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Accounting News & Events
Beta Gamma Sigma Co-Liaison Attends Student Leadership Forum
Brendan Kazmierski, one of the College's Beta Gamma Sigma (BGS) co-liaisons, recently represented the School of Business and the Fisher chapter at the annual BGS Student Leadership Fall Forum in Tampa, Florida. The forum took place from November 7-10 at the BGS headquarters. Read MoreFisher Students Compete in PricewaterhouseCoopers Tax Competition
On Friday, November 8, 39 St. John Fisher College accounting students competed in the annual PricewaterhouseCoopers (PwC) tax competition, sponsored by PwC. Fisher is one of 90 colleges from around the country selected to participate. Read MoreAccounting Students Win Regional Tax Competition
A team of St. John Fisher College Accounting students won first place in the Northeast Region Deloitte FanTAXtic Competition. The competition took place in Boston November 1-3, and the students were accompanied by Professor Lynn Mucenski-Keck. Read MoreFaculty Participate in "Brain Game" Fundraiser
For the third year in a row, St. John Fisher College faculty participated in the "Brain Game," the annual fundraiser for Literacy Volunteers of Rochester, on October 10. Read MoreAccounting Club Holds Annual Golf Outing
Even the intense rain could not keep St. John Fisher College accounting students from participating in the Accounting Club's annual golf outing at the College's golf course on Saturday, September 21. Read MoreAccounting Awards Banquet
Student and alumni achievements are recognized every spring at the Accounting Awards Banquet, held at the Riverside Convention Center in downtown Rochester.
Attended by nearly 200 alumni, students, and recruiters, it is an opportunity for students to meet professionals in various fields of accounting and to be recognized for their accomplishments during the past year.
The Accounting Alumnus of the Year Award is also given out at the banquet.
Upcoming Events
There are no Accounting Department events scheduled at the moment. Please check back for further updates.


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Learn about organic grape and fruit farming as you wander the Good Neighbor Organic Vineyard and Winery in Northport in Leelanau County, Northern Michigan's first and only totally Certified Organic Vineyard. Founder Stan Silverman explains why organic farming is no more difficult than conventional farming and how the difference really lies in the willingness to be proactive and react specifically to specific conditions.
Good Neighbor Organic Vineyard has been selling certified organic products since 2001, producing the first organic wines in 2007. This year, Good Neighbor offered five crafted hard ciders/fruits; and a limited availability of wines, including only 400 bottles of our Gerwurtztraminer. Also new in 2010 is the introduction of Ice Wines, a Chardonnay/Riesling blend, a fruit dessert wine and an Apple Jack style wine that is not a Brandy but does come in at 40 proof. All of these are Certified Organic.
Good Neighbor Organic Vineyard is located approximately three miles south of Northport off Manitou Trail.
Contact Good Neighbor at firstname.lastname@example.com or 231-386-5636 to check on times and days they are open.
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PBS NewsHour - Monday, April 22, 2013
Monday, November 25, 2013
Tonight on the program, we examine the interim deal on Iran's nuclear program which has drawn cautious support as well as criticism internationally. Also: Cuts to the food stamp program lead to a "staggering" increase in need, Doonesbury's Garry Trudeau takes up political satire in web series "...
Air date: 11/26/2013
Saturday, November 9, 2013
Tonight on NewsHour Weekend, we hear from one witness who lived through the powerful typhoon Haiyan, which hit the Philippines on Friday. Later, in our signature segment, one state's bold plan to reduce the cost of prescription drugs by allowing residents to import medication from foreign countries...
Air date: 11/09/2013
Sunday, November 24, 2013
On this edition, a look at what the agreement on Iran's nuclear program means. Plus, in our signature segment, a get-tough program in Hawaii that's keeping probationers out of prison.
Air date: 11/24/2013
Friday, November 8, 2013
Tonight on the program, we examine the October jobs report that showed a rise in hiring and good news for the economy. Also: Super Typhoon Haiyan pummels the Philippines, no agreement reached on Iran's nuclear program, new rules set the standard for mental health care coverage parity, conservatives...
Air date: 11/08/2013
Saturday, November 23, 2013
On tonight?s episode, we take a look at ?Save to Win? programs that gives savers the chance to win small monthly prizes or a yearly grand prize - even if you don't win you get to keep the money you put in, plus interest. Margaret Warner reports from Geneva on the Iran nuclear talks. Later, Bob...
Air date: 11/23/2013


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Where: 151 Park St , 04463 Milo (United States). When: on 11-12-2010.
Written at 11-12-2010 by Paul Madore
Labels - maine fighting snow balls beating
14129 Reads
Eventually we tired of fighting and throwing snow balls at each, so we turned on the traffic. First we built a little bunker behind which we could hide.
We kept chucking snow balls at cars and hitting them, but then eventually my cousin's Uncle was one of our victims, and his happened to have a rock in it, and the windshield was broken. He stomped on his breaks with a loud screech and backed up and got out of the pick-up truck and came into the woods. He had a flashlight and easily found us.
He grabbed hold of my cousin and then tried to grab hold of me. I ran but he chased me and the result was no good. He beat all of us and threatened us with the police. We had broken his windshield, after all.
I don't think we threw snow balls very often after that.


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- Meets NSA CSS Specifications 04-02 and 02-01


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Las Vegas Airport and Convention Center Hotels + Las Vegas Outlet Center + Internet
Know When You're Going?
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Note: The nightly rates shown above do not yet include Tax Recovery Charge & Service Fees or (if applicable) Extra Person Fees, Child Fees, Additional Mandatory Hotel Charges or optional incidentals, such as parking, room service or movies.


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Last Updated: 8th May 2013
Tags: european highlights, tours
France, Monaco, Italy, Vatican City, Austria (in transit), Germany, Netherlands, Belgium (in transit)
Paris, Beaujolais Wine Region, French Riviera, Florence, Rome, Venice, Munich, Rhine Valley, Amsterdam
Meet others who are going at the European Highlights Meeting Place
Full itinerary, optional excursions, maps, booking, departure dates and more at the European Highlights page
Create your own with My Trip Journals
Who is going on this tour from 3rd July 2013?? :)
Every person loves it when folks get jointly and share ideas. Fantastic internet site, adhere with it!
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You made some decent points there. I looked on the internet to find out more about the issue and found most individuals will go along with your views on this site.
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An outstanding share! I've just forwarded this onto a co-worker who has been doing a little homework on this. And he actually bought me lunch simply because I discovered it for him… lol. So allow me to reword this…. Thank YOU for the meal!! But yeah, thanks for spending some time to discuss this matter here on your website.
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Hello world!
First time traveling to Europe and first time flying solo internationally, can't wait!
Booked my euro highlights tour for Aug 5, 2011 and staying an extra day in London
Aug 4th. Hit me up if you're joining the adventure….
Hey Liss,
Me and 3 of my girlfriends will be doing that same tour. Cant wait to meet you :)
Hello All
I'm booked to go on the European Highlights tour beginning 2nd Of August! Am going to be traveling solo and would love to meet people that will be in the same group as me!
Drop me a line! :)
Amount for transit visa to UK app. R700 but major problems if you have a parent from UK or Europe and are eligible for dual nationality.
Total money spent on obtaining a UK visa in South Africa R2400.
(Hopefully awaiting refund of R1000 for my mistakes)Amount for the French Schengen visa app. R700. no ptoblems there :D
The UK Border Agency in South Africa refused to give me a visa on my South African passport since I am eligible for dual nationality. The only problem is that my registration as an Italian Citizen at the Italian Consulate in Johannesburg has been unsuccessul so far and the verification process will take at least three months. So, now I have to apply for a visa from the UK Embassy again and repay the fees.
...I wish obtaining visas and passports could have been easier…
Oh, the passport issue is real… just to get an unabridged birth certificate from South African Home Affairs takes you like two years.
Word of advice to South African travellers… do not make bank transfers into the British High Commission's bank account, I just made that mistake and possibly lost out on like R700. They only accept cash deposits :(
By the by… we're going on the one dated the first three weeks of June 2009 ;)
Hi :D I'm going to this one with my friend Franci ;) Having troubles with organizing the Visas at the moment though…
Hi,explorer 1091812
Me(Franci) and Friend(Margaritha) is also going on the trip, leaving From Joburg on 1June. If you want to contact us firstname.lastname@example.com
Hey guys im from South Africa & im really interested in going on the European Highlights. Can anyone tell me of their experiences…i'm planning on going in JUNE


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Tag: cincinnati
Sneak Peek 21c Cincinnati
Steve Wilson and Laura Lee Brown hosted a Sneak Peek at 21c Museum Hotel Cincinnati for friends Dec 1.
Walk Like An Egyptian
When you think of style icons, who typically comes to mind? Marilyn Monroe, Audrey Hepburn, and Jackie O to name a few. But who was the original It Girl, the eternal fashionista, whose style was as bold as her leadership skills and her charms.


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I don't know what people are accustom to but this is by far one of the worst I've stayed at. As an elite members I would expect a little more. After being the 2nd room I cancelled my reservation. I would have left but couldn't get out of the parking lot.
- Also Known As:
- La Quinta Inn Daytona Beach/International Speedway Hotel Daytona Beach
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- The La Quinta Inn Daytona Beach / International Speedway was recently named a 2011 TripAdvisor Certificate of Excellence award winner!NEW! Flat-panel TVs with 30 channels of HD programming. Easy-access Plug-and-Play feature makes it simple to connect electronics.The La Quinta Inn Daytona Beach is the place to stay for visitors to Daytona International Speedway. Enjoy the Atlantic Ocean and sprawling sand beaches. Catch seafaring ships from the Ponce Inlet Lighthouse. Try your luck at the Greyhound Dog Race Track. Go wet and wild at Daytona Lagoon. You will find LPGA Championship Golf Courses and the USTA Tennis Center here, and even some unique attractions: The World's Largest Outdoor Flea Market and The World's Largest Harley Davidson Dealership. St. Augustine World Golf Village, Walt Disney World, Kennedy Space Center and Universal Studios are easily accessible from here. When you return to the La Quinta Inn Daytona Beach after a day of fun, our courteous and helpful staff will be waiting. We have an on-site restaurant and a sports bar. All spacious rooms are interior corridor with a patio, free high-speed Internet access, and more. We have a sparkling swimming pool and a large sundeck with shaded tables. Easy access from I-95 at Route 92. ... more less
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- November 3, 2011
- 7:31 a.m.
- Suggest removal
- Reply to this post
bana writes:
Morning after demons.
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Knoxville —
Time remains to protest valuations
- News
Flags ordered at half-staff through the weekend
Gov. Terry Branstad has ordered all flags in Iowa be flown at half-staff from 5 p.m. Friday, December 6, 2013 – 8 a.m. Monday, Dec. 9, 2013 in honor of Pearl Harbor Remembrance Day weekend.
Galeazzi on quest to make Knoxville a Compassionate City
In the past two weeks, Chuck Galeazzi with Helping Hands has visited the Knoxville School Board and Knoxville City Council in the hopes of gaining support to make the town the most compassionate city in America.
Council moves forward on rail port study
The Knoxville City Council approved documentation at its regular meeting Monday night to move forward with a railport study.
Fair Board election held
The Marion County Fair Association's annual election was held Monday night and new faces were added to the board.
Knoxville to be featured on RAGBRAI® program
Knoxville will share the spotlight on a national television show with several other cities that hosted RAGBRAI this summer.
Rodgers' bike to be enshrined
Donnie Rodgers purchased a red bicycle for $50 from a Knoxville hardware store in 1967. Little did he know that he and the bike would become a part of the town's history.
Firefighters take part in training
Approximately 25 members of the City of Knoxville Fire/Rescue Department and Knoxville Township Fire Department took part in a training exercise over the weekend.
Supervisors approve County Engineer work agreement
The Marion County Board of Supervisors met Monday morning in special session to approve a work agreement with Tyler Christian, the new County Engineer.
NASCAR purchases Iowa Speedway
NASCAR, though its subsidiary Iowa Speedway, LLC, has been identified as the new owners of the Iowa Speedway.
Ladies' Night is December 5
Knoxville businesses are working together to host a ladies' night event on Thursday, Dec. 5. On that night, several shops will be open until at least 8 p.m.
- More News Headlines
Flags ordered at half-staff through the weekend


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Wikipedia lexicon project, What does it all mean? |
General Discussion? What's that all about?This subforum is for general discussion of Wikipedia and other Wikimedia projects. For a glossary of terms frequently used in such discussions, please refer to Wikipedia:Glossary. For a glossary of musical terms, see here. Other useful links:
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Herschelkrustofsky Wikipedia lexicon project Sat 6th October 2007, 6:59am
LamontStormstar Hard to follow a bit. I also don't know what ... Sat 6th October 2007, 7:12am Poetlister `Twas Jayjg, and the slithy toves Did gyre ... Sat 6th October 2007, 7:16pm jorge And hast thou a strong POV? Join the ArbCom my te... Sat 6th October 2007, 8:15pm LamontStormstar Maybe somehere on this forum is knowledgeable at... Sat 6th October 2007, 9:51pm jorge I was hoping for a critique of this thread's ... Sat 6th October 2007, 10:17pm guy I was hoping for a critique of this thread's ... Sat 6th October 2007, 11:10pm Herschelkrustofsky [quote name='LamontStormstar' post='53183' date='... Sat 6th October 2007, 11:56pm The Joy The wiki is lonely, dark and deep. But I have my P... Sat 6th October 2007, 8:21pm Herschelkrustofsky s3SuAwHgEaE&hl Fri 14th May 2010, 10:16pm 1 User(s) are reading this topic (1 Guests and 0 Anonymous Users)
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In Friday's edition, Kaylie Rhoads was omitted from the Newton Senior High School "A" honor roll list. The Daily News regrets the omission.
In Monday's edition, the theme of the Lighted Christmas Parade was incorrectly named. The theme was "Christmas on the Silver Screen." The Daily News regrets the error.
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See All
The son of a Brooklyn policeman who died when he was eight, African-American comedy superstar Eddie Murphy was raised in the comfortable middle-class community of Hempstead, NY, by his mother and stepfather. A natural-born class clown, he was voted the most popular student at Roosevelt Junior and Senior High. By the age of 15, he was doing standup gigs at 25 to 50 dollars a pop, and within a few years he was headlining on the comedy-club circuit.
Murphy was 19 he was when hired as one of the backup performers on the NBC comedy weekly Saturday Night Live. His unique blend of youthful arrogance, sharkish good cheer, underlying rage, and street-smart versatility transformed the comedian into SNL's prime attraction, and soon the country was reverberating with imitations of such choice Murphy characterizations as sourball celebrity Gumby, inner-city kiddie host Mr. Robinson, prison poet Tyrone Green, and the Little Rascals' Buckwheat. Just when it seemed that he couldn't get any more popular, Murphy was hastily added to the cast of Walter Hill's 1982 comedy/melodrama feature film 48 Hours, and voila, an eight-million-dollars-per-picture movie star was born. The actor followed this cinematic triumph with John Landis' Trading Places, a Prince and the Pauper update released during the summer of 1983, the same year that the standup album Eddie Murphy, Comedian won a Grammy. In 1984, he finally had the chance to carry a picture himself: Beverly Hills Cop, one of the most successful pictures of the decade. Proving that at this juncture Murphy could do no wrong, his next starring vehicle, The Golden Child (1986), made a fortune at the box office, despite the fact that the picture itself was less than perfect. After Beverly Hills Cop 2 and his live standup video Eddie Murphy Raw (both 1987), Murphy's popularity and career seemed to be in decline, though his staunchest fans refused to desert him. His esteem rose in the eyes of many with his next project, Coming to America (1987), a reunion with John Landis that allowed him to play an abundance of characters -- some of which he essayed so well that he was utterly unrecognizable.


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You're watching...
Feeding America: The current state of US hunger
Ross Fraser on how the program's launch is helping them keep their local food banks stocked
Apr 27, 2012
Ross Fraser
You're watching...
Ross Fraser on how the program's launch is helping them keep their local food banks stocked
Apr 27, 2012
Ross Fraser
Also in this playlist...
Auto-advance: ON
Auto-advanceThis transcript is automatically generated
Okay let's move on with a very important topic in a way to I want to recruit all of you to help this morning so I put this out their first and then talk the guest.
The website is called feeding America -- war.
And it -- the current state of US hunger.
Joining us now to talk about it -- -- the Ross Frazier he's the director of media relations for feeding America good to see you Ry good morning to you you having me on here absolutely.
First of all when you talk about the state of US hunger.
What is it all right.
We're -- and the people who are food insecure.
Polluting -- -- secure food insecure.
Which is -- -- in the USDA uses.
And basically that means people who do not have access to three square meals a day.
And that they're putting something in their stomachs but it's not always the best food for them not nutritious food often needing food that -- and fat and sodium so we want to make sure that every one gets has access to adequate amounts of nutritious food.
So what we're looking is we have a network of all the food banks in the country.
-- here in New York City harvest and the food bank for New York City.
It any given that we we have about six million people.
Who come to one of -- the food pantries -- soup kitchens that we provide food to six million people here in America.
Week after week.
We're we're going to see about 37 million total people come to us for hope this here.
So there's enormous need.
You know who else is healthy lives millions of -- longer.
It's interesting when you look at the numbers I -- many of them are our children so I wanna be careful when I compare Arkansas I wanna do apples and oranges my.
I I'm wondering if when we look at numbers -- we see that unemployment number loom above 8% do you see a difference in that term absolutely are.
Demand for food has increased by nearly 50%.
Through in just the past four years so in other words we were.
-- -- five million people a year now we're treating 37 million about seventeen million of those are children.
If you look at the food stamp program about half of the recipients of food stamps -- children in households with children.
So there's a tremendous need and where we're deeply concerned about children especially.
Because if there inadequately nourished as young children they don't develop properly.
So lack of nutrition can -- their and their mental physical and emotional development in ways that could never be prepared.
-- he gave me the chills when -- -- a 50% increase in demand for food up for the past four years.
So -- for for many reasons you're hoping that the unemployment numbers come back to normal.
Because that's a lot of people to -- what about the ability to feed them has that changed.
Well it depends on where we are where you are geographically what -- the worst areas with the highest the worst areas are in the south.
Unfortunately in the you have so so minister poverty right you have the most poverty.
Poverty and hunger are not synonymous but when you have areas with vast poverty what -- what I think would surprise people is that.
In rural areas hunger is often more prevalent than it is an urban environments in the big city.
And where they can grow -- where they can grow through because it doesn't make -- so well because they can grow the food but they're -- we've got the food that's being grown there.
-- you how to you know areas where you have counties where.
There are few jobs or the jobs and pay a lot of money you have a lot of people who were underemployed or unemployed.
And then getting services to them -- an event.
Because you're serving people in sparsely populated communities.
Here here in New York City it's much easier everything is condensed you can walk through food pantry can -- -- -- -- you can take the subway well you can eleven Mississippi.
Let's stick with the rural -- for just the second farmers are now getting involved in a new campaign to fight hunger in rural America though so there is some rescue.
-- -- -- -- -- -- Invest an -- and this is a brilliant idea what we're always looking for -- new ways to get more food to people so Howard Buffett who is the farmer and philanthropist.
Came to us and if you.
Works with our archer Daniels any relation medium yes -- -- Warren Buffett's there we go yeah.
And he hasn't foundation and he's worked for many years and with hunger developing nations -- he's become interested in helping feeding America.
And looking at domestic hunger.
So as I said rural areas -- the hardest to reach.
So what he came up with it is a program.
Where we're going to work with eighty.
And it's called invest in makers of a farmer grows thousand acres of corn he goes stadium to sell -- corn and says I want to give one acre.
Back to my community and so they earmarked one acre of corn -- -- -- or whatever we whatever it is and that's process that.
-- -- is donated that the proceeds from that go back to the community -- so it's if the food is grown in Macon Illinois it is about to make -- Illinois so -- -- literally growing food and that you're feeding your own neighbors.
How -- there's -- way for farmers to help the people who live in the community where the -- Ingraham that's amazing that's brilliant idea.
How we learn more about that particular program go to our website feeding America dot org and you'll learn all about invest an -- And how you can participate we're always looking for people to become hunger advocates as well.
If people can can volunteer if they can talk to their neighbors about hunger.
Or if they can communicate.
-- what's very important and our keeping the federal nutrition programs funded.
So if they can communicate with -- policy makers and legislators.
And tell them that they believe that we have a moral obligation to feed everyone at risk of hunger in America that will be much appreciate -- we.
-- live -- that's going on right now we're an interactive programming -- and I want it just.
Linden your two or -- all of them now.
Richard Brett writes government needs to stop hindering the farmers the stupid new regulations no food shortages so far jobs are the answer.
Put America back to work -- they can afford to buy their own food.
Charles -- says if you have a lot of money pick a Stanley.
Our -- several families to help we can help each other more than any government can -- help us get out what I'm hearing and I haven't heard anything and maybe I'm wrong -- This is not a government thing now I mean these are people helping people announcing this investor they had -- from.
-- feeding America is not a government organization we're -- everything and it's working.
No we're feeding six million people that's mainly -- This the government ever offered to help well we get food many of Newton mass.
I know you never gonna come by and see how it works.
That are.
Many of them do we have a lot of supporters and the federal government a lot of senators and congressmen who are big advocates and the work that we do.
We have others that we that we would love do come to a food -- food pantry and learn about.
The work that we do -- the people that we serve.
So there are various tremendous needs and many different ways that people can help in terms of food funds advocates -- except -- -- Bryant calmly in New York race.
And I want to -- comments.
-- the departments of agriculture and labor are trying to restrict farm kids from working on their own.
Family farms they just can't mind their own business actually that was struck down the president decided that they weren't gonna go down that -- yesterday.
Armed but rural America there anything we want to make sure we -- -- them.
-- -- -- -- -- -- How much would you say.
We need to do just in terms to get back to where we were four years ago I mean is it just about jobs are there are other issues at play here and we don't have enough land that we.
Yet it's about jobs -- -- where it's about jobs and that's about the federal nutrition programs it's about with this safety net.
You know there's a lot of talk in Washington about needing to balance the budget and reduce government spending.
And I and one of those things that's been talked about this cutting the food stamp program substantially.
And and we can't have that happen.
I think the food stamp program is often misunderstood by people -- the average benefit is only -- 132 dollars a month.
The supplemental program most people -- -- on food stamps for nine months food stamps little money back into the economy and so if you.
There there's an interesting argument if you have a a small town that's in -- deep poverty.
And you have a thousand people on food stamps and they're each getting a hundred dollars.
In food -- -- the 100000 dollars.
Coming into the all of you don't understand -- said about a 100000 dollars coming in the community keeps the grocery store opened keeps the people employee who -- at the -- -- Keeps the farmers who -- the aides to vigorously -- the man who's driving the truck.
So food stamps do benefit local economies.
And if we cut those we're going to affect that economy and people will lose jobs is a result.
Right now one in seven Americans are on food stamps.
Which is astonishing.
One in seven Americans -- This is an economy that in terms of where we've been in this country if that's some flinty old school 1950 -- it's been it was.
Bear in mind you know this is all -- mostly because of the economy tanking and there's been proportionate.
Good job losses in the economy falling many more people are on food stamps because many people need -- help.
We have won six Americans at risk of hunger.
And one in eight Americans this is astonishing one in eight Americans actually come to feeding America.
For help feeding -- themselves or their families.
At some point during the year.
Wow so at least once during the year -- maybe more than once families need.
Help again feeding America dot org is the web site.
-- Ross Fraser good enough to come by on this Friday and tell us how we all can help is there anything specifically wants to do.
Yes -- -- -- learning about hunger I want you to learn that people are hungry through no fault of their own.
That -- really exists in America we have a moral obligation to make sure the people at risk of hunger.
Can get adequate nutrition we need to keep the safety nets strung.
And if you care about your neighbors who were at risk of hunger you need to pick up the phone and call your senator and congressman and tell them that.
-- -- -- all right thank you summit here we're gonna take.
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Engage Comms Engaging Reads – The Spanish town taking Twitter to the next level, the rise of the #UNselfie and the question, how do comms professionals stay relevant?
December 5, 2013This week's edition of 'Engaging Reads' brings you the most interesting and useful digital comms insights we've come across over the last few weeks, including – news that using Twitter has become law for one Spanish town, 2014 will be … Continue reading
Our first CIPR Yorkshire & Lincolnshire PRide Awards as Engage Comms Ltd!
November 29, 2013Having both worked in PR/comms in Yorkshire for around 10 years, Helen and I (Founding Directors of Engage Comms Ltd) have been regulars at the CIPR Yorkshire & Lincolnshire PRide Awards in the past. However, this was our first year … Continue reading
Comms2point0 guest editor for the day: 3 reasons why you can't build a decent website without a communications expert
November 26, 2013We were very chuffed to be asked by the founders of the fantastic comms2point0 blog – a free online creative communications resource created by leading Local Government communicators Dan Slee and Darren Caveney in their spare time (what little of it … Continue reading
Engage Comms' Engaging Reads – increasing recognition for digital communications management, viral video to stop the spread of infection and don't underestimate the power of Pinterest
November 8, 2013This edition of 'Engaging Reads' brings you the most useful digital comms insights we've come across over the last few weeks, including news that digital communications management is gaining greater recognition, how a viral video helped stop the spread of … Continue reading
Yorkshire and Lincolnshire's 'professional communicators': Why volunteer to sit on the CIPR's regional committee?
October 29, 2013I've been a member of the Chartered Institute of Public Relations (CIPR) since I embarked on an accredited Masters in PR back in 2005. I've always seen being a member of my industry's Chartered Institute as playing my part in … Continue reading
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When picking out desserts for your dessert table, consider the season ripe with fresh produce from May to late September. Here are five mouthwatering ways to serve them:
1. Mixed Berries Chiffon Cake - From strawberries, raspberries, blueberries, blackberries and cherries, they all have one thing in common — they're rich in antioxidants.
Photo: Feels Like Today Photography; Cake: 10th Street Baking Company


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A case study on the use of the PALM MicroBeam laser microdissection workstation in the study of cancer - Prof. Stephen Bustin and Dr. Shu Rui-Li of the Bowel and Cancer Research Laboratory, Royal London Hospital utilise the unique laser technology incorporated in the PALM MicroBeam to isolate, recover and compare single cells from the tumour and normal tissue without any mechanical intervention, thus eliminating the possibility of cross contamination and guaranteeing cell population purity.
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'Detective's Wife' to Landmark Project: Now onstage and set in Chicago
"Northwest Highway" is a new play by William Nedved set in Jefferson Park, opening soon at the Gift Theatre.
There have been plays about Chicago as long as there has been a Chicago theater. Indeed, I've long thought that one way of understanding the best early work of David Mamet, arguably the greatest of the Chicago scribes, is to think in terms of Lincoln Avenue.
Mamet set "Sexuality Perversity in Chicago" near where that street starts, in Old Town, where Mamet was living at the time. He set "American Buffalo" in the Lakeview and North Center neighborhoods, and there is some evidence to suggest "Glengarry Glen Ross" takes place in Lincoln Square.
But I don't think there has ever been quite so many plays about this city as are rushing our way.
Let's review. You can read my new review of Keith Huff's "The Detective's Wife," which is a drama set in Edgebrook on the Northwest Side. This weekend, Theatre Seven will open The Chicago Landmark Project, a two-part program of a dozen short plays, all set in Chicago. Theatre Seven is listing them by intersection: State and Madison; Lincoln and Webster; Garfield and State; Division and California; 63rd and Woodlawn; and so on.
Continue reading "'Detective's Wife' to Landmark Project: Now onstage and set in Chicago" »


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Hey, bitches. I'm Elli. Love me or hate me.Trust no man, fear no bitch. I am who I am, && I don't plan on changing for you. I'm not emo, scene, or any other label you throw across my face. I'm socially awkward. I have major trust issues, but if you earn my trust, consider yourself lucky. Wanna know more? Just ask c:
Toodles c: Add me on Facebook: Elli Marie (Ellieatsyourface).
HAILEY.x3 I love you Sexy Ninja! Forever&&ever c: You're beautiful && absolutely amazing c:
It's funny how most of you bitches on here are fake c: It's very obvious when you use the same pictures as everyone else, but still try to say you're that person :D I'm not nice, I WILL CALL YOU OUT. So don't try to pull your bullshit off on me, because trust me, I know(;


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One Teaspoon
Freaky Love Denim Bustier
Australian designer Jamie Blakey sewed her first collection in her very own bedroom. Now, nearly a decade later, her Sydney-based line has found an international fan base. Known for clothing that is casual and beachy, One Teaspoon offers pieces that are effortless, cool, and still have that handmade feel.
- 100% cotton
- Button front closure
- Elastic back detailing
- Fading throughout
- Styled with One Teaspoon Bandit Cut Offs in Hunger.
- Styled with Dream Collective Diamond River Cuff in Poppy Red.
- Styled with gorjana Kaia Ring in Gold.
- Styled with gorjana Delaney Wave Ring in Rosegold.
- Styled with gorjana Infinity II Ring in Gold.
- Styled with gorjana Blake Gem Cuff in Gold.
- Modeled in size S. See fit guide for model's dimensions.
- Revolve Style No. ONET-WS51
- Manufacturer Style No. 11879
Clearwater, Fl
Some Curves/Average Height


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Over the past few months Legal Correspondent David Lesch has cover a variety of topics in his constitutional law series that include contracts, the legalization of marijuana, and the right to privacy. He concluded the series on the topic of weight discrimination and also talks on some of the legal issues discussed throughout the year.
OPEN is shot LIVE from BronxNet's studios and invites viewers to participate through phone or email. The show builds on the station's mission to provide useful information to the Bronx public, while helping young adults develop media careers. Every Monday, Wednesday, and Friday OPEN helps Bronx community organizations share information about issues and services, give exposure to artists working in various media, showcase video art, provide a forum for discussion and debate, and updates viewers about what's happening in the Bronx and beyond.
The hosts are a diverse group o f personalities who interact with the audience via phone calls and internet. Lead hosts include experienced personalities such as WBLS Radio personality Bob Lee, Bronxnet own Executive Producer of Perspectives, Daren Jaime and noted Bronx performer Rhina Valentin. Guest and segment hosts will include newspaper journalists, experts and aspiring journalists who participate in BRONXNET?s journalism production training programs.
It is seen live on Cablevision's channel 68 and Verizon Fios channel 35 every Monday, Wednesday and Friday at 10:00 am. Rebroadcast schedule: Monday: 2 am, 5 pm, 10 pm | Tuesday: 2 am, 10am, 5 pm, 10 pm | Wednesday: 2 am,?5 pm, 10 pm | Thursday: 2 am, 10 am, 5 pm, 10 pm | Friday: 2 am, 5 pm & 10 p.m.


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This Best Western has all of the usual amenities of a hotel of this genre. However all of the rooms have balcony views of the ocean and the staff go out of their way to be friendly and helpful The free breakfast is an extra; love the pancake machine. Had to keep the kids from pressing the button over and... More
- Also Known As:
- Best Western Plus Shore Cliff Hotel
- Best Western Plus Shore Cliff Hotel Pismo Beach
- Best Western Pismo Beach
- Pismo Beach Best Western
- Official Description (provided by the hotel):
- Perched atop the cliffs in Pismo Beach, 90 feet above the Pacific Ocean, the BEST WESTERN PLUS Shore Cliff Lodge features a beautiful newly renovated oceanfront location. Boasting private balconies or patios from every room to enjoy the panoramic views, the Shore Cliff Lodge offers travelers the ideal Pismo Beach location. Enjoy the largest oceanfront heated pool in Pismo Beach, spa services, complimentary expanded continental breakfast, free Wi-Fi and free parking. ... more less
- Reservation Options:
- TripAdvisor is proud to partner with Booking.com, Expedia, Hotels.com, Orbitz, Priceline, Travelocity, Olotels, Best Western, Cheap Tickets and Tingo so you can book your BEST WESTERN PLUS Shore Cliff Lodge reservations with confidence. We help millions of travellers each month to find the perfect hotel for both holiday and business trips, always with the best discounts and special offers.


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Central America Tours
- Ometepe Island (Nicaragua)
- Bay Islands (Honduras)
- Antigua (Guatemala)
- Bocas del Toro (Panama)
- Lake Atitlan/Panajachel (Guatemala)
- Actun Tunichil Muknal Cave (Belize)
- Havana (Cuba)
- Tikal (Guatemala)
- Palenque (Mexico)
- Playa Hermosa (Costa Rica)
Diversity. The word sums up Central America travel. So geographically close to the frenzy of North America, yet a million miles away in culture and lifestyle, this small area changes colours as quickly as a chameleon. Each country is so different that a simple border crossing will bring a whole new mix of surprises and cultural experiences. If beach life and water activities are your thing then a Central America tour is perfect for you. Snorkeling, sailing, SCUBA diving, surfing, parasailing, swimming and windsurfing are all possible in virtually any Central American country. For history and culture buffs the archaeological ruins of Tikal in Guatemala or Copan in Honduras are fascinating reminders of the ancient Mayan civilization. Whether you have just a week or a full month to travel, Central America has something for you.
Cuban Rhythms (CCCR)
For too many people, Cuba is nothing more than a beach resort. That's crazy; the island practically buzzes with energy and you should do likewise—get moving. Journey through the culture-soaked streets of Trinidad and Old Havana for your fill of drinking and dancing. The music here pours out of open windows. Hit the beach and explore the outdoors then connect with the locals in homestays and make friends for life as you hit the sites with other young people like yourself. Boring? Impossible!
Highlights: Dance the night away with other young travellers in Old Havana, mingle with the locals at overnight homestays, sample the local rum and cigars, connect to the salsa culture on the dance floor, move those hips to incredible live music, explore colonial Havana's alleyways, laze under the Caribbean sun.
Costa Rica on a Shoestring (CRBC)
Hit two of Costa Rica's famed features—volcanoes and beaches—on this exciting trip that isn't too hard on the wallet. Get the adrenaline pumping in La Fortuna, then soak up the hippie spirit of Montezuma and relax on the beach. While you're free to choose your own adventure and optional adrenaline-inducing activities like waterfall rappelling, your accommodation and transportation are included and our expert CEOs will help you make the most of your time. Take a trip that's packed with just the essentials—eight days of maximum Costa Rica at minimum cost.
Highlights: Try adrenaline sports like whitewater rafting and waterfall rappelling, take in the views of Arenal Volcano towering over La Fortuna, chill out on the Pacific, try to catch some waves.
Basic Costa Rica (CRCR)
Stay flexible in Costa Rica on this unique 2-week adventure. You'll hit the volcanoes, a cloud forest and both of the incredible coasts. Chill out on white-sand beaches and explore pristine wildlife reserves. Best of all, this trip gives you the flexibility to create the adventure of a lifetime, so you can soar across the treetops by zipline, rappel down a waterfall or learn to surf the Pacific breaks. Take a trip that's packed with just the essentials—everything you need to explore the diversity and beauty of Costa Rica.
Highlights: Chill out on the Caribbean and Pacific coasts, cruise across Lake Arenal with beautiful views of Arenal Volcano, enjoy opportunities to go whitewater rafting and horseback riding along the beach, explore the cloud forest on a guided tour
Panama Experience (CRSP)
From San José, hit the beach and mountain retreats on your way to the locks of the world-famous Panama Canal at the centre of the Americas. Visit gorgeous islands and chill to reggae beats on Caribbean beaches. Search for the quetzal bird in cloud forests and shake your tailfeather in the clubs of Panama City. With your hotel and transport arranged by our CEOs, you can concentrate on choosing your own adventure.
Highlights: Listen to the reggae rhythms wafting through the Caribbean air, stare out at the crystal blue ocean, walk through lush greenery in the highlands, kick back in a hammock on the Pacific, marvel at ships passing through the Panama Canal.
- Travel Style:
- Yolo
- Trip Type:
- Small Group
- Service Level:
- Basic
- Physical Grading:
- 3
Trip | Length | Style | Service Level | Starting Price |
Cuban Rhythms (CCCR) | 8 days | Yolo | Basic |
Costa Rica on a Shoestring (CRBC) | 8 days | Yolo | Basic |
Basic Costa Rica (CRCR) | 14 days | Yolo | Basic |
Panama Experience (CRSP) | 14 days | Yolo | Basic |


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Dr. Shaffer is Professor of Clinical Radiology and Clinical Internal Medicine at the University of Virginia School of Medicine and Co-Director of the Division of Thoracoabdominal Imaging at the University of Virginia Health Sciences Center in Charlottesville, VA.
C olorectal cancer (CRC) is a lethal disease and is gaining attention as an important public heath issue. The American Cancer Society estimates that 129,400 new cases of CRC will occur in the United States in 1999. 1 One out of every 20 Americans will develop this cancer within their lifetime. 2,3 CRC is the second leading cause of cancer deaths, exceeded only by lung cancer. Approximately 56,600 Americans will die of CRC this year, and well over 6 million Americans alive today will succumb to this malignancy. 1,4
Risk factors
A number of risk factors for CRC are well documented. 3,5,6 A genetic predisposition to CRC is present in those persons with a family history of CRC or adenomas in first degree relatives, familial adenomatous polyposis (FAP) syndrome, or hereditary non-polyposis colorectal cancer (HNPCC) syndrome. Individuals who have a personal history of CRC or adenomatous polyps are at increased risk of having subsequent colon neoplasms. 7,8 Chronic inflammatory bowel disease, especially ulcerative colitis, places a patient in jeopardy for acquiring CRC. Women who have had breast, ovarian, or endometrial cancer also may develop CRC as part of the Lynch II syndrome. 2,5 However, to put things in perspective, it should be recognized that individuals at high and moderate risk make up only a small fraction of the general population, and 70 to 80% of CRC occurs sporadically in persons with no known risk factors. 3,6
Adenoma-carcinoma sequence
Most CRC develops from adeno- matous polyps--the well-recognized "adenoma-carcinoma sequence." 6 An exception to this is found in patients with chronic inflammatory disease of the large bowel, where a malignancy can develop within dysplastic mucosa without passing through a polypoid stage. 5 Although most CRC arises from adenomas, the majority of adenomas do not become cancers. It is estimated that 95% of all 5-mm diameter adenomas will remain benign. 9,10 Unfortunately, we have no way to identify the one adenoma in 20 that will become malignant. However, we do know that the larger the polyp, the more likely it is to harbor malignancy (table 1). 11,12 An adenomatous polyp which is less than 10 mm in diameter has approximately a 1.0% chance of containing an invasive carcinoma. Cancer is found in 5 to 10% of polyps between 1 and 2 cm in size and in 11 to 46% of polyps over 2 cm in diameter. Based on autopsy data, the anticipated malignancy conversion rate for large adenomas is 3% per year. 13
CRC survival
The major determinant of CRC survival is the stage at which the cancer is discovered. 14-17 A tumor confined to the mucosa (carcinoma-in-situ) has a 100% 5-year survival rate after surgery; the prognosis for survival becomes progressively worse for patients with a greater depth of colon wall invasion, local spread to adjacent structures, regional lymph node involvement, and distant metastases (table 2). Detection and endoscopic removal of precursor adenomas can prevent CRC, and early-stage cancer detection can lead to surgical cure. 6
Testing scenarios
There are three clinical scenarios in which testing for the presence of CRC or its precursors may be considered. The first is diagnostic testing of persons suspected of having CRC or polyps because of signs or symptoms of the disease. This would include individuals with documented intestinal bleeding, manifested either by visible blood per rectum or invisible bleeding detected by a fecal occult blood test (FOBT). Diagnostic testing also would apply to persons with unexplained anemia, change in bowel habits, or weight loss. Secondly, surveillance testing is appropriate for patients at increased risk of developing CRC because of a personal history of CRC, polyps, or inflammatory bowel disease, or a strong family history of CRC or adenomatous polyps. Lastly, the term CRC screening describes testing in average-risk individuals in the appropriate age group without signs or symptoms of the disease.
Rationale for screening
The rationale for recommending CRC screening in the asymptomatic general population is that about 75% of all CRC occurs in people classified as "average" risk. 6 This malignancy is a major cause of morbidity and mortality, yet it is both curable and preventable. 18 Clinical studies have found that periodic screening and removal of adenomatous polyps decreases the incidence of CRC, and detection of early-stage cancers reduces CRC mortality. 6 Although most cancers develop from adenomas, the malignant potential of these precursor polyps is low and slow to develop. Only 5% of 5-mm adenomas become malignant, and it takes a minimum of 5 years, and an average of 10 years, for a small adenoma to develop into carcinoma. 6,19 The demonstrated stability of most polyps and the generally long lead time for malignant transformation are reasons for optimism in determining strategies for detecting and removing precancerous polyps and early-stage cancers. 6
Adenomas can be found in approximately 25% of people by age 50 years, and the prevalence increases to 50 to 60% by the age of 80 years. 20 The incidence of CRC has shown an increase after age 40 and accelerates sharply after age 50, with 90% of cancers occurring in persons 50 years of age and older (figure 1). 21,22 Thus, a CRC screening strategy should logically begin no later than 50 years of age, and testing should be performed at intervals that allow timely detection of previously overlooked small polyps, as well as new lesions, that have enlarged to sizes of 10 mm or greater. 23 It is projected that universal CRC screening has the potential to increase the current 5-year survival rate of 63% for whites and 53% for African Americans to 91% for all Americans. 18,24 Sadly, fewer than 20% of American adults currently undergo CRC screening. 25
Screening tests
There are at least six desirable attributes in any CRC screening test: 1) it should be widely available and easily accessible; 2) it should reliably detect premalignant polyps and early-stage cancer, not just advanced disease; 3) the test should reliably exclude the presence of the disease in normal individuals; 4) it should produce minimal discomfort to assure patient acceptance and compliance; 5) it must have a low risk of serious complications; and 6) the cost-benefit ratio must seem reasonable to the payer. Four generally-accepted tests are available for CRC screening: fecal occult blood test (FOBT), sigmoidoscopy, barium enema, and colonoscopy. Unfortunately, none of these tests is ideal for screening average-risk individuals. 26
Fecal occult blood test
The FOBT is universally available, simple to perform, noninvasive, very safe, and of relatively low cost. It has been well documented that FOBT screening achieves a statistically and clinically significant reduction in death from CRC. 3,6 Its biggest drawback, however, is that it is unreliable. 27 In persons who have positive test results, CRC is found only in 2 to 17%; thus, the large majority of reactive tests are false-positive. The test also has a high false-negative rate. The average sensitivity reported for FOBT is in the range of 40 to 60% for cancers and 5 to 10% for adenomas. 16,28,29 This is due to the intermittent nature, or even absence, of bleeding from these lesions. In addition, the FOBT has poor patient compliance, and it does not provide direct structural evaluation of the large intestine. The general recommendation that the FOBT be repeated annually is based on the theory that a test of low sensitivity may be more effective if repeated often. 27 For those individuals who elect a periodic total colon examination with colonoscopy or double-contrast barium enema (DCBE), there is no need for an annual FOBT. 3
This examination is widely available, minimally invasive, relatively safe, and only moderately expensive. Sigmoidoscopy is well tolerated by most individuals, so sedation is not commonly used. Reports of bowel perforation are rare. 27 Examination with a flexible 60 cm scope is preferred over a 25 cm rigid sigmoidoscope because of the greater length of colon that can be evaluated. Still, the flexible instrument permits visualization of only about 40% of the large intestine and can be expected to detect the presence of no more than 40 to 60% of CRC and polyps. 6,27,30 In patients under 50 years of age, this test may be considered adequate for screening because 75% of polyps will be located in the rectosigmoid colon. However, as patients grow older, an increasing number of tumors are located in the more proximal colon and beyond the reach of the sigmoidoscope (figure 2). 31
After age 60, a majority of polyps are beyond the reach of the sigmoidoscope, and this CRC screening strategy is no longer as effective or cost-effective.
The barium enema and colonoscopy
Colonoscopy and the barium enema are the only currently available screening tests capable of providing structural evaluation of the entire colon from the rectum to the cecum. The American Cancer Society (ACS) terms both procedures "total colon examinations" (TCE). 3 Although published reports indicate that the air- or double-contrast barium enema (DCBE) and the single-contrast barium enema (SCBE) are approximately equivalent in sensitivity for the diagnosis of colonic cancer and large polyps, 32-34 the DCBE is generally considered superior for detection of rectal lesions and small polyps, making it the radiologic screening examination of choice. 27,35,36 The SCBE remains useful in selected screening situations, such as with very elderly and/or immobile patients. 37
There is voluminous literature comparing DCBE and colonoscopy for the diagnosis of CRC and polyps, but most reports are retrospective studies in symptomatic patients or those with rectal bleeding. There are no published clinical studies specifically evaluating whether screening DCBE or screening colonoscopy alone reduces the incidence or mortality from colorectal cancer in people at average risk for the disease. 6 For comparative studies, colonoscopy usually is designated as the "gold standard." This may lead to an overestimation of the sensitivity of colonoscopy, because all false-negative colonoscopies are assumed to be true negatives. This comparison also leads to a bias against the specificity of the DCBE, as all false-negative colonoscopies are assumed to be false-positive barium enemas. 26 The best controlled studies comparing colonoscopy and DCBE show that while colonoscopy detects more small polyps, there is little difference in the ability of these tests to detect large polyps (>=10 mm) and cancers. The combined false-positive rate (higher for DCBE) and rate of inadequate examinations (higher for colonoscopy) are about the same for the two procedures.
Schrock 38 is likely correct in commenting that the "barium enema is neither as good as radiologists claim nor as bad as endoscopists believe. Colonoscopy is neither as good as endoscopists claim nor as bad as radiologists believe."
In the best hands, both colonoscopy and DCBE are reported to have a sensitivity of about 90% for detection of clinically significant polyps and CRC. 30,39 However, both tests are operator dependent, and this level of lesion detection is unlikely to be achieved in clinical practice except by experts under ideal circumstances. Results from the studies with the fewest biases suggest that the sensitivity of the DCBE is between 50 and 80% for polyps of less than 10 mm, 70 and 90% for polyps greater than 10 mm, and about 90% for CRC. 6,40 Studies using the barium enema as the gold standard consistently show that colonoscopy misses about 10 to 20% of confirmed lesions detected by barium enema. 27 Studies using same day back-to-back colonoscopy as a gold standard show a miss rate for colonoscopy of 16 to 27% for polyps of 5 mm in diameter or less, 12 to 13% for polyps of 6 to 9 mm, and up to 6% for polyps measuring 10 mm or greater. 41-43
While colonoscopy generally is considered superior to DCBE for detection of polyps of less than 6 mm in size, the rate of colonoscopic perforation is greater than the low incidence of malignancy in these small polyps; thus, the need to detect such small polyps has been seriously questioned. 44
Why do colonoscopy and DCBE fail to diagnose some colorectal tumors? During colonoscopy, undetected lesions usually are missed either because the tumor site is not reached or the lesion is passed by the scope but not identified by the endoscopist. A prospective survey study done in 1984 by the American Society of Gastrointestinal Endoscopy showed that 26% of colonoscopies performed by the 672 responding society members were incomplete. 45 Other studies report failure to reach the cecum in anywhere from 5 to 45%, with operator experience and newer scope designs being significant factors in attaining the higher rates of success. 27 Other causes of incomplete colonoscopy are poor bowel cleansing, excessive bowel redundancy, benign or malignant stricture, and severe diverticulosis (figure 3). Because the right colon frequently harbors polyps and cancers, incomplete studies require that either a repeat colonoscopy or a barium enema be performed (figure 4). 6 When lesions are passed but not detected by colonoscopy, it usually is because the lesion was hidden behind a fold, particularly on the inside of a tight turn, such as that which occurs at colonic flexures (figure 5). 46
Conversely, a barium enema rarely fails to reach the cecum and allow complete colon evaluation. When carcinomas are missed on a DCBE, the lesions are visible about 90% of the time on retrospective review of the films; thus, a technical problem or perceptive error by the radiologist usually is responsible for failure to report the lesion or properly interpret its nature. 47-49 Because human error is a frequent cause of failure to make a correct diagnosis, it has been postulated that performing double-reading of barium enema examinations could raise the diagnostic sensitivity of the study, possibly to as high as 94%. 26,49,50
Both colonoscopy and DCBE are painful or, at best, uncomfortable procedures. It is not clear which is more acceptable to patients. Medications to provide analgesia, sedation, and amnesia are regularly given during colonoscopy but are rarely used during barium enema studies. Because of the delayed amnestic effect of drugs like medazolam (Versed, Roche Laboratories, Nutley NJ), it is not surprising that patients surveyed several weeks after undergoing the two procedures recall that they found the procedures to be equally well tolerated or that they preferred colonoscopy. 51,52 The reverse is true when patients are questioned immediately following the two procedures, as was done in a randomized study by Stein of 190 patients agreeing to undergo CRC screening by both procedures. 53 When her patients were questioned immediately afterwards, moderate to severe pain was reported by 85% of individuals during colonoscopy and by 46% during DCBE. The intensity of the pain on a scale of 1 to 10 (nonesevere) was 6.0 for colonoscopy and 3.4 for DCBE. The length of time that the patients experienced pain was related to the length of the procedure, which averaged 31 minutes for colonoscopy and 14 minutes for DCBE.
Serious complications as a result of colonoscopy or DCBE are infrequent. However, perforation is 10 to 90 times more common during colonoscopy (1:500 to 1:1000) than during DCBE (1:10,000 to 1:46,000). 6,30,39,54 Fatalities are 100 to 200 times more frequent with colonoscopy (1:5000 to 1:10,000) than with DCBE (1:1,000,000). 27,54 In addition, with colonoscopy, reports indicate that 3:1000 have major hemorrhage and 5:1000 experience clinically significant respiratory depression. 6,55
The radiation dose received by an individual during barium enema examination has been of concern to many patients and physicians. In reality, the dose is relatively small. During a barium enema, patients are exposed to 300 to 500 mrem, which compares to a radiation dose of 300 mrem during mammography. Considering the age and frequency at which screening is commonly recommended, a CRC screening strategy using barium enema every 5 to 10 years would deliver a lifetime dose that is considerably lower than that for annual screening mammography. There is no direct evidence that barium enema examinations cause clinically important increases in the risk of cancer or other tissue damage. 6
Little attention has been paid to the potential for disease transmission between patients from fecal contamination of instruments. The U.S. Food and Drug Administration and three state health departments found that 24% of fiber-optic endoscopes harbored a significant number of viable bacteria after they had undergone routine disinfection. As a result, they report that "outbreaks with substantial morbidity and mortality have occurred." 56 Other scattered reports in the literature have described minor epidemics caused by contaminated endoscopes. 27 To our knowledge, no studies have investigated the potential for viral transmission by contaminated endoscopes. Conversely, with barium enemas, disease transmission by instruments is not an issue, as only disposable administration sets and contrast media are used to perform the examination.
With the current focus on cost containment in medical care, it is important to appreciate that colonoscopy is much more expensive than DCBE: In most reported series, colonoscopy is 3 to 5 times more costly. In performing CRC screening of large populations, this cost differential is multiplied and becomes enormous. Also contributing to the economic impact of colonoscopy is the fact that the patient must have a recovery period of 1 to 2 hours following the administration of conscious sedation and can not immediately drive an automobile or return to work following the procedure.
Cost-effective screening
Because of a lack of large clinical trials comparing CRC screening tests in an average-risk population, computer models have been used to evaluate the cost-effectiveness of the four common screening tests: FOBT, flexible sigmoidoscopy, DCBE, and colonoscopy. Data largely derived from studies in symptomatic patients have been extrapolated to predict the most effective screening strategies for asymptomatic subjects.
After review of the applicable literature, Eddy discovered that the most cost-effective way to decrease the death rate from cancer is to perform a barium enema every 3 to 5 years (figure 6); 39 slightly less cost-effective was colono-scopy performed every 5 years. Eddy found that more frequent testing was more costly and was ineffective in saving additional lives.
In 1995, the Congressional Office of Technology Assessment published a comprehensive study which found that all four of the CRC screening strategies offer health benefits at a price considerably less than the benchmark value--roughly $40,000 per added year of life--commonly applied to preventive technologies. 57 Despite using an assumption that the sensitivity of DCBE for polyps and cancer is only 70% in an average-risk screening population, they found that DCBE and colonoscopy are comparably cost-effective screening strategies at both 5-year and 10-year intervals (figure 7).
In 1997, an expert panel convened by the United States Agency for Health Care Policy and Research concluded from computer simulations that a screening barium enema every 5 years and screening colonoscopy every 10 years are approximately equivalent in the ability to save lives. In 1998, Glick et al reported the results of another computer model, also using a conservative assumption of 70% sensitivity for detection of polyps and cancer by DCBE compared to a liberal assumption of 90% sensitivity for colonoscopy. Despite this, their data also indicate that the DCBE is comparatively cost-effective as a screening procedure in average-risk individuals. 58
All four of the above mentioned studies observed that screening sigmoidoscopy alone (at any interval) is less effective that the other screening strategies. It should be noted, however, that all of the commonly recommended strategies for CRC screening are more cost-effective than breast cancer screening with mammography and cervical cancer screening using the Papanicolaou technique. 39,57
The American Cancer Society, American Gastroenterological Association, American College of Physicians, American College of Gastroenterology, American Society of Colon and Rectal Surgeons, American Society for Gastrointestinal Endoscopy, American College of Radiology (ACR), American Medical Association, and others are promoting CRC screening and the use of the DCBE as a primary screening tool in average-risk individuals. 3,6,39,59,60 Most of their current recommendations are based on a landmark article in 1997 by Winawer et al, which established guidelines and rationale for CRC screening. 6 The highly respected and frequently quoted ACS guidelines are rather complex because they are tailored to the risk potential of each patient group; however, their recommendations are straightforward for the estimated 70 to 80% of the population who are at average risk (table 3). 3
Medicare reimbursement
Recently, the potential for universal CRC screening was greatly enhanced with the approval of Medicare coverage for such screening tests. Medicare payment was authorized by enactment of The Balanced Budget Act of 1997; 61 the details of Medicare coverage were left to the Secretary of Health and Human Services to define and were published in The Federal Register. 62 Medicare payment for CRC screening was implemented on January 1, 1998. Currently, the Healthcare Financing Administration (HCFA) is allowing Medicare coverage of CRC screening for persons aged 50 years and older (table 4). Under their rules, FOBT can be performed annually, and for average risk individuals, DCBE or sigmoidoscopy can be performed every 4 years. For high-risk individuals, DCBE or colonoscopy can be performed every 2 years.
Colonoscopy has not been approved for CRC screening in the general population due to its higher risk of morbidity and mortality and its much greater cost.
One would expect that Medicare payment for CRC screening would stimulate an increase in the number of barium enemas being performed in this country. However, in the year since the government authorized Medicare coverage for this service, many, if not most radiologists have seen no evidence of a jump in the volume of these studies. Instead, there has actually been a steady decline in the number of barium enemas performed in this country for the last 15 years, with a commensurate increase in the number of colonoscopies performed.
What is wrong? One obvious answer is that radiologists have been much less interested and effective in educating the public and referring physicians about the benefits of the DCBE than have the endoscopists regarding colonoscopy. In addition, many radiologists have focused their attention on mastering newer technologies. As a result, the quality of barium enema examinations has reportedly become inconsistent, and many referring physicians have lost confidence in the value of the examination. If the barium enema is to be utilized for CRC screening, individual radiologists must rededicate themselves to improving the quality of the study and convince their colleagues that it is an effective technique. 63
Standards and quality control
To improve the uniformity and quality of barium enema examinations, the American College of Radiology (ACR) has developed performance standards for these studies. 64 The standards include: 1) appropriate training/certification of radiologists and radiologic technologists, 2) equipment standards and quality control procedures to maintain high-quality fluoroscopic and radiographic images, 3) effective bowel preparation to achieve a clean colon, and 4) strict quality control during the examination using a barium suspension specifically designed for the procedure, introducing an adequate volume of the contrast agent(s) to achieve complete colon examination, and using optimal patient positioning and radiographic technique for film documentation. The ACR quality controls specific to the DCBE are: 1) complete barium coating of the entire colon, 2) good distension of the colon with gas, and 3) demonstration of every segment of the colon in double contrast on at least two radiographs taken in different positions. The ACR also has developed a Barium Enema Quality Control Manual to help facilities establish and maintain a quality control program. 65 This manual, published in 1998, follows the highly successful manual on mammography quality control, first published by the ACR in 1990.
Dr. Richard Mendelson, an Australian radiologist, expressed clearly the challenge that faces radiologists worldwide when he wrote, "The DCBE remains a potentially useful tool...but its continued existence and accuracy are highly dependent on adherence to strict quality control issues....There needs to be an acceptance by radiologists that good-quality barium radiology is a challenge and a goal to be strived for and that gastrointestinal (GI) radiology is a valid subspecialty." 26
As new approaches to CRC screening--with blood and stool tumor markers or new imaging modalities such as CT and MR colonography--come to market, screening strategies will undoubtedly change. For the present, however, DCBE has been established as a safe, accurate, cost-effective, and widely-available total colon examination. Radiologists are obliged to perform the procedure well and educate patients and medical colleagues about the advantages of DCBE as a primary screening test for colorectal cancer and polyps. AR
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Statewide media consultant Ron Sachs went on a Facebook rant after Florida companies were skipped over for a local government contract in Tallahassee.
"The Tallahassee Airport leadership outsourced - without competitive bidding - a web development contract for about $23-thousand to an Atlanta-based company."
The average student loan debt for new graduates last year was more than $26 thousand.
A leading Florida educator compiled data showing most students end up owing less than $20 thousand for a degree that will give them greater earning power.
"People with college degrees make more money than people without college degrees in their lifetime," Dr. Ed Moore says. "People with college degrees are more likely in this kind of economy to be employed."
This year, every proposed change to our state's Constitution placed on the ballot came from the state Legislature.
Experts and activists say that this is because getting an amendment on the ballot in Florida is harder than ever before for citizens, yet significantly easier for state lawmakers.
What Happened to Citizen-led Petitions?
Robin Rorapaugh of Hollywood is the president of a political consulting company that helps groups who want to get an issue on a ballot.
Florida has a national reputation for its Public Records Law. But a new study by the Center for Public Integrity and Public Radio International has given the Sunshine State a D in "Public Access to Information."
The State Integrity Investigation is the first attempt to look across all states at how good the system is for preventing political corruption.
The investigation graded each state on more than 300 indicators of accountability, transparency, and corruption risk. The indicators are divided into 14 categories, which appear on the report card.
State senators decided by two votes last night to kill a massive privatization program designed to reduce state prison costs by seven percent a year. Nine Republicans joined the Democratic minority to kill the bill, which had divided the Senate and called into question the leadership of Senate President Mike Haridopolos.
The privatization scheme called for turning 28 southern Florida institutions over to private contractors, eliminating thousands of jobs and reducing the state prison budget by an estimated seven percent.
Florida's no-fault insurance requirement is set to undergo major changes this legislative session.
Right now, Florida drivers are required to have $10,000 worth of personal injury protection, or PIP, for payout in a crash regardless of who is at fault.
But fraudsters have taken advantage of this system, and auto insurance rates are skyrocketing.
Florida is one of the most expensive states for car insurance, according to the Insurance Information Institute. A fender bender can cost an insurance company tens of thousands of dollars.


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The way the government should be investing in alternative energy
So far, government attempts at making alternative enery happen have been uniformly disasterous. They either give direct subsidies or create mandated government markets (such as Governor Rhino of Minnesota passing a law that dictates the amount of green energy that the state utilities will provide). Neither of these approaches result in actual "alternatives" but rather higher costs for everyone. What's worse, they take money from | Read More »