text:
Here's whats weird about it: 1st off, it works totally fine in parallels 6, which I've just tested and had zero problems whatsoever, so I'm sure that it has something to do with the way VMware and Virtualbox deal with the USB devices as they're plugged in. On top of that, if you're using it from a hard boot, and only have rt2800usb loaded, then you dhcp and wicd manager work perfectly fine...
I thought that you needed to use rt2870sta if you wanted to connect regularly for browsing the web or whatever, but I guess not.
Anyways, you certainly should have rt2870sa blacklisted, theres no way that it will work for injection otherwise.
hi guys,
tried to run Alfa AWUS036NH on BT5 ghnom 64, VM v.7, installed older compat-wireless ant tried a newer one also, patched 'maxim' but still cnat get a decent handshake...
my mon0 channel is circling throw all channel like hell and just cant get it fixed.
i red that some have made throw this hell-installation-configuration a got fixed the channel problem but a lot more say like i did, cant fix the channel problem..
i'm thinking maybe to get back to BT4 and then use the old version of compat-wireless + maxim patch.
Hi everyone,
I'm new here and i joined specifically because of this thread. ... I have the us036nh on an
older Thinkpad with BT5-GNOME installed about 10 days ago. I finally got everything
working last night and nnmap'd a net of interest all night long with xml results on the
drive when i got up. The AWUS036NH is definitely superior to anything out there in
that price range. The reception sensitivity is nearly double that of the AWUS036.
I have an engineer friend who claims that's not possible but I don't care because I
know it is. Alfa definitely did something innovative with this little gem.
I did install compat-wireless-2-6.38-2-2.tar.bz2 from wireless.kernel.org since the BT5
kernel is 2.6.38. Not sure if the 2010-04-20 package would have worked but don't really
care right now. No aircrack-ng patches were needed. In the driver folder, I ran
./scripts/driver-select rt2x00. All the drivers can be seen in lsmod:
rt2800usb which is apparently the top driver in the device driver chain
rt2800 lib using rt2800usb
rt2x00usb using rt2800usb
rt2x00libusing rt2800usb, rt2800lib, rt2x00usb
mac80211 using everything above
cfg80211 using rt2x00lib and mac80211
These are all the drivers needed. Nothing else is needed. You don't need to blacklist anything
or use modprobe to delete any. I don't know where that information came from regarding
rt2870sta and everything but it simply is not true.
The make should be clean. Then make install and make unload. You don't need to modprobe
the usb driver. Just reboot with the Alfa now plugged it. The drivers will all load automatically.
Now, here's the catch. At this point, Aircrack-ng runs perfectly. Injection worked fine
with aireplay-ng and airodump-ng picks up networks I never dreamt existed. But I could
not get an i.p., either using WICD or, from the terminal, iwconfig & dhclient. In fact,
ifconfig does not show the adaptor. You have to bring it up manually. But even then
wicd will not connect UNLESS you restart it with /etc/init.d/wicd restart. Then I get
You tell me why and we'll both know...
I am having a little problem with AWUS036NH on BT5, I tried "aireplay-ng -9 mon0" and it shows that injection is working!
after that I tried "aireplay-ng -9 -i mon0 wlan0" and got this:Code:aireplay-ng -9 mon0 23:14:20 Trying broadcast probe requests... 23:14:20 Injection is working! 23:14:22 Found 3 APs
I tried to test my WPA security but couldn't initiate packet injection! Any advice??Code:aireplay-ng -9 -i mon0 wlan0 23:14:33 Trying broadcast probe requests... 23:14:33 Injection is working! 23:14:35 Found 3 APs 23:14:35 Trying directed probe requests... 23:14:35 **:**:**:**:**:** - channel: 6 - 'xxxxx' 23:14:35 Ping (min/avg/max): 2.191ms/2.563ms/6.497ms Power: -68.79 23:14:35 28/30: 93% 23:14:35 **:**:**:**:**:** - channel: 6 - 'xxxxx' 23:14:36 Ping (min/avg/max): 2.224ms/3.588ms/11.204ms Power: -61.86 23:14:36 28/30: 93% 23:14:36 **:**:**:**:**:**- channel: 6 - 'xxxxx' 23:14:36 Ping (min/avg/max): 2.131ms/2.529ms/4.409ms Power: -74.00 23:14:36 30/30: 100% 23:14:36 Trying card-to-card injection... 23:14:40 Attack -0: Failed 23:14:44 Attack -1 (open): Failed 23:14:49 Attack -1 (psk): Failed 23:14:53 Attack -2/-3/-4/-6: Failed
@Robbb: What are you using to start up airmon? if you use the -c option to specify a channel, then it should lock onto that channel. If that doesn't work right away, the first thing to do is to make sure you dont have something else running thats scanning the channels (ie- aireplay -9 or another instance of airodump w/out the -c option specified). Next, I would doOnce you've done that then try starting airodump -c with the same channel. Another thing is that it can be very very difficult to gather a WPA handshake. The problem is that even if you can hear the router that your trying to crack, you need to be able to hear the packets coming from the client as well. Not only that, but both the router and the client have to be able to hear the packets you're sending them as well. My setup is this 18db gain directional antenna hooked up to the 36NH running at 31db, and I have to aim this thing around until I get it pointed directly at the target client until I can get a handshake. Even then, it's very touchy and takes a lot of time to get a good one. Use this:Code:iwconfig wlan0 channel <CHANNEL> iwconfig mon0 channel <CHANNEL>to inspect the packets. You'll see on the right something like "key request (1/4)" and so on. You need all 4 packets to get a full handshake. You will know which one you're not hearing by the source and dest. of the packets you're looking at.Code:wireshark -R eapol <CAP FILE>
@calig - Yes, you dont need to blacklist rt2870sta because an update in BT5 actually did it for you already. Those comments describing that mod are from before the patch was released, so at one point that was actually what you had to do to get it working. I've also had trouble obtaining an IP address with the nh sometimes, but if I modprobe -r the drivers, and then replug the thing, eventually I can get one.
If you dont see the adapter in ifconfig, but you do in iwconfig, then you can doto manually put it up. But, I get the feeling that it's a problem with the driver because I can get and I.P. fine on any network in windows or on OS X with the same adapter, yet for some reason it struggles in BT5. Still workin on it tho.Code:ifconfig wlan0 up
@Doppler - What is it that you're trying to do there? If you want to crack wpa, you don't at all need to use the wlan0 interface, you can simply capture packets with airodump-ng, and use aireplay-ng -0 to de-auth clients.
With this, I am just trying to test my wireless adapter injection! For the comparison test can you explain whole WPA crack procedure!?
@mreidiv - obviously that doesn't solve the problem for everyone.. I'm not sure what it is you're getting at...?
Thank dem0critus,
i tried to run airmon with -c but it wont lock on the specified channel;
and then i get a few process that can interrupt like dhclient3 so i useCode:airmon-ng start wlan0 channel x
then -Code:pkill dhclient3
did you mean, run airodump like this:Code:airodump-ng mon0 airodump-ng --bssid (xxxxxxxxxxxx) -c x -w somthing mon0i'm getting the beacons abd i can see the packets, the router is really not far, just one floor under me... but i'm still getting the bouncing channel so no handshake.Code:airodump-ng mon0 channel x
thanks again dem0critus, i appreciate it.


text:
Date: 02/08/2007
Views: 505
into an interesting looking house
WA skip, Brady is figurin' the shot (look at the stones in the house)
Brady takes his shot
and now, look at the stones
AK skip, Dennis is figurin' out what to do with the hammer stone
ok, get ready, here it comes
kept them down to 2 (sorry it's a little blurred :)
WA figurin' the skip's rock in the 2nd
the warm room is really packed
WA vice, Cristin calls the skip's shot inthe 5th (check out the scoreboard)
and AK rallies to take 2 in the 5th
meanwhile, Jay's still pushing the airline tickets raffle :)
some last minute shopping at the Goldline store
cribbage, the never-ending game :)
WA skip, Dennis (in the 6th): ok, here's what I want to do
7th end, just hangin' out
whew! felt like a tennis match :)
AK skip, Dennis figuring his shot (notice AK picked up one in the 6th)
did I make it?
yep! in the house
but look what WA did
well, not everyone is enamored of the game :)
skip's rock in the 9th, WA skip asked his team if they wanted a blank end (they did)
and he delivered, so to speak :)

subset: commoncrawl


text:
- Vitamin Guide
- Health Conditions
- Health Centers
- Diet & Weight Loss
- Herbal Remedies
- Current News
- Food Guide
- Recipes
Researchers in Europe tracked 313,074 adults for an average of eight years, while accounting for other factors that affect heart disease risk, such as smoking, body weight, exercise patterns, other eating habits, high blood pressure, and diabetes. They found that:
Another large study shows that fiber deserves attention too. Researchers in the US followed 388,122 older men and women (50 to 71 years old) for an average of nine years, also accounting for things that can affect disease risk. They found that:
These studies were observational, so they don't prove cause and effect, but they do suggest that some simple diet changes are in order if we want to stay healthy for the long haul. Our tips will get you started.
(Arch Intern Med Published Online Feb 14, 2011: doi:10.1001/archinternmed.2011.18; Eur Heart J Published Online Jan 18, 2011: doi:10.1093/eurheartj/ehq465)
Copyright © 2017 Healthnotes, Inc. All rights reserved. www.healthnotes.com


text:
Meticulously designed, this late 18th century ring of 15k yellow gold and silver provides a radiant example of the detailed and fine craftsmanship of Georgian jewelry. An oval faceted amethyst 7 mm by 9 mm in size has been foiled and claw set closed back in a yellow gold crimped collet. The amethyst gem with pink and lilac hues appears to be floating within an openwork frame of lightly twisted gold work accented at the each cardinal points with an old mine cut diamond in a square rub-over silver collet. Decorated shoulders and sides employ patterning and engraving.
Date: Circa 1780.
Important: Foiled jewelry should not be exposed to water for any extended period of time nor soaked in any other liquid or exposed to cleaning products or harsh chemicals. In addition, avoid steam cleaning.


text:
About Long Lellang STOLport
Long Lellang STOLport serves the rural area of Long Lellang in Sarawak. The STOLport serves Malaysia Airlines' MASwings, whichflies to Miri and Marudi twice a week.
Latest News
10 April 2017
We are pleased to inform that runway recovery works at Sibu Airport is now complete and the airport had resumed normal operations at 0000 hours, 10 April 2017, with the first flight commencing operations 0928 hours this morning.
The runway had earlier been damaged on 8 April 2017 when a Malaysia Airlines aircraft,...
Read more
Everything you need to know about Long Lellang STOLport
Download the factsheet
Passenger Service Charges
See the Passenger Service Charges ↗
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text:
Asheboro, N.C. - The doubleheader scheduled for this afternoon between the Brevard College baseball team against St. Andrews Presbyterian at McCrary Park, home of the Asheboro Copperheads, has been cancelled due to inclement weather. The games will not be made up.
Coach Matt McCay and the Tornados turn their attention to tomorrow afternoon as they travel to Salisbury, N.C. and Newman park as they take on the Pfeiffer Falcons at 4 p.m. and will play SAC opponent Catawba College in the night cap at 7 p.m.


text:
Hi all,
Been struggling with Anapanasati for a while, literally not being able to find the breath. Then, a few days ago there it was, back again. This happened after just relaxing into a sort of awareness of the generic feeling of my whole body. This awareness seemed to shrink into a very focussed concentrated awareness of just the breath. Then, out of the blue came a palpable feeling of excitment, really quite uncomfortable really and not Jhana(ish) in the way I would have expected - or maybe it was, but it left me feeling like I'd had a small electric shock.
Now for the rest of that day and for the ensuing few days I felt really really low. Very low mood and low self esteem as well as feeling really vulnerable. I am fine now...it lifted almost as quickly as it came.
I'm not a wilting daisy nor am I prone to whining about my feelings so for this to happen after such an unusual experience seems odd.
What do you think?


text:
An in-depth report on the causes, diagnosis, treatment, and prevention of osteoporosis.
Osteoporosis Risk Factors
- Age is the main risk factor for osteoporosis. Aging causes bones to thin and weaken. Although osteoporosis affects mostly postmenopausal women, older men are also at risk.
- Osteoporosis is more common in people who have a small, thin body frame and bone structure.
- Dietary calcium and vitamin D deficiencies are important factors in the risk for osteoporosis.
- Women who smoke, particularly after menopause, have a significantly greater risk of spine and hip fractures than those who do not smoke. Men who smoke also have lower bone density.
- Excessive alcohol consumption increases osteoporosis risk.
- Lack of exercise and a sedentary lifestyle can increase the risk of osteoporosis. Engaging in regular weight-bearing and resistance exercises (such as walking or strength training) can help prevent it.
Screening for Osteoporosis
- Current guidelines from the American College of Obstetricians and Gynecologists (ACOG) recommend that women receive bone mineral density (BMD) screening beginning at age 65. Postmenopausal women younger than age 65 should be screened only if they have significant risk factors for osteoporosis or bone fracture.
- Current practice recommends BMD retesting every 2 years. However, recent research suggests that some women may be able to wait a much longer time between their screening tests, perhaps as long as 5 - 15 years. Discuss with your doctor how often you should be tested.
New Calcium and Vitamin D Supplement Recommendations
Healthy postmenopausal women with good diets do not need to take calcium and vitamin D supplements, according to a 2013 recommendation from the U.S. Preventive Services Task Force (USPSTF). According to the USPSTF, daily low-dose amounts of vitamin D and calcium supplements do not prevent fractures and can increase the risk of kidney stones. Talk with your doctor about whether or not you need these supplements. Additional research is needed to evaluate possible benefits of higher doses of vitamin D.
- Bisphosphonates are the main drugs used for osteoporosis prevention and treatment. Alendronate (Fosamax, generic), risedronate (Actonel, generic), and ibandronate (Boniva, generic) come in pills that are taken by mouth. Zoledronic acid (Reclast) is given by once-yearly injection. Ibandronate is also available as a four-times a year injection. Denosumab (Prolia) is a new type of antiresorptive medication that works differently than bisphosphonates.
- The Food and Drug Administration (FDA) is currently reviewing whether long-term (more than 3 - 5 years) use of bisphosphonate drugs provides any benefits for fracture prevention. Possible concerns for long-term use of bisphosphonates are increased risks for thigh bone (femoral fractures), esophageal cancer, and osteonecrosis (bone death) of the jaw.
Drug Approval
Selective estrogen-receptor modulators (SERMs) are another type of drug used to treat osteoporosis. Raloxifene (Evista) has been the only SERM approved for osteoporosis treatment and prevention. In 2013, the FDA approved Duavee, a drug that combines the SERM bazedoxifene with the conjugated estrogens used in hormone replacement therapy for menopause. The drug is approved mainly to treat menopausal symptoms such as hot flashes, but may also be used to prevent osteoporosis. However, the FDA recommends that other, non-estrogen drugs should be tried first.
Drug Warning
In 2013, an FDA advisory committee recommended against the use of calcitonin salmon for the treatment of osteoporosis because of concerns the drug may increase the risks for cancer. Calcitonin salmon products are available as a nasal spray (Miacalcin, Fortical, generic) and injectable (Miacalcin, generic). The FDA is expected to make a final decision in the coming year.
Osteoporosis is a progressive skeletal disease in which bones become thin, weak, brittle, and prone to fracture. Osteoporosis literally means "porous bones." Thinning bones are caused by loss of bone density. Calcium and other minerals contribute to the bone mineral density that helps strengthen and protect bones.
The Bones
Bones are made of living tissue that is constantly being broken down (resorbed) and formed again. The balance of bone build-up (formation) and break down (resorption) is controlled by a complex mix of hormones and chemical factors. If bone resorption occurs at a greater rate than bone formation, your bones lose density and you are at increased risk for osteoporosis.
Until a healthy adult is around age 40, the process of formation and resorption is a nearly perfectly coupled system, with one phase balancing the other. As a person ages, or in the presence of certain conditions, this system breaks down and the two processes become out of sync. Eventually, the breakdown of bone eventually overtakes the build-up.
In women, estrogen loss after menopause is particularly associated with rapid resorption and loss of bone density. Postmenopausal women are therefore at highest risk for osteoporosis and subsequent fractures.
Primary and Secondary Osteoporosis
Primary osteoporosis is the most common type of osteoporosis. Itis usuallyage-related and associated with the postmenopausal decline in estrogen levels, or related to calcium and vitamin D insufficiency.
Secondary osteoporosis is osteoporosis caused by other conditions, such as hormonal imbalances, diseases, or medications.
The Role of Sex Hormones in Bone Breakdown
Women and Estrogen. A woman experiences a rapid decline in bone density after menopause, when her ovaries stop producing estrogen. Estrogen comes in several forms:
- Thestrongest form of estrogen is estradiol.
- The other important but less powerful estrogens are estrone and estriol.
The ovaries produce most of the estrogen in the body, butestrogen can also be formed in other tissues, such as the adrenal glands, body fat, skin, and muscle. After menopause, some amounts of estrogen continue to be manufactured in the adrenals and in peripheral body fat. Even though the adrenals and ovaries stop producing estrogens directly, they continue to be a source of the male hormone testosterone, which converts into estradiol.
Estrogen may have an impact on bone density in various ways, including slowing bone breakdown (resorption).
Men and Androgens and Estrogen. In men, the most important androgen (male hormone) is testosterone, which is produced in the testes. Other androgens are produced in the adrenal glands. Androgens are converted to estrogen in various parts of a man's body, including bone.
Studies suggest that falling levels of testosterone and estrogencan contribute to bone loss in elderly men. Both hormones are important for bone strength in men.
Vitamin D and Parathyroid Hormone Imbalances
Low levels of vitamin D and high levels of parathyroid hormone (PTH) are associated with bone density loss in women after menopause:
- Vitamin D is a vitamin with hormone-like properties. It is essential for the absorption of calcium and for normal bone growth. Lower levels result in impaired calcium absorption, which in turn causes an increase in parathyroid hormone (PTH).
- Parathyroid hormone is produced by the parathyroid glands. These are four small glands located on the surface of the thyroid gland. They are the most important regulators of calcium levels in the blood. When calcium levels are low, the glands secrete more PTH, which then increases blood calcium levels. High persistent levels of PTH stimulate bone resorption (bone mineral loss).
Causes of Secondary Osteoporosis
Secondary osteoporosis results from medications or other medical conditions.
Medications. Medications that can cause osteoporosis include:
- Oral corticosteroids (also called steroids or glucocorticoids) can reduce bone mass. Inhaled steroids may also cause bone loss when taken at higher doses for long periods of time.
- Loop diuretics, such as furosemide (Lasix, generic), increase the kidneys' excretion of calcium, which can lead to thinning bones. Thiazide diuretics, on the other hand, protect against bone loss, but this protective effect ends after use is discontinued .
- Hormonal contraceptives that use progestin without estrogen (such as Depo-Provera injection or other progestin-based contraceptives), can cause loss of bone density. For this reason, Depo-Provera injections should not be used for longer than 2 years.
- Anticonvulsant (anti-seizure) drugs increase the risk for bone loss (as does epilepsy itself).
- Proton pump inhibitors (PPIs), which are used to treat gastroesophageal reflux disease ("heartburn"), can increase the risk for bone loss and fractures when they are used at high doses for more than a year. These drugs include omeprazole (Prilosec, generic), lansoprazole (Prevacid, generic), and esomeprazole (Nexium).
- Other drugs that increase the risk for bone loss include the blood-thinning drug heparin, and hormonal drugs that suppress estrogen (such as gonadotropin-releasing hormone agonists and aromatase inhibitors).
Medical Conditions. Osteoporosis can be secondary to other medical conditions, including alcoholism, diabetes, thyroid imbalances, chronic liver or kidney disease, Crohn's disease, celiac disease, scurvy, rheumatoid arthritis, leukemia, cirrhosis, gastrointestinal diseases, vitamin D deficiency, lymphoma, hyperparathyroidism, anorexia nervosa, premature menopause, and rare genetic disorders such as Marfan and Ehlers-Danlos syndromes.
Risk Factors
The main risk factors for osteoporosis are:
- Female gender
- Age over 65
- Menopause
- Low body weight
- Tobacco and excessive alcohol use
- Family history of fractures associated with osteoporosis
Seventy percent of people with osteoporosis are women. Men start with higher bone density and lose calcium at a slower rate than women, which is why their risk is lower. Nevertheless, older men are also at risk for osteoporosis.
As people age, their risks for osteoporosis increase. Aging causes bones to thin and weaken. Osteoporosis is most common among postmenopausal women, and screening for low bone density is recommended for all women over the age of 65.
Although adults from all ethnic groups are susceptible to developing osteoporosis, Caucasian and Asian women and men face a comparatively greater risk.
Body Type
Osteoporosis is more common in people who have a small, thin body frame and bone structure. Low body weight (less than 127 pounds or a BMI less than 21) is a risk factor for osteoporosis.
Family History
People whose parents had a fracture due to osteoporosis are themselves at increased risk for osteoporosis.
Hormonal Deficiencies
Women. Estrogen deficiency is a primary risk factor for osteoporosis in women. Estrogen deficiency is associated with:
- Menopause
- Surgical removal of ovaries (oophorectomy)
- Anorexia nervosa, (an eating disorder), or extreme low body weight can affect the body's production of estrogen
Men. Low levels of testosterone increase osteoporosis risk. Certain types of medical conditions (hypogonadism) and treatments (prostate cancer androgen deprivation) can cause testosterone deficiency.
Lifestyle Factors
Dietary Factors. Diet plays an important role in both preventing and speeding up bone loss in men and women. Calcium and vitamin D deficiencies are risk factors for osteoporosis. Other dietary factors may also be harmful or protective for certain people.
Exercise. Lack of weight-bearing exercise and a sedentary lifestyle increases the risk for osteoporosis. Conversely, in competitive female athletes, excessive exercise may reduce estrogen levels, causing bone loss. (The eating disorder anorexia nervosa can have a similar effect.) People who are chairbound or bedbound due to medical infirmities and who do not bear weight on the bones are at risk for osteoporosis.
Smoking. Smoking can affect calcium absorption and estrogen levels.
Alcohol. Excessive consumption of alcoholic beverages can increase the risk for bone loss.
Lack of Sunlight. Vitamin D is made in the skin using energy from the ultraviolet rays in sunlight. Vitamin D is necessary for the absorption of calcium in the stomach and gastrointestinal tract and is the essential companion to calcium in maintaining strong bones.
Risk Factors in Children and Adolescents
The maximum density that bones achieve during the growing years is a major factor in whether a person goes on to develop osteoporosis. People, usually women, who never develop adequate peak bone mass in early life are at high risk for osteoporosis later on. Children at risk for low peak bone mass include those who are:
- Born prematurely
- Have anorexia nervosa
- Have delayed puberty or abnormal absence of menstrual periods
Exercise and good nutrition during the first three decades of life (when peak bone mass is reached) are excellent safeguards against osteoporosis (and other health problems).
Low bone density increases the risk for fracture. Bone fractures are the most serious complication of osteoporosis. Spinal vertebral fractures are the most common type of osteoporosis-related fracture, followed by hip fractures, wrist fractures, and other types of broken bones. About 80% of these fractures occur after relatively minor falls or accidents. In addition to causing disability, hip fractures can increase the risk of early death. Complications of hip fractures include hospital-acquired infections and blood clots in the lungs.
Osteoporosis is usually quite advanced before symptoms appear. Unfortunately, a fracture of the wrist or hip is often the first sign of osteoporosis. These fractures can occur even after relatively minor trauma, such as bending over, lifting, jumping, or falling from a standing position.
Compression fractures can occur in the vertebrae of the spine as a result of weakened bone. Early spinal compression fractures may go undetected for a long time, but after a large percentage of calcium has been lost, the vertebrae in the spine start to collapse, gradually causing a stooped posture called kyphosis, or a "dowager's hump." Although this is usually painless, patients may lose as much as 6 inches in height.
Candidates for Bone Density Testing
Because osteoporosis can occur with few symptoms, testing is important. Bone density testing is recommended for:
- All women age 65 or older
- Women under age 65 with one or more risk factors for osteoporosis
- All men over age 70
- Men ages 50 - 70 with one or more risk factors for osteoporosis
In addition to age, the main risk factors for osteoporosis are:
- Low body weight (less than 127 pounds) or low body mass index (less than 21)
- Long-term tobacco use
- Excessive alcohol use
- Having a parent who had a fracture caused by osteoporosis
Other risk factors that may indicate a need for bone mineral density testing include:
- Long-term use of medications associated with low bone mass or bone loss such as corticosteroids, some anti-seizure medications, Depo-Provera, thyroid hormone, or aromatase inhibitors.
- History of treatment for prostate cancer or breast cancer
- History of medical conditions such as diabetes, thyroid imbalances, estrogen or testosterone deficiencies, early menopause, anorexia nervosa, rheumatoid arthritis
- Significant loss of height
Tests Used for Measuring Bone Density
Central DXA. Bone densitometry is a test for measuring bone density. The standard technique for determining bone density is called dual-energy x-ray absorptiometry (DXA). DXA is simple and painless and takes 2 - 4 minutes. The machine measures bone density by detecting the extent to which bones absorb photons that are generated by very low-level x-rays. (Photons are atomic particles with no charge.) Measurements of bone mineral density are generally given as the average concentrations of calcium in areas that are scanned.
Central DXA measures the bone mineral density at the hip, upper thigh bone (femoral neck), and spine.
Other Tests. Other tests may be used, but they are not usually as accurate as DXA. They include ultrasound techniques, DXA of the wrist, heels, fingers, or leg (peripheral DXA) and quantitative computed tomography (QCT) scan.
Screening tests using these technologies are sometimes given at health fairs or other non-medical settings. These screening tests typically measure peripheral bone density in the heels, fingers, or leg bones. The results of these tests may vary from DXA measurements of spine and hip. While these peripheral tests may help indicate who requires further BMD testing, a central DXA test is required to diagnose osteoporosis and to monitor treatment response.
Diagnosing Osteoporosis and Predicting the Risk for Fracture
Osteoporosis is diagnosed when bone density has decreased to the point where fractures can result from mild stress, the so-called fracture threshold. This is determined by measuring bone density and comparing the results with the norm, which is defined as the average bone mineral density in the hipbones of a healthy 30-year-old adult.
The doctor then uses this comparison to determine the standard deviation (SD) from this norm. Standard deviation results are given as Z and T scores:
- The T score gives the standard deviation of the patient in relationship to the norm in young adults. Doctors often use the T-score and other risk factors to determine the risk for fracture.
- The Z score gives the standard deviation of the patient in relationship to the norm in the patient's own age group and body size. Z scores may be used for diagnosing osteoporosis in younger men and women. They are not normally used for postmenopausal women or for men age 50 and older.
Results of T-scores indicate:
- Higher than -1 indicates normal bone density.
- Between -1 and -2.5 indicates low bone density (osteopenia).
- A score of -2.5 or lower indicates a diagnosis of osteoporosis.
The lower the T-score, the lower the bone density, and the greater the risk for fracture. In general, doctors recommend beginning medication when T-scores are -2.5 or below. Patients who have other risk factors may need to begin medication when they have osteopenia (scores between -1 and -2.5). Osteopenia refers to bone mineral density that is lower than normal, but not low enough to be classified as osteoporosis. Osteopenia is considered a precursor to osteoporosis.
Doctors don't yet know the best testing schedule for women whose first test does not reveal osteoporosis. Current practice recommends that older patients have a bone mineral density test every 2 years. However, some recent research suggests that low-risk women who have normal test results may be able to wait for up to 15 years to be rescreened. (Women at higher risk would need to have another test at much shorter intervals.) Discuss with your doctor how often you should be tested based on your individual risk factors. .
Laboratory Tests
In certain cases, your doctor may recommend that you have a blood test to measure your vitamin D levels. A standard test measures 25-hydroxyvitamin D, also called 25(OH)D. Depending on the results, your doctor may recommend you take vitamin D supplements.
Lifestyle Changes
Healthy lifestyle habits, including adequate intake of calcium and vitamin D, are important for preventing osteoporosis and supporting medical treatment.
Calcium and Vitamin D
A combination of calcium and vitamin Dmay reduce the risk of osteoporosis. (For strong bones, people need enough of both calcium and vitamin D.) The best sources are from calcium-rich and vitamin D-fortified foods.
The National Osteoporosis Foundation (NOF) recommends:
- Adults under age 50 should have 1,000 mg of calcium and 400 - 800 IU of vitamin D daily.
- Adults age 50 and older should have 1,200 mg of calcium and 800 - 1,000 IU of vitamin D daily.
Dietary Sources. Good dietary sources of calcium include:
- Milk, yogurt, and other dairy products
- Dark green vegetables such as collard greens, kale, and broccoli
- Sardines and salmon with bones
- Calcium-fortified foods and beverages such as cereals, orange juice, soymilk
Certain types of foods can interfere with calcium absorption. These include foods high in oxalate (such as spinach and beet greens) or phytate (peas, pinto beans, navy beans, wheat bran). Diets high in animal protein, sodium, or caffeine may also interfere with calcium absorption.
Dietary sources of vitamin D include:
- Fatty fish such as salmon, mackerel, and tuna
- Egg yolks
- Liver
- Vitamin D-fortified milk, orange juice, soymilk, or cereals
However, many Americans do not get enough vitamin D solely from diet or exposure to sunlight.
Supplements. Doctors are currently reconsidering the use of calcium and vitamin D supplements based on studies suggesting that supplements do not make much difference for bone mineral density protection. The U.S. Preventive Services Task Force (USPSTF) advises that healthy postmenopausal women don't need to take these supplements.
According to the USPSTF, taking daily low-dose amounts of vitamin D supplements (less than 400 IU), with or without calcium supplements (less than 1,000 mg), does not prevent fractures. For higher doses, the USPSTF says there is not enough evidence to make a recommendation. In addition to possible lack of benefit, these supplements are associated (even at lower doses) with certain risks, like kidney stones.
Vitamin D and calcium supplements may be appropriate for certain people including those who do not get enough vitamin D through sunlight exposure and those who do not consume enough calcium in their diet. They are also helpful for people who have been diagnosed with osteoporosis.
Calcium and vitamin D supplements can be taken as separate supplements or as a combination supplement. If separate preparations are used, they do not need to be taken at the same time.
- Calcium supplements include calcium carbonate (Caltrate, Os-Cal, Tums), calcium citrate (Citracal), calcium gluconate, and calcium lactate. Although each kind provides calcium, they all have different calcium concentrations, absorption capabilities, and other actions.
- Vitamin D is available either as D2 (ergocalciferol) or D3 (cholecalciferol). They work equally well for bone health.
Given the controversies over the benefits and safety of these supplements, be sure to discuss with your doctor whether supplements are a good choice for you. As an alternative to supplements, many doctors recommend making dietary changes to increase calcium and vitamin D intake, and getting 15 minutes a day of sun exposure.
Exercise is very important for slowing the progression of osteoporosis. Although mild exercise does not protect bones, moderate exercise (more than 3 days a week for more than a total of 90 minutes a week) reduces the risk for osteoporosis and fracture in both older men and women. Exercise should be regular and life-long. Before beginning any strenuous exercise program, talk to your doctor.
Specific exercises may be better than others:
- Weight-bearing exercise applies tension to muscle and bone and can help increase bone density in younger people. Weight training is also beneficial for middle-aged and older people.
- Regular brisk long walks improve bone density and mobility. Most older individuals should avoid high-impact aerobic exercises (step aerobics), which increase the risk for osteoporotic fractures. Although low-impact aerobic exercises such as swimming and bicycling do not increase bone density, they are excellent for cardiovascular fitness and should be part of a regular regimen.
- Exercises specifically targeted to strengthen the back may help prevent fractures later on in life and can be beneficial in improving posture and reducing kyphosis (hunchback).
- Low-impact exercises that improve concentration, balance, and strength, particularly yoga and tai chi, may help to decrease the risk of falling.
Other Lifestyle Factors
Other lifestyle changes that can help prevent osteoporosis include:
- Limit alcohol consumption. Excessive drinking is associated with brittle bones.
- Limit caffeine consumption. Caffeine may interfere with the body's ability to absorb calcium.
- Quit smoking. The risk for osteoporosis from cigarette smoking appears to diminish after quitting.
Preventing Falls and Fractures
An important component in reducing the risk for fractures is preventing falls. Risk factors for falling include:
- Slow walking
- Inability to walk in a straight line
- Certain medications (such as tranquilizers and sleeping pills)
- Low blood pressure when rising in the morning
- Poor vision
Recommendations for preventing falls or fractures from falls include:
- Exercise to maintain strength and balance if there are no conflicting medical conditions.
- Do not use loose rugs on the floors.
- Move any obstructions to walking, such as loose cords or very low pieces of furniture, away from traveled areas.
- Rooms should be well lit.
- Have regular eye checkups.
- Consider installing grab bars in bathrooms especially near shower, tub,and toilet.
Two types of drugs are used to prevent and treat osteoporosis:
- Antiresorptive Drugs. Antiresorptives include bisphosphonates, selective estrogen-receptor modulators (SERMs), and calcitonin. Bisphosphonates are the standard drugs used for osteoporosis. Denosumab (Prolia) is a newer type of antiresorptive. These drugs block resorption (preventing bone break down), which slows the rate of bone remodeling, but they cannot rebuild bone. Because resorption and reformation occur naturally as a continuous process, blocking resorption may eventually also reduce bone formation.
- Anabolic (Bone-Forming) Drugs. Drugs that rebuild bone are known as anabolics. The primary anabolic drug is low-dose parathyroid hormone (PTH), which is administered through injections. This drug may help restore bone and prevent fractures. PTH is still relatively new, and long-term effects are still unknown. Fluoride is another bone-building drug, but it has limitations and is not commonly used.
Both types of drugs are effective in preventing bone loss and fractures, although they may cause different types of side effects. The United States Preventive Services Task Force (USPSTF) recommends that these drugs should be prescribed only to patients who have been diagnosed with osteoporosis.
Bisphosphonates are the primary drugs for preventing and treating osteoporosis. They can help reduce the risk of both spinal and hip fractures, including among patients with prior bone breaks.
Studies indicate that these drugs are effective and safe for up to 5 years. Eventually, however, bone loss continues with bisphosphonates. This may be due to the fact that bone breakdown is one of two phases in a continuous process of rebuilding bone. Over time, blocking resorption interrupts this process and impairs the second half of the process -- bone formation.
Candidates. Clinical guidelines recommend that the following people should take or consider taking bisphosphonates:
- Any woman who has a T score of -2.5 or lower on a DXA scan
- Women who have a T score between -1 and -2.5 (indicates low bone density [osteopenia]) and a history of fractures
Brands. Bisphosphonates for osteoporosis prevention and treatment are available in different forms:
- Oral bisphosphonates. These pills include alendronate (Fosamax, generic), risedronate (Actonel, generic), and ibandronate (Boniva, generic). Alendronate and risedronate are taken once a week. Ibandronate is available as a once-monthly pill. Risedronate is also available as a once-a-month pill and in a pill that contains calcium. Alendronate is available in a formulation that has vitamin D. Risedronate and alendronate are approved for both men and women.
- Injectable bisphosphonates. Zoledronic acid (Reclast) is approved for treatment and prevention of osteoporosis in postmenopausal women. It is given as a once-yearly injection. The injectable form of ibandronate (Boniva) requires injections 4 times a year. Injectable bisphosphonates are an alternative for patients who may have difficulty swallowing pills or sitting upright after oral bisphosphonate treatment.
Side Effects. The most distressing side effects of bisphosphonates are gastrointestinal problems, particularly stomach cramps and heartburn. These symptoms are very common and occur in nearly half of all patients. Other side effects may include irritation of the esophagus (the tube that connects the mouth to the stomach) and ulcers in the esophagus or stomach. Some patients may have muscle and joint pain. To avoid stomach problems, doctors recommend:
- Take the pill on an empty stomach in the morning with 6 - 8 ounces of water (not juice or carbonated or mineral water).
- After taking the pill, remain in an upright position. Do not eat or drink for at least 30 - 60 minutes. (Check your drug's dosing instructions for exact time.)
- If you develop chest pain, heartburn, or difficulty swallowing, stop taking the drug and see your doctor.
Other Concerns. The FDA is currently reviewing whether long-term (more than 3 - 5 years) use of bisphosphonate drugs provides any benefits for fracture prevention. Possible concerns for long-term use of bisphosphonates are increased risks for thigh bone (femoral fractures), esophageal cancer, and osteonecrosis (bone death) of the jaw. The FDA recommends that doctors periodically reevaluate patients who have been on bisphosphonates formore than5 years. Patients should inform their doctors if they experience any new thigh or groin pain, swallowing difficulties, or jaw or gum discomfort. Do not stop taking your medication unless your doctor tells you to do so.
For the injectable drug zoledronic acid (Reclast), kidney failure is a rare but serious side effect. Zoledronic acid should not be used by patients with risk factors for kidney failure.
Denosumab (Prolia)
Denosumab (Prolia) is a newer drug approved for treatment of osteoporosis in postmenopausal women who are at high risk for fracture. Denosumab is the first "biological therapy" drug approved for osteoporosis. It is considered an antiresorptive drug, but it works in a different way than bisphosphonates. It is a monoclonal antibody that works by targeting RANKL, a chemical factor involved with bone resorption.
Denosumab slows down the bone-breakdown process. However, because it also slows down the bone build-up and remodeling process, it is unclear what its long-term effects may be. Possible concerns are that denosumab may slow the healing time for broken bones or cause unusual fractures. For now, denosumab is recommended for women who cannot tolerate or who have not been helped by other osteoporosis treatments.
Denosumab is given as an injection in a doctor's office twice a year (once every6 months). Common side effects include back pain, pain in the arms and legs, high cholesterol levels, muscle pain, and bladder infection. Denosumab can lower calcium levels and should not be taken by women who have low blood calcium levels (hypocalcemia) until this condition is corrected.
Because denosumab is a biologic drug, it can affect or weaken the immune system and may increase the risk for serious infections. Other potential adverse effects include inflammation of the skin (dermatitis, rash, eczema) and inflammation of the inner lining of the heart (endocarditis). Denosumab may increase the risk of jaw bone problems such as osteonecrosis.
Selective estrogen-receptor modulators (SERMs) are a class of drugs that are similar, but not identical, to estrogen. They can provide the bone benefits of estrogen without increasing the risks for estrogen-related breast and uterine cancers.
Raloxifene (Evista). Raloxifene (Evista) is the only SERM approved for both treatment and prevention of osteoporosis in postmenopausal women. Raloxifene is recommended for postmenopausal women with low bone mass or younger postmenopausal women with osteoporosis. It may help prevent bone loss and reduce the risk of vertebral (spine) fractures. It is less clear how effective it is for preventing other types of fractures. Raloxifene is taken as a pill once a day. Common mild side effects include hot flashes, joint pain, and swelling of legs, feet, and ankles.
Bazedoxifene and Conjugated Estrogens (Duavee). In 2013, the FDA approved Duavee, a drug that combines the SERM bazedoxifene with the conjugated estrogens used in hormone replacement therapy for menopause. The medication is approved both to treat moderate-to-severe menopausal symptoms such as hot flashes, and to prevent post-menopausal osteoporosis. When Duavee is used solely for the prevention of osteoporosis, the FDA recommends that it should be reserved for high-risk women, and that other, non-estrogen drugs should be tried first. Common side effects include muscle spasms, nausea, diarrhea, and upset stomach.
Serious Side Effects. All SERMs increase the risk for blood clots in the veins. Because of this side effect, these drugs also increase the risk for stroke (but not other types of cardiovascular disease). These side effects, though rare, are very serious. Women should not take a SERM drug if they have a history of blood clots, or if they have certain risk factors for stroke and heart disease.
Parathyroid Hormone
Teriparatide (Forteo), an injectable drug made from selected amino acids found in parathyroid hormone, may help reduce the risks for spinal and non-spinal fractures. Although high persistent levels of parathyroid hormone (PTH) can cause osteoporosis, daily injections of low doses of this hormone actually stimulate bone production and increase bone mineral density. Teriparatide is usually recommended for patients with osteoporosis who are at high risk of fracture.
Side effects of PTH are generally mild and include nausea, dizziness, and leg cramps. No significant complications have been reported to date.
Early animal studies reported bone tumors in mice that were given parathyroid long-term. Such effects have not been observed in humans to date. However, people with Paget disease, (a disorder in which bone thickens but also weakens), should not take parathyroid hormone, because they are at higher than normal risk for bone tumors.
Produced by the thyroid gland, natural calcitonin regulates calcium levels by inhibiting the osteoclastic activity, the breakdown of bone. The drug version, calcitonin salmon, is derived from salmon and is available as a nasal spray (Miacalcin, Fortical, generic) and an injected form (Miacalcin, generic). Calcitonin is used to treat, not prevent, osteoporosis. In 2013, an FDA advisory committee recommended against the use of calcitonin products for osteoporosis due to concerns that the drug may increase the risk for cancer. According to the advisors, the risks for cancer outweigh any possible benefits. The FDA is currently considering the committee's recommendations and will make a final decision by 2014.
Side Effects. Side effects include headache, dizziness, anorexia, diarrhea, skin rashes, and edema (swelling). The most common adverse effect experienced with the injection is nausea, with or without vomiting. The nasal spray may cause nosebleeds, sinusitis, and inflammation of the membranes in the nose. Many people who take calcitonin develop resistance or allergic reactions after long-term use. As noted above, cancer risks are a concern.
Hormone Replacement Therapy
Hormone replacement therapy (HRT) was formerly used to prevent osteoporosis, but is rarely used for this purpose today. Studies show that estrogen increases the risk for breast cancer, blood clots, strokes, and heart attacks. For this reason, women need to balance the benefits that HRT has on bone-loss protection, with the risks it carries for other serious health conditions. HRT is now mainly used for short-term treatment of symptoms of menopause. The United States Preventive Services Task Force (USPSTF) recommends against the use of HRT for prevention of osteoporosis or other chronic health conditions.
- www.nof.org -- National Osteoporosis Foundation
- www.niams.nih.gov/Health_Info/Bone -- National Institute of Arthritis and Musculoskeletal and Skin Diseases
- www.iofbonehealth.org -- International Osteoporosis Foundation
- www.menopause.org -- North American Menopause Society
Berry SD, Samelson EJ, Pencina MJ, McLean RR, Cupples LA, Broe KE, et al. Repeat bone mineral density screening and prediction of hip and major osteoporotic fracture. JAMA. 2013 Sep 25;310(12):1256-62.
Black DM, Kelly MP, Genant HK, Palermo L, Eastell R, Bucci-Rechtweg C, et al. Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur. N Engl J Med. 2010 May 13;362(19):1761-71. Epub 2010 Mar 24.
Bolland MJ, Grey A, Avenell A, Gamble GD, Reid IR. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis. BMJ. 2011 Apr 19;342:d2040.
Chung M, Lee J, Terasawa T, Lau J, Trikalinos TA. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2011 Dec 20;155(12):827-38.
Committee on Practice Bulletins-Gynecology, The American College of Obstetricians and Gynecologists. ACOG Practice Bulletin N. 129. Osteoporosis. Obstet Gynecol. 2012 Sep;120(3):718-34.
Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009 Aug 20;361(8):756-65. Epub 2009 Aug 11.
Gourlay ML, Fine JP, Preisser JS, May RC, Li C, Lui LY, et al. Bone-density testing interval and transition to osteoporosis in older women. N Engl J Med. 2012 Jan 19;366(3):225-33.
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30. Epub 2011 Jun 6.
Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. National Academies Press (US); 2011.
Kennel KA, Drake MT. Adverse effects of bisphosphonates: implications for osteoporosis management. Mayo Clin Proc. 2009 Jul;84(7):632-7.
Khosla S. Increasing options for the treatment of osteoporosis. N Engl J Med. 2009 Aug 20;361(8):818-20. Epub 2009 Aug 11.
Lewiecki EM. In the clinic. Osteoporosis. Ann Intern Med. 2011 Jul 5;155(1):ITC1-1-15.
Li K, Kaaks R, Linseisen J, Rohrmann S. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg). Heart. 2012 Jun;98(12):920-5.
Lim LS, Hoeksema LJ, Sherin K; ACPM Prevention Practice Committee. Screening for osteoporosis in the adult U.S. population: ACPM position statement on preventive practice. Am J Prev Med. 2009 Apr;36(4):366-75.
Moyer VA; U.S. Preventive Services Task Force. Menopausal hormone therapy for the primary prevention of chronic conditions: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013 Jan 1;158(1):47-54.
Moyer VA; U.S. Preventive Services Task Force. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013 May 7;158(9):691-6.
National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2010.
North American Menopause Society. Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause. 2010 Jan-Feb;17(1):25-54; quiz 55-6.
Park-Wyllie LY, Mamdani MM, Juurlink DN, Hawker GA, Gunraj N, Austin PC, et al. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA. 2011 Feb 23;305(8):783-9.
Qaseem A, Snow V, Shekelle P, Hopkins R Jr., Forciea MA and Owens DK. Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008;149(6): 404-15.
Reid IR, Bolland MJ, Grey A. Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. Lancet. 2013 Oct 10. pii: S0140-6736(13)61647-5 [Epub ahead of print]
Silverman SL, Landesberg R. Osteonecrosis of the jaw and the role of bisphosphonates: a critical review. Am J Med. 2009 Feb;122(2 Suppl):S33-45.
U.S. Preventive Services Task Force. Screening for osteoporosis: U.S. preventive services task force recommendation statement. Ann Intern Med. 2011 Mar 1;154(5):356-64. Epub 2011 Jan 17.
Watts NB, Diab DL. Long-term use of bisphosphonates in osteoporosis. J Clin Endocrinol Metab. 2010 Apr;95(4):1555-65. Epub 2010 Feb 19.
Watts NB, Adler RA, Bilezikian JP, Drake MT, Eastell R, Orwoll ES, et al. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012 Jun;97(6):1802-22.
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Advanced Studyec
Related Informationec
Review Date: 12/16/2013�
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


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WATCH: Jennifer Lopez releases teaser for new single
Listen to Jennifer Lopez on iHeartRadio
Jennifer Lopez is giving fans a taste of her new single "Same Girl." The superstar has released a teaser for her upcoming video, featuring footage of herself visiting her old neighborhood in the Bronx.
The 45-second preview shows a casually dressed J. Lo singing from a subway station behind graffitied walls. She sings, "I'm tired of trying to make you see that I'm still me."
The single has been in the works since last year, when Jennifer posted a photo of herself in the studio with Chris Brown with the hashtag "Same Girl." It appears that the controversial singer is a co-writer on her latest song, which will be featured on her upcoming tenth studio album.
Check it out below!


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2012 All-Star Dining Line-Up EventMarch 26, 2012
The Mets recently held their 2012 All-Star Dining Line-Up Event which showcases the food for the upcoming season at Citi Field. I couldn't sample most of the food as I am currently fasting for Lent but below are a number of photo's I took. Some of the most talked about items were: Buffalo Dog from Box Frites, Flash Fried Beer Battered Shrimp Skewers from Catch of The Day, Smothered Swedish Meatball from Delta Sky360 Club and the 7-1-ATE Special from the Promenade Club.
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Rituximab and Combination Chemotherapy in Treating Patients With Diffuse Large B-Cell Lymphoma
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- No Study Results Posted
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- How to Read a Study Record
RATIONALE: Monoclonal antibodies, such as rituximab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them. Drugs used in chemotherapy work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving rituximab together with combination chemotherapy may kill more cancer cells. It is not yet known which combination chemotherapy regimen is more effective when given with rituximab in treating diffuse large B-cell lymphoma.
PURPOSE: This randomized phase III trial is studying rituximab when given together with two different combination chemotherapy regimens to compare how well they work in treating patients with diffuse large B-cell lymphoma.
|Large B Cell Lymphoma
|Biological: rituximab Drug: cyclophosphamide Drug: doxorubicin Drug: vincristine Drug: prednisone Drug: etoposide Drug: filgrastim Drug: pegfilgrastim
|Phase 3
|Study Type:
|Study Design:
|Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:
|Phase III Randomized Study of R-CHOP V. Dose-Adjusted EPOCH-R With Molecular Profiling in Untreated De Novo Diffuse Large B-Cell Lymphomas
- Event-free survival [ Time Frame: Up to 5 years post-registration ]
- Response rate [ Time Frame: Up to 5 years post-registration ]
- Overall survival [ Time Frame: Up to 5 years post-registration ]
- Whether the gene expression signatures that were previously associated with survival following CHOP therapy are associated with survival in either of the treatment arms of the prospective trial [ Time Frame: Up to 5 years post-registration ]
|Study Start Date:
|May 2005
|Estimated Primary Completion Date:
|May 2018 (Final data collection date for primary outcome measure)
|Assigned Interventions
Active Comparator: Arm A - R-CHOP
Patients receive the following treatment:
Required ancillary medications is administered during all cycles as defined in the protocol.
Cycles will be repeated every 21 days for 6 treatment cycles. Restaging will occur after Cycles 4 and 6.
Biological: rituximab
IVDrug: cyclophosphamide
IVDrug: doxorubicin
IV or CIVIDrug: vincristine
IV or CIVIDrug: prednisone
oralDrug: filgrastim
IVDrug: pegfilgrastim
Experimental: Arm B - DA-EPOCH-R
Patients receive the following treatment:
Cycle 1 Doses:
Doses for subsequent cycles will be determined by the absolute neutrophil (ANC) or platelet nadir from the previous cycle.
Required ancillary medications are administered during all cycles as defined in the protocol.
Cycles will be repeated every 21 days for a maximum of 6 cycles. Restaging will occur after Cycles 4 and 6.
Biological: rituximab
IVDrug: cyclophosphamide
IVDrug: doxorubicin
IV or CIVIDrug: vincristine
IV or CIVIDrug: prednisone
oralDrug: etoposide
CIVIDrug: filgrastim
Detailed Description:
Primary Objectives:
- To compare the event-free survival of R-CHOP versus DA-EPOCH-R chemotherapy in untreated CD20+ diffuse large B-cell lymphomas
- To develop a molecular predictor of outcome of R-CHOP and DA-EPOCH-R chemotherapy using molecular profiling
Secondary Objectives:
- To compare the response rates, overall survival and toxicity of R-CHOP versus DA-EPOCH-R
- To define the pharmacogenomics of untreated DLBCL and correlate clinical parameters (toxicity, response, survival outcomes and laboratory results) with molecular profiling
- To assess the use of molecular profiling for pathological diagnosis
- To identify new therapeutic targets using molecular profiling
- To perform a comprehensive analysis of somatic alterations to the tumor genome and to understand which genomic alterations are somatically acquired by the tumor and which are encoded in the germ line of the patient
- To identify biomarkers of response to chemotherapy by FDG-PET/CT imaging that are predictive of histopathologic remissions and survival in patients with stage I (mediastinal), II, III, or IV untreated DLBCL
- To evaluate the use of semiquantitative measurements of FDG uptake in defining FDG-PET/CT based biomarkers of response to chemotherapy in patients with DLBCL
- To determine whether FDG-PET/CT measurements of tumor response after the second cycle of chemotherapy can predict clinical response
- To establish a standardized protocol for FDG-PET/CT image acquisition
- To determine additional FDG-PET/CT parameters (e.g., the ratio of tumor SUVmax to liver SUVmean; SUVs corrected for body surface area and lean body mass; nuclear medicine physician's assessment) and evaluate their utility in refining FDG-PET/CT based biomarkers of response to therapy
- To evaluate inter-institutional reproducibility of FDG-PET/CT measurements for this indication
After patients have completed treatment on this study, all patients will be asked to return to the clinic for follow-up exams every three months for the first two years, and then every six months thereafter for three years. A total of five years from study registration.
|Ages Eligible for Study:
|18 Years and older (Adult, Senior)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Histologically documented de novo CD20+ DLBCL with stage II, III or IV disease.
- Stage I primary mediastinal (thymic) DLBCL is also eligible.
- Patients with an underlying low-grade lymphoma, such as a transformed lymphoma or low-grade lymphoma in the bone marrow, are not eligible.
- Diagnosis should be based on an adequate tissue sample, including open biopsy or core needle biopsy.
- Needle aspiration for primary diagnosis is unacceptable.
Patients must have one of the following WHO classification subtypes:
- Diffuse large B-cell lymphoma (includes morphological variants: centroblastic, immunoblastic, T-cell/histiocyte rich, and anaplastic)
- Mediastinal (thymic) large B-cell lymphoma
- Intravascular large B-cell lymphoma
Note: Failure to submit a pathology block within 60 days of patient registration will be considered a major protocol violation.
- Fresh (frozen) tumor biopsy must be available or attempted. A frozen tumor biopsy equivalent to a minimum of four at least 16 gauge needle cores is an important component of this study.
- Patients without adequate frozen material should have a biopsy performed to obtain material.
- If a biopsy is performed and does not yield adequate material, the patient is still eligible for the study. If a biopsy cannot be done safely, the patient may still be eligible for the study if permission is granted.
- Note: This study does not allow concurrent radiation unless a patient has a documented CNS treatment failure with no systemic failure.
- No prior cytotoxic chemotherapy or rituximab. Patients may be entered if they have received prior limited field radiation therapy or a short course of glucocorticoids (< 10 days) for an urgent local disease complication at diagnosis (e.g., cord compression, SVC syndrome). Patients who have received chemotherapy for prior malignancies are not eligible.
- Age ≥ 18 years
- ECOG Performance Status 0-2
- No active ischemic heart disease or congestive heart failure. If there is suspicion of cardiac disease, a cardiac ejection fraction must show LVEF > 45%, but the study is not required
- No known lymphomatous involvement of the CNS. A lumbar puncture prior to study is not required in the absence of neurological symptoms
- No known HIV disease. Patients with a history of intravenous drug abuse or any other behavior associated with an increased risk of HIV infection should be tested for exposure to the HIV virus. Patients who test positive or who are known to be infected are not eligible.
- Non pregnant and non-nursing. Treatment would expose an unborn child to significant risks. Women and men of reproductive potential should agree to use an effective form of contraception.
- Patients with active medical processes (e.g., uncontrolled bacterial or viral infection, bleeding) not related to their lymphoma should be excluded.
Required Initial Laboratory Values (unless non-Hodgkin lymphoma):
- ANC ≥ 1000/μL
- Platelets ≥ 100,000/μL
- Creatinine≤ 1.5 mg/dL or creatinine clearance ≥ 50 cc/min
- Total Bilirubin ≤ 2 mg/dL (unless a history of Gilbert's Disease)
Please refer to this study by its ClinicalTrials.gov identifier: NCT00118209
Show 47 Study Locations
|Study Chair:
|Wyndham H. Wilson, MD, PhD
|National Cancer Institute (NCI)
|Study Chair:
|Andrew D. Zelenetz, MD, PhD
|Memorial Sloan Kettering Cancer Center
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
|Responsible Party:
|Alliance for Clinical Trials in Oncology
|ClinicalTrials.gov Identifier:
|NCT00118209 History of Changes
|Obsolete Identifiers:
|Other Study ID Numbers:
CDR0000433265 ( Other Identifier: NCI Physician Data Query )
NCI-2009-00480 ( Registry Identifier: NCI Clinical Trial Reporting Program )
U10CA031946 ( U.S. NIH Grant/Contract )
U10CA180821 ( U.S. NIH Grant/Contract )
|Study First Received:
|July 8, 2005
|Last Updated:
|July 1, 2016
Additional relevant MeSH terms:
Lymphoma, B-Cell
Lymphoma, Large B-Cell, Diffuse
Neoplasms by Histologic Type
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Lymphoma, Non-Hodgkin
Liposomal doxorubicin
Etoposide phosphate
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists
Antibiotics, Antineoplastic
Topoisomerase II Inhibitors
ClinicalTrials.gov processed this record on July 25, 2017


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Horseback Riding on Hawaii Island
The paniolo (Hawaiian cowboy) culture is a big part of the lifestyle and history of Hawaii Island. With a wealth of scenic, open landscapes to explore in Waimea and other spots throughout the island, ranchers are happy to share their paniolo stories and knowledge with you on horseback.
Hawaii Island offers a variety of fun ways to saddle up for an unforgettable paniolo experience. From scenic storytelling tours by horse-drawn wagon to a hands-on chance to take the reins and go on a real cattle drive. Choose from a diverse selection of beautiful environments to ride through including the upcountry pastures of Kahua Ranch, the tropical Waipio Valley stream and waterfalls trails, or the southern reaches of a historic trail to Kealakekua Bay – complete with swimming and snorkeling. As you ride along these scenic vistas you'll see why horseback riding on Hawaii Island is truly unique.


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A Third of US Is on Debt Collectors' Books
(NEWSER) – More than a third of Americans with credit scores have debt "in collections"—meaning one in three of us has been reported to collection agencies, a study finds. That's a total of 77 million people whose non-mortgage debt is significantly overdue, the Urban Institute notes. The study includes debts ranging from credit card and medical bills to parking tickets, CNNMoney notes. And the widespread issue "can tip employers' hiring decisions, or whether or not you get that apartment," an analyst tells the AP.
Read the full story on Newser.com
PHOTO: Shutterstock


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If you suffer from frequent headaches, jaw clicking and popping ear pain, you may have TMJ. Top dentist Hamidreza Nassery, DMD, has the best TMJ treatments for you.
Diabetes-friendly recipes and tips for your game day party.
Chemical linked to adverse health effects found in popular canned foods
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Allstate Sugar Bowl Announces Corbett and Robinson Award Winners
Thursday, June 3, 2010
The Allstate Sugar Bowl and the Greater New Orleans Sports Hall of Fame announced their Corbett Award winners and the annual Eddie Robinson Award honoree on Thursday. All of the 2009-10 honorees will be recognized at a banquet on Friday, July 23 at the Louisiana Superdome.
The Corbett Awards are presented to the top male and female amateur athletes in the state and are based on achievements from the entire 2009 calendar year through May of 2010. This year's winners are both from Louisiana State University. Susan Jackson, of the LSU Gymnastics team, is the female winner, and Louis Coleman, from LSU's 2009 National Champion baseball team, earns the male honor. It is the sixth time since 2000 that LSU has swept both honors.
The Eddie Robinson Award was instituted last year to honor the legendary football coach from Grambling State University; it recognizes an individual who demonstrates the qualities most closely associated with Coach Robinson: outstanding achievement in athletics, academics, sportsmanship and citizenship by maximizing the use of limited resources. This year's honoree is long-time New Orleans prep football coach Eddie Flint.
The Corbett Award was created in 1967 to honor the late James J. Corbett and to commemorate his many contributions to intercollegiate athletics and specifically to the Sugar Bowl. When looking through its history, Corbett Award winners have gone on to great success, including 14 NFL players, six Major League baseball players, four NBA players, including two Hall of Famers, three WNBA players and eight Olympians, including seven Gold Medal winners.
The Greater New Orleans Sports Awards Selection Committee, made up of local media members, honors athletes in a wide-range of categories. In addition to Thursday's release of the Corbett Award winners and the Eddie Robinson Award honoree, the organization released its annual award winners on Tuesday. On Saturday, the Committee will announce its 2010 inductees for the Greater New Orleans Sports Hall of Fame, as well as multiple Special Award winners.
Jackson finished her career with three individual titles, a first for the LSU gymnastics program. Her four First Team All-America honors this year make a total of 12 for her career. In addition, Jackson is a two-time SEC vault champion and an SEC beam champion, and as one of the nation's top elite-level performers, she was a four-time member of the USA National Team during her club career. In addition to her school-record performances at the NCAA Championships, she also set the LSU record for all-around titles in a single season with 11. In all, Jackson tallied 45 individual titles in 14 meets - 12 vault titles, 11 all-around, nine bars, seven floor and six beam - to end her career with 74 titles, third most in program's storied history.
In 1967, Eddie Flint and his Purple Knights carried the hopes of the African-American community when St. Aug integrated the LHSAA, essentially wiping out segregation in prep sports in the state.
Flint's work during the sixties laid the foundation for what would become one of the top high school football programs in the country. It was accomplished without gymnasium and locker room facilities. A public playground a block away from the school served as the team's practice field. Flint served as a defensive assistant on the staff of Otis Washington from 1970 to 1979, helping St. Aug win three more state football titles. Following that stint, he was instrumental in helping coach Wayne Reese rebuild football programs at Washington And Carver High Schools in New Orleans. Currently "retired" at age 79, Eddie Flint continues to work with Reese at McDonogh 35 Senior High School.


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Industry research
Industry research
The following database will help you find industry information:
Industry reports in S&P NetAdvantage
Industry ratios
ABI/INFORM Complete has the Dun and Bradstreet publication FirstResearch, which does the reports for Hoover's. The most efficient way to search is to use the keywords for your industry AND FirstResearch. Find the appropriate quarterly report.
Industry Norms and Key Business Ratios: Located on the table behind the reference desk. Call number #HF5681.R25 I525 (this is the easiest one to use, so I recommend using this one). Find your industry by SIC code.
RMA Statement Studies: Reference books in the reference room. Located on the table behind the reference desk. Call #HF5681.B2 R6. Find your industry by the NAICS code.
Almanac of business and industrial financial ratios: Located same as above books. Call number #HF5681.R25 A45.


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Bob Seger to duet with Swon Brothers on 'Voice' finale
Listen to Bob Seger on iHeartRadio
(Yahoo!) - "The Voice" Season 4 finale is this week, and as usual, NBC has a pretty impressive slew of talent lined up. Earlier today, it was announced that Hunter Hayes and OneRepublic will be two contestants' duet partners, and now Yahoo!'s Reality Rockscan exclusively reveal that reclusive rock legend Bob Seger will also be dueting on Tuesday's big show.
It's no shocker that heartland country-rockers the Swon Brothers, whose recent stellar cover of Bob's "Turn the Page" help propel them to the finale, are singing with Seger. As for the other two duets, Hunter will surely be the perfect match for country-pop teen Danielle Bradbery, while pop-rocker Michelle Chamuel will surely hold her own alongside Ryan Tedder and company.
While the specific song that the Swons and Seger will be performing is still secret (my vote is for "Night Moves"; just putting that out there), it is known that Hunter and Danielle will duet on "I Want Crazy," and OneRepublic and Michelle will be doing "Counting Stars."
This is in addition to already-announced performances by returning coach Christina Aguilera with Pitbull and A-listers Bruno Mars, Florida Georgia Line with Nelly, and (GASP!!!) the one and only Cher. Set your DVRs now, people.
Which "Voice" duet or performance are you most excited to see Tuesday night?
Photo Credit Getty Images


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Wednesday, June 29 2011 - 9/11 Consequences
How much will our wars cost? Report says $4 trillion
June 29, 2011
Estimated cost of post-9/11 wars: 225,000 lives, up to $4 trillionPublished June 29, 2011
Contact: Deborah Baum (401-863-2478)
Costs of War
New estimates by the "Costs of War" project provide a comprehensive analysis of the total human, economic, social, and political cost of the U.S. War on Terror. The cost of wars in Afghanistan, Iraq, and Pakistan are estimated at 225,000 lives and up to $4 trillion in U.S. spending, in a new report by scholars with the Eisenhower Research Project at Brown University's Watson Institute for International Studies. The group's "Costs of War" project has released new figures for a range of human and economic costs associated with the U.S. military response to the 9/11 attacks.
PROVIDENCE, R.I. [Brown University] -- Nearly 10 years after the declaration of the War on Terror, the wars in Afghanistan, Iraq, and Pakistan have killed at least 225,000 people, including men and women in uniform, contractors, and civilians. The wars will cost Americans between $3.2 and $4 trillion, including medical care and disability for current and future war veterans, according to a new report by the Eisenhower Research Project based at Brown University's Watson Institute for International Studies. If the wars continue, they are on track to require at least another $450 billion in Pentagon spending by 2020.
The group's "Costs of War" project, which involved more than 20 economists, anthropologists, lawyers, humanitarian personnel, and political scientists, provides new estimates of the total war cost as well as other direct and indirect human and economic costs of the U.S. military response to the 9/11 attacks. The project is the first comprehensive analysis of all U.S., coalition, and civilian casualties, including U.S. contractors. It also assesses many of the wars' hidden costs, such as interest on war-related debt and veterans' benefits.
Catherine Lutz, the Thomas J. Watson Jr. Family Professor of Anthropology and International Studies at Brown University, co-directs the Eisenhower Research Project with Neta Crawford, a 1985 Brown graduate and professor of political science at Boston University.
Among the group's main findings:
The U.S. wars in Afghanistan, Iraq, and Pakistan will cost between $3.2 and $4 trillion, including medical care and disability for current and future war veterans. This figure does not include substantial probable future interest on war-related debt.
More than 31,000 people in uniform and military contractors have died, including the Iraqi and Afghan security forces and other military forces allied with the United States.
By a very conservative estimate, 137,000 civilians have been killed in Iraq and Afghanistan by all parties to these conflicts.
The wars have created more than 7.8 million refugees among Iraqis, Afghans, and Pakistanis.
Pentagon bills account for half of the budgetary costs incurred and are a fraction of the full economic cost of the wars.
Because the war has been financed almost entirely by borrowing, $185 billion in interest has already been paid on war spending, and another $1 trillion could accrue in interest alone through 2020.
Federal obligations to care for past and future veterans of these wars will likely total between $600-$950 billion. This number is not included in most analyses of the costs of war and will not peak until mid-century.
Photo: Human costs An Afghan resident, wounded by an insurgent grenade, receives medical treatment from a U.S. Navy corpsman near Kalach in the Oruzgan district of Afghanistan.
"This project's accounting is important because information is vital for the public's democratic deliberation on questions of foreign policy," said Lutz. "Knowing the actual costs of war is essential as the public, Congress and the President weigh the drawdown of troops in Afghanistan, and other areas including the deficit, security, public investments, and reconstruction."
"There are many costs and consequences of war that cannot be quantified, and the consequences of wars don't end when the fighting stops," Crawford said. "The Eisenhower study group has made a start at counting and estimating the costs in blood, treasure, and lost opportunities that are both immediately visible and those which are less visible and likely to grow even when the fighting winds down."
The Eisenhower Research Project is a new, nonpartisan, nonprofit, scholarly initiative that derives its purpose from President Eisenhower's 1961 farewell address, in which he warned of the "unwarranted influence" of the military-industrial complex and appealed for an "alert and knowledgeable citizenry" as the only force able to balance the often contrasting demands of security and liberty in the democratic state.
The Costs of War has released its findings online, at www.costsofwar.org, to spur public discussion about America at war.
Editors: Brown University has a fiber link television studio available for domestic and international live and taped interviews, and maintains an ISDN line for radio interviews. For more information, call (401) 863-2476.
Photo credit: Credit: U.S. Army photo by Pfc. Simon Lee/Released
The views expressed in this article are the sole responsibility of the author, who is solely responsible for its content, and do not necessarily reflect those of 911Truth.org. 911Truth.org will not be responsible or liable for any inaccurate or incorrect statements contained in this article.
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This page contains copyrighted material, the use of which has not always been specifically authorized by the copyright owner. We are making such material available in our efforts to advance understanding of political issues relating to alternative views of the 9/11 events, etc. We believe this constitutes a "fair use" of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material on this site is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes. For more information go to: http://www.law.cornell.edu/uscode/17/107.shtml. If you wish to use copyrighted material from this site for purposes of your own that go beyond "fair use", you must obtain permission from the copyright owner.


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By Dan Byfield
Published May 2010
In 2007, five courageous mayors in eastern Bell County, Texas formed the very first sub-regional planning commission utilizing Section 391 of the Texas Local Government Code as their basis to fight and stop the Tran-Texas Corridor through their five school districts.
It worked and now, the entire TTC project is flickering out like a shooting star.
That's the real story behind the demise of the TTC. Through a strategy only promoted by American Stewards of Liberty, a non-profit private property rights organization located in Taylor, Texas, those five mayors initiated a process that today is revitalizing and protecting the rights of citizens in our State through an effective local control process called Coordination.
Coordination is a simple word with an extraordinarily powerful legal meaning found in both federal and state statutes that requires government agencies to "coordinate" with local government in developing and implementing plans, policies and management actions.
American Stewards showed the five mayors where the important language was found in the Texas Local Government Code and they immediately formed a planning commission to take advantage of the coordination strategy. The first meeting they called was with the Texas Department of Transportation (TxDoT) to begin "coordinating" their state plans to build the Trans-Texas Corridor through their jurisdiction.
TxDoT was not prepared for what happened next. The five mayors, through the Eastern Central Texas Sub-Regional Planning Commission, adopted a policy that stated "No Trans-Texas Corridor shall be allowed through our jurisdiction." From that point, they demanded TxDoT begin coordinating their plans with their policy. It was that simple.
Through the three coordination meetings that followed with TxDoT, the mayors discovered that TxDoT had not followed the federal environmental statutes properly. So, they began demanding the federal agencies in charge of enforcing the federal laws force TxDoT to follow the law. Naturally, TxDoT resisted, but the more they resisted, the more the five mayors pushed back.
It was an amazing site to see. Five unpaid mayors representing a total of about 6,000 people stood up to the most arrogant and well-financed state agency in the nation and won. How could they do this incredible feat? Coordination!
Normally, citizens or even local government like counties and cities, are limited to their ability to influence any decision of federal or state agencies. Many times the only participation individuals have is the ability to offer written or brief oral comments at a public meeting called by the agency and run by the agency. Local governments are relegated to negotiations, contracts, cooperative agency status or similar controlling schemes.
It is the way our federal and state agencies control our lives and our purse strings, until now.
Legally, the only responsibility agencies have to the public is to summarize their comments in their final plans that, in reality, normally have a pre-determined outcome. They are under no obligation to negotiate any alterations of their plans, policies or actions based on public input.
However, when local government represents its constituent's positions through coordination, like the five mayors did, agencies have much broader duties and responsibilities owed to the local government.
The agencies are required to listen and receive local input, analyze the local position to determine if there is conflict between the proposed agency action and the local policy or plan, and they must use good faith effort to resolve any existing conflict to achieve consistency between the proposed state plan, policy or action with the local plan or policy.
That is the power of coordination. It places your local leaders in a government-to-government basis placing them on an equal footing with the larger government agencies that must work with your local leaders before they can proceed with their plans.
This is what those five mayors did. By forming a planning commission, they adopted a local policy of "no TTC through our jurisdiction." Then, they used 391.009(c) that contained the "coordination" word to force TxDoT to their table to work out any inconsistencies between their local policy and the plan to build the TTC through their jurisdiction. In essence, they placed a 30 mile gap in the TTC right in the center of the State. Who is going to build a 1,200 foot wide toll road from Mexico to Canada with a 30 mile gap in it, hence the beauty of what those mayors did.
The common definition, which is used in lawsuits to define coordination, is not a term of art or one of scientific and special meaning. It's a word of common usage that literally means "of equal importance, rank or degree, not subordinate." (Webster's New International Dictionary)
In Texas, the Texas Court of Civil Appeals referred to the dictionary definition and defined "coordination" in Empire Ins. Co. of Texas v. Cooper (138 S.W.2nd 159 (1940)) as "equal, not subordinate."
In 2001, then state Representative Rob Junell, now a U.S. District Judge from San Angelo, Texas, amended Section 391.009(c) of the Local Government Code to include this powerful coordination language. His amendment to the code reads:
"In carrying out their planning and program development responsibilities, state agencies shall, to the greatest extent feasible, coordinate planning with commissions to ensure effective and orderly implementation of state programs at the regional level."
This is what the five mayors relied on in getting not only TxDoT, but Texas Parks and Wildlife and the Texas Commission on Environmental Quality to their table. Then, when they found that TxDoT had violated federal environmental laws that also contain coordination language, they brought in the Environmental Protection Agency, Region 6 and the Natural Resource Conservation Service to begin the coordination process. And, this is where they nailed TxDoT.
They discovered that TxDoT had improperly performed the environmental impact statement according to the federal National Environmental Policy Act (NEPA) and through coordination was able to notice all the proper federal and state agencies in a way no other entity could.
In essence, the mayors informed TxDoT and the federal agencies overseeing the federal environmental study they were all in violation of federal law and if they didn't do it right, they were going to take them to court. They utilized the laws to bring every agency that was studying and planning for the construction of the international Trans-Texas Corridor to Holland, Texas, population 1,200, to coordinate their plans with their local policy.
Since the first sub-regional planning commission was formed in Bell County, many more have formed. For example, the City of Mason and Mason County have formed the Mason Sub-Regional Planning Commission (MSRPC) to fight the CREZ (competitive renewable energy zone) electric transmission line being proposed by the Lower Colorado River Authority through Mason County.
MSRPC is relying on coordination found in both the Local Government Code and the federal NEPA statute to bring LCRA and U.S. Fish and Wildlife Service (FWS) to Mason, Texas to begin coordinating the plan to build the transmission line through their jurisdiction.
LCRA tried to claim there is no "federal action" so NEPA didn't apply to them, but through coordination, the MSRPC brought FWL to Mason and got them to admit in a government-to-government meeting that not only is there is a federal action, but because of endangered species two federal laws apply – the Endangered Species Act and NEPA.
Fortunately for the landowners in Mason County, their private property rights are being defended and protected by local government through the sub-regional planning commission and the City of Mason and Mason County by utilizing coordination.
They, like those five tough mayors, are standing up to LCRA by utilizing federal and state laws to their advantage. Coordination is being utilized in hundreds of locations nationwide, but Texas has lead the way through courageous local leaders to protect private property in a new and exciting way never accomplished in our State.
To learn more about the coordination strategy, go to www.Stewards.us or call the author of this article at 512-365-2699.


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Hello guys. I'm working on small project i want to put to codecanyon, but I don't know is this going to be accepted. This is User management script where users can register, login, view other profiles, send message to them. Users have they roles ( admin , global mod, member , unverified ). Admins can do everything in administration, ban, check double IP's, statistics, verify users,database backup. Globals can check double IP's and verify users. Here's sshttp://pokit.org/get/?e211abd5e35339a71f73749dee7fe8fc.jpg
Nice and clean design! I think it will be accepted, but the best way to know is to upload and wait for your inspector. Don't be afraid about rejection, it's always good to get feedback from pros.
Just make sure you have good documentation and follow the submission guidelines. If it gets rejected, follow the suggestions from the reviewer and try again. Good luck!
As this is your first item, it may get rejected first. You easily forget something with the submission guidelines. But that's not the end of the world! Just follow the suggestions from the reviewer (as iapcsolutions said already) and you can get it accepted.
Just a little design note: Try to get the content in the middle into some sort of container (white background, border/box-shadow) and choose a smoother background for the page.
Hope I could help, and good luck!


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….for the renewal of our millage on Tuesday. We are grateful for this strong confirmation of the services we are offering and the priorities we have set with community input.
Thanks to the Citizens Committee for KPL, the Friends of the Kalamazoo Public Library, our board and staff, but most importantly to the voters for this vote of support.
Come visit soon!
Posted by Ann Rohrbaugh at 05/07/2014 10:06:58 AM |
Books for: Kids, Teens & Tweens


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Building Bridges, Raising Economies
Catching up with the Gerald Desmond Bridge Replacement Project
(Please click on photos to read captions)
On January 8, 2013, the world got its first look at the height of the new Gerald Desmond Bridge towers.
In a dramatic display at a Port of Long Beach groundbreaking ceremony, two helicopters hovered 515 feet above the crowd to illustrate just how tall the bridge will be. The twin 50-story high towers will make the new bridge one of the tallest cable-stayed bridges in the U.S. and the first of its kind in California. The new bridge will raise the clearance over the channel from 155 feet to 200 feet, allowing the world's largest ships and their descendents for generations to come to enter the Port's inner harbor, something the current bridge cannot accommodate.
The $1 billion bridge replacement project is a joint effort of Caltrans and the Port of Long Beach with funding also from the U.S. Department of Transportation and the Los Angeles County Metropolitan Transportation Authority.
Speaking at the ceremony, Caltrans Director Malcolm Dougherty said that "the new bridge will be a monument to the power of partnerships. Everyone stepped up to the plate to make this a reality – the state, the port, the federal government, the local transportation agency and the construction industry."
Caltrans is contributing $500,000, with $300,000 coming from the U.S. Department of Transportation, $114 million from the Port of Long Beach and $28 million from the Los Angeles County Metropolitan Transportation Authority.
This project will ease congestion and improve safety on a structure that currently has nearly 70,000 vehicles a day going over it and about 15 percent of the nation's waterborne cargo traveling under it, he added.
"Caltrans is particularly interested in another element of this project—the fact that it's being designed and constructed simultaneously," Dougherty said, adding that the design-build construction method allows for greater flexibility and will speed up the construction timeline.
The Gerald Desmond Bridge, which opened in 1968, provides a critical link from Terminal Island and the ports of Long Beach and Los Angeles to downtown Long Beach and the Long Beach Freeway (I-710).
Other features of the new bridge include a bike path, pedestrian path and scenic observation decks 200 feet above the water. Construction costs will be about $650 million, with site preparation, demolition of the existing bridge and other aspects bringing the total project to $1 billion.
Although there is a lot of activity occurring at the bridge construction site now, it is largely still preliminary, involving the capping or relocating of nearly three dozen active oil production wells and moving related infrastructure and utilities to make way for the new bridge. This has been a massive, two-year effort as the Port of Long Beach is located directly over the Wilmington Oil Field, one of the nation's largest at the time of its discovery in the 1930s.
Meanwhile, the design/build contractor SFI (a consortium of Shimmick Construction Co., Inc., FCC Construction S.A. and Impregilo S.p.A.) has been conducting pile tests in the areas of the west and east approaches, among other testing. The nearly 8,000-foot new bridge will include at least 300 below-ground piles that will support more than 70 columns holding up the two approaches.


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Christoph Gysin wrote:
> Chris Bagnall wrote:
>> General netiquette is that sigs should be no more than 4 lines. That
>> includes really annoying corporate disclaimers. Since we're on the
>> subject
>> of netiquette, it'd be nice if people posting from their offices
>> might have
>> a word with their IT departments about this. Posting a url for a
>> disclaimer
>> might be a good alternative if you really *must* have a ridiculously
>> long
>> disclaimer on the damned thing.
> Like Vincent Engel's sig, adding 2660 byte to his 79 byte question...
> Well, I personally don't care about bandwith. It's just annoying to
> scroll endlessly, just to find someones answer.
> Christoph
I agree!