy, except for two instances where good articles were written based on attending the conference but no mention was made as to where the sessions or interviews were held! The story just said, "during a recent interview with so-and-so" or "according to new research just revealed"… with no mention of the conference. This is bad journalism and a bad business practice for several reasons:

 Many readers want to know where the writer conducted the interview and/or attended a session. If journalists report on a conference session they attended or interview they conducted, the obvious question is "what session were you attending and where"? It is all part of the basic journalism Who, What, Where, When format.

 It adds credibility to the journalist and their publication that they are active in their industry and attended an event where the industry experts were convening. This is more in-depth reporting than calling someone on the phone and interviewing them. It also allows the reporter to hear things during the presentation that they can report about in the story. They can also report on the crowd reaction and any interesting question and answer sessions.

 The conference organizer provided the journalist with free access while all other attendees had to pay several hundred dollars to attend. It was always a given that if a reporter was covering the event they would say "during an interview at XYZ conference". Or, the results of a new research study were revealed during the XYZ conference." There is no value to the conference organizer if a great article appears based on content gleaned from the conference but without acknowledgment of the organizer.

 It makes conference organizers wary of inviting media in the future if they know they will receive no mention of their event in the report.

 I had one of the writers tell me that the attribution was in the story she submitted but that her editor took it out due to space restrictions. If so, shame on the editor - find some other words to cut. In summary, not mentioning the event in post-conference reporting breaks an unspoken bond between the organizer and journalist that "if you come, we expect you will mention the conference in your coverage." I know there are several journalists who read this blog - so please let me know if you don't agree.
posted by Roger Halligan on Thu, 04/03/2014 - 07:48
Good Things Come In All Kinds of PackagesI just returned from the BAA Marketing Conference in Chicago where I heard some outstanding brand marketers talk about innovative and effective ways to activate a brand. Readers of this blog may recall that a couple weeks ago I attended the ANA Brand Masters Conference in Miami - and they had some great presentations as well. Of all the impressive content presented and lessons learned, two in particular stand out in my mind. Several of the speakers talked about how more and more brands are focusing on connecting emotionally with customers. There were some excellent examples, including the recent WestJet "Christmas Miracle" program and Coca Cola's World Cup campaign. It's not surprising to me that brands are putting a growing emphasis on emotionally connecting with consumers. What did pleasantly surprise me, however, was the special emphasis some brands are placing on packaging as an integral and emotional part of an integrated marketing program. McDonald's gave a great presentation on how they are redesigning their french fry boxes to form an emotional bond with consumers during the World Cup. You may have seen their commercials for how people can enter a contest to win tickets to the World Cup. Hello Products CEO told the audience how packaging defines the entire brand and forms an emotional connection with consumers. So, the biggest take-away from these meetings for me is that forming an emotional connection with customers to build loyalty is now the big "thing" with many brands. And, that packaging needs to play a key role in that process.
posted by Roger Halligan on Wed, 03/19/2014 - 21:41
Crisis Communications & the Missing Malaysia Airlines FlightFrom a PR perspective, there are two tragedies connected with the missing MH 370. The first and foremost is, of course, that no one knows the fate of the 239 passengers. However, from a communications perspective, the other tragedy is that Malaysian government and airline officials appear not to have a Crisis Communications Plan in place. Or if they do, it isn't a very effective plan. Imagine the emotional roller coaster the families of the missing passengers are riding every time a new report comes to light. As most PR pros know, there are a few very basic rules of an effective Crisis Communications Program:

 Always have a spokesperson Chain-of-Command in place so everyone automatically knows who is authorized to speak to the media and in what order. No one else should make any comments to the media and just refer them to the authorized spokesperson. Where many Crisis Communications Plans fail, especially in drawn-out situations like this, is when unauthorized people make statements to the media that may not be accurate.

 When a crisis occurs, only issue a basic statement summarizing the situation until you can gather and verify the facts. In this case, it would have been "Malaysia Airlines Flight 370 with 239 passengers aboard is missing. We are in the process of gathering more information and will let you know as we have more facts. "It is also appropriate to share facts that you know for sure, such as the time it took off, the weather conditions, the last communications from the cockpit and how the passengers and crew are. There should be no speculation as to what may have happened to the plane - leave that to the media and other "experts".

 Depending on the crisis, always try to meet early on in the crisis with the victims' families to share what facts you have. You want them to know you care and are trying to resolve the situation. If the families are not brought in early in the crisis, they can become very vocal detractors of your efforts and credibility.

 There should be a process in place to check all related facts as quickly and thoroughly as possible and to internally discuss all possible scenarios. Once you have some solid facts, those can be relayed to the media by the appropriate spokesperson as they are confirmed. For example, the pilot and co-pilot's homes should have been checked right away and reported to the media that this was being done. It should have also been reported that "we are in close communications with authorities in the region and as we know the facts, we will share them with you".

 Reach out to all concerned parties and ask them to keep you appraised of any facts they discover and if possible, share them with you first. Ask them if you can deliver the news and credit them as the source. In this case, that would mean Malaysia working with the other government officials to deliver the news. For example, the official Malaysian spokesperson would say "We just talked with Chinese officials and they have satellite evidence that the plane changed course." If other governments won't cooperate, be prepared to respond to the news by either confirming or denying that you just heard it from that source as well.

 There are several other elements and strategies that make up an effective Crisis Communications Program, but getting these basic elements right are the critical first steps. Of course it is easy for us to second-guess what should have been done after the fact - but the point here is having a good Crisis Communications Plan BEFORE a crisis occurs. Your crisis probably won't involve a missing airplane, but there are a number of other crises no one anticipates that occur every day. A few we have dealt with for our clients include floods, strikes, environmental challenges and suicides. I hope you have a Crisis Communications Plan in-place, and that you'll never have to use it.
posted by Roger Halligan on Fri, 03/14/2014 - 08:18
Tricking Your Competitors Into Promoting Your BrandHave you seen the new YouTube video that shows DHL tricking its competitors into delivering huge packages promoting its brand to major metropolitan areas around the world? It's truly an innovative and hilarious prank whereby a marketing agency came up with the brilliant idea of using thermo active packaging that is black when frozen but reveals a message as the temperature warms up. The agency shipped several large packages through their DHL competitors to hard-to-find addresses in major cities throughout Europe that had the hidden message "DHL Is Faster". As UPS, Fedex, TNT and other delivery services transported the five feet tall packages through busy city intersection and the temperature got warmer, big red letters on the side of the package appeared promoting the DHL brand and its slogan "DHL Is Faster". What could be sweeter than hundreds of consumers chuckling as a UPS delivery person wrestles a large box promoting their competitor down a busy thoroughfare. You say that is a lot of money to pay to prank your competition and give a couple hundred people a good chuckle. That's true, but like many marketing strategies these days, the idea was surely to cause a buzz on social media. And it worked! So far, more than 600,000 people have viewed the video and I'm sure many of them have clicked through to the DHL website to send a package. Although I haven's seen any official results of the campaign, and DHL claims they had nothing to do with the prank, I'm sure it has gained them several news customers and much greater recognition for being faster than their competitors. There is another lesson to be learned form this clever idea - and that is how powerful innovative packaging can be in growing a brand. But that is the topic of a future blog.
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Culture, Gender
Same-sex unions and gay marriage: Revisiting anti-gay sentiment and population figures
On Oct. 6, 2014, the U.S. Supreme Court let stand rulings at three Federal appeals courts, clearing the way for same-sex marriages in Indiana, Oklahoma, Utah, Virginia and Wisconsin, bringing the total of U.S. states permitting such unions to 24, in addition to the District of Columbia.
Although dynamics could change if the Court eventually decides to rule on the matter, its latest action could lead to even more states permiting gay marriage: The three appeals courts in question have jurisdiction over six other states that currently ban same-sex unions — Colorado, Kansas, North and South Carolina, West Virginia and Wyoming.
In the months following the June 2013 Supreme Court ruling that struck down key parts of the 1996 Defense of Marriage Act, states have continued to take measures to legalize same-sex marriage, most recently Illinois and Hawaii. New Jersey also began to recognize them after Governor Chris Christie withdrew a challenge to such unions, and in November federal judges struck down gay-marriage bans in Arkansas and Mississippi. While many continue to oppose gay marriage, recent polls indicate that attitudes are softening even among conservatives. However, some polling indicates that a majority would like to see the issue resolved by individual states — a February 2014 New York Times/CBS News poll indicated that nearly two-thirds of Americans would prefer a state-based approach.
On the international stage, Pope Francis has made public comments on not judging homosexuality, setting a different tone for the Catholic Church. In Russia, however, President Vladimir Putin has signed a law banning "propaganda on nontraditional sexual relationships," seen as part of a larger crackdown on advocates' efforts to improve gay rights in the country. The law and its heavy-handed enforcement cast a pall over the 2014 Winter Olympics, in the Black Sea town of Sochi.
A June 2013 Pew survey of lesbian, gay, bisexual and transgender adults found that the vast majority (92%) felt that U.S. society had become more accepting over the past decade. At the same time, discrimination was common: Nearly 40% said they'd experienced rejection because of their sexual orientation or gender identity; 30% had received threats or been physically attacked; and 58% said they've been the target of slurs or jokes.
A 2013 paper for the National Bureau of Economic Research, "The Size of the LGBT Population and the Magnitude of Anti-Gay Sentiment are Substantially Underestimated," looks at the possibility that discrimination may be more pervasive than previously understood — and that the extent of the U.S. gay population remains under-counted. The researchers — Katherine B. Coffman and Lucas C. Coffman of Ohio State University and Keith M. Marzilli Ericson of Boston University — suggest that survey respondents are often hesitant to express negative attitudes toward the LGBT community if they believe they will sound intolerant. Previous research indicates that honest replies increase when survey participants are guaranteed anonymity and privacy, and the use of computers has been shown to be effective. But is this sufficient for eliciting completely truthful responses to deeply personal questions?
The researchers used an experiment design that allowed them to compare results from a traditional anonymous survey with one that uses an item count technique (ICT), also called an "unmatched count technique." Rather than asking participants to answer sensitive questions directly, ICT surveys typically involve asking a control group to look at a list of neutral, non-sensitive items and report how many are true for them. A second group is given the same list, plus one sensitive, personal item, such as an indication of sexual orientation. The researcher is then able to estimate the population mean for the sensitive item by comparing it with the control group. (This technique has also been used to measure subjects such as risky driving by veterans and voter turnout.)
In the NBER study, which was conducted in November 2012, participants from Amazon's Mechanical Turk service were randomly given "direct report" or "veiled report" treatments. Each group was presented with both neutral statements and sexuality-related questions. The direct-report group was asked to reply to sensitive questions anonymously and privately on a computer, imitating the design of many current surveys. The veiled-report group was given the same neutral and sensitive statements, but merely had to report the number of statements — innocuous or sensitive — that applied to them. (Note that percentage points and percent are not synonymous; our article on statistics for journalists has more information.)
Key results from the study include:
- The veiled-report treatment significantly raised the overall number of answers to sensitive questions: Reports of non-heterosexual identity rose by 65%, same-sex sexual experiences by 59% and directionally same-sex attraction by 9.4%.
- The veiled report increased measured rates of anti-gay sentiment: Participants were 67% more likely to express disapproval of an openly gay manager at work, 71% more likely to say it should be legal to discriminate in hiring on the basis of sexual orientation, 22% less likely to support the legality of same-sex marriage, 46% less likely to support adoption by same-sex couples, and 32% less likely to state they believe homosexuality is a choice.
- "Individuals in demographic categories that other research has identified as more openly anti-gay — Christians, African-Americans, and older populations — are more likely to lie about their sexual identity without a veil." For example, Christians increased reports of non-heterosexuality by 13 percentage points and same-sex sexual experiences by 14 percentage points in the veiled report as opposed to the direct report.
The authors conclude that "standard methods of eliciting respondents' sexual orientation and behavior underestimate the true fraction of individuals who do not identify as heterosexual and who have had a same-sex sexual encounter." They argue that such findings — although not from a perfectly representative sample of the U.S. population — suggest "a societal stigma of being LGBT," coupled with the fact that "individuals are reluctant to report that they have attitudes or policy opinions that are not accepting of LGBT individuals, consistent with a stigma of holding anti-gay sentiments."
The Pew Research Center also analyzes the implications of this study and provides more detail on the "veiled report" survey techniques that were employed.
Keywords: gay and lesbian issues, equality, bisexuality, discrimination
We welcome feedback. Please contact us here.
Media/analysis tips
Analysis assignments
Read the issue-related Deseret News article titled "Employment Bill Signals Changes in Attitudes for, Against Gay Rights."
- What key insights from the news article and the study in this lesson should reporters be aware of as they cover these issues?
Read the full study titled "The Size of the LGBT Population and the Magnitude of Anti-Gay Sentiment are Substantially Underestimated."
- What are the study's key technical terms? Which ones need to be put into language a lay audience can understand?
- Do the study's authors put the research into context and show how they are advancing the state of knowledge about the subject? If so, what did the previous research indicate?
- What is the study's research method? If there are statistical results, how did the scholars arrive at them?
- Evaluate the study's limitations. (For example, are there weaknesses in the study's data or research design?)
- How could the findings be misreported or misinterpreted by a reporter? In other words, what are the difficulties in conveying the data accurately? Give an example of a faulty headline or story lead.
Newswriting and digital reporting assignments
- Write a lead, headline or nut graph based on the study.
- Spend 60 minutes exploring the issue by accessing sources of information other than the study. Write a lead (or headline or nut graph) based on the study but informed by the new information. Does the new information significantly change what one would write based on the study alone?
- Compose two Twitter messages of 140 characters or fewer accurately conveying the study's findings to a general audience. Make sure to use appropriate hashtags.
- Choose several key quotations from the study and show how they would be set up and used in a brief blog post.
- Map out the structure for a 60-second video segment about the study. What combination of study findings and visual aids could be used?
- Find pictures and graphics that might run with a story about the study. If appropriate, also find two related videos to embed in an online posting. Be sure to evaluate the credibility and appropriateness of any materials you would aggregate and repurpose.
Class discussion questions
- What is the study's most important finding?
- Would members of the public intuitively understand the study's findings? If not, what would be the most effective way to relate them?
- What kinds of knowledgeable sources you would interview to report the study in context?
- How could the study be "localized" and shown to have community implications?
- How might the study be explained through the stories of representative individuals? What kinds of people might a reporter feature to make such a story about the study come alive?
- What sorts of stories might be generated out of secondary information or ideas discussed in the study?


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Blog | clare
Degrassi: Declan... whoa.Posted on 10/15/2010 by Mary
Ummm. So... well, first SPOILERS BELOW if you haven't watched Love Lockdown pt. 1 yet. (It'll be online soon, don't worry.) Everyone else:
1) What just happened with Holly J and Declan? What are your thoughts? I was gripping the sides of my chair and just... upset but confused and flabbergasted and confused and upset. I don't think Declan is an evil person -- at ALL -- but that really, really upset me, personally. What was your reaction to that last scene?
2) Oh God. What about Sav? Ohhh man.
3) Did you see that glint in Clare's eye when she realized her parents were united in opposition to her piercing? Ruh roh...
4) Here's how we know Eli truly, truly cares for Clare: he's worried her parents won't like him. What's the opposite of a red flag, a green flag? Well then that right there is what we call a new boyfriend green flag. Eli... your perfection is simply intoxicating.
5) Haha, as much as I felt bad for Chantay fighting the good fight to save a Spirit Squad no one else seems to care about... I probably would have felt pretty meh if the cheerleading squad (if you could call it that) got disbanded in high school. What clubs would you fight to save if Simpson shut them down?
This week in Degrassi: Let's ReviewPosted on 08/26/2010 by Mary
"OMG" does not even begin to cover it. Let's attempt to break things down...
IS Degrassi out of hand?? Do you think Simpson is right to be completely at his wits' end after tonight? Do the students of Degrassi need a totally different environment? Or are they just another high school? (It's funny... there's sort of a perpetual debate in the message boards about whether Degrassi is tamer than a real high school, or completely off-the-wall bonkers. Which side do you fall on?)
Eli and Clare. OK. First of all, thank GOD he's alive. Second of all... what do you think the future holds for these two? Do you think Eli really learned his lesson tonight... or is he going to be even more angry and vengeful about being put through that?
Drew and Alli: Opinions on whether Drew is a good guy or a bad guy seem mixed... what's yours? (Mine is that he's neither good nor bad... he's a human teenager who makes super, super-dumb choices sometimes.) Also: that whole thing between Alli and Mrs. Torres... I have known sooo many moms of teenagers who are like that. They think their kid can do no wrong, so their friends take the fallout when everyone gets in trouble together. Sucks.
Holly J and Sav: Daaaag, girl! I have to say: Charlotte Arnold is probably my favorite young actress in the world. The subtle stuff happening on her face in that scene... she is one talented lady. And she looked really pretty tonight, and I dig her and Sav together. You?
Thursday Night: The Boiling PointPosted on 08/26/2010 by Mary
Mr. Simpson said he trusts Sav and Holly J to make sure the Night in Vegas dance is 100% problem-free. What could possibly go wrong?
If the look on Mrs. Torres' face is any indication... pretty much everything.
Because after tomorrow night... Degrassi will never be the same again.
Eli Passes His French ExamPosted on 08/25/2010 by Mary
I'd say Eli got an A+ on that there French exam, yes? Please, feel free to watch Eli kiss Clare again. And perhaps again. And I suppose you could watch it again after that. Forty times would be weird though.
...But not that weird.
Thursday Night: Uhh... E-Clare isn't on? We guess?Posted on 08/18/2010 by Mary
I'm sooo confused.
But probably only half as confused as Clare, who actually felt the warm, soft touch of Eli's lips on her own before he went completely bafflingly cold, which, what the hell??
Anyone? Anyone?
I guess if he's gonna be baffling, at least he has the decency to look good doing it:
E-Clare's First KissPosted on 08/18/2010 by Mary
Sooo... does a kiss performed in service of a school project still count?
Gauging by the way Clare had to put her hand on her head to hold her brains in after Eli BLEW HER MIND with his lips, I'm guessing yes.
Click here to relive the moment. And again. Annnd one more time just to make sure.
Wednesday Night: E-Clare. It's on.Posted on 08/17/2010 by Mary
The Week in Degrassi: Let's ReviewPosted on 08/06/2010 by Mary
So much Degrassi, so little time to really dig into the details all week! Luckily it's Friday catch-up night... this week's episodes will air again tonight starting at 9p et. Let's talk about what all happened since Monday
Eli: What is Eli's DEAL? What do you think is going on with him? And do you think Clare is going to get frustrated enough to lose interest? (Not that she's interested. Of course.)
Holly J and Declan: Buh! Do you think she was right to break up with him? The money thing was interesting -- when people have different amounts of money to mess around with, it can be difficult to figure out a way to hang out that's cool for both of you. Have you ever run into weirdness about money with a friend?
Sav: What advice would you give him about dealing with his parents totally unrealistic demands -- should he go outright rebellion, or just waiting until college to start being his own person?
Jenna: It seems to me -- like with the whole Jenna thing , and KC's reaction to it -- that girls are so much more critical of their own and each other's bodies than guys are of girls' bodies. What IS that?
Poor Eli's Nards.Posted on 08/04/2010 by Mary
I don't know if our dude friends are going to be all that stoked that we isolated this clip... but it definitely made us go "Oh my GOD" when it happened.
Anyway, do you think Clare is right that the more Eli tries to even the score, the worse it's going to get? Or do you think he should keep fighting back?
This Week in Degrassi: Let's Review.Posted on 07/30/2010 by Mary
Friday night = catch up night -- if you missed any eps this week or just want to treat yourself to two hours of uninterrupted, gently-used Degrassi, 9pm et is where it's at. Man, a lot happened this week... Zane trying out for football was only four days ago! So let's review:
Riley and Zane:Think they'll last? What do you forecast for them?
Riley: Do you think he'll come out in high school, or wait 'til college?
Alli: That desperate bid for the social life of her dreams was odd, but... does she actually have a point about needing more friends? Clare is always hyper-busy (and will probably disappear onto Love Island with Eli soon); Dave has a crush on her which is fine but... that can be really hard on a friendship. She might have more in common with Connor and Wesley than she cares to admit, but I can also see how she would want some people around her that she has more in common with. I don't know, what do you guys think?
Alli and Drew: Can she tame him?
KC: Are you happy about him reuniting with his mom? What's your take on her?
Clare and Eli: Squeee! Oh also, I clipped this little snippet from a Degrassi script for you... it's Clare's writing assignment about her parents fighting.


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- {{matchup.date.fullday}}{{matchup.date.month + ' ' + matchup.date.day}}
Recap - Kings Defeat Edmonton 4-1
Los Angeles skated to a 4-1 victory over Edmonton on Saturday in NHL action at STAPLES Center.
Los Angeles won as a -170 favorite, while Over-Under bettors who played PUSH the total of 5 were rewarded at the payout window.
Los Angeles got goals from Jeff Carter, Mike Richards, Drew Doughty, and Slava Voynov in the victory. Richards opened the scoring at 1:38 of the first period.
Jonathan Quick turned in a 23-save effort for the Kings.
Edmonton got a goal from Magnus Paajarvi in the loss, but it wasn't enough.
Edmonton got a 35-stop effort from Devan Dubnyk in the loss.
Los Angeles scored 2 times on 5 chances on the power play, while Edmonton went 1-for-4 with the man advantage.
Edmonton lost the shots on goal battle to Los Angeles by a margin of 39-24.
Los Angeles looks to continue their winning ways next game with a battle against the Ducks. The Oilers will aim to get back on the winning track at Anaheim.


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|< back
Cross Country - Boys Varsity
vs. Salisbury School
vs. The Gunnery
vs. So. Kent"
|Event Type:
|October 26, 2013
|Berkshire 15 – Salisbury 50; Berkshire 15 – South Kent 50; Berkshire 24 – Gunnery 35
Event Recap:
On Saturday, October 26th, Berkshire's senior cross country runners competed for one final time on their home course. Seniors Nick Asaro, Nate MacKenzie, and Bao Nguyen undoubtedly sensed the importance of this day because each of them ran a home course PR (personal record) for the season. In fact, some of them ran their personal best for their high school running career!
The records did not stop there. Out of twenty Berkshire runners, TWELVE of them ran for personal records including Dan Aldam '17, Rafael Arredondo '17, Nick Asaro '14, Peter Giordano '15, Kevin Kim '15, John Leasure '15, Victor Leung '17, Ray Li '16, captain Nate MacKenzie '14, Mike Melvin '17, Shaan Peckham '16, and Rad Savage '15! Wow! Moreover, the remaining eight runners matched their previous PR times within a couple seconds.
Berkshire ran the best race of the season even considering the winter like temperatures caused by 30 mph winds from the South. Gunnery, Salisbury, South Kent brought tough competition to the Bears. In particular, Gunnery's Matt Logue was a force to be reckoned with as he crossed the line first. But, there was a sea of green trailing him not far behind. Berkshire sophomore Derrick Burt crossed the line twenty seconds later as the fastest Bear of the day followed by teammate Peter Giordano '15 in third place out of 62 runners. Rounding out our top five runners, were James Donovan '15, Daniel Kim '15, and Jack Scarafoni '17 in 5th, 6th, and 8th place respectively. Nick Asaro '14 and captain Nate Mackenzie '14 also helped the Bears gain a greater lead with their spots in 9th and 10th place, helping to misplace other runners from opposing teams. Way to go guys!
The Bears ran with tremendous passion which resulted in three more wins!
Overall Score: Berkshire wins with 24 pts; Gunnery 37 pts, Salisbury 80 pts, and South Kent 109 pts.
Dual Meet Scores: Berkshire wins all three
Berkshire 15 – Salisbury 50; Berkshire 15 – South Kent 50; Berkshire 24 – Gunnery 35
To celebrate, the team dashed off to a fabulous Halloween party hosted by the Kinney Family where the team bonded over burgers, basketball and a bonfire. But the competition didn't stop there as the team took to pumpkin carving. The designs and outcomes were phenomenal! This party truly topped off what was an amazing day in Berkshire Cross Country.
In appreciation: For all their help in making this season (although not over) the best it could be, Berkshire Cross Country would like to thank Mr. and Mrs. Kinney, Ms. Morgan, Mr. and Mrs. Slyer, Mr. and Mrs. Liddy, Gwynne Domashinski '16, and of course, Coaches Lloyd, Plante, and Romano!