text:
So I build an HTML website for our local church for free, and it has been heck updating it. So i've decided on our next billing cycle to switch hosts from intuit (sucks, btw, for building custom sites), and going to a host that supports wordpress.
So, my needs:
At least 5gb storageBandwidth is really not an issue, but id say more than 10gb at least.Wordpress/CMS support
And thats pretty much it. Just hit me with your cheapest options, trying to save the church a few $$Thanks
What about Windows Azure, Web sites (shared). One site with 20 GB of bandwidth is about $12 a month. (If you use Pay-as-you-go). https://www.windowsazure.com/en-us/pricing/calculator/?scenario=web Btw, when you use pay-as-you-go, you only pay for what you use, database/storage/bandwidth for example using only 1 GB of 20 GB you will only pay for 1 GB.
Setting up Wordpress on Windows Azure is also a built in feature. http://www.youtube.com/watch?v=MpsIh2HwdPo&feature=plcp
I should also mention that i want to use my own domain and that the site is only about 10 pages big- not huge by any means
Will look through windows azule
I'm a bit puzzled here. You say the site is "low volume" and has only ten pages - but you want 5GB disc space and 10GB bandwidth? That sounds like serious overkill to me. Are you really sure you need all that?
The sites gonna have a lot of streaming Mp3 files (around 100mb each), and probably a few video files as well. 5gb storage is good, but 10gb bandwidth may be a mit much, I was aiming high on that...
Do you have any specific location in mind? You might considering opting for a VPS if you have a lot of streaming files.
Any of the big hosting companies like Godaddy should be able to accomodate you. They are the most reliable
Ok, ive been looking around more and am narrowing down...
Right now my first choice seems to be going for BigRock hosting, even one of the most basic plans has 10gb hosting and supports wordpress. And only $2 a month. Anyone have any experience with them?
Second and third respectively are PacificHost and 2Mhost...
Also, I am just a beginner web designer, and i need to make this site accesible to the next guy who comes in and changes it- who may have no knowledge of web design whatsoever... Is wordpress an OK solution to technologically deprived folks?
Yes, Wordpress would be an excellent choice
I really would not suggest hosting with BigRock as they are more of a Domain company than a Hosting and they are just a division of Directi which is again primarily a Domain Reg. Company. For the same reason do not go with GoDaddy.
Ok, bigrock- out
PacificHost- out (too long of a renewal rate for me..)
Looking around, still like 2Mhost (of anyone can give me info on that. Its NOT M2host (M2host looks to be just too crappy for me ATM))
Also, found an odd one, bluelemonhost. Never heard of it but looks really sketchy
You know you would just be wasting your time looking for dirt cheap hosting. When you get web hosting you should be more focused on customer support and reliability. With dirt cheap hosting you won't get that. This is why I like Windows Azure, it is cheap enough but they have awesome support so my clients are never hanging off the edge when I turn everything over to them.
So far we have not had any issues that would require the involvement of the hosts themselves. I know that getting customer service is very important, especially if I leave, but i am trying to alleviate any issues that might be brought up with the wordpress installation, as well as a host with some customer support.
I just don't know what to do.... I want to get an inexpensive host for the church, which has enough to worry about without the prospect of hosting, without creating a black hole of need for me to do things with the website...Thats where I am now and it sucks somewhat. Unless I can get this to its simplest edit-ability, or hope the next guy will be good with web dev, Im just not sure.
Being just a high school kid and designing for clients is a pretty big load... Don't know how you guys deal with the stress.
Rambling now... IDK what to do. Probably go with hostgator, they seem to have a great place for newbies as well as veteran web developers.
I am surprised to see simple HTML pages are not served better with your current host. any how.
Looking through your requirements I could see you may want to host multiple websites at least later point of time, so then check for windows azure. or other web hosts probably HostASP, Speedhost, HostGator may allow you host multiple domains, should work better for your requirements.
Will check those out.
At the moment I do not wish to be in charge of the hosting (e.g, I do not want it to be under my account), I want the church to be in charge of it when I leave. Otherwise I would just attach it to my current host (webhostingbuzz, which I will probably choose for the site).
Our current host is Intuit (Homestead.com). Which does not support or allow PHP. All it allows is basic html, java, and flash.
As @logic_earth has suggested, the pay-of-use services like Windows Azure are often very good for minimal use websites. This can be true of even accounts that are serving video. It really depends on how often people connect to and play your video clips. Have you gone through Windows Azure 'Pay as You Go' pricing model and see what it would cost you? The service and the infrastructure are hard to equal for such low prices and you don't dump problems in your or the church member's laps by hosting it in a reliable environment.
One more vote for Windows Azure. The 'Pay as You Go' option will probably save you money if the site doesn't get much traffic. It probably will give you and the guy that comes after you less headaches when support is needed.


text:
Main squeeze: Williams again stars in Philly's win
Starter goes eight strong, improves to 2-0 with club; Rollins goes deep
PHILADELPHIA -- Five months and three cities later, Jerome Williams appears to have finally settled in.
The journeyman right-hander proved to be an experiment gone wrong in stints with the Astros and Rangers earlier this year, but he continued to make his case for a spot in the Phillies' future rotation on Sunday afternoon with another stellar outing in the team's 7-1 win against the Cardinals at Citizens Bank Park.
"He could be," Phillies manager Ryne Sandberg said when asked if Williams was a candidate to break into the team's 2015 rotation. "We'll have some time to continue to watch. He's had three outstanding games for us."
Behind a 73/37 strike-to-ball ratio, Williams threw eight innings of one-run ball. He struck out five and limited the Cardinals to five hits, three walks and a 1-for-9 mark with runners in scoring position.
"Just controlling both sides of the plate. Keeping these guys off balance," Williams said.
After posting a 6.71 ERA with the Astros and Rangers prior to arriving in Philadelphia, Williams is 2-0 with a 1.77 ERA and 0.98 WHIP in three starts as a Phillie.
"My stuff was [always] there. It's just I wasn't using it right. I think I'm using it right now," Williams said. "Using every pitch and every part of the zone, just mixing speeds instead of being a one-dimensional pitcher, and using every pitch in every count."
After a 12-inning affair that took 4 hours and 53 minutes to complete on Saturday night, being efficient on the mound and going deep into the game was atop Williams' agenda on Sunday.
"That's my normal thought process every time I go out there. Just to go as long as I can," Williams said. "You know, last night was a long one, and I felt like I really needed to help the ballclub. And I needed to throw a pretty good game, go deep in the game. And that's what I did. That's what I'm going to keep doing."
The offense did its part to assure Williams pitched with a lead. The Phillies grabbed a 1-0 advantage in the first on an RBI single by Chase Utley. They tacked on two in the second, when Williams helped his own cause by laying down a perfectly placed safety squeeze bunt, allowing Domonic Brown to score. A Ben Revere bloop single added another run to make it 3-0.
In the third, Philly plated two more after a wild pitch by Justin Masterson let Ryan Howard cross the plate, and a flare to right by Wil Nieves brought home Philadelphia's fifth run.
The Phillies knocked Masterson out after just three innings and 67 pitches. He allowed five earned runs on six hits and two walks.
The Cardinals broke through for a run against Williams in the fourth that was set up by a bad read on a ball by Revere in center field. Jhonny Peralta hit a cutter from Williams that got plenty of hangtime, but Revere didn't break in initially. The wind carried the ball away from Revere, whose dive came up short as Peralta ended up on second with a double. He came around to score two batters later on a single by Oscar Taveras.
After allowing just one run in seven innings in his last start against the Mariners, Williams credited catcher Carlos Ruiz with helping to make it a seamless outing. On Sunday, Williams pointed to Nieves, who served as his backstop during winter ball in Puerto Rico in the 2008-09 season before catching him again six years later.
"It's fun to have Wil behind there again, because we both know each other," Williams said. "I know how he sets up, I know how he calls the game, and now he knows how I pitch. It was fun back there, to throw with him again. It was just like the days in Puerto Rico."
"I just called the game the way I thought it was good, and he followed it," Nieves said. "When you have something like that going on, not a lot of shaking off and doubting, games like this happen. It was fun."
The Phillies cushioned their lead in the seventh, when Jimmy Rollins launched his third homer of the season from the right side of the plate, 16th overall, to make it 7-1.
The win gave the Phillies back-to-back series wins for the first time since April 21-27. They had played 33 total series without consecutive wins, the longest drought of that kind since they went 53 straight between the 1996-97 seasons.
The victory was personally just as important for Williams, considering the course of his 2014 season. And as for 2015, the 32-year-old isn't viewing each passing start as another audition.
"No. I'm just trying to pitch to do well. And whatever happens, happens," he said. "I'm not thinking about the offseason. I'm thinking about this team right now. Finishing strong as a team."
Erik Bacharach is an associate reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.

subset: commoncrawl


text:
NASSAU COUNTY, Fla. - A 17-year-old thrown from a pickup truck he was driving during a crash Friday afternoon in Nassau County is in stable condition at the hospital, but his 15-year-old passenger died in the crash.
The family of Dustin Hunt said they have hired attorney Gene Nichols to represent them.
"It's such a tragic event on both ends," said Nichols.
Nichols, speaking on behalf of Hunt's family, he said everyone's heart is going out to the family of Kyle Warren, who was killed in the accident.
The Florida Highway Patrol said Hunt and Warren were in a red Chevrolet Silverado on County Road 119 just before 4 p.m. when the driver, Hunt, tried to pass some other cars.
"The driver lost control, came back onto the roadway and overturned several times, ejecting the driver," said FHP Lt. Michael DuBois.
RELATED: Teenager killed in crash, driver critical
Troopers said charges against Hunt are pending.
Nichols said he believes investigators will find out that Hunt wasn't using drugs or alcohol, wasn't texting and wasn't trying to cause any trouble at the time of the crash.
Nichols said he hasn't spoken with Hunt yet about what happened, as the teen remains in the hospital. He told Channel 4's Vic Micolucci that Hunt's family is very close with the Warrens and the two families are consoling each other right now.
As the community mourns the death of Warren, Nichols said he hopes the surviving teen gets well soon.
"He is still very groggy. He is unaware as to what happened in the crash," said Nichols. "He is unaware of what happened to his friend Kyle, but he is at least somewhat on the road to recovery."
Copyright 2013 by News4Jax.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


text:
Tsunami warning in Hawaii downgraded to advisory
Hawaii Gov. Neil Abercrombie says a tsunami warning that spurred coastal evacuations statewide is being downgraded to a tsunami advisory, ending the threat of serious damage.
Abercrombie said early Sunday that the Aloha State was lucky to avoid more severe surges after a powerful earthquake struck off the coast of Canada.
Abercrombie says beaches and harbors are still closed statewide.
Meanwhile, the National Weather Service canceled tsunami advisories for Canada and Oregon, leaving northern California as the only spot in North America still under a tsunami advisory.
(Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)


text:
The Peterson Farm Bros. are back with a new parody that's sure to get your attention with guest artists, rapping and more farmer pride.
For this parody, the popular farming trio broke away from their standard pop tunes to take on "All I Do is Win," by DJ Khaled.
Some of the lyrics featured in "All I Do is Farm" include:
"Peterson Farm Brothers going in 'cause you know that we can't stop, won't stop now!"
"I fly like Julius Erving so that you get a serving of fresh and healthy food. That is what is called the agricultural version."
"I still love to farm, farm, farm and if you know you know the charm, put your hands in the air and let them stay there"
Other parody stars made a cameo appearances in the parody, including Lil' Fred and Derek Klingenberg.
Watch the YouTube video above or click here.
The trio's other parodies of Katy Perry's "Roar," "I'm Sexy and I Know It," "Gangnam Style," "Fresh Prince of Bel-Air," and "Sail" have been seen more than 23 million times on YouTube, and there is little doubt that this will also quickly become popular among agricultural producers and consumers.
More videos and parodies from the Peterson Brothers
- Peterson Farm Bros: Fall in full-swing
- The Peterson Farm Brothers are at it again
- Peterson Farm Bros: Staying busy during rainy August
- Peterson Bros take a break from rapping to show life on the farm
- Peterson Farm Brothers: One year later
- Life of a Farmer: Rushing to harvest wheat
- Will Smith dethroned in latest Peterson Farm Bros. parody
- Peterson Brothers: What summer vacation?
- Peterson Brothers: Springtime on the farm
- Peterson brothers help promote Kansas agriculture
- Life of a Farmer: What spring break?
- Peterson brothers: Farmers don't get snow days
- Peterson brothers begin new video series
- The Peterson brothers are back!
- Ranching music video goes viral


text:
Multiple Coin Toss Model Documents
This material has 2 associated documents. Select a document title to view a document's information.
Main Document
Multiple Coin Toss Model
written by
Wolfgang Christian and
Mario Belloni
The Ejs Multiple Coin Toss model displays the result of the flipping of N coins. The result of each set of coin tosses is shown by the image of the pennies on the screen and the complete results of the tossing experiment is shown on a graph of the cumulative probability of heads. The number of coins tossed, N, and change the "fairness" of the coin by setting the probability of a "heads" result, p, can be set via text boxes. You can modify this simulation if you have Ejs installed by right-clicking within the plot and selecting "Open Ejs Model" from the pop-up menu item.
Ejs Multiple Coin Toss model was created using the Easy Java Simulations (Ejs) modeling tool. It is distributed as a ready-to-run (compiled) Java archive. Double clicking the ejs_MultipleCoinToss.jar file will run the program if Java is installed. Ejs is a part of the Open Source Physics Project and is designed to make it easier to access, modify, and generate computer models. Additional Ejs models for classical mechanics are available. They can be found by searching ComPADRE for Open Source Physics, OSP, or Ejs.
- Download ejs_stp_MultipleCoinToss.jar - 1333kb Java Archive File
Published November 15, 2008
Last Modified June 10, 2014
This file has previous versions.
Source Code Documents
Multiple Coin Toss Model Source Code
The source code zip archive contains an XML representation of the Multiple Coin Toss Model. Unzip this archive in your Ejs workspace to compile and run this model using Ejs.
- Download ejs_stp_MultipleCoinToss.zip - 107kb Compressed File
Published November 15, 2008
Last Modified November 15, 2008
This file has previous versions.


text:
- Our Work
- Wildlife
- Wild Places
- How You Can Help
- Become a Defender
- Ways to Give
- Adopt an Animal
- Gifts & Gear
- Take Action
- Attend an Event
- Hold Congress Accountable
- Explore Wildlife Stories
- News
- Blog
You are hereHome | Learn About Wildlife | Defenders Magazine | Winter 2011 | Rescue at Toad Mountain
Rescue at Toad Mountain
Conservationists race to save Panamanian frogs from extinction.
by Mark Cheater
© B. Gratwicke/Smithsonian Conservation Biology Institute
Bob Chastain is standing calf-deep in the tumbling waters of the San Antonio River in eastern Panama, staring intently at the rocky banks and mossy boulders. It's an overcast morning in late June, and the leaves of the tropical plants above are still dripping from an early shower. Here, on the flanks of auspiciously named Cerro Sapo (Toad Mountain), in a remote part of Darien National Park, Chastain and a group of other biologists are stalking some small, slippery creatures.
"It can sometimes be like finding a needle in a haystack," says Chastain, the director of the Cheyenne Mountain Zoo in Colorado, referring to his quarry, Atelopus certus, an imperiled harlequin frog found only in Panama. Fortunately for us, these particular needles are moving. A slight twitch on the far bank sends the hipwader-clad Chastain splashing across the water. His hand darts out toward a rock and grabs an inch-long creature mottled in orange and black. "Got him!" he says, smiling.
Defending Amphibians
Defenders of Wildlife has played a crucial role in the Panama Amphibian Rescue and Conservation Project since its inception. Defenders was not only one of the founding partners of the project, but it has contributed $150,000 toward the effort, along with lending the time and expertise of Defenders' staff and board members.
In addition to this work to safeguard Panama's amphibians, Defenders has been a longtime leader in efforts to address threats to amphibian populations worldwide—especially the threat posed by the massive international trade for the pet, food, medicinal, scientific and live-bait markets. Most recently, Defenders worked with Latin American and Middle Eastern governments to gain protection for amphibians at the 2010 meeting of parties to the Convention on International Trade in Endangered Species of Wild Fauna and Flora.
Defenders has also petitioned the U.S. departments of interior and agriculture to immediately screen amphibian imports to block the deadly chytrid fungus. "These imports are currently unregulated and pose a major threat to native amphibians," says Defenders international counsel Alejandra Goyenechea. "We are urging the federal government to follow the latest international animal health standards to ensure that the massive volumes of live amphibian imports do not continue to carry the chytrid fungus."
"For some species, it's sad to say, but there's no hope if they stay in the wild."
Before dawn the previous day, Chastain, Griffith and PARC's international director Brian Gratwicke tell me about chytrid and the Panama project as we drive out of Panama City in a pickup truck on the first leg of our journey to Toad Mountain.
The fungus that causes chytrid grows on the skin of frogs and other amphibians and interferes with the balance of water and salts in their bodies, causing lethargy and eventually death. Where and when the fungal disease originated and exactly how it spread are uncertain, but by the time it was identified and named by scientists in the late 1990s, it had already begun cutting a deadly swath through amphibian populations in Australia and the Americas. Although habitat loss, global warming and pollution also pose major threats to amphibians, chytrid is arguably their biggest peril, believed to be behind the disappearance of 94 species of frogs in the past 30 years.
"A whole class of vertebrates—a diverse and ancient evolutionary lineage of animals—is just vanishing," says Gratwicke, a biologist based at the Smithsonian Institution's National Zoo in Washington, D.C.
In response to chytrid's devastation, conservationists in several parts of the world have recently created "amphibian arks" to protect and breed imperiled creatures. One such facility was founded in 2005 by the Houston Zoo in El Valle, a town about an hour west of Panama City. Griffith—a native Panamanian biologist who is so enamored with frogs that he has a skeleton of one tattooed on his left calf—runs this center with his wife. They care for about 1,200 frogs representing 60 species, mostly from western-central Panama. When officials from the Smithsonian contacted Griffith in 2008 about protecting frogs from the eastern portion of the country, which has not yet been inundated by the chytrid wave, he told them he couldn't handle more and suggested they create a new rescue center.
The Smithsonian began assembling a team of groups to launch such a facility. Chastain's zoo, which had previous experience rescuing Wyoming toads from the chytrid fungus, was brought in as a partner, along with Griffith and the Houston Zoo, Defenders of Wildlife, the Summit Municipal Park zoo in Panama and several other organizations—and the PARC project was formally established in May 2009. They subsequently hired Roberto Ibanez, Panama's leading frog expert and Griffith's mentor, as the in-country director. The Summit Zoo in Panama City donated space for temporary quarantine and breeding facilities, and the group began organizing a series of field expeditions in Panama to collect imperiled frog species.
Cerro Sapo has been chosen for this expedition because of its location in Darien National Park. This is not only the largest park in Central America, but also its largest untouched wilderness, Gratwicke explains as we approach the boundary of the province, about four hours south of Panama City. This wildness makes it not only a world-class haven for frogs and other wildlife, but a notorious refuge for drug runners, armed rebels and other outlaws—as we are reminded by dour soldiers with guns who stop us at several checkpoints along the way.
At Puerto Quimba—a small collection of buildings near a dock on an inlet of the Pacific—we transfer our gear to a motor boat. From there, it's a bumpy, 2-hour ride to Garachine, a fishing village near the western edge of Darien park. Toad Mountain—likely named for its squat, green, 3,500-foot-high profile—looms before us, smudged with clouds.
In Garachine, we hire indigenous Embera people and their horses to help get us and our equipment to our camp—a six-hour slog along, across and in the San Antonio River, with frequent bushwhacking forays into the jungle and around venomous snakes. At 8 p.m., we finally reach camp—a few blue tarps lashed between trees, a couple small platforms of palm-leaf mats, and a propane stove—in a small clearing about 50 feet above the river. We eat a light meal of chicken and rice and then hurry into our tents to escape swarms of ants, mosquitoes, gnats and other biting insects.
"A whole class of vertebrates—a diverse and ancient evolutionary lineage of animals—is just vanishing."
The next morning, Chastain and I are the first ones down to the water. After his disclaimer about how difficult the frogs are to find, he quickly bags #001 and two more before Griffith and Gratwicke arrive. The three biologists move upriver as sunlight begins to break through the clouds and filter through the green canopy above the river. They scour the boulders and leaves with their eyes, poking through the vegetation with hiking poles in search of their small quarry.
Griffith describes the procedure to me as he plucks an unsuspecting male Atelopus off a damp tree root near the river. The scientists put on a fresh set of latex gloves for each capture, to avoid accidentally transmitting the chytrid fungus. Each frog is rubbed with a cotton swab that is stored in a small sterile tube for later analysis and chytrid detection in the lab.
So far the frogs at Toad Mountain appear to be disease-free; they move vigorously in their plastic bags even after a day or two of captivity. This is a welcome contrast to PARC's first expedition a few months earlier in a park north of Panama City. Most of the frogs there were sick from chytrid. "We got there too late," Griffith says, sadly. "I've seen it before and every time we get the same results—the loss of amphibian diversity, which will bring lots of bad consequences for the ecosystem since amphibians are such an important link between different levels of the food chain, and also they are one of the biggest groups of vertebrates that inhabit the planet."
The biologists continue moving up the river all day, pausing only for a brief meal at midday. They return to base camp, sweaty, soaked and exhausted, about 5 p.m. and unload a few dozen bags, each with a frog inside, into a large plastic cooler at base camp. The team tallies the day's take and spends the next hour swabbing frogs, putting damp paper towels inside the plastic bags to keep the creatures moist, and giving the captive frogs fresh air. "There are a lot of steps," says Gratwicke, "but it's what we need to do to figure out what's going on here."
"Amphibians are such an important link between different levels of the food chain, and also they are one of the biggest groups of vertebrates that inhabit the planet."
The scientists are finding many male Atelopus, which tend to stay closer to the water and out in the open so that potential mates can find them. The females, which are slightly larger than the males and have redder bellies, are playing hard-to-get. As Griffith notes, "if you want to have a captive breeding population, you need to have females," so the scientists decide to concentrate on capturing females and juveniles (which are so tiny they're difficult to sex, but have a 50-50 chance of being female.)
On the afternoon of the third day in the field, Griffith spots a juvenile on a mossy rock next to the river. This young frog is no larger than a house fly—and in contrast to the adults, its body is a dark, metallic green, and it has bright yellow feet. He points out how the creature walks rather than hops—a characteristic of this species. "Come on boy—come on!" he says, trying to coax the frog into a plastic bag.
Two hours and another mile or so upstream, Griffith spots a pair of adults mating on a mossy rock ledge about a yard above a rushing cataract. "This is the first female we've found in what—six, seven hours of work?" he says, guiding the couple into a bag. "It's not like they'll jump out of the rocks and into the plastic bag. So it can be frustrating. But I know that if we keep thinking positive and really looking for them, we'll get rewarded." The biologists bag two more females that day, along with several juveniles.
The next morning, Griffith and Chastain explore a small upstream tributary and return two hours later proudly carrying four more females. We spend the next few hours at camp transferring all of the captured frogs from baggies to sturdier plastic cups lined with damp moss to keep the animals moist and protected during their long journey out of the jungle. The final count: 50 males, 10 females, 16 juveniles.
The cups are carefully stacked back in the coolers, along with cold packs to keep the frogs from overheating as they're carried out of the jungle and into the hot sun by two of our Embera helpers. Ibanez and Chastain will ensure the coolers make it onto a plane to Panama City leaving from Garachine the next morning. Flying the animals will be more expensive than hauling them by boat and car with the rest of us, but speed is crucial when the lives of imperiled frogs are at stake.
"This is precious cargo because this is the founding population for a species that could well go extinct in the wild," says Gratwicke as he watches the porters leave camp. "We hope they all survive the trip back."
"We need people to love frogs at a whole new level—like they love pandas and trout."
Twenty-four hours later we are at the Summit zoo with the airlifted frogs. "We didn't have a single mortality on the way here, so you can't ask for anything better than that," a relieved Gratwicke reports.
PARC has converted a room inside a one-story wooden building near the zoo entrance into a quarantine area for newly arrived frogs. Here, a team of zoo staffers and volunteers carefully removes the creatures from their plastic cups, washes them briefly in a mild antifungal solution, rinses them in filtered water and then puts them into clear plastic cages stacked neatly on metal shelves.
Griffith helps with the operation in the quarantine room and reflects on the expedition. "It's very difficult to collect only certain species and leave others behind," he says. "It breaks my heart but we only can do so much and work with only a handful of species because all the resources and space we have is limited."
The frogs will stay in this quarantine area for 30 days until the scientists are certain they are free of the fungus. Then they will be moved to their permanent homes in one of several modified shipping containers—or "rescue pods"—that sit a few yards away on the lawn at the front of the zoo.
Gratwicke gives me a tour of one of the 40-foot-long pods, instructing me to leave my shoes outside and wash my hands carefully before entering. The pod is like a cramped and sterile zoo exhibit. Plastic containers of frogs are lined up in rows on metal shelving units, each furnished with water, rocks, moss and potted plants to make the captive frogs feel at home. There's artificial lighting, air conditioning and an automatic misting system, all of which are carefully calibrated to simulate the animals' natural habitat. The frogs are fed a diet of live crickets and fruit flies raised on zoo grounds, and carefully watched over seven days a week by a dedicated staff.
"This is where we're trying to breed frogs as the insurance colony to prevent against extinction in the wild," Gratwicke says, walking down the rows of cages. There are about 120 frogs from several species in this, the first shipping container to be converted into a rescue pod. Two other containers nearby are in the process of being outfitted with water, plumbing and electrical systems so that they will be able to house the Toad Mountain frogs and animals from future expeditions.
Gratwicke stops at a cage containing another imperiled harlequin frog—the green-and-black Atelopus limosus, rescued from a part of Panama hit hard by chytrid. This is the only female of its species in captivity, and probably one of the few left in the world, he says. "If we're lucky, this will be the first captive-bred Atelopus limosus ever," he says.
He stops at another cage holding a two-inch-long leaf-colored creature with large eyes—a La Loma treefrog. "We've had pretty good success at keeping these guys alive, but we've had no breeding yet." (As the magazine was going to press, Gratwicke reported that both the treefrog and the green-and-black harlequin frog at Summit zoo had successfully reproduced.)
PARC's goal is to have 20 species in the rescue pods, each with a minimum of 20 males and 20 females. Assuming they can get the frogs to breed successfully, the animals will stay at the Summit zoo until it's safe for them to return to their wild homes. "It could be a really long time or forever, we just don't know," Gratwicke says.
To help hasten the day the frogs can go back home, PARC is partnering with researchers who are searching for cures to chytrid. One of the most promising research avenues, Gratwicke says, is a "probiotic" method using bacteria that naturally produce antifungal chemicals. Conservationists hope these bacteria can be grown safely and effectively on a frog's skin to kill the fungus and protect the animal from the disease. "The idea is the offspring of these frogs could be treated with a probiotic bacteria and put back into their wild homes where they're extinct, and hopefully they'll be able to survive," he says.
No one knows if or when this potential cure will work, so the PARC team is preparing for the long haul at Summit zoo. In addition to outfitting several other rescue pods, they plan to build a permanent quarantine facility, a laboratory and offices for staff. All of this, as well as on-going expenses for salaries, utilities, equipment and travel, will cost money—much more than the $314,000 PARC managed to raise last year, Gratwicke says. "We sorely need to raise funds to build the capacity to house these frogs."
The key to that—and, ultimately, to the survival of frogs—is getting people passionate about amphibians, Gratwicke says. "We need people to love frogs at a whole new level—like they love pandas and trout. We need to tell people to get off their butts, because if they don't, their kids will not see these magnificent animals in the wild, ever."
Mark Cheater is editor of Defenders. Learn more about the Panama Amphibian Rescue and Conservation Project.
Go Behind the Scenes on this story:
More Articles from Winter 2011
Firm footing is hard to find for Mexican wolves in the American Southwest
Vaccinating prairie dogs may be the key to saving rare black-footed ferrets
There's a saying in politics that dates at least to the French Revolution, to the effect that the public gets the government it deserves.
A preternatural quiet has fallen over the land. On this cold snap of a February day, even exhaled air is quickly stilled, flash-frozen into ice crystals. Wind-whipped snow rests in six-foot-high banks that stretch for miles along Maryland's Chesapeake Bay.
Global climate change could spell disaster for some South American birds as more rain and warmer temperatures cause the populations of parasites that plague them to explode.
With all-too-frequent reports of rare panthers killed on roads as their habitat is lost to development, Florida's big cats are in urgent need of help. Enter the idea to expand the boundaries of the 26,000-acre Florida Panther National Wildlife Refuge.
Icons of the West, bison are as American as apple pie and the 4th of July. But with only one genetically pure wild bison herd left—the approximately 3,000-strong Yellowstone National Park herd—the future for these wild animals is in doubt.
The oil that bled into the Gulf of Mexico for months last year and caused the death of thousands of animals continues to impact coastal communities and natural habitats.
When wolves began returning to the Northern Rockies more than two decades ago, Defenders pioneered a program to compensate ranchers for livestock lost to the imperiled animals—a crucial foundation for building rancher tolerance for wolves.
Defenders has long worked to make residents in the West and Alaska more bear aware.
Swift and silent as the falling snow, these adeptly named big cats stalk wild sheep, goats and other mountain mammals across some of Central Asia's rockiest terrain.
Get Your Copy
Get Instant Alerts & Updates
Enter email address
Enter mobile number
On the Blog
March 3, 2016 | 9.36 AM
February 24, 2016 | 8.21 AM
December 4, 2015 | 2.03 PM


text:
Earthbound Farm is recalling salad kits because peanuts — not spinach — in the product could be contaminated with salmonella.
This is part of a larger recall of peanut products produced by Sunland Inc. that could be contaminated, said Samantha Cabaluna, Earthbound Farm spokeswoman.
The organic salads, Earthbound Farm Baby Spinach Grab & Go Salad Kit with Peanuts, are sold in a 3.5-ounce clamshell with a Universal Product Code of 0-32601-08875-0.
No illnesses related to the recalled product had been reported as of the morning of Oct. 18, Cabaluna said. She said it was likely that fewer than 500 cases of product were recalled.
The peanuts used in the kits were chopped by Sunland, then packed in sealed packages by a third-party packer that contracts with Earthbound Farm.
The kits were distributed to retail supermarkets and foodservice operators in California, Connecticut, Florida, Hawaii, Louisiana, Massachusetts, Montana, Nebraska, New Jersey, New York, Ohio, Oregon, Pennsylvania, Texas, British Columbia and Ontario.
The Earthbound Farm news release announcing the recall referred to the company as Natural Selection Foods.
In 2009, Earthbound Farm announced it was no longer using Natural Selections Foods LLC as a trade name.
But on Oct. 18, Cabaluna said that Natural Selection Foods is still a legal entity, "doing business as" Earthbound Farm.
The recall release included both names because many of the company's foodservice customers still know it as Natural Selection Foods, and the company wants as many people as possible to be aware of the recall, Cabaluna said.


text:
Kluber to get the call in second game of doubleheader
KANSAS CITY -- The Indians moved Corey Kluber into the starting rotation last week, but a pair of rainouts have robbed the right-hander of a turn on the mound. That will change on Sunday.
Prior to Saturday's game against the Royals, Indians manager Terry Francona announced that Kluber would start for the Tribe in the second game of Sunday's doubleheader at Kauffman Stadium. The game is a makeup of Friday night's postponement in Kansas City.
Cleveland will also promote a player from the Minor Leagues to serve as the team's 26th man for the double dip on Sunday, but Francona was not ready to say who would be joining the Indians.
"We have some things to work through," Francona said on Saturday. "Obviously, I've talked to [general manager Chris Antonetti] numerous times. We'll wait until we get through tonight to see what we think helps us the most. We walked through all kinds of scenarios."
As a result of Friday's rainout, Cleveland shuffled its rotation slightly, having left-hander Scott Kazmir start on Saturday and pushing Ubaldo Jimenez, who was originally slated to start Saturday, back to Monday's game against the Royals. The Indians will also need to name a starter for Wednesday's home game against the Phillies. One possibility is Triple-A Columbus right-hander Trevor Bauer.
"There's a lot of things to sift through," Francona said. "We're trying to figure out how best to do it. This works out. Putting Corey in that second game, it'll help free up some things. It gives us some options down the road if we need them."
Francona said Jimenez (0-2 with a 10.06 ERA through four starts) threw a bullpen session on Saturday, giving the righty another day to try to keep his mechanics in order. Jimenez has been throwing two side sessions between starts under normal circumstances.
"It's been really good," Indians pitching coach Mickey Callaway said of Jimenez's side work. "I thought he was really good his last time out. His stride direction was really good and he took it right into his 'pen. We worked a little more in-between the last couple starts on being out of the stretch and things like that. He's done a really good job."
Jordan Bastian is a reporter for MLB.com. Read his blog, Major League Bastian, and follow him on Twitter @MLBastian. This story was not subject to the approval of Major League Baseball or its clubs.


text:
Louisville Clock Rededicated
The Louisville Clock was rededicated at its new home on Theater Square Aug. 24 during the Rock Around the Louisville Clock event. The clock now sits just on Fourth Street close to the site where it originally operated in 1976. Five iconic figures, designed by Barney Bright and representing Daniel Boone, Thomas Jefferson, King Louis XVI, George Rogers Clark and the Belle of Louisville, race around the tilted clock face. Mayor Greg Fischer presided over the ceremony, sponsored by Commonwealth Bank and Theater Square businesses. Music was provided by Caribou.
Second Mellow Mushroom
Mellow Mushroom Pizza Bakers is proud to announce their newest opening in Louisville, in the heart of St. Matthews, on Monday, Sept. 3. This Mellow, which marks the second location for Louisville, is located at 3920 Shelbyville Road. The owners of the location, Jason Nase and Damon Coates, are thrilled to open a Mellow in St. Matthews. The menu features a variety of pizzas, hoagies, salads, calzones and appetizers. Options for vegetarians, vegans, kids and those on a gluten-free plan are also available.
The St. Matthews' Mellow Mushroom location, deep in the heart of an older neighborhood of Louisville, Ky., allowed the owners to tap into the history of the region. Reclaimed wood from the original building can be found on the floor and ceiling joist. Metal sculpture dragon flies with illuminated Edison bulb tails guide you to the bar, reclaimed chandeliers add eclectic flavor to the ceilings and booth seating, and a variety of found-object art adorns the walls for visual impact throughout the restaurant. Suiting any diner's needs, this Mellow has 250 plus seats and includes a party room for up to 35 people, a patio and garage doors that open to give a great open air feel. This location also features a full service bar with a wide array of liquor, craft beer and wine options. The Mellow Mushroom will operate seven days a week and opens at 11 a.m. For more information on Mellow Mushroom St. Matthews, visit www.mellowmushroom.com/stmatthews.
Justice For All Names Chair
John R. Crockett III, Chairman of Frost Brown Todd, has been named Chair of the Legal Aid Society 2012 Justice for All Campaign. Proceeds from the 2012 campaign will help the Legal Aid Society continue its mission of pursuing justice for people living in poverty.
As Chairman of the Firm, Crockett is responsible for driving the firm's growth and strategic planning, merger opportunities, ancillary business ventures, and new business opportunities. His practice focuses primarily on commercial litigation, products liability, and mass tort litigation. Crockett is AV® Preeminent™ Peer Review Rated by Martindale-Hubbell®, listed in The Best Lawyers in America®, mentioned in Benchmark Litigation® and selected as a Kentucky Super Lawyer.
The mission of the Legal Aid Society is to pursue justice for people in poverty. To learn more visit www.laslou.org. Frost Brown Todd is a full-service law firm serving some of America's top corporations and emerging companies. With attorneys regularly identified by clients, peers and industry organizations as leaders in their practice areas, the firm advises and protects clients in business transactions and litigation in industries including insurance, banking, financial services, manufacturing, transportation, real estate, construction, energy and healthcare. To learn more, visit www.frostbrowntodd.com.
Estes PR Grows
Jamie Estes, the president and founder of Estes Public Relations, continues to grow her company with the addition of two new employees, public relations associate/social media coordinator Rachel Goldenberg and public relations assistant Anna Kate Delavan. Founded in 2004, Estes Public Relations now has eight full-time employees, with offices in Louisville, Chicago and Beaufort, S.C. The company is a national public relations firm that serves a diverse client base which includes associations, health and lifestyle businesses, retail companies, hotels and restaurants.
Rachel Goldenberg joined Estes Public Relations in May to spearhead digital media efforts and garner media coverage for several client accounts including The Brown Hotel, Ghyslain Chocolatier and The Summit. The Muncie, Ind. native and Ball State University graduate is a former Online Content Producer at the Louisville Courier-Journal and WHAS-TV.
Dothan, Ala. native Anna Kate Delavan joined Estes Public Relations in August as a public relations assistant working on several of the company's accounts. The recent University of Alabama graduate studied public relations, earning a B.A. in Communications. She served as an intern at Ann Taylor Inc. in New York City and The Bradford Group in Nashville, Tenn. and is a former staff writer for The Crimson White.
For additional information on Estes Public Relations, visit www.estespr.com.
Filson Receives Grant
The Filson Historical Society is pleased to announce that it was recently awarded a $1 million challenge grant by Louisville's James Graham Brown Foundation in support of its Old Louisville Campus Expansion Project. Under the grant, the Foundation will donate $1 for every $2 pledged to the Expansion in the future, up to a total Foundation grant of $1 million. The grant is a powerful endorsement of The Filson and its Campus Expansion Project, providing a dramatic boost to The Filson's efforts to make the expansion a reality.
To date, The Filson has secured pledges of $4.2 million in support of the Campus Expansion Project. In addition to the challenge grant, pledges have come from many individuals, the Brown-Forman Corporation, the Gheens Foundation and the Paul Ogle Foundation, Inc. The Campus Expansion Project will expand, renovate and modernize The Filson's facilities and campus in Old Louisville, creating another cultural and event destination for the community. The Expansion will continue the revitalization of Old Louisville and enhance the quality of life for neighbors and for the residents of the entire community.
The Filson is headquartered in the Ferguson Mansion and Carriage House in Old Louisville and houses an archive and research center, a small museum and is a center for history education and learning. For more information, visit www.filsonhistorical.org.
Sojourn Reopens St. Vincent
Louisville's multi-campus Sojourn Community Church is the 45th fastest-growing church in the U.S., according to Lifeway Research's new report in Outreach Magazine. Their growth continues with the launching of Sunday services at the historic St. Vincent's de Paul church building, 1207 S. Shelby St., at the corner of Oak and Shelby Streets. Although dormant since 1996, St. Vincent's has played a part in Louisville's history since 1886, when the first sermons were given in German, the mother tongue of its mostly-immigrant congregation. By the 1920s, nearly 1000 families worshiped weekly at St. Vincent's, which continued to enrich the community for decades afterwards.
Sojourn has spent the last two years restoring the interior and exterior of St. Vincent's. Earlier this year they transformed a vacant lot into a Shelby Park Community Garden. Weekly Sunday worship begins Sunday, Aug. 26. Sojourn will hold identical services at 9 and 11 a.m. and 5 p.m., with childcare and children's classes provided at all three. They also hold a weekly service at 7 p.m., during which no children's classes are provided. Prior to the first Sunday service, Sojourn held a free health clinic for the community Aug. 25, followed by an opening reception for the art gallery at St. Vincent's and an open house. For more information on Sojourn, visit sojournchurch.com.


text:
Board of Supervisors Plans Retreat June 29 and 30
June 22, 2009
News Highlights
More Information
The Fairfax County Board of Supervisors has scheduled a retreat for Monday and Tuesday, June 29-30, at the Frying Pan Farm Park Visitors Center, Herndon.
This two-day meeting will be an opportunity for the board to consider its priorities for the next few years that will ensure the overall health and well-being of Fairfax County.
The informal, rural setting will provide an opportunity for board members to discuss their views on issues that impact the quality of life for residents of the county and to focus on priorities for protecting and enriching the quality of life for the county's people, and its neighborhoods and diverse communities. There will be no formal action taken during the retreat. The ideas and concepts discussed at this retreat will serve as a framework for the board's priorities.
Due to the limited space, attendees to this board retreat will be seated as space permits. This is not a public hearing and there will be no opportunity for public comment during the two days.
Who: Fairfax County Board of Supervisors
What: Board Retreat
When: Monday and Tuesday, June 29-30, 9 a.m. – 5 p.m. each day.
Proposed Topics: FY 2011 Budget process, affordable housing, comprehensive planning and transportation
Where: Frying Pan Farm Park Visitors Center
2709 West Ox Road
Herndon, VA 20171
For more information, contact the Office of Public Affairs at 703-324-3187, TTY 711.
Contact: Merni Fitzgerald, Director, Office of Public Affairs
703-324-3189, TTY 711, Media Pager: 703-324-NEWS (6397)
To request this information in an alternate format, call 703-324-3187, TTY 711


text:
"I'm told this street is respectable," says one character in Edith Wharton's novel The Age of Innocence.
"It's not fashionable," comes the reply.
That's pretty much how it was on North Broad Street in the late 19th century. The industrial revolution had begun, and Philadelphia was known as the "Workshop of the World," making textiles, locomotives and beer.
"After the Civil War, Philadelphia was really going full blast," said Robert Morris Skaler, forensic architect and author of Philadelphia's Broad Street South and North. "They were making all kinds of things. North Broad Street was a great place for people to live, because it hadn't been developed yet."
Skaler's book is filled with images from this golden age of North Broad, an age capped by the construction of the grand Lorraine Apartments, which are now the abandoned Divine Lorraine Hotel.
He describes what made the area so desirable.
"It was big and wide," he said. "About six carriages could go side-by-side, so it was a great street to jump on your carriage and go all the way out, perhaps to Diamond, and then make a left and head out to the park — and also the fact that there were so many churches on the street that, on a nice Sunday afternoon, it was packed. People walking back and forth — it's almost like a Boardwalk kind of thing going on."
The rise of new money
So the street became populated by the so-called nouveau riche — those who made, rather than inherited their money.
Skaler says some of them included Michael Bouvier, the ancestor of Jacquelyn Bouvier Kennedy, department store owners, Alice Gimble, and industrialist Henry Disston and his son, along with P.A.B. Widener and William Elkins.
"You get these huge houses built along there," said Skaler. "Their stables were in the back streets unlike Rittenhouse Square, where the stables and the houses were all mixed up together."
Rittenhouse Square, of course, was where old money lived in Philadelphia.
A passage from a book called North of Broad, published by an anonymous author during the time period, is telling.
"By the way, what's your locality? Is it north or south of Market?" he asked anxiously.
"I don't know," answered Helen. "It's on Grafton Street, about a mile from Girard College."
"Oh dear, dear," said he, in a distressed tone. "That is all wrong. It should be two miles or two miles and a fraction at least, if my memory serves. An inch or more makes all the difference in the world your social position in Philadelphia."
A north-south rivalry
Nowhere does this conflict play out more succinctly than in the battle for cultural superiority of the day. What South Broad Street had in the Academy of Music, North Broad emulated in the Metropolitan Opera House, built by the famous Oscar Hammerstein. In the 2000 WHYY-TV documentary A Walk Up Broad Street, architect Hy Myers said the Met represented efforts to one-up the establishment.
"The Academy of Music had 3,100 seats," said Myers. "The Met, 4,100 — a thousand more. The proscenium of the Academy, 50 feet wide. [Hammerstein] made his a hundred feet wide. The Academy was made of brownstone on the front. He decided to make his white, marble and white brick, because he wanted his to be bigger in appearance, more glamorous in appearance."
On the Met's opening night, Nov. 17, 1907, the two venues had a showdown.
"Hammerstein's Metropolitan Opera House opened with Carmen and a cast of 700," Skaler said. "That same night, the Academy of Music opened its season with the great tenor Enrico Caruso."
"Now Philadelphia society doesn't know where to go," said Myers. "'Shall I go to the Academy? Shall I go to the Met?' They do both!"
At intermission, the audience left the Academy, rushed to the waiting carriages and cars, and headed north on Broad Street to arrive at the Met in time to see the second half of Carmen. Hammerstein purposely delayed the opera's intermission, thus filling all his 4,000 seats.
However, Skaler said, it was a hollow victory. Within five years, the Met went bankrupt.
Around 1920, he said, the subway was built beneath Broad Street. "And the racket and noise from them ripping up Broad Street probably got a lot of people to move. And of course the subway stops come in, and those areas become commercial, and neighborhoods change."
A little later, industry started to sputter because of the Great Depression. Philadelphia's Baldwin Locomotive Works shut down, laying off 17,000 people.
"We'd love to get a new industry in Philadelphia that might give us 2- or 3,000 [jobs]," said Myers. "So this was a big loss for Philadelphia, and it was the first signs that the 'Workshop of the World' that was Philadelphia was just beginning to fray at the edges and change."
That change would signify the end of North Broad Street's gilded opulence.
All historical images are from Philadelphia's Broad Street South and North, by Robert Skaler courtesy of Arcadia Publishing.


text:
Lung Cancer Prevention (PDQ®)
Note: Separate PDQ summaries on
Lung Cancer Screening; Small Cell Lung
Cancer Treatment; Non-Small Cell Lung Cancer Treatment; and Cigarette Smoking: Health Risks and How to Quit are also available.
Who is at Risk?
Lung cancer risk is largely a function of older age combined with extensive cigarette smoking history. Lung cancer is more common in men than women and in those of lower socioeconomic status. Patterns of lung cancer according to demographic characteristics tend to be strongly correlated with historical patterns of cigarette smoking prevalence. An exception to this is the very high rate of lung cancer in African American men, a group whose very high lung cancer death rate is not explainable simply by historical smoking patterns.
In nonsmokers, important lung cancer risk factors are exposure to secondhand smoke, radon exposure, and occupational exposure to lung carcinogens, such as asbestos. Cigarette smoking often interacts with these other factors. There are several examples, including radon exposure and asbestos exposure, in which the combined exposure to cigarette smoke plus another risk factor results in an increase in risk that is much greater than the sum of the risks associated with each factor alone.
Factors associated with increased risk of lung cancer
Cigarette smoking
Starting with the 1964 Surgeon General's Report and followed by each subsequent Surgeon General's Report that has included a review of the evidence on smoking and lung cancer, an enormous body of scientific evidence clearly documents that cigarette smoking causes lung cancer, and that cigarette smoking is the major cause of lung cancer.
Based on solid evidence, cigarette smoking causes lung cancer. The risks of lung cancer associated with cigarette smoking are dose-dependent and increase markedly according to the number of cigarettes smoked per day and the number of years smoked. On average, current smokers have approximately 20 times the risk of lung cancer compared with nonsmokers.
Magnitude of Effect: Increased risk, very large.
- Study Design: Numerous prospective cohort and case-control studies, combined with quasi-experimental evidence showing population-level smoking prevalence predicts the population-level burden of lung cancer.
- Internal Validity: Good.
- Consistency: Good.
- External Validity: Good.
Exposure to secondhand smoke
Based on solid evidence, exposure to secondhand smoke is an established cause of lung cancer.
Magnitude of Effect: Increased risk, small magnitude. Compared with nonsmokers not exposed to secondhand smoke, nonsmokers exposed to secondhand smoke have approximately a 20% increased risk of lung cancer.
- Study Design: Prospective cohort and case-control studies.
- Internal Validity: Good.
- Consistency: Good.
- External Validity: Good.
Radon exposure
Based on solid evidence, exposure to radon increases lung cancer incidence and mortality.
Magnitude of Effect: Increased risk that follows a dose-response gradient, with small increases in risk for levels experienced in most at-risk homes to greater increases in risk for high-level exposures.
- Study Design: Cohort and case-control studies.
- Internal Validity: Fair.
- Consistency: Good.
- External Validity: Fair.
Occupational exposure to lung carcinogens
Based on solid evidence, workplace exposure to asbestos, arsenic, beryllium, cadmium, chromium, and nickel increases lung cancer incidence and mortality.
Magnitude of Effect: Increased risk, large magnitude (more than fivefold). Risks follow a dose-response gradient, with high-level exposures associated with large increases in risk. Cigarette smoking also potentiates the effect of many of these lung carcinogens so that the risks are even greater in smokers.
- Study Design: Cohort and case-control studies.
- Internal Validity: Good.
- Consistency: Good.
- External Validity: Good.
Air pollution
Based on solid evidence, exposure to outdoor air pollution, specifically small particles, increases lung cancer incidence and mortality.
Magnitude of Effect: Increased risk; compared with the lowest exposure categories, those in the highest exposure categories have approximately a 40% increased risk of lung cancer.
- Study Design: Cohort and case-control studies.
- Internal Validity: Good.
- Consistency: Good.
- External Validity: Good.
Factors of uncertain association with risk
Dietary factors
Based on equivocal evidence, the observed inverse associations between lung cancer and dietary factors, such as fruit and vegetable consumption, are difficult to disentangle from cigarette smoking.
Magnitude of Effect: Inverse association, moderate magnitude, but difficult to determine if true cause-effect association or due to confounding by cigarette smoking.
- Study Design: Numerous cohort and case-control studies, and meta-analyses.
- Internal Validity: Fair.
- Consistency: Fair.
- External Validity: Good.
Physical activity
Based on equivocal evidence, the observed inverse associations between lung cancer and higher levels of physical activity are difficult to disentangle from cigarette smoking.
Magnitude of Effect: Inverse association, moderate magnitude, but difficult to determine if true cause-effect association or due to confounding by cigarette smoking.
- Study Design: Numerous cohort and case-control studies, and meta-analyses.
- Internal Validity: Fair.
- Consistency: Fair.
- External Validity: Good.
Interventions Associated With Decreased Risk of Lung Cancer
Smoking avoidance
Based on solid evidence, cigarette smoking causes lung cancer and therefore, smoking avoidance results in decreased mortality from primary lung cancers.
Magnitude of Effect: Decreased risk, substantial magnitude.
- Study Design: Cohort and case-control studies.
- Internal Validity: Good.
- Consistency: Good.
- External Validity: Good.
Smoking cessation
Based on solid evidence, long-term sustained smoking cessation results in decreased incidence of lung cancer and of second primary lung tumors.
Magnitude of Effect: Decreased risk, moderate magnitude.
- Study Design: Cohort and case-control studies.
- Internal Validity: Good.
- Consistency: Good.
- External Validity: Good.
Eliminating secondhand smoke
Based on solid evidence, exposure to secondhand smoke causes lung cancer and therefore, preventing exposure to secondhand smoke results in decreased incidence and mortality from primary lung cancers.
Magnitude of Effect: Decreased risk, small magnitude.
- Study Design: Cohort and case-control studies.
- Internal Validity: Good.
- Consistency: Good.
- External Validity: Good.
Reducing or eliminating occupational exposure to lung carcinogens
Based on solid evidence, occupational exposures such as asbestos, arsenic, nickel, and chromium are causally associated with lung cancer. Reducing or eliminating workplace exposures to known lung carcinogens would be expected to result in a corresponding decrease in the risk of lung cancer.
Magnitude of Effect: Decreased risk, with a larger effect, the greater the reduction in exposure.
- Study Design: Cohort and case-control studies.
- Internal Validity: Good.
- Consistency: Good.
- External Validity: Good.
Reducing or eliminating exposure to radon
Based on solid evidence, indoor exposure to radon increases lung cancer incidence and mortality, particularly among cigarette smokers. In homes with high radon concentrations, taking steps to prevent radon from entering homes by sealing the basement would be expected to result in a corresponding decrease in the risk of lung cancer.
Magnitude of Effect: Increased risk that follows a dose-response gradient, with small increases in risk for levels experienced in most at-risk homes to greater increases in risk for high-level exposures.
- Study Design: Cohort and case-control studies.
- Internal Validity: Fair.
- Consistency: Good.
- External Validity: Fair.
Interventions Associated With an Increased Risk of Lung Cancer
Beta-carotene supplementation in current smokers
Based on solid evidence, high-intensity smokers who take pharmacologic doses of beta-carotene have an increased lung cancer incidence and mortality that is associated with taking the supplement.
Magnitude of Effect: Increased risk, small magnitude.
- Study Design: Two randomized controlled trials with consistent results.
- Internal Validity: Good.
- Consistency: Good.
- External Validity: Good.
Interventions That Do Not Decrease Risk of Lung Cancer
Beta-carotene in nonsmokers
Based on solid evidence, nonsmokers who take pharmacological doses of beta-carotene do not experience significantly different lung cancer incidence or mortality compared with taking a placebo.
Magnitude of Effect: No substantive effect.
- Study Design: Randomized controlled trial.
- Internal Validity: Good.
- Consistency: Good.
- External Validity: Fair.
Vitamin E (Tocopherol)
Based on solid evidence, taking vitamin E supplements does not affect the risk of lung cancer.
Magnitude of Effect: Strong evidence of no association.
- Study Design: Randomized controlled trials.
- Internal Validity: Good.
- Consistency: Fair.
- External Validity: Good.
Description of the Evidence
Incidence and mortality
Lung cancer has a tremendous impact on the health of the American public, with an estimated 224,210 new cases and 159,260 deaths predicted in 2014 in men and women combined.
Lung cancer causes more deaths per year in the United States than the next four leading causes of cancer death combined. Lung cancer incidence and
mortality rates increased markedly throughout most of the last century, first in
men and then in women. The trends in lung cancer incidence and mortality rates have closely mirrored historical patterns of smoking prevalence, after accounting for an appropriate latency period. Because of historical differences in smoking prevalence between men and women, lung cancer rates in men have been consistently declining since 1990. The incidence rate in men declined from a high of 102.1 cases per 100,000 men in 1984 to 80.0 cases per 100,000 men in 2010. Consistent declines in women have not been seen. In the United States, it is estimated that lung cancer will account for about 13% of new cancer cases and about 27% of all cancer deaths in 2014. Lung
cancer is the leading cause of cancer deaths in both men and women. In 2014, it
is estimated that 72,330 deaths will occur among U.S. women due to lung
cancer, compared with 40,000 deaths due to breast cancer.
Lung cancer incidence and mortality is highest in African Americans compared with any other racial/ethnic group in the United States, primarily due to the very high rates in African American men. In 2007, the incidence rate in black men was 33% higher than in white men (101.2 vs. 76.3 cases per 100,000 men, respectively), whereas among women no racial difference in incidence rates was present (54.8 vs. 54.7 cases per 100,000 women, respectively). Similarly, the mortality rates among black men were 28% higher than among white men for the same year (87.5 vs. 68.3 deaths per 100,000 men, respectively), whereas the mortality rates among black women were 5% lower than among white women (39.6 vs. 41.6 deaths per 100,000 women, respectively).
Surgical treatment or radiation therapy is the treatment of choice for early stages of cancer.
The overall 5-year relative survival rate from lung cancer was 16% in 2006. Lung cancer survival is worse for men compared with women and for blacks compared with whites. For example, 5-year lung cancer survival was 18% lower in black men compared with white men (11.3% vs. 13.8%, respectively) and 23% lower in black women compared with white women (14.4% vs. 18.6%, respectively).
The hypothesis has been proposed that women may be more susceptible than men to smoking-caused lung cancer. However, the results of studies that have compared the association between smoking and lung cancer in men and women using appropriate comparisons do not support this hypothesis.
The results of the Multi-Ethnic Cohort Study indicated that for a given degree of cigarette smoking, African Americans had a higher risk of lung cancer compared with other racial/ethnic groups.
Menthol cigarettes have been hypothesized as one potential factor contributing to the observed greater susceptibility to smoking-caused lung cancer in African Americans, but menthol cigarettes have not been observed to be associated with a higher risk of lung cancer than nonmenthol cigarettes.
Cigarette smoking is the primary risk factor
The epidemic of lung cancer in the 20th century was primarily due to increases in cigarette smoking, the predominant cause of lung cancer. The threefold variation in lung cancer mortality rates across the United States more or less parallels long-standing state-specific differences in the prevalence of cigarette smoking. For example, average annual age-adjusted lung cancer death rates for 1996 to 2000 were highest in Kentucky (78 deaths per 100,000 individuals) where 31% were current smokers in 2001; whereas the lung cancer death rates were lowest in Utah (26 deaths per 100,000 individuals), which had the lowest prevalence of cigarette smoking (13%).
The biology of carcinogenesis
Understanding the biology of carcinogenesis is crucial to the development of effective prevention and treatment strategies. Two important concepts in this regard are the multistep nature of carcinogenesis and the diffuse field-wide carcinogenic process. Epithelial cancers in the lung appear to develop in a series of steps extending over years. Epithelial carcinogenesis is conceptually divided into three phases: initiation, promotion, and progression. This process has been inferred from human studies identifying clinical-histological premalignant lesions (e.g., metaplasia and dysplasia). The concept of field carcinogenesis is that multiple independent neoplastic lesions occurring within the lung can result from repeated exposure to carcinogens, primarily tobacco. Patients developing cancers of the aerodigestive tract secondary to cigarette smoke also are likely to have multiple premalignant lesions of independent origin within the carcinogen-exposed field. The concepts of multistep and field carcinogenesis provide a model for prevention studies.
Risk Factors
Factors associated with increased risk of lung cancer
Cigarette smoking
The most important risk factor for lung cancer (and for many other cancers) is cigarette smoking.
Epidemiologic data have established that cigarette smoking is the predominant cause of lung cancer. This causative link has been widely recognized since the 1960s, when national reports in Great Britain and the United States brought the cancer risk of smoking prominently to the public's attention. The percentages of lung cancers estimated to be caused by tobacco smoking in males and females are 90% and 78%, respectively. The manufactured cigarette has changed over time, but there is no evidence to suggest that changes such as "low tar†or "low nicotine†cigarettes have resulted in reduced lung cancer risks. Cigarette smoking is the most important contributor to the lung cancer burden because of its high prevalence of use and because cigarette smokers tend to smoke frequently, but cigar and pipe smoking have also been associated independently in case-control and cohort studies with increased lung cancer risk. The cigar risks are of particular concern because of the increased prevalence of cigar use in the United States.
The development of lung cancer is the culmination of multistep carcinogenesis. Genetic damage caused by chronic exposure to carcinogens, such as those in cigarette smoke, is the driving force behind the multistep process. Evidence of genetic damage is the association of cigarette smoking with the formation of the DNA adducts in human lung tissue. A strong link between tobacco smoke and lung carcinogenesis has been established by molecular data.
Secondhand tobacco smoke
Secondhand tobacco smoke is also an established cause of lung cancer.
Secondhand smoke has the same components as inhaled mainstream smoke, though in lower absolute concentrations, between 1% and 10% depending on the constituent. Elevated biomarkers of tobacco exposure, including urinary cotinine, urinary NNK metabolites, and carcinogen-protein adducts, are seen in those who are exposed to secondhand cigarette smoke.
Family history
A positive family history of lung cancer is a risk factor for lung cancer. The results of a meta-analysis of epidemiologic studies indicated that those with a positive family history of lung cancer were at approximately twice the risk of lung cancer compared with those with no affected relatives.
Cigarette smoking behavior tends to run in families and family members are exposed to secondhand smoke, so the extent to which measured family history represents a genetic predisposition to lung cancer independent of the shared risk factor of cigarette smoking is uncertain.
Human immunodeficiency virus (HIV) infection
HIV infection has been observed to be statistically associated with an increased lung cancer risk; for example, the results of a meta-analysis of 13 studies indicated HIV-infected individuals had a 2.6-fold higher risk of lung cancer than non-HIV-infected individuals (standard incidence ratio = 2.6; 95% confidence interval [CI] 2.1–3.1).
The clinical significance of this association remains to be elucidated, as it raises the possibility that HIV infection increases susceptibility to lung cancer, but may merely reflect the high smoking prevalence (study estimates ranged from 59% to 96%) among those infected with HIV compared with the general population (smoking prevalence approximately 20%).
Other environmental causes of lung cancer
Occupational exposures to lung carcinogens
Several environmental exposures other than tobacco smoke are causally associated with lung cancer, but the proportion of the lung cancer burden due to these exposures is small compared with cigarette smoking. Many lung carcinogens have been identified in studies of high occupational exposures. Considered in total, occupational exposures have been estimated to account for approximately 10% of lung cancers.
These carcinogens include asbestos, radon, tar and soot (sources of polycyclic aromatic hydrocarbons), arsenic, chromium, nickel, beryllium, and cadmium. For many of these workplace carcinogens, cigarette smoking interacts synergistically to increase the risk. In developed countries, workplace exposures to these agents have largely been controlled.
Approximately 10% of all lung cancer deaths and 30% of lung cancer deaths in lifetime nonsmokers are estimated to be attributable to indoor exposure to radon, estimations that are supported by a meta-analysis and pooled-analyses of case-control studies of lung cancer and indoor radon exposure.
Due to a synergistic interaction between cigarette smoking and radon exposure, the radon-associated risk of lung cancer among smokers is considerably greater than for nonsmokers. The prevention strategy for residents of homes with high radon concentrations is to have the basement sealed to prevent radon gas from leaking into the home.
Air pollution
Although early evidence from case-control and cohort studies did not support an association between air pollution and lung cancer, the evidence now points to a genuine association.
In particular, two prospective cohort studies provide evidence to suggest that air pollution is weakly associated with the risk of lung cancer. In an extended follow-up of a study of six U.S. cities, the adjusted relative risk (RR) of lung cancer mortality for each 10 µg/m 3 increase in concentration of fine-particulate was 1.27 (95% CI, 0.96–1.69). Using data from the American Cancer Society's Cancer Prevention Study II, it was observed that compared with the least polluted areas, residence in areas with high sulfate concentrations was associated with an increased risk of lung cancer (adjusted RR = 1.4; 95% CI, 1.1–1.7) after adjustment for occupational exposures and the factors mentioned above. In a subsequent update to this report, the risk of lung cancer was observed to increase 14% for each 10 μg/m 3 increase in concentration of fine particles. The evidence indicating an association between constituents of ambient air pollution and increased lung cancer mortality continues to strengthen, with reports from Asia, New Zealand, and Europe, documenting increased risks with exposure to certain components of particulate matter.
Factors of uncertain association with risk
Dietary factors
The results of many case-control and prospective cohort studies show that individuals with high dietary intake of fruits or vegetables have a lower risk of lung cancer than those with low fruit or vegetable intake.
In a systematic review of the evidence, the World Cancer Research Fund (WCRF) rates the evidence as "limited suggestive†that nonstarchy vegetable consumption decreases lung cancer risk and "probable†that fruit consumption and foods containing carotenoids decrease lung cancer risk. However, a subsequent systematic review and meta-analysis limited to prospective studies that adjusted for cigarette smoking found the evidence for carotenoids to be equivocal.
While the focus has been on fruit and vegetable consumption and micronutrients, a wide range of dietary and anthropometric factors have been investigated. Anthropometric measures have been studied, indicating a tendency for leaner persons to have increased lung cancer risk relative to those with greater body mass index.
The results of a meta-analysis showed that alcohol drinking in the highest consumption categories only (in excess of about a drink a day) was associated with an increased risk of lung cancer.
Studies of dietary factors have yielded intriguing findings, but because the diets of smokers tend to be less healthy than those of nonsmokers, it is challenging to separate the influence of dietary factors from the effects of smoking. When considering the relationships between lung cancer and dietary factors, confounding factors related to cigarette smoking cannot be dismissed as a possible explanation.
Physical activity
A meta-analysis of leisure-time physical activity and lung cancer risk revealed that higher levels of physical activity protect against lung cancer.
The overall evidence for physical activity has been mixed, but several studies have reported that individuals who are more physically active have a lower risk of lung cancer than those who are more sedentary, even after adjustment for cigarette smoking. The WCRF evidence review rated the inverse association between physical activity and lung cancer as "limited suggestive†evidence.
Studies of physical activity yield findings consistent with an inverse association, but because physical activity behaviors differ between smokers and nonsmokers, it is difficult to infer that there is a direct relationship between physical activity and lung cancer risk.
Lung cancer in never smokers
In countries where cigarette smoking is common, about 10% to 20% of lung cancer cases occur in never smokers.
Radon and second-hand smoke exposure are established causes of lung cancer in never smokers. An increase in lung cancer risk among never smokers also has been observed with exposure to asbestos, ionizing radiation from sources other than radon, and indoor air pollution caused by combustion of coal or other solid fuel. Limited data are available about the association of lung cancer in never smokers with physical activity, diet, alcohol, and anthropometry, yet they typically suggest that the relationships do not differ markedly from those in ever smokers. Nevertheless, the inability to fully control for confounding by smoking in epidemiologic analyses of ever smokers and the possibility of different lung cancer causal pathways from never and ever smokers warrants care when extrapolating results for ever smokers to never smokers.
Interventions Associated With Decreased Risk of Lung Cancer
Smoking avoidance and cessation
Substantial harm to public health accrues from addiction to cigarette smoking. Compared with nonsmokers, smokers experience a dose-dependent increase in the risk of developing lung cancer (and many other malignancies).
Approximately 85% of all lung cancer deaths are estimated to be attributed to cigarette smoking. Substantial benefits accrue to the smoker by quitting smoking. (Refer to the PDQ summary on
Cigarette Smoking: Health Risks and How to Quit for more information.) Avoidance of tobacco use is the most effective measure to prevent lung cancer. The preventive effect of smoking cessation depends on the duration and intensity of prior smoking and upon time since cessation. Compared with persistent smokers, a 30% to 50% reduction in lung cancer mortality risk has been noted after 10 years of cessation.
The benefits of tobacco control at the population level provide strong quasi-experimental evidence that reducing population-level exposure to cigarettes has resulted in population-level declines in the occurrence of lung cancer. Reduced tobacco consumption, due to both decreases in smoking initiation and increases in smoking cessation, led to a decline in overall age-adjusted lung cancer mortality among men since the mid-1980s, consistent with reductions in smoking prevalence among men since the 1960s.
Gender differences in time trends for lung cancer are a reflection of (1) the later adoption of cigarette smoking in women compared with men and (2) the later reduction in smoking prevalence among women compared with men.
Smoking cessation guidelines
Nicotine dependence exposes smokers in a dose-dependent fashion to carcinogenic and genotoxic elements that cause lung cancer.
Overcoming nicotine
dependence is often extremely difficult. The Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and
Research [AHCPR]) developed a set of clinical smoking-cessation guidelines for
helping nicotine-dependent patients and health care providers. The six major
elements of the guidelines include the following:
Pharmacotherapy for smoking cessation
Many pharmacotherapies for smoking cessation, including nicotine replacement therapies (e.g., gum, patch, spray, lozenge, and inhaler) and other smoking cessation pharmacotherapies (e.g., varenicline and bupropion), result in statistically significant increases in smoking cessation rates compared with placebo. Based on a synthesis of the results of 110 randomized trials, nicotine replacement therapy treatments, alone or in combination, improve cessation rates over placebos after 6 months (RR, 1.58; 95% CI, 1.50–1.66).
Since the AHCPR guidelines were published, additional evidence of the effectiveness of such pharmacotherapies for smoking cessation has been published. The choice of therapy should be individualized based on a number of factors, including past experience, preference, and potential agent side effects. (Refer to the PDQ summary on Cigarette Smoking: Health Risks and How to Quit for more information on pharmacotherapy for smoking cessation.)
Population-level interventions
In addition to individually focused cessation efforts, a number of tobacco control strategies at the community, state, and national level have been credited with reducing the prevalence of smoking. Strategies include the following:
- Reducing minors' access to tobacco products.
- Disseminating effective school-based prevention curricula together with media strategies.
- Raising the cost of tobacco products by raising taxes.
- Using tobacco excise taxes to fund community-level interventions including mass media.
- Providing proven quitting strategies through health care organizations.
- Adopting smoke-free laws and policies.
Smoke-free workplace legislation
A review of more than 50 studies found that smoke-free workplace legislation was consistently associated with reduced secondhand smoke exposure, whether measured in reduced time of exposure (71%–100% reduction) or prevalence of persons exposed to secondhand smoke (22%–85% reduction), with particularly marked reductions among hospitality workers.
Smoke-free workplace legislation was associated with consistent and statistically significant reductions in levels of nicotine, dust, benzene, and particulate matter. Health indicators including respiratory systems, sensory symptoms, and hospital admissions were reported as outcomes in 25 studies. With respect to health outcomes, a consistent finding was reduced hospital admissions for cardiac events. Evidence suggested that smoke-free workplace legislation may also result in reduced prevalence of active cigarette smoking; for example, one study observed a 32% decreased smoking prevalence in a county that enacted smoke-free workplace legislation compared with a 2.8% decrease in nearby counties with no smoke-free workplace legislation.
Preventing occupational exposure to lung carcinogens
After cigarette smoking and exposure to secondhand smoke, occupational exposure to lung carcinogens, such as asbestos, arsenic, nickel, and chromium, is the most important contributor to the lung cancer burden. When occupational exposure to lung carcinogens are all considered together, 9% to 15% of all lung cancer deaths can be attributed to occupational exposure to lung carcinogens.
Reducing or eliminating workplace exposures to known lung carcinogens would be expected to result in a corresponding decrease in the risk of lung cancer. Consequently, the proportion of the lung cancer burden attributable to occupational exposures is declining over time in countries like the United States that have taken steps to protect the workforce from exposure to known lung carcinogens.
Interventions Associated With Increased Risk of Lung Cancer
Beta-carotene supplementation in smokers
Results of the National Cancer Institute (NCI) Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) trial were first published in 1994.
This trial included 29,133 Finnish male chronic
smokers aged 50 to 69 years in a 2 x 2 factorial design of alpha-tocopherol (50
mg/day) and beta-carotene (20 mg/day). Subjects were randomly assigned to one of the following four
groups for 5 to 8 years: beta-carotene alone, alpha-tocopherol alone, beta-carotene plus
alpha-tocopherol, or placebo. Subjects receiving beta-carotene (alone or with alpha-tocopherol) had a higher incidence of lung cancer
(RR = 1.18; 95% CI, 1.03–1.36) and higher
total mortality (RR = 1.08; 95% CI, 1.01–1.16). This effect appeared to be
associated with heavier smoking (one or more packs/day) and alcohol intake
(at least one drink/day). Supplementation with
alpha-tocopherol produced no overall effect on lung cancer (RR = 0.99; 95% CI,
In 1996, the results of the U.S. Beta-Carotene and Retinol Efficacy Trial (CARET) were published.
This multicenter trial involved 18,314
smokers, former smokers, and asbestos-exposed workers who were randomly assigned to
beta-carotene (at a higher dose than the ATBC trial, 30 mg/day) plus retinyl
palmitate (25,000 IU/day) or placebo. The primary endpoint was lung cancer
incidence. The trial was terminated early by the Data Monitoring Committee and NCI because its results confirmed the ATBC finding of a harmful
effect of beta-carotene over that of placebo, which increased lung cancer incidence
(RR = 1.28; 95% CI, 1.04–1.57) and total mortality (RR = 1.17; 95% CI,
In a follow-up study of CARET participants after the intervention discontinued, these effects attenuated for a period of time. After 6 years of postintervention follow-up, the postintervention RR for lung cancer incidence was 1.12 (95% CI, 0.97–1.31) and for total mortality was 1.08 (95% CI, 0.99–1.71). During the postintervention phase a larger RR among women, rather than men, emerged for both outcomes in subgroup analyses; the reason for this observation, if reliable, is not known.
The overall findings from the ATBC
and CARET studies, which
include over 47,000 subjects, demonstrated that pharmacological doses of beta-carotene increase lung cancer risk in relatively high-intensity smokers. The
mechanism of this adverse effect is not known. Lung cancer risks were not
increased in subsets of moderate-intensity smokers (less than a pack per day)
in the ATBC study, or in former smokers in the CARET study. Evidence from other studies, such as the Physicians' Health Study (PHS), does not indicate that beta-carotene supplementation increases lung cancer risk in
nonsmokers. Subsequent analyses of participants in these trials and cohorts suggest that the beneficial outcomes
associated with high beta-carotene plasma levels may be due to increased
dietary intake of fruits and vegetables. These findings show the importance of
randomized controlled trials to confirm epidemiologic studies.
Interventions With Adequate Evidence That They Do Not Reduce Risk
Studies have examined whether it is possible to prevent cancer development in the lung using chemopreventive agents. Chemoprevention is defined as the use of specific natural or synthetic chemical agents to reverse, suppress, or prevent carcinogenesis before the development of invasive malignancy. So far, agents tested for efficacy in lung cancer chemoprevention have been micronutrients, such as beta-carotene and vitamin E.
Beta-carotene supplementation in nonsmokers
Two other randomized controlled trials of beta-carotene were carried out in populations that were not at excess risk of lung cancer. The PHS was designed to study the effects of beta-carotene and aspirin in cancer and cardiovascular disease. The study is a randomized, double-blind, placebo-controlled trial begun in 1982 involving 22,071 male physicians aged 40 to 84 years. After 12 years of follow-up, beta-carotene was not associated with overall risk of cancer (RR = 0.98) or lung cancer among current (11% of study population) or former (39% of study population) smokers.
In the Women's Health Study (WHS) approximately 40,000 female health professionals were randomly assigned to 50 mg beta carotene on alternate days or placebo. After a median of 2.1 years of beta-carotene treatment and 2 additional years of follow-up, there was no evidence that beta-carotene protected against lung cancer, as there were more lung cancer cases observed in the beta-carotene (n = 30) than placebo (n = 21) group.
The strong evidence from rigorous randomized, placebo-controlled trials clearly indicate that beta-carotene supplementation does not lower the risk of lung cancer in populations that are not high-risk for lung cancer.
Vitamin E supplementation
The Heart Outcomes Prevention Evaluation (HOPE) trial began in 1993 and continued follow-up as the HOPE-The Ongoing Outcomes (HOPE-TOO) through 2003. In this randomized, placebo-controlled trial, patients aged 55 years or older with vascular disease or diabetes were assigned to 400 IU vitamin E or placebo. With a median follow-up of 7 years, the group randomly assigned to vitamin E had a significantly lower lung cancer incidence rate (1.4%) than the placebo group (2.0%) (RR = 0.72; 95% CI, 0.53–0.98).
However, the protective association between vitamin E supplements and lung cancer in the HOPE-TOO study needs to be interpreted in the context of evidence from other randomized trials. In the ATBC study, supplementation with alpha-tocopherol produced no overall effect on lung cancer (RR = 0.99; 95% CI, 0.87–1.13). In the WHS of 40,000 female health professionals, using 600 IU of vitamin E every other day showed no evidence of protection against lung cancer in women (RR = 1.09; 95% CI, 0.83–1.44). The Medical Research Council/British Heart Foundation Heart Protection Study (HPS) is a randomized placebo-controlled trial to test antioxidant vitamin supplementation with vitamin E, vitamin C, and beta-carotene among 20,536 United Kingdom adults with coronary disease, other occlusive arterial disease, or diabetes. The trial began recruitment in 1994, and as of the 2001 follow-up the results showed a slightly higher rate of lung cancer in the vitamin group compared with the placebo group (1.6% vs. 1.4%, respectively).
Looking at the vitamin E results for the ATBC, HPS, and HOPE-TOO studies combined, the summary odds ratio was 0.97 (95% CI, 0.87–1.08),
and adding the results from the WHS to this would bring the association even closer to the null. The combined evidence for vitamin E supplementation thus continues to be consistent with no effect on lung cancer risk.
Changes to This Summary (02/27/2014)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
statistics with estimated new cases and deaths for 2014 (cited American Cancer Society as reference 1).
This summary is written and maintained by the
PDQ Screening and Prevention Editorial Board, which is
editorially independent of NCI. The summary reflects an independent review of
the literature and does not represent a policy statement of NCI or NIH. More
information about summary policies and the role of the PDQ Editorial Boards in
maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.
Questions or Comments About This Summary
If you have questions or comments about this summary, please send them to Cancer.gov through the Web site's
Contact Form. We can respond only to email messages written in English.
About This PDQ Summary
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about lung cancer prevention. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the
PDQ Screening and Prevention Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
- be discussed at a meeting,
- be cited with text, or
- replace or update an existing article that is already cited.
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's
Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Screening and Prevention Editorial Board uses a
formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].â€
The preferred citation for this PDQ summary is:
National Cancer Institute: PDQ® Lung Cancer Prevention. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at:
http://cancer.gov/cancertopics/pdq/prevention/lung/HealthProfessional. Accessed <MM/DD/YYYY>.
Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in
Visuals Online, a collection of over 2,000 scientific images.
The information in these summaries should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the
Coping with Cancer: Financial, Insurance, and Legal Information page.
Contact Us
More information about contacting us or receiving help with the Cancer.gov Web site can be found on our
Contact Us for Help page. Questions can also be submitted to Cancer.gov through the Web site's Contact Form.
Get More Information From NCI
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
For more information from the NCI, please write to this address:
- NCI Public Inquiries Office
- 9609 Medical Center Dr.
- Room 2E532 MSC 9760
- Bethesda, MD 20892-9760
NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the
NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).
Talk about this article with other patients, caregivers, and advocates in the Lung CURE discussion group.


text:
On eve of 'State of the State,' Dems say Christie too focused on Sandy
A day before Gov. Chris Christie will deliver his State of the State address, Democratic leaders of the state Senate offered their own assessment of where New Jersey stands.
The governor's speech expected to focus on rebuilding from Hurricane Sandy.
But Senate President Steve Sweeney claimed Monday that Christie is using Sandy to ignore other problems.
"If you're one of the 9.6 percent of the people unemployed in this state, you can't wait for when that benefit of unemployment might come to you," he said. "We've got to do something now."
Senate Majority Leader Loretta Weinberg maintains Christie has failed to adequately address issues affecting women.
"Whether it's the right to choose to access health care or to receive equitable pay, the Democratic members of New Jersey's Legislature have taken a stand against the Republican war on women," said Weinberg, D-Bergen.
That's something the Christie administration has not done, Sweeney charged.
"The health-care issues and the women's issues have not gone away. The foreclosure issues have not gone away," he said. "We can't just say forget about that."
Sweeney, D-Gloucester, says the state has to deal with the people harmed by Sandy, but he's urging Christie to work with the Democrats who control the Legislature to also resolve other issues and move the state forward.
Christie will deliver his annual address at 2 p.m. Tuesday at the Statehouse in Trenton.


text:
Simple Logo Blue text Adhesive Pocket Inserts, 8 per sheet
Avery Pre-Designed Templates Microsoft Word
Organize or identify your belongings with style using this easy template. Look for matching designs for Avery Branding and Merchandising products.
Compatible Products:
28373, 38373, 5881, 6574, 8373, 88220, 88221, 8869
Reviewed by 1 customer
This review is from AVERY Simple Logo Blue text Adhesive Pocket Inserts, 8 per sheet:
This design is simple, professional, and nice looking. Easy to use.