text:
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Topic Suggestion Description
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View Topic Suggestion Disposition (PDF) 48 kB
Date submitted: June 01, 2011
- Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.
- For patients with rectal cancer, what is the comparative effectiveness of different imaging modalities, alone or in combination (i.e., incremental benefit from using more than one modality) for preoperative staging and treatment selection?
- Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)
- yes
- If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:
- 1. Computerized Tomography (CT) scans
2. Positron Emission Tomography (PET)
3. Magnetic Resonance Imaging (MRI)
4. Endorectal Ultrasound (ERUS)
- What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)
- Adults with newly diagnosed rectal cancer
- Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)
- Patients with primary resectable rectal cancer.
- Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)
- Improvements in preoperative tumor staging and prediction of tumor-free resection margin (local extension of rectal cancer).
Appropriate selection of patients for treatment (e.g., neoadjuvant therapy, local excision of tumors, or radical surgery) resulting in decreased local recurrence, improved quality of life and overall survival. For example, more accurate staging may decrease need for more extensive surgery in some patients.
- Describe any health-related risks, side effects, or harms that you are concerned about.
- Harms associated with inaccurate (preoperative) clinical staging resulting in
inappropriate treatment selection. For example, indications for surgery that is more
extensive than warranted by the "true" stage, or inadequate margins that require re-
operation or expose patients to a higher risk of recurrence.
Appropriateness for EHC Program
- Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?
- yes
- Which priority area(s) and population(s) does this topic apply to? (check all that apply)
- EHC Priority Conditions (updated in 2008)
- Cancer
- AHRQ Priority Populations
- Low income groups
- Minority groups
- Women
- Elderly
- Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care
- Federal Health Care Program
- Medicaid
- Medicare
- Describe why this topic is important.
- Rectal cancer is a relatively common malignancy. There were 39,670 estimated new cases from rectal cancer in the United States in 2010.* Over the last two decades multimodality treatment has led to important improvements in the treatment of this disease. Preoperative radiation therapy, often combined with chemotherapy, followed by surgery has become the standard of care for most patients. In this respect, modern imaging techniques in the preoperative workup are extremely important for treatment decision making.
* National Cancer Institute (PDQ®). Rectal cancer treatment (2010)
- What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)
- This topic was given a high priority by a multi-disciplinary stakeholder panel (including patient advocates/representatives) convened to identify and select important research questions on cancer amenable for systematic and comparative effectiveness review. Assessment of the evidence-base supporting clinical utility of the available imaging modalities used for preoperative staging is needed to ensure appropriate patient selection for neoadjuvant therapy and extent of surgery.
- Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)
- yes
- If yes, please explain:
- There is uncertainty on the optimal preoperative imaging modalities, and on incremental benefit from using multiple modalities, to differentiate between rectal cancers by severity/stage of disease. There is also variation across centers on types of modalities used for preoperative clinical staging.
Potential Impact
- How will an answer to your research question be used or help inform decisions for you or your group?
- A report would inform clinical decision-making for patients, payers and providers.
- Describe the timeframe in which an answer to your question is needed.
- Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.
- Being age 40 years or older is one of the risk factors of developing rectal cancer. Among all racial groups in the United States, African Americans have the highest sporadic colorectal cancer incidence and mortality rates.*
* It is difficult to separate epidemiological considerations of rectal cancer from those of colon cancer because epidemiological studies often consider colon and rectal cancer (i.e., colorectal cancer) together (National Cancer Institute (PDQ®). Rectal cancer treatment (2010)).
Nominator Information
- Other Information About You: (optional)
- Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)
- Other
- Are you making a suggestion as an individual or on behalf of an organization?
- Organization - BlueCross BlueShield Association Technology Evaluation Center
- Please tell us how you heard about the Effective Health Care Program
- The BlueCross BlueShield Association Technology Evaluation Center is an Evidence-based Practice Center of AHRQ.


text:
ING Direct was barely known in the UK when it crashed on to the savings scene in May 2003 grabbing both headlines and armfuls of customers with its 'no strings attached' high-interest savings account. And now for the second time in two years it is voted best savings provider.
Cynical observers warned that the Dutch-owned internet, postal and phone bank could not possibly afford to maintain such a high interest rate and that once customers had been hooked rate cuts were sure to follow. The bank proved the critics wrong for a long period, gaining a regular slot in the best-buy tables and at the last count pulling in 900,000 savers and £21 billion of deposits.
Only in August 2005 did push finally come to shove. Citing competitive forces, ING chopped its interest rate from 5 per cent to 4.75 per cent, just before the Bank of England reduced base rates to 4.5 per cent. This compared with a launch rate of 4.3 per cent, when the base rate was 3.75 per cent.
This first significant interest rate reduction has pushed ING's account outside the best-buy tables. Even so, that is not a paltry rate in a market where many chart-topping deals only earn their position by offering short-term interest rate bonuses or asking savers to endure lengthy notice periods before making a withdrawal. And rivals were busy reducing their rates too.
ING chief executive Lindsay Sinclair says he is not interested in best-buy charts. He says: 'We want it to be that savers don't have to keep looking at best buy tables. We want them to be able to save with us and get on with things knowing that when they look at their account again, they will have had a consistently high rate of interest.'
A spokeswoman for Moneyfacts, the Norwich-based savings analyst, says: 'ING still offers a good rate. You can get higher with accounts paying bonuses for six months, but then you have to remember to keep a check six months down the line when the rate has dropped off.'
Anna Bowes of independent investment adviser Chase de Vere Investments in Bath, says ING Direct was head and shoulders above the rest when it launched. 'It's disappointing that it is not so competitive now but the interest rate is not a disgrace. I like its straightforward approach in a market where so many deals have restrictive introductory bonuses. My only comment would be that I would like to see it do more in terms of products, perhaps introducing a cash Individual Savings Account.'
ING's successful march on the savings market is undoubtedly partly due to a powerful and pricey advertising campaign, with its life-belt logo now a firm financial brand.
Sinclair says: 'As a direct operation we don't have the branches for people to see, so we must advertise. And since we don't have a branch network to pay for, advertising is a very efficient way to get our name across.'
Sinclair says his customers, who range in age from 18 to 102 years old, are happy enough for 98 per cent of them to recommend ING to friends and family, according to the bank's own survey. Sinclair says the secret of the company's success, which has earned it a 3 per cent share of the savings market, is 'focus', product by product.
Now that savings are well and truly under its belt, it is turning its attention to shaking up mortgages. The company says it plans to adopt the same 'open, honest and simple approach' as it has in savings when it launches a home loan next year. As if to emphasise that it is a customer-driven business, ING will shortly send out a questionnaire asking people what they really want from a mortgage.

subset: commoncrawl


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As seen on


text:
Pence Tricked Us into believing he was not a TEABAGGER!
Posted in the Indianapolis Forum
1 - 20 of 24 Comments Last updated Oct 17, 2013
#1 Oct 4, 2013
Just like Mayor Ballard, Pence acted one way to get elected and now he is showing his tea bagger roots. We should recall him or Obama should declare him a traitor and imprison him till after the revolution.
We have enough of lying politicians!
#2 Oct 4, 2013
Yes, that sweet talking Pence is a traitor to his State, to his Country, to his People and to any joker who believed in him. We have to take him down. He needs to be in prison for sedition until the revolution is over, or he needs to be banned to Mississippi! Those are his true kind of people.
The nerve of this joker to pretend he was not a tea bagger then go all Pat Robertson on us. IT is a total betrayal of honesty.
#3 Oct 5, 2013
Truly he is a tea bagger and this moron state deserves him. He will send all over profitable businesses to the Koch Brothers or to France. He is such a scum ball.
#4 Oct 5, 2013
Just follow the news. He was a biker yesterday. Today he is a cowboy.
This man is all hat. All show. He is has no substance or leadership. He is a biobot of the Koch Brother and is about as smart as a spent and wet tea bag.
#5 Oct 5, 2013
I wonder when he is going to start going on junkets to China?
Has he taken up drinking yet like Ballard?
#7 Oct 5, 2013
Tea party is the best
#8 Oct 5, 2013
The Tea Baggers will all be on death row in prison when this is all over. Good riddance to these pieces of craps.
#9 Oct 5, 2013
No it will never happen.
#10 Oct 5, 2013
Yes it will. Where do you live so we can come and get you?
The world will be such a better place without tea baggers. They have been the source of ruin for the USA and will cease to exist soon.
#11 Oct 5, 2013
Ralph explain this .....The Quote of the Decade:
"The fact that we are here today to debate raising America 's debt limit is a sign of leadership failure. It is a sign that the US Government cannot pay its own bills. It is a sign that we now depend on ongoing financial assistance from foreign countries to finance our Government's reckless fiscal policies. Increasing America 's debt weakens us domestically and internationally. Leadership means that, "the buck stops here.' Instead, Washington is shifting the burden of bad choices today onto the backs of our children and grandchildren. America has a debt problem and a failure of leadership. Americans deserve better." ~ Senator Barack H. Obama, March 2006
Since: Aug 12
#12 Oct 6, 2013
The Tea Party is nothing more than a conservative branch of the Republican party. Considering that Pence has been a conservative Republican for his entire political career it should be expected that he is in agreement with them on many issues.
Pence hasn't changed a bit. If you were fooled that means you weren't paying attention in the first place.
#13 Oct 6, 2013
Pence is using the governor's office as a stepping stone to run for President. This was his plan all along! He did nothing as congressman and he will do nothing good for Indiana. The biggest reason he won is people knew the name, not his track record.
#14 Oct 6, 2013
Yes he a do nothing like BAllard.
Friday pence was a biker
Saturday he was a cowboy.
Sunday he was a cheerleader at the colts game.
Monday, he will be a tea bagger with his good buddy REichard Murderdock.
United States
#15 Oct 7, 2013
Though you're too gentle by far on the Tea Party, I completely agree with your point. I'd wish to say, if Pence fooled you into thinking he'd be judicious and non-partisan and *especially* if he fooled you into believing he wouldn't be a Dominionist when he got into office, then you deserve what you got. Unfortunately, a lot of other, smarter people have to suffer along with you. I posted ALL ALONG that any Republican acting as if (s)he'd call a truce on social issues is flat-out NOT TO BE TRUSTED, and I was right. We can only continue to publicize Pence's shameless breaking of Constitutional principles to favor his own religion, knowing that the other non-Mississippi states out there would not be fooled so easily into voting for him in a national election
#16 Oct 7, 2013
Excellent post! You are right. He is a Dominionist, a tea bagger, a prosperity gospel proponent, and a do nothing leader. His only goal is advancement. It is not helping the governing of the citizens. He is all show. He is a joke and will never go further in politics. He has learned to cover up his racist beliefs though, but he still has them.
#18 Oct 9, 2013
and KKK. all so true
#19 Oct 10, 2013
I wwonder where he and that drunk Mayor Ballard is today? They are the type that caused the government shut down.
United States
#21 Oct 12, 2013
He is rey
#22 Oct 13, 2013
He is a scum bag and we all should do what we can to send him, Ballard, and Plowman to prison forever.
#23 Oct 15, 2013
Is he drunk driving an 18 wheeler to DC with his Moll, Wild eyed Bachman?
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Rock N Roll Easter
When: Saturday, March 30
Time: 2:00pm – 4:00pm
Location: Edgewood Presbyterian Church – 3617 Macon Road (corner of Macon Road and University Avenue)
Children, ages 3 yrs – 5th grade – completed, and their families will hear why we really celebrate Easter through games, activities and an Easter Egg Hunt to bring Jesus' resurrection to life. Invite all your friends to come join you!
Registration form is on our website at www.epclife.com. Please complete one so we can be looking forward to seeing you.
Please contact our church office if you have any questions – 706-561-5137


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Kearns • Everybody at Gates Field knew that Mountain View's Dakota Carlson was going to risk the suicide squeeze.
Salem Hill coach Scott Haney was yelling at catcher Mitch Jorgensen to stand up and cover the plate while the infield moved into position. But a perfectly laid bunt sent Carlson sliding into home for the first run.
Not nearly as many predicted Salem Hills' No. 9 hitter would save the season.
But that's what Conner Rollins accomplished with one swing of the bat in a Class 4A winners bracket semifinal. The Skyhawks came from behind in the seventh inning to down Mountain Crest 2-1.
In a game that featured a duel between Mountain View's Jayce Hill and Salem Hills' Colton Hill, the difference came down to the Skyhawks risking everything in the final frame and Rollins' clutch hitting.
"He got big for us, real big for us," Colton Hill said. "We've been in situations like this all year long, and he did what he had to do to win this for us."
Salem Hill loaded the bases with a Jorgensen walk, Junior Centeno getting hit by a pitch and Garrett McEwans beating out a bunt.
Rollins strode to the plate and pulled the trigger on a 1-1 changeup that broke between the shortstop and third baseman gap to drive in two runs.
"I did it for Colton," Rollins said. "He pitched a heck of a one-run game. There's no question we should win those for him."
Colton Hill was dominant on the mound, striking out six. The Bruins never mounted a threat after the fourth with his defense scooping up grounders and snatching fly balls.
"They know what is at stake," Colton Hill said about his defense. "They come to play, make the stops and help me out of any jams."
Jorgensen said that the Skyhawks' pitcher has been doing this all season. His fastball was pinpointed and his curve broke over the plate.
"He's a big-game pitcher, and he got the job done," Jorgensen said.
Colton Hill said the celebration that smothered Rollins after his game-winner was just a taste of what Salem Hills has in store for the next round.
"I have no doubt we're winning a state championship," Colton Hill said.
Class 4A state tournament
Winners bracket
Thursday at Utah Valley University
4:30 p.m. • Salem Hills vs. Maple Mountain
Losers bracket
Wednesday at Kearns High
1:30 p.m. • Murray vs. Mountain View
4 p.m. • Cyprus vs. Timpanogos
7 p.m. • Winners of first two games