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A Rule Against Murder
by Louise Penny
Book #4 in the Armand Gamache series, published 2008
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"What happened here last night isn't allowed," said Madame Dubois.
It was such an extraordinary thing to say it stopped the ravenous Inspector Beauvoir from taking another bite of his roast beef on baguette.
"You have a rule against murder?" he asked.
"I do. When my husband and I bought the Bellechasse we made a pact….Everything that stepped foot on this land would be safe."
It is the height of summer, and Armand and Reine-Marie Gamache are celebrating their wedding anniversary at Manoir Bellechasse, an isolated, luxurious inn not far from the village of Three Pines. But they're not alone. The Finney family—rich, cultured, and respectable—has also arrived for a celebration of their own.
The beautiful Manoir Bellechasse might be surrounded by nature, but there is something unnatural looming. As the heat rises and the humidity closes in, some surprising guests turn up at the family reunion, and a terrible summer storm leaves behind a dead body. It is up to Chief Inspector Gamache to unearth secrets long buried and hatreds hidden behind polite smiles. The chase takes him to Three Pines, into the dark corners of his own life, and finally to a harrowing climax.


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Yesterday my husband and I had the same thought at the same time. It's not an uncommon occurrence for two writers who've spent decades arguing and enthusing about pop music. I mention it, in part, to stave off accusations that I'm plagiarizing from a nearby source, but also because I think what we reflected upon in light of the writer Jonah Lehrer's fatal mistake was probably in the minds of many music obsessives. Here's what Eric wrote on Facebook just as I was pitching the idea for this column:
This might be obvious, but the person whose quotes Lehrer made up, Dylan, fabricated characters and quotes in his own autobiography, lied about his upbringing when he appeared on the scene, steals all the time, and is celebrated as our culture's very definition of genius.
Eric's observation inspired 20 or so responses, mostly from other writers, mostly insisting that Lehrer not be given a pass for a grievous journalistic misstep. The best-selling author fabricated quotes from one of the world's most-quoted artists — a reckless act that, to me, suggests desperation more than anything else. (How much time did his publishing company give him to write Imagine, I wonder?) He resigned his position at The New Yorkerand, like other fallen stars from James Frey to Jayson Blair, has become an overnight example of what the pressure of stardom can do to young, smart minds. Yet there is painful poetry in the fact that rock's ultimate purveyor of what P.T. Barnum called " humbug" — "glittering appearances" and "novel expedients" — was the source of Lehrer's downfall.
Before the Dylanologists out there attack, let me quickly add that I believe Bob Dylan is also one of the world's ultimate purveyors of truth. He's the greatest lyricist pop has ever seen (up there, anyway, with Chuck Berry and Cole Porter), and the living example of how to turn a Buddy Holly fixation into world-changing art. In the New York Times, Ben Sisario responded to the Lehrer scandal by writing that Dylan's "oracular, mysterious voice" has been the downfall of many who've tried to interpret him. To say Dylan is what my Bing Crosby-loving late father would have called a "bulls- - -ter" is not to underestimate his greatness.
As Sisario's article suggests, one reason Dylan resists easy interpretation is because he's downplayed his own specialness over the years in order to shove off the burden of being overly mythologized. That hasn't stopped others from making hay of his every utterance. If only Lehrer had added something new to this pile. As music writing, Lehrer's analysis of Dylan's creative process is hackneyed; he regurgitates a story every Dylan fan knows without adding any particular insight. The quotes he falsely assembled are mostly just throat-clearing. Dylan's the victim of wrongdoing here, but he was hardly wounded in the scuffle. Maybe I'm wrong, but I've been imagining him having a mournful little laugh over this minor chapter in the long history of others trying to grasp his game.
The history of people's attempts to understand Bob Dylan, which stretches back as long as the bard's own career, takes a few turns. Early advocates lauded him as a socially conscious game-changer. Later, followers debated his choices to go electric, get off the bus, go country, get religion, make indulgent art movies, explore reggae and record a bunch of Christmas classics.
Most recently, following the publication of Greil Marcus' groundbreaking 1997 book Invisible Republic: Bob Dylan's Basement Tapes, it's become de rigueur to understand Dylan as part of the American tradition of self-made fantastical folk heroes. Dylan's been exposed — and happily exposed himself — as a semi-fictional character constructed from memories of Barnum's circus freaks, the caricatures of blackface minstrelsy and the ghost stories of the Wild West, as much as from "higher" sources like Walt Whitman or the civil rights movement.
In Imagine, Lehrer focuses on the transformative moment in which Dylan penned "Like a Rolling Stone" — a process of inspiration and execution so overwhelming that the songwriter compared it to vomiting. "Vomit is the essential word here," Lehrer writes. "Dylan was describing, with characteristic vividness, the uncontrollable rush of a creative insight, that flow of associations that can't be held back." It was a life-changing moment for Dylan, one stressed in most accounts of his life, including Marcus' own short book on the song. And there's no doubt that at the time, Dylan felt like he'd done something new and profound. "I mean, nobody's ever really written songsbefore, really," he said in the same radio interview that included that colorful regurgitation reference.
Yet by 1966 Dylan was already a major faker who lifted his original drawl from Woody Guthrie, his protective sunglasses from Roy Orbison — and his new artistic ambitions, arguably, from The Beatles. The phrase that Lehrer singles out as particularly original from the lyric, "You've gone to the finest school all right, Miss Lonely / But you know you only used to get juiced in it," is an unusual word choice that, according to Lehrer, serves Dylan's need to rhyme something with "get used to it" — and was common parlance for getting drunk in the language of the Beats and the blues hipsters from whom Dylan constantly and shamelessly borrowed.
This is the essence of the popular arts in America: Be a magpie, take from everywhere, but assemble the scraps and shiny things you've lifted in ways that not only seem inventive, but really do make new meanings. Fabrication is elemental to this process — not fakery, exactly, but the careful construction of a series of masks through which the artist can not only speak for himself, but channel and transform the vast and complicated past that bears him or her forward.
Integrity arises in the process of solidifying your relationship to those sources. For a journalist like Lehrer, there's a code, and he clearly violated it. An artist like Dylan shows us a different way of operating: of using insight not to shore up a myth of originality, but to connect to all the tall tales and ghost stories that establish a culture's character, to walk through a dreamscape whose atmosphere sticks to us and makes us who we are.
Dylan himself described this process in a 1963 poem he wrote for his hero, another truth-telling, self-made character. "You need something to open up a new door / To show you something you seen before / But overlooked a hundred times or more," read the lines from "Last Thoughts on Woody Guthrie." In art, originality is never that original. But that doesn't make it less real.
Copyright 2020 NPR. To see more, visit https://www.npr.org.

subset: commoncrawl


text: Essay and poster winners in the Elks Drug Abuse competition for 2011 were honored by the Elks Club of Ocean City/Berlin. Each winner received a Savings Bond and a soccer ball. Pictured, from left, are Paul Yates, Exalted Ruler of the Ocean City/Berlin Elks; seventh graders Caroline Savage, Kathleen Emche and Lauren Meoli; and Pete Peterson, Elks Drug Awareness Chairman.


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Looking Back on a Banner Year
By James Davis, Education Program Manager
June 2018
Sierra Club BC's Education Program wrapped up another year of our school-based programming last week, with Kirsten delivering workshops at schools in Terrace and Kitimat and Amira facilitating our new French language workshops for kindergarten and grade 1 and 2 students in Victoria.
Over the past nine months, Amira and Kirsten have worked with over 7,300 students across the province. They facilitated 334 workshops at 116 schools in 25 different school districts. Pretty incredible!
Kirsten and I facilitated professional development training for teachers in Vanderhoof (School District 91), Victoria (School Districts 61, 62 and 63) and Chilliwack (School District 33). We also supported teachers in the Capital Regional District to take their students outside more often for meaningful learning experiences through our monthly after-school teacher gatherings and the mentorship sessions that Kirsten facilitated with teachers at 13 different schools.
We are grateful to the Victoria Foundation, the Greater Victoria Savings and Credit Union Legacy Foundation and NSERC for funding this pilot project and we hope to be able to continue some iteration of it during the 2018/2019 school year.
It's been a pleasure for all three of us to work with students and teachers across the province and we are thankful for all that we have learned from them. We look forward to helping more students get outside and learn in the fall.
In the meantime, here's some inspiration for getting the kids in your life outside over the summer break.
And some awesome photos of our team in action from this year:
Photos by Brynne Morrice


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LOS ANGELES (thefutoncritic.com) -- The latest development news, culled from recent wire reports:
Looking to keep track of all the various projects in development? Click here to visit our signature "Devwatch" section. There visitors can view our listings by network, genre, studio and even development stage (ordered to pilot, cast-contingent, script, etc.). It's updated every day!
Commitment: Ordered to pilot Cast: Bruce McGill (General Keller), Jane Lynch (Irene Maloof), Kelvin Yu, Matthew Lillard (Colonel Steven Isaac), Paul Reubens (The Alien) Writer: Mike Armstrong Director: Dean Parisot Executive Producers: David Latt, Dean Parisot, Mike Armstrong Studio: NBC Universal Television Studio
Chase then is set as Michael - "24-27, smart, funny, wry and unathletic, he is the polar opposite of his father Calvin and is highly aware that he was not Calvin's first choice for a partner. (In fact, he was about 20th down the line.) Kind and easy-going, Michael has a degree in psychology and is currently a fly-fishing instructor, neither of which has earned him his father's respect. Though he's not thrilled to be participating in Dash 4 Cash, he does want to form a better relationship with his dad and takes steps toward making that happen. Sparks fly between Michael and Noelle, another contestant." - with Hall as his father, Calvin - "Mid 40s. This no-nonsense, super-patriotic, blue-collar man's man has reluctantly partnered up with his son and polar opposite, Michael. He would much rather have his other son (a lumberjack) on his team and frequently lectures and berates Michael for his lack of cajones. Vaguely homophobic, proud and difficult to please, he just wants his son to man-up so they'll have a decent shot at winning. He's furious when Michael sprains his ankle, but secretly, he wouldn't mind having a closer relationship with his son. He's not about to say that in so many words, though."
Commitment: Ordered to pilot Cast: Jonathan Chase (Michael), Kyle Bornheimer (Nick), Rick Hall (Calvin) Writers: Boyce Bugliari, Jamie McLaughlin Director: Betty Thomas Executive Producers: Kelsey Grammer (Grammnet Productions), Steve Stark (Grammnet Productions) Co-Executive Producers: Boyce Bugliari, Jamie McLaughlin Studio: CBS Paramount Network Television
Commitment: Ordered to series (seven episodes) Cast: Brad Daugherty (Host), Kenny Mayne (Host) Writer: TBA Director: TBA Executive Producers: TBA Studio: @radical.media
Commitment: Ordered to pilot (14-20 minute presentation) Cast: Jaime Ray Newman (Paige Armstrong), Neal Bledsoe (Michael "Birdy" McGinty), Will Lyman (Congressman Noah Benjamin Foxworthy) Writer: Rod Lurie Director: Rod Lurie Executive Producers: Darryl Frank (DreamWorks Television), Justin Falvey (DreamWorks Television), Marc Frydman (Battle Plan Productions), Rod Lurie (Battle Plan Productions) Studio: ABC Television Studio
Commitment: Ordered to pilot Cast: Atticus Shafer (Brick), Brenna O'Brien (Sue), Michael Mitchell (Elvis), Lex Medlin, Ricki Lake (Frankie) Writers: DeAnn Heline, Eileen Heisler Director: Chris Koch Executive Producers: DeAnn Heline, Eileen Heisler Studio: Warner Bros. Television
Commitment: Ordered to pilot Cast: Caroline Chikezie (Rachel), Flex Alexander (Eric), Gregory Itzin (Gary Stone), Jane Curtin (Joy), Jayma Mays (Angela), Kathryn Hahn (Price), Matthew Morrison (Brody) Writers: Jeff Ventimilia, Josh Sternin Director: Gail Mancuso Executive Producers: Brian Grazer (Imagine Television), David Nevins (Imagine Television), Jeff Ventimilia, Josh Sternin Producers: Julie Richardson, Lois Frankel Studio: 20th Century Fox Television
Commitment: Ordered to pilot Cast: Dana Ivey (Molly), Lauren Ambrose (Sarah), Michael Arden (Buddy), Parker Posey (Coco), Ron McLarty (Donald), Scott Cohen (Marcus) Writer: Amy Sherman-Palladino Director: Amy Sherman-Palladino Executive Producers: Amy Sherman-Palladino (Dorothy Parker Drank Here Productions), Daniel Palladino (Dorothy Parker Drank Here Productions) Studio: Regency Television
Commitment: Ordered to pilot Cast: Angus Macfadyen (Claude), Cynthia Watros (Eva), Erick Avari (Dr. Hakim), Marisa Tomei (Penelope Cloud), Nick D'Agosto (Ivy) Writer: Jeff Greenstein Director: TBA Executive Producers: Jeff Greenstein Studios: ABC Television Studio, CBS Paramount Network Television
Commitment: Ordered to pilot (14-20 minute presentation) Cast: Annie Potts (Bunny), Enuka Okuma (Joanna), Justin Hartley (Danny), Lauren Bittner (Alex) Writer: Maggie Friedman Director: James Frawley Executive Producers: Becky Hartman-Edwards, Maggie Friedman Studio: Warner Bros. Television
Commitment: Script Cast: TBA Writer: James L. White Director: TBA Executive Producers: TBA Producer: Anne-Marie Mackay Studio: HBO Films
Commitment: Script Cast: TBA Writers: Joel Fields, Steven Bochco Director: TBA Executive Producers: Joel Fields, Steven Bochco (Steven Bochco Productions) Studio: TBA
Sources: Variety, The Hollywood Reporter, Reuters


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Digman, Matthew | |
SHINNERS, KEVIN - University Of Wisconsin |
Submitted to: Symposium Proceedings
Publication Type: Proceedings Publication Acceptance Date: 2/15/2013 Publication Date: 2/28/2013 Citation: Digman, M.F., Shinners, K.J. 2013. Technology background and best practices: yield mapping in hay and forage. In: Proceedings of the Idaho Hay and Forage Conference, February 28-March 1, 2013, Burley, Idaho. p. 44-49. Interpretive Summary: Technical Abstract: Over the last decade, researchers have worked to develop yield and moisture sensors that allow on-the-go collection of hay and forage yields in a spatial manner. Work has been conducted on windrowers, forage harvesters, large square and round balers. However, commercial implementation has been limited to the forage harvester and square baler, and the square baler application does not yet allow yield to be spatially predicted. Adoption has been slowed by three main factors: cost of the systems, uncertainty of payback given generally low forage crop inputs, and challenges associated with accurately estimating hay and forage moisture, which is needed to accurately determine dry matter yield. However, as sensor cost decreases and input costs increase, Precision Agriculture applications will make more economic sense for our hay and forage crops. |


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Are you planning an outdoor wedding and just need a beautiful place to exchange vows? Our Gazebo or Pergola outdoor space is the perfect solution! The Gazebo and Pergola is rented separately from the Banquet Facility, as long as there isn't another event taking place that day. You may decorate the Gazebo or Pergola to your individual taste, and either rent chairs from us or bring in your own chairs.
You and your guests will have use of the patio and outdoor area, and access to the restrooms inside the Civic Center. Unfortunately there can be no alternate accommodations in the event of inclement weather. See page seven (7) of our RENTAL POLICY.
To plan for inclement weather, and to have your ceremony and reception all in one location, you may rent the gazebo or pergola space in addition to renting the Banquet Facility. Renting the two spaces together ensures you have a back-up location for your ceremony in case of inclement weather, as well as you can have the flexibility of hosting an outdoor ceremony location and an indoor reception location for your guests.


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Australian tarantula venom contains novel insecticide against agricultural pests
Spider venoms are usually toxic when injected into prey, but a new protein discovered in the venom of Australian tarantulas can also kill prey insects that consume the venom orally. The protein is strongly insecticidal to the cotton bollworm, an important agricultural pest, according to research published September 11 in the open access journal PLOS ONE by Glenn King and Maggie Hardy from the Institute of Molecular Bioscience at the University of Queensland, Australia, and colleagues from other institutions.
The small protein, named orally active insecticidal peptide-1 (OAIP-1), was found to be highly toxic to insects that consumed it, with potency similar to that of the synthetic insecticide imidacloprid. Cotton bollworm, a pest that attacks crop plants, was more sensitive to OAIP-1 than termites and mealworms, which attack stored grains.
These and other insect pests reduce global crop yields by 10-14% annually and damage 9-20% of stored food crops, and several species are resistant to available insecticides. Isolated peptides from the venom of spiders or other venomous insectivorous animals, such as centipedes and scorpions, may have the potential to serve as bioinsecticides. Alternately, the authors suggest the genes encoding these peptides could be used to engineer insect-resistant plants or enhance the efficacy of microbes that attack insect pests. King elaborates, "The breakthrough discovery that spider toxins can have oral activity has implications not only for their use as bioinsecticides, but also for spider-venom peptides that are being considered for therapeutic use."
More information: Hardy MC, Daly NL, Mobli M, Morales RAV, King GF (2013) Isolation of an Orally Active Insecticidal Toxin from the Venom of an Australian Tarantula. PLoS ONE 8(9): e73136. DOI: 10.1371/journal.pone.0073136
Journal information: PLoS ONE
Provided by Public Library of Science


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HIPAA compliant file transfer and messenger securing the healthcare sector
Secure patient data and transfer files of any size in an end-to-end encrypted zone. Chat and share files with colleagues in inbuilt multi-platform messenger.
Meets privacy regulations and requirements set out in the Health Insurance Portability and Accountability Act (HIPAA) for transmitting and securing private electronic health data. -
Files secured with AES 256-bit encryption and sent via a secure channel (https). Encrypt data on your server or in the cloud. Send files and manage confidential records while protecting patient data. -
Fully customizable for hospitals, healthcare centers or even physicians. A unique get2Cloulds can be created for individual enterprises to be downloaded by their staff on all major app stores. -
Inbuilt intuitive messenger lets doctors chat and send files such as X-Rays and MRI imaging to colleagues without the risk of third party interference or hindering doctor/patient confidentiality.
Storing and sharing patient data in the digital age
Patient data has moved from paper to digital, and the cloud is surpassing tradition hard copy storage. As well as patient databases being stored the cloud, physicians often communicate with each other over common messenger apps.1 These practical, but risky solutions make healthcare the most cyber-attacked sector.In 2017 alone, the NHS in the UK was rocked by a breach of 26 million patient files,2 and in the US 5.6 million patient files were compromised.3 Hackers steal patients' personal information and sell the data on the dark web or use it for fraud. Medical data is more profitable than financial records for cyber criminals.
The sacred right to doctor/patient confidentiality—which is recognized by the 1948 Universal Declaration of Human Rights—is being jeopardized. In this environment, cloud security measures are vital. With a moral and legal obligation to secure patient confidentiality, healthcare providers need to do more. Personal health information should never be shared through email or personal cloud storage if it is not encrypted. With get2Clouds, medical staff can securely send and access sensitive files from anywhere, on any device.
- https://www.androidheadlines.com/2018/01/new-whatsapp-security-flaw-can-compromise-group-chats.html
- http://www.telegraph.co.uk/news/2017/03/17/security-breach-fears-26-million-nhs-patients/
- https://www.healthcare-informatics.com/news-item/cybersecurity/2017-breach-report-477-breaches-56m-patient-records-affected
get2Clouds for the health sector
- HIPAA compliance thanks to encryption
- Customizable for individual hospitals, healthcare centers or doctors
- Send high res images in messenger
- Compatible with all major cloud providers
- Sync your current cloud to secure get2Clouds
- Encrypt data on network attached storage (NAS)
- Set personalized password for highly sensitive files
- Verify recipients' identity with FaceCheck®
- 555 number for devices with no SIM or to protect anonymity
- Easy-to-use drag and drop functionality
- Mobile and desktop application, use across multiple devices


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Truly Scary Texas-Themed Halloween Costume Ideas
There's no shortage of scary stuff going on in the Lone Star State to inspire your Halloween costume this year. A little ingenuity and some duct tape can take you far this holiday. If you're having trouble thinking of costume ideas, here's my list of truly scary concepts that are, sadly, not just ghost stories:
President Rick Perry
Rick Perry's sinking poll numbers show that maybe even Republicans are afraid to send our governor to the White House, which means this costume has what it takes to cross the aisle and scare everyone at the party. Items needed: Suit and tie (preferably red), hair gel and a cardboard podium with a presidential seal. For extra bonus, bring mangled talking points about Mitt Romney.
A Voter Redistricting Map
What could be more terrifying for Texans than a future as unrepresented voters? It could happen if the recently redrawn voter districts are approved by a federal court in Washington, D.C. And if a decision isn't made by the December 12 deadline, we're in for a series of confusing election cycles while the courts impose temporary districts that can then be changed in 2014. Try figuring out who's representing you then. Items needed: A print-out of the proposed maps from the internet, all-black clothes. Tape the maps to your clothes and face-palm yourself repeatedly throughout the evening.
A Forced Sonogram
This is a group costume if we ever saw one. You'll need one abortion patient and several men in suits, with at least one of them wearing a cowboy hat like Rep. Sid Miller, (R-Stephenville). Texas' new abortion sonogram law hasn't become law while its constitutionality is debated in federal court. But there's still a chance that Texas women will have to obtain a sonogram—and listen to scripted description of the fetus—before an abortion. Items needed: A hospital gown for the patient and a print out of a sonogram. The men should point at the patient disapprovingly.
A Feral Hog
Forget the Chinese calendar. In Texas, 2011 was the year of the feral hog. All culminating with a reality show that debuted this month on A&E called American Hoggers featuring a family of Central Texas hog hunters who are much in demand. "Texas is home to nearly 2.6 million feral hogs, the largest feral hog population in the U.S." says the Texas Department of Agriculture homepage. "Texas AgriLife Extension Service estimates that statewide annual economic damage caused by feral hogs is $500 million." Perhaps even more terrifying, the American Hoggers website describes the porcine beasts as, "Creatures of the night that roam in packs and eat almost anything, including their young." Gulp. Items needed: A pig mask and a leg of lamb.
A Confederate Flag License Plate
This silly thing is still being debated by the Texas Department of Motor Vehicles board, which means it could become a reality despite Texas' exploding minority population. Want to scare all the people of color? Wear a giant Texas Confederate license plate made out of cardboard. Items needed: Cardboard, paint and an athletic cup would probably be advisable. And maybe protective head gear too.
A St. Louis Cardinal
At the time of this writing, we're not sure who will win the 2011 World Series, but we can bet that whoever wins, a St. Louis Cardinal will be seen as a real villain to most Texas Rangers fans. Items needed: Cardinals cap and uniform, baseball bat (this serves as handy protection) and heart-shaped locket with photo of Tony LaRussa inside.
A Middle School-Aged Rick Perry Campaign Donor
In the tradition of Children of the Corn comes "Children of the GOP." That's what I'm calling the two kids who gave $3,500 worth of campaign money to Rick Perry in August. Who were they? According to Christina Wilkie at The Huffington Post they belonged to recently appointed Texas Railroad Commissioner Barry Smitherman. Smitherman, his wife and his college-aged son all donated the maximum of $2,500 each to Perry's presidential campaign that month, but it was Smitherman's minor children's generosity that really raise some eyebrows (mine anyway):
Their only daughter, who appears to be of middle school age judging from her dad's campaign website, also donated $2,500. And one of her brothers, who is a junior in high school according to his Twitter feed, donated $1,000. Smitherman declined to respond to questions from The Huffington Post about whether the money belonged to his children or to him.
Items needed: A Justin Bieber t-shirt and some monopoly money to wave around.
The Fast & Furious Arms & Drug Scandal
I don't know what's scarier, that the federal government is importing cocaine and providing arms for Mexico's Zeta cartel or the fact that very few people are talking about it. Needed: This one is best for a pair or couple. You need one U.S. Border Patrol uniform and one Narco costume (cowboy hat, sunglasses, gold chain should do it), a fake automatic rifle and a fake bag of cocaine. If you figure out a way to create a bed to lie in together, you're sure to win your local costume contest.
The Texas School Budget
Perhaps the scariest thing on this list. Texas lawmakers cut an unprecedented $5 billion from public education this year. Items needed: An adding machine and some illiterate children—they shouldn't be hard to find


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Experience easy web & multipoint video conferencing, it takes just seconds to start a free trial. There is no obligation.
Our solution experts can provide live web demos, referrals to more information or quickly answer any questions you may have. Contact Us.
Depending on how a conference has been set up, there can be up to 13 different privileges in a conference. These privileges can be given or taken away from any conference attendee by a Host.
You can give or remove specific privileges from attendees by the following steps.
The Record privilege, allows the attendee to record the conference by selecting "Record conference" via the "n" application menu.


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Cold-Brew Coffee Kick
Cold is not a word usually associated with making java, but a growing number of caffeine connoisseurs are snapping up cold-brewing systems like the Toddy Coffee Maker. Ground coffee and cold water go into a plastic brewing container and are allowed to steep for 8 to 12 hours, resulting in a coffee concentrate that is then combined with hot water and warm milk or poured over ice to make the cup of your choice. The lack of brewing heat means fewer acids are extracted from the coffee, resulting in a beverage that's smoother and milder than your traditional cupful.


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Allied health professions
Direct health professions are health care professions distinct from nursing, medicine, and pharmacy.[1] They work in health care teams to make the health care system function by providing a range of diagnostic, technical, therapeutic and direct patient care and support services that are critical to the other health professionals they work with and the patients they serve.
In September 2012 the organization of International Chief Health Professions Officers (ICHPO) provided an agreed-upon definition of an allied health professional.
Direct Health Professions are a distinct group of health professionals who apply their expertise to prevent disease transmission, diagnose, treat and rehabilitate people of all ages and all specialties. Together with a range of technical and support staff they may deliver direct patient care, rehabilitation, treatment, diagnostics and health improvement interventions to restore and maintain optimal physical, sensory, psychological, cognitive and social functions.
The International CHPO group is a network of chief officers with a professional and policy leadership role for direct health professions and supports knowledge exchange and partnership working across the international community ICHPO member countries: Australia, Belgium, Canada, Denmark, England, Hong Kong (SAR), Malaysia, Malta, Namibia, New Zealand, Northern Ireland, Scotland, Singapore, Slovenia, South Africa, Republic of Ireland, and Wales.
Depending on the country and local health care system, a limited subset of the following professions (professional areas) may be represented, and may be regulated:
- Anesthesia technician
- Anesthesiologist assistant
- Art therapist/art psychotherapist
- Athletic trainer
- Audiologist
- Autotransfusionist
- Cardiovascular technologist
- Chiropractor
- Clinical laboratory scientist
- Clinical neurophysiology
- Clinical officer
- Dental hygienist
- Dental therapist
- Denturist/clinical dental technician
- Dietitian/nutritionist
- Electrocardiogram technician
- Emergency medical technician
- Environmental health officer
- Exercise physiologist
- Lactation consultant
- Massage therapist
- Medical assistant
- Medical coder
- Medical interpreter
- Medical laboratory scientist
- Medical radiation scientist
- Medical scribe
- Medical transcriptionist
- Music therapist
- Occupational therapist
- Operating department practitioner
- Orthoptist
- Orthotist/prosthetist
- Osteopathy
- Paramedic
- Pedorthist
- Perfusionist
- Phlebotomist
- Psychologist
- Physician Assistant
- Physical therapist/physiotherapist
- Podiatrist
- Public health epidemiologist
- Radiographer (or radiology technologist; includes specialist radiographers, e.g. angiographer, mammographer, etc.)
- Radiotherapist/radiation therapist/medical dosimetrist
- Recreational therapist
- Rehabilitation counselor
- Renal dialysis technologist[2]
- Respiratory therapist
- Social workers
- Sonographer (often, but not always, state-registered radiographers)
- Speech and language pathologist
- Sterile processing technician
- Surgical technologist
The precise titles, roles and requisites of allied health professionals may vary considerably from country to country.
Training and education
Some Direct health professions are more specialized, and so must adhere to national training and education standards and their professional scope of practice. Often they must prove their skills through degrees, diplomas, certified credentials, and continuing education. Other allied health professions require no special training or credentials and are trained for their work by their employer through on-the-job training (which would then exclude them from consideration as an allied health profession in a country like Australia). Many allied health jobs are considered career ladder jobs because of the opportunities for advancement within specific fields.[3]
Allied health professions can include the use of many skills. Depending on the profession, these may include basic life support; medical terminology, acronyms and spelling; basics of medical law and ethics; understanding of human relations; interpersonal communication skills; counseling skills; computer literacy; ability to document healthcare information; interviewing skills; and proficiency in word processing; database management and electronic dictation.[4]
The explosion of scientific knowledge that followed World War II brought increasingly sophisticated and complex medical diagnostic and treatment procedures. Increasing public demand for medical services combined with higher health care costs provoked a trend toward expansion of service delivery from treating patients in hospitals to widespread provision of care in physician's private and group practices, ambulatory medical and emergency clinics, and mobile clinics and community-based care. In the developing world, international development assistance led to numerous initiatives for strengthening health workforce capacity to deliver essential health care services. What followed has been an increase in the need for skilled health care delivery personnel worldwide.
Changes in the health industry and emphasis on cost-efficient solutions to health care delivery will continue to encourage expansion of the allied health workforce. The World Health Organization estimates there is currently a worldwide shortage of about 2 million allied health professionals (considering all health workers aside from medical and nursing personnel) needed in order to meet global health goals.[5]
In recognition of the growth of the number and diversity of allied health professionals in recent years, the 2008 version of the International Standard Classification of Occupations increased the number of groups dedicated to allied health professions. Depending on the presumed skill level, they may either be identified as "health professionals" or "health associate professionals". For example, new categories have been created for delineating "paramedical practitioners"—grouping professions such as clinical officers, clinical associates, physician assistants, Feldshers, and assistant medical officers—as well as for community health workers; dietitians and nutritionists; audiologists and speech therapists; and others.[6]
Employment projections
Projections in the United States and many other countries have shown an expected long-term shortage of qualified workers to fill many allied health positions. This is primarily due to expansion of the health industry due to demographic changes (a growing and aging population), large numbers of health workers nearing retirement, the industry's need to be cost efficient, and a lack of sufficient investment in training programs to keep pace with these trends.[7][8]
Studies have also pointed to the need for increased diversity in the allied health workforce to realize a culturally competent health system in the United States[9] and elsewhere.
Workforce and health care experts anticipate that health services will increasingly be delivered via ambulatory and nursing care settings rather than in hospitals. According to the North American Industry Classification System (NAICS), the health care industry consists of four main sub-sectors, divided by the types of services provided at each facility:[10]
- Hospitals: primarily provides inpatient health services and may provide some outpatient services as a secondary activity.
- Ambulatory health care settings: primarily provides outpatient services at facilities such as doctors' offices, outpatient clinics and clinical laboratories.
- Nursing and residential care facilities: provides residential care, such as community care for the elderly or mental health and substance abuse facilities.
- Social Assistance: provides services for the elderly and/or disabled, services for the homeless and poor, vocational rehabilitation, or child day care services.
In the US, a larger proportion of the allied health care workforce is already employed in ambulatory settings. In California, nearly half (49.4 percent) of the allied health workforce is employed in ambulatory health care settings, compared with 28.7 percent and 21.9 percent employed in hospital and nursing care, respectively.[11] One source reported allied health professionals making up 60 percent of the total US health workforce.[12]
In the United Kingdom there are 12 distinct professions who are considered allied health professionals; in combination they account for about 6% of the NHS workforce. In 2013 the annual expenditure on services provided by allied health professionals amounted to around ₤2 billion, although there is a lack of evidence around the extent to which these services improve the quality of care.[13]
Advancements in medical technology also allow for more services that formerly required expensive hospital stays to be delivered via ambulatory care. For example, in California, research has predicted the total consumption of hospital days per person will decline from 4 days in 2010 to 3.2 days in 2020 to 2.5 days in 2030. In contrast, the number of ambulatory visits per person will increase from 3.2 visits per person in 2010 to 3.6 visits per person in 2020 to 4.2 visits in 2030.[14]
In developing countries, many national human resources for health strategic plans and international development initiatives are focusing on scaling up training of allied health professions, such as HIV/AIDS counsellors, clinical officers and community health workers, in providing essential preventive and treatment services in ambulatory and community-based care settings.[15]
With this growing demand for ambulatory health care, researchers expect to witness a heavier demand for professions that are employed within the ambulatory sector and other non-hospital settings—in other words, allied health.[16]
See also
- Health care providers
- Human resources for health
- Unlicensed assistive personnel
- "What is Allied Health?". Association of Schools of Allied Health Professionals. Archived from the original on 2014-03-31. Retrieved 6 March 2014.
- Allied Health, Sciences. "Renal Dialysis Technology". SRU AHS. Retrieved 26 May 2014.
- "United States Bureau of Labor Statistics". Archived from the original on 20 April 2010. Retrieved 2010-04-24.
- "Explore by career: Allied Health Professions: Skills required". NHS Careers. Retrieved 17 August 2014.
- World Health Organization (2006), The World Health Report 2006. Geneva: World Health Organization.
- Dal Poz MR et al. (2009), Boundaries of the health workforce: definition and classifications of health workers. In: Handbook on monitoring and evaluation of human resources for health. Geneva: World Health Organization.
- "National Skills Coalition, America's Forgotten Middle Skills Jobs Report" (PDF). Archived from the original (PDF) on 2011-07-27. Retrieved 2010-04-24.
- "Association of Academic Health Centers Out of Order Out of Time Report". Retrieved 2010-04-24.
- "California Endowment, Workforce Diversity". Archived from the original on 2010-05-25. Retrieved 2010-04-24.
- "2017 NAICS Definition". North American Industry Classification System. Retrieved 14 December 2018.
- "California Health Jobs, Help Wanted Report". p. 13. Retrieved 2010-04-24.
- "University of California San Francisco, Advancing the Allied Health Professions". Futurehealth.ucsf.edu. Retrieved 2012-03-06.
- Bardsley, Martin. "Focus on: Allied health professionals". QualityWatch. Nuffield Trust/Health Foundation. Retrieved 12 March 2015.
- "California Health Jobs, Help Wanted Report" (PDF). www.calhealthjobs.org. p. 14. Retrieved 18 February 2016.
- "PEPFAR Country Profile" (PDF). Retrieved 2012-03-06.
- "California Health Jobs, Help Wanted Report". Retrieved 2010-04-24.
External links
Wikimedia Commons has media related to Allied health professions. |


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Charlotte ( SHAR-lət) is the most populous city in the U.S. state of North Carolina. Located in the Piedmont region, it is the county seat of Mecklenburg County. The population was 874,579 at the 2020 census, making Charlotte the 16th-most populous city in the U.S., the seventh most populous city in the South, and the second most populous city in the Southeast behind Jacksonville, Florida. The city is the cultural, economic, and transportation center of the Charlotte metropolitan area, whose 2020 population of 2,660,329 ranked 22nd in the U.S. Metrolina is part of a sixteen-county market region or combined statistical area with a 2020 census-estimated population of 2,846,550.Between 2004 and 2014, Charlotte was ranked as the country's fastest-growing metro area, with 888,000 new residents. Based on U.S. census data from 2005 to 2015, Charlotte tops the U.S. in millennial population growth.
Barclay Downs, Biddleville, Carmel, Chantilly, Charlotte center city, Cherry, Clanton Park/Roseland, Commonwealth Park, Derita / Statesville, Dilworth, Double Oaks, Druid Hills North, Druid Hills South, East Forest, Eastover


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A pro-bitcoin head of digital assets from TD Ameritrade has been appointed as the Federal Reserve System's chief innovation officer. This is "a new role in which she will lead efforts to identify, research, enable and advocate for new technologies," the Fed explained.
The Fed's New Chief Innovation Officer Is Pro-Bitcoin
The Federal Reserve Bank of Richmond serves as the hub of the Federal Reserve's enterprise IT organization. This nationwide team delivers technology solutions and support across the Federal Reserve System and the Board of Governors. The Richmond Fed announced Monday:
Sunayna Tuteja has been appointed as the Federal Reserve System's chief innovation officer.
The announcement explains that this is a new role and Tuteja "will lead efforts to identify, research, enable and advocate for new technologies while fostering a culture of innovation, collaboration and experimentation." The appointment became effective on Feb. 22.
Prior to joining the Fed, Tuteja worked at TD Ameritrade, one of the largest online brokers in the U.S., where she was head of digital assets. She also previously served as head of strategic partnerships and emerging technologies as well as head of digital strategy, experience and innovation at the company.
The crypto community sees Tuteja's appointment as bullish. Lawyer Jake Chervinsky opined, "Continuing the trend of leadership roles in government being filled by extremely talented people with deep crypto knowledge & experience." Bitcoin bull Mike Novogratz congratulated Tuteja, tweeting, "This is a big deal."
Tuteja shared her thoughts about bitcoin and its supporters in a series of tweets on Dec. 16, 2020. The former head of digital assets at TD Ameritrade wrote:
[The] Thing I admire most about the bitcoin community is resilience. Sheer amount of shade & schadenfreude directed at bitcoin and the community over the years is enough to make anyone curl up into a ball.
"Yet like bitcoin, this is a community that keeps bouncing back every time they are written off, and bounce back stronger, having been stress tested in ways expected and unexpected," she continued. "I am sure there are many twists and turns yet to come that we'll have to suit up and slay … but for today, take a moment and enjoy the power of this movement."
What do you think about the Fed appointing a pro-bitcoin chief innovation officer? Let us know in the comments section below.
Tags in this story
chief innovation officer, fed bitcoin, fed crypto, fed cryptocurrency, Federal Reserve, Federal Reserve Bank, Sunayna Tuteja, TD Ameritrade, TD Ameritrade bitcoin, TD Ameritrade crypto, TD Ameritrade cryptocurrency
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Toxic Mac Pro's emitting benzene?
A french newspaper Liberation.fr has published a report (English translation) stating that Mac Pro owners run the risk of getting diseases as dangerous as leukemia (blood cancer) simply by using their computer. The newspaper was warned by a national agency scientist that the smell (already detected by many Mac Pro users on Apple forums) is actually toxic, composed of several toxins, including benzene.
An Apple Core reader requesting anonymity, sends the following details:
Here's a proof that the smell problem was previously known, check this page.
The real news here is that the smell is toxic... but still no official answer from Apple. I've submitted this piece of news to let english-speaking Mac Pro users know about it (since it was published in french). Libération is a very well known newspaper in France, it's not a blog or anything like that, so normally you should be able to trust this article.
I just called AppleCare (in France). They confirmed the problem but they told me it only concerned Mac Pros built before 2008 (without mentioning if being built in China was a condition, as suspected by users on the Apple forums). Mine is early 2008 so I should not worry they said.
When I asked them to send me this answer in written form, even by e-mail, they refused. They put me on hold for 40 minutes to forward me to the customer relations service, but apparently they didn't want to talk to me so I got instead a level 2 technical agent who told me the exact same thing: don't worry, we guess your Mac Pro is safe, but we can't confirm in written form which Mac Pro have toxicity problems until Apple decides to communicate about it. Apple did nothing since they knew of this problem, which may be in the beginning of 2007, so we can still wait very long for any change in their policy...
The fact that my Mac Pro may not be concerned is not the problem I have with their answer. The problem is that I could very well own one of those toxic Mac Pro and never know about it, with Apple never issuing a Mac Pro recall to prevent serious health problems. Considering the problem exists for more than a year, some people have been knowingly exposed to toxins, and if some of them ever develop a blood cancer it will not be before some years, and Apple will silently get out of this problem. This problem is as bad for Apple as the contaminated milk problem for China, and it may very well be the first scandal of this kind in the computer industry.
Apple doesn't want to confirm which Mac Pro have a problem because they know users could sue them for this reason. I invite all Mac Pro owners around the world to send a letter to Apple and ask them which Mac Pro have the toxicity problem, in written form. If Apple doesn't change its methods very fast, a class-action lawsuit may unfortunately be the next step...


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There is a sense of haunting to the roar of a lion veiled in darkness. The emphatic "ooooaa!" demands attention as it starts in the abdomen and reverberates through the night air. Its direction and distance are secondary to one's primordial reaction – a sudden dilation of the pupils and a flare of prickles on the neck. The call unmistakably announces a large carnivore, yet as each roar fades into solitary grunts it feels less like an act of aggression than the lonely imploring of a lost soul in the darkness.
The plight of Africa's lions is lamentable. Since the 1960s, the world has lost at least 70% of these magnificent cats, which until a few thousand years ago inhabited most of Europe, Asia and the Americas. Now we're down to around 20,000, all of them in Africa apart from one sub-species in India. Habitat loss and the encroachment of people are largely responsible – lions in Kenya and Tanzania are shot by wildlife officials if they consistently kill livestock, for instance. And trophy hunters still shoot lions in the wild every year in countries where it is permitted, including Tanzania and Zimbabwe.
But if you were expecting a fable in which cunning Human steals from noble Lion, this story is not so clear-cut. Living with these predators is not easy. For many people in rural Africa, livestock pay for school fees and hospital bills, and insure against misfortune. Imagine finding half your nest egg has been taken overnight and, worse, worrying your family might be next. Unsurprisingly, many lions that live near people end up shot or poisoned. Yet it doesn't have to be this way. A new five-year study that I have been involved in shows that when people directly benefit from lions, they become more tolerant of their faults.
We focused on an area surrounding the Mara National Reserve in Kenya, a protected zone at the northern extent of the Serengeti ecosystem. These fertile grasslands are the home of the Maasai, semi-nomadic pastoralists who share them with the great annual migration of over a million wildebeest and their predators, including lions.
Maasai have always speared any rogue that dares interfere with their livestock; and today there are far more people and livestock and much less space for lions. Yet many on the northern edge of the Mara have wisely noted the premiums that tourists are prepared to pay for the Serengeti experience.
Lions help attract over 350,000 visitors to the area every year, generating $90 million (£63 million) in entrance fees alone. Beyond the national reserve, many families have combined landholdings into community conservancies which welcome visitors for a fee. They attract wildlife by managing and protecting resources such as livestock, water and unique habitats; and they distribute income fairly around the community to avoid feuds. Other families have declined this opportunity, relying purely on their livestock for income.
Hence there is a 1,500sqkm patchwork of conservancies and other privately owned pastureland to the north of the Mara National Reserve. Together with the reserve itself, where no one lives and lions can roam freely, it amounts to a perfect three-way natural experiment to investigate the effects of conservancies on lions. Lead author Sara Blackburn and Laurence Frank, a veteran predator biologist, spent five years observing the lifespan of 382 lions in the area. This is the first time anyone has looked at the survival rates of individual lions in relation to conservancies, rather than just counting them.
The natural life expectancy of a lion living in the wild rarely exceeds 13 years. When we compared the survival of lions living outside national parks, our results consistently showed that survival is not determined by how many prey are available or the quality of the habitat – there are enough of both to sustain this population. The number of livestock in a lion's territory makes no difference either.
The only factor that consistently cuts short a lion's life, sometimes lowering the chances of survival by as much as 40%, is the number of homesteads in its territory that are not part of a community conservancy. Homesteads that are members of a conservancy, on the other hand, have no negative effect on lions' survival chances. This suggests that when people receive income from lions via ecotourism, they become tolerant and lions survive. There is a good chance that the same would also be true for other animals that are declining across the region, such as giraffe and impala.
Cecil, the lion shot by an American hunter last year, drew a line in the sand regarding the public's opinion on conservation of this remarkable predator. These events have sparked heated debates about the role of trophy hunting and using fences to protect lions in the wild, even while recent footage of an agitated lion walking the streets of Nairobi highlights the continued struggle for space.
In this worrying context, our research points to how this story can end more happily. Community conservancies are a viable and working alternative to protecting wildlife. Although they exist in many parts of Kenya and Tanzania, we must continue encouraging governments to develop similar opportunities for local communities to benefit from wildlife through ecotourism. Evidence such as ours gives reason to be optimistic that community conservancies will continue to expand and benefit human and lion alike.
Sara Blackburn, an MSc student in biodiversity and conservation, assisted in the writing of the piece
This article was originally published on The Conversation. Read the original article.
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When my mother shook me awake, to not only let me know it was time for school, but to announce that Jimmy Carter had just been elected President of the United States, even at 15 years of age, I knew this was not good news for America. It wasn't that I was waiting breathlessly for Gerald Ford, who was? But what captured my 15 year old emerging political and patriotic heart during the Republican primary was Ronald Reagan.
There are giants among men in all of our lives, ones who seem to rise above others and touch the heavens. Mortal they may be, but they transcend the times and history and gain an immortality. For me, Ronald Reagan forever will stand taller then the rest of us.
I was only 17 when I enlisted in the Air Force and after training was shipped to a tour in West Germany. What a different world it was back in 1979 and 1980. There was a cartoon that ran in US News & World Report, of two soldiers dressed in rags, trying to push a 18th century cannon up a hill in the dead of winter. One observer asked another "is that a movie set for Napoleon's retreat from Moscow." And the other observer says, "no, it is NATO on maneuvers." The truth was not far off. There were military families on food stamps, 5 men to 2 men dorms, mechanics working on trucks outside in the dead of winter due to lack of enclosed garages. Vietnam had just ended a few years before, Americans were being held hostage in Tehran, the Soviets seemed to be on the march and morale was low, in society at large, and in the military in particular.
Then the world changed, and oh so dramatically. On November 4th, 1980 a new man rode in on a white horse, my hero of a few years before was now President. It might sound like an exaggeration, but the mood within the ranks of the military changed with the speed of light. We knew that America had been saved. I can't list all that was to change; we all know the story that unfolded over the next 8 years and how this man forever changed the world. For us in the military, it might be selfish to say that we loved Reagan when in the first days of his Presidency he instituted a significant pay raise for all the men and woman in uniform. But it was more than a pay raise, a message was being sent. That money was put into not just planes, tanks, and ships, but also in military housing, base facilities, and yes, even garages for our mechanics. Above all else, what Ronald Reagan brought to all of us in uniform was a strong esprit de corps that had waned in the preceding years. He made us all proud to be Americans again and for one 18 year old, who in voting for the very first time was able to punch the ticket for Ronald Reagan, he became a larger than life hero. He became our generation's George Washington.
On the 100th celebration of his birth, we all celebrate a great man, a great President and an example of what the times can bring out this great country and the great people of America. We can reach back and touch the examples of greatness and leadership and when we think the times are dark and that there won't be another Washington, Lincoln or Reagan, one appears. Happy Birthday and thank you President Reagan!


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2019 whilst being a little poor on the actual reading front has been a great year in respect of the audio book having followed on from great success I had with this format especially with non-crime fiction genre.
Still Me is the last part in the trilogy written by the fabulously talented Jojo Moyes which started with Me Before You which I read as back in January 2013 where Lou Clark takes on a job being a nurse/companion to a quadriplegic man. This story was so popular, being later made into a film that Jojo Moyes bought Lou Clark back for more adventures. In After You we see her living a new life, meeting new people and coping with grief and her journey kept me company during my walks home from work and preparing food that I missed Lou Clarke so very much when this book finished and felt that the narrator Anna Acton now encapsulated the story for me so despite having a physical book it seemed obvious to continue in audio format.
In Still Me Lou Clarke has takes up a new job in New York through an old friend. New York is new and exciting and although Lou misses her boyfriend Sam in London, at times he seems very far away. With a whole new cast of characters in New York and this really is how Jojo Moyes captures the hearts of her readers – they are so well drawn, multi-layered and as far removed from clichés and stereotypes that lesser authors employ. There is no doubt in my mind when I was listening that Lou Clarke was a real woman, with problems not so very different to those that I have suffered, and despite being a fair bit younger than I am, it still manages to feel relevant as the cast of characters takes in the whole spectrum of people. We have the fussy old woman with her beloved dog, the unfriendly housekeeper, the spoilt rich wife, the personal trainer, the jock, the vintage clothes shop owner to name but a very few.
So although the characters are the chief pull of course even the most captivating of studies can't stand up without a plot. Perhaps this novel has more of the general romance pitfalls than the previous two books, chiefly misunderstandings that are left to fester rather than spoken about on both sides, but despite this I was still swept along hoping for a good result for Lou whether that be a good man or no man at all. Pleasingly the latter is always a possibility especially as we also catch up with Lou's brilliantly portrayed parents and sister as they come to terms with life not following the predictable route they thought it would. In fact Lou's mother and her father's reaction to life's changes provided some of my favorite comedic moments in the book.
I finished Still Me quite some time ago but I won't forget Lou Clarke in a hurry. It takes a special kind of skill to pen a story that has all the ranges of human emotions without it tipping into the sickly sweet arena and for someone like me who has an antipathy to 'romantic' tales that is high praise indeed!
First Published UK: 24 January 2018
Publisher: Penguin Books
No of Pages: 496
Listening Length: 13 hours 37 minutes
Genre: Contemporary Fiction
Amazon UK
Amazon US


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Understanding Outlook Anywhere
Applies to: Exchange Server 2010 SP3, Exchange Server 2010 SP2
In Microsoft Exchange Server 2010, the Outlook Anywhere feature, formerly known as RPC over HTTP, lets clients that use Microsoft Office Outlook 2010, Outlook 2007, or Outlook 2003 connect to their Exchange servers from outside the corporate network or over the Internet using the RPC over HTTP Windows networking component. This topic describes the Outlook Anywhere feature, provides information about deploying Outlook Anywhere, discusses coexistence with older versions of Exchange, and lists the benefits of using Outlook Anywhere.
Looking for management tasks related to Outlook Anywhere? See Managing Outlook Anywhere.
Outlook Anywhere and Exchange 2010
Benefits of Using Outlook Anywhere
Deploying Outlook Anywhere
Managing Outlook Anywhere
Outlook Anywhere in Multiple Active Directory Sites
Testing Outlook Anywhere Connectivity
Outlook Anywhere and Exchange 2010
The Windows RPC over HTTP Proxy component, which Outlook Anywhere clients use to connect, wraps remote procedure calls (RPCs) with an HTTP layer. This allows traffic to traverse network firewalls without requiring RPC ports to be opened. In Exchange 2010, as in Exchange 2007, it's easy to deploy and manage this feature. To deploy Outlook Anywhere in your Exchange 2010 messaging environment, you need to enable Outlook Anywhere on at least one Client Access server using the Enable Outlook Anywhere wizard in the Exchange Management Console.
Outlook Anywhere should be enabled only on Client Access servers that are exposed to the Internet. Do not enable Outlook Anywhere on internal Client Access servers.
Benefits of Using Outlook Anywhere
Outlook Anywhere offers the following benefits to clients that use Outlook 2010, Outlook 2007, or Outlook 2003 to access your Exchange messaging infrastructure:
Users have remote access to Exchange servers from the Internet.
You can use the same URL and namespace that you use for Outlook Web App and Microsoft Exchange ActiveSync.
You can use the same Secure Sockets Layer (SSL) server certificate that you use for both Outlook Web App and Exchange ActiveSync.
Unauthenticated requests from Outlook can't access Exchange servers.
You don't have to use a virtual private network (VPN) to access Exchange servers across the Internet.
You don't have to configure anything in Exchange 2010 when you're using SSL session ID load balancing on the Client Access server with Outlook Anywhere.
If you already use Outlook Web App with SSL or Exchange ActiveSync with SSL, you don't have to open any additional ports from the Internet.
You can test end-to-end client connectivity for Outlook Anywhere and TCP-based connections by using the Test-OutlookConnectivity cmdlet.
Return to top
Deploying Outlook Anywhere
Deploying Outlook Anywhere for your organization is straightforward. The following recommendations should be followed to successfully deploy Outlook Anywhere:
Use at least one Client Access server per site In Exchange 2010, a site is a network location with high-bandwidth connectivity between all computers. We recommend that you install at least one Client Access server in each site to provide client access to the Mailbox server. However, you can have multiple Client Access servers in each site for increased performance and reliability.
Enable Outlook Anywhere on an Internet-exposed Client Access server Outlook Anywhere should be enabled on Internet-exposed Client Access servers only. This lets clients that use Outlook 2010 or Outlook 2007 connect to a user's mailbox through the Client Access server in the site. Users will connect by using HTTPS to the Client Access server that's in the site where the user's mailbox is located.
For more information, see Enable Outlook Anywhere.
Managing Outlook Anywhere
You can manage Outlook Anywhere by using the Exchange Management Console or the Exchange Management Shell. By default, when you enable Outlook Anywhere on a Client Access server, all users who have mailboxes on Exchange 2010 Mailbox servers are enabled for Outlook Anywhere. For more information, see Managing Outlook Anywhere.
Return to top
For mailboxes on Exchange 2010 Mailbox servers, clients must connect through Exchange 2010 Client Access servers. Outlook Anywhere can be used in environments where Microsoft Exchange Server 2007 and Exchange Server 2003 servers are still being used. If you have users with mailboxes on Exchange 2003 servers, and these users are using Outlook 2007 or Outlook 2003 to connect, you must configure these clients manually. To configure Outlook Anywhere with Exchange 2007 or Exchange 2003, see Configure Outlook Anywhere in an Environment with Earlier Versions of Exchange.
Return to top
Outlook Anywhere in Multiple Active Directory Sites
If you have multiple Active Directory sites that are separated by low-bandwidth network connectivity, you can enable a Client Access server in each site. The Autodiscover service will then automatically detect which Client Access server is closest to the user's mailbox that resides either on an Exchange 2003 back-end server enabled for RPC over HTTP or on a later Exchange version running the Mailbox server role. After the user has connected across the Internet using RPC over HTTP, the Client Access server will then use RPC requests. This ensures that RPC requests stay within the site's intranet. For more information about how to provide an external host name for Outlook Anywhere, see Configure an External Host Name for Outlook Anywhere.
Users with mailboxes on Exchange Server 2003 servers with SP1 or a later version or Exchange 2003 servers enabled for RPC over HTTP will also be able to access their Exchange information from the Internet. For these users, you can use the Shell to manage the Outlook Anywhere feature on the Exchange 2010 Client Access server in the site.
Return to top
Testing Outlook Anywhere Connectivity
After you enable Outlook Anywhere in your Microsoft Exchange Server 2010 organization, you can test for end-to-end client Outlook connectivity. You can test end-to-end Outlook connectivity by doing either of the following:
Running the Test-OutlookConnectivity cmdlet. The cmdlet tests for Outlook Anywhere (RPC over HTTP) and TCP/IP connections. If the cmdlet test fails, the output notes the step that failed.
Running the Outlook Anywhere connectivity test using the Exchange Remote Connectivity Analyzer (ExRCA). When you run this test, you get a detailed summary showing where the test failed and what steps you can take to fix issues.
Both tests try to log on through Outlook Anywhere after obtaining server settings from the Autodiscover service. End-to-end verification includes the following:
Testing for Autodiscover connectivity
Validating DNS
Validating certificates (whether the certificate name matches the Web site, whether the certificate has expired, and whether it's trusted)
Checking that the firewall is set up correctly (ExRCA checks overall firewall setup. The cmdlet tests for Windows firewall configuration.)
Verifying client connectivity by logging on to the user's mailbox
For more information, see Test Outlook Anywhere Connectivity.
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© 2010 Microsoft Corporation. All rights reserved.


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"People often recognise subtleties about what's happening that scientists who are looking at the longer-range and larger-scale changes just don't pick up. Yet these finer scale responses can be very important when thinking about impacts." - Mike MacCracken
Dr Michael MacCracken
Posted on 10 July 2008
Dr Michael MacCracken is chief scientist for climate change programs at the Climate Institute, a small non-governmental organisation that pro-actively works towards solutions for climate change and climate change adaptation.
Dr Michael MacCracken is chief scientist for climate change programs at the Climate Institute, a small non-governmental organisation that pro-actively works towards solutions for climate change and climate change adaptation. Nigel Allan, communications manager at WWF Climate Witness, spoke with Dr MacCracken about his participation on the Science Advisory Panel and the role that Climate Witness can play in public discussions of climate change. Nigel Allan: When and why did you get involved in climate science in the first place?
Mike MacCracken: I became involved in studies of climate change as part of my graduate studies during the mid and late 1960s.
My graduate dissertation examined how changes in Arctic sea ice extent might be contributing to the cycling of ice ages, to their advances and retreats. My first task was to construct one of the very first climate models and the second was to use the model to try and understand what would happen if the Arctic Ocean were free of ice or if there were a more extensive glacial cover over the northern hemisphere.
I then got interested after that in both natural and human influences on the climate, including investigating the potential effects of the proposed international fleet of super-sonic aircraft and of volcanic eruptions and increasing concentrations of greenhouse gases, which were a concern way back in the 1970s.
NA: Beyond "doing the science", what role do you think scientists can play to encourage policy-makers to adequately address climate change?
MM: There are two important roles.
Firstly a very important role is helping build public awareness and that includes understanding by the policy-makers themselves. But for policy-makers to act they have to be able to talk to the public and have a public that understands what is happening and what could happen.
A second role for scientists is to help the policy-makers understand what the options are for taking action. Not only which technologies might be able to have an effect, but to understand the influences of each of the different compounds we're putting into the atmosphere, whether carbon dioxide or methane or nitrous oxide or soot, and which ones can be most effectively dealt with?
NA: What role do you think a programme like Climate Witness can play in addressing climate change?
MM: Well, during the late 1990s I was in charge of co-ordinating the US National Assessment of the Consequences of Climate Change. There was clear recognition through the Intergovernmental Panel on Climate Change (IPCC) that the climate was changing and now the question was what was happening in various areas around the United States.
We had a number of regional workshops where we described the kinds of things that could happen and then we asked people what was happening. We heard a lot of stories about how climate change was affecting their region, whether sea level rise or changes in water resources. Then we had these groups look and talk about what they thought the implications for their region would be as a result of these kinds of changes.
So, we learned a lot by just listening to the people about what was happening, because impacts happen locally; climate change is looked at from the global to local scale, but impacts start locally.
That assessment activity went on from 1997 to 2000 but it was largely discontinued by the Bush Administration. So, I was glad to hear Climate Witness was getting started because it was, again, listening to the people about the kinds of changes they are seeing. People often recognise subtleties about what's happening that scientists who are looking at the longer-range and larger-scale changes just don't pick up. Yet these finer scale responses can be very important when thinking about impacts.
NA: As a member of the Climate Witness Science Advisory Panel, what do you think is the significance of the Panel in the Climate Witness Programme's work?
MM: It's very helpful when the witnesses themselves identify changes they are seeing and experiencing, but it is also important to recognise that there are many things changing in the world and not all the changes people see are going to be due to climate change. They might be due to other kind of factors, including how increasing development is changing the landscape.
"We found it was just very useful to talk to people and to listen to them and have a good interaction about what they were seeing and how the changes might be explained or consistent with or sometimes inconsistent with what the scientific community is projecting to occur as a result of global warming." - Mike MacCracken
Having a scientist go over what is being suggested to look at whether the identified changes are likely to be consistent with scientific findings helps clarify some of the issues. Based on my familiarity with the larger scale changes, I can try to put what is happening locally in a larger context and that can help give people some appreciation about what they're observing and also give a sense of what might be happening regionally and why it's happening. So it's a very useful linkage.
Encouraging interactions between those focused on large and on local scales was also something we did a lot during the National Assessment, where we had the scientists sit down with the resource, business, and government experts who had a real interest in local conditions and talk through what the issues were, what they were seeing, and what they wanted to know. We found it was just very useful to talk to people and to listen to them and have a good interaction about what they were seeing and how the changes might be explained or consistent with or sometimes inconsistent with what the scientific community is projecting to occur as a result of global warming.
Even with many climate models, we are not yet able to make detailed projections down to the local scale, so we can learn a lot by listening to what people are observing. Observations of small changes can be very important.
NA: Are there Climate Witness observations that stand out for you?
MM: Well the two Climate Witness submissions that I have responded to were very thoughtful observations about what was happening.
Joe Schaedler in Minnesota was observing how not only the warming of winter was affecting the dates of freezing and melting of the region's lakes and the effects on lake fishing, ice fishing and other kinds of things, but he was also noticing how the ground was not freezing as deeply and this turns out to be important in determining how long the snow cover lasts. If you don't freeze the ground, then the snow cover tends to melt more quickly. If you don't get an early winter cooling from cold air coming out of the Arctic the ground doesn't get cold enough to really sustain the snow that does fall, so that starts affecting what happens when the snow melts and water penetrates into the ground.
The other submission was from Cheryl Aldrich, a horticulturalist in Georgia, and she seemed to have all kinds of interesting observations about what was happening with respect to how the plants were responding. I know up here in Washington where I live the flower-plant zone that we are in has changed. We are now part of the southern plant zone instead of the mid-Atlantic zone. This change was made because plants more typical of the southern US are surviving through the winter and so we are getting different mixes of vegetation; simultaneously, more northern are not surviving because conditions get too hot in the summer and do not get cold enough to shut them down in the right way.
So I thought both of the witness statements that I got to comment on were very thoughtful and represented well-informed views about what was happening.


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100 Black Men
100 Black Men Chapters are educating and empowering youth and their families while positively impacting communities.
The membership of 100 Black Men of America, Inc has spent the past 40 years carefully laying the foundation for success. In 1994, we installed our signature Four For The Future, which focuses on mentoring, education, health & wellness, and economic development. We must continue to prepare individuals and institutions that can lead the way. The only way to keep pace with the current level of change is through constant learning and adapting. Leadership development is the best investment for our collective futures.
To Create Positive Black Male Development
programs are specific:
Four for the Future
– Mentoring
– Education
– Health and Wellness
– Economic Development
100 Black Men of America, Inc. is committed to the intellectual development of youth and the economic empowerment of the African American community based on the following precepts: respect for family, spirituality, justice, and integrity.
100 Black Men of America, Inc. seeks to serve as a beacon of leadership by utilizing our diverse talents to create environments where our children are motivated to achieve, and to empower our people to become self-sufficient shareholders in the economic and social fabric of the communities we serve.


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By Eyanir Chinea and Diego Ore, Reuters
CARACAS.- Venezuela's opposition said it agreed to attend exploratory talks on Tuesday with President Nicolas Maduro's government in a bid to end the country's worst political unrest for a decade.
Clashes between security forces and pro-government militants on one side and hooded opposition demonstrators blocking streets on the other have killed at least 39 people since mid-February.
Foreign ministers from the regional Union of South American Nations (Unasur) are in the capital Caracas, shuttling between meetings with the administration and opposition and seeking to persuade both sides to talk.
Ramon Guillermo Aveledo, a top opposition official, said the Unasur ministers told them the government was open to opposition demands, including the presence of a "good faith" mediator at any substantive discussions.
"We accept the foreign ministers' proposal to hold an exploratory, preparatory meeting to agree the conditions, date and time for public dialogue," Aveledo told reporters.
As a condition for talks, the opposition has demanded they be broadcast live. It also wants freedom for what it calls "political prisoners" arrested since the start of the unrest, and the disbanding of armed pro-government militant groups.
Maduro said late on Monday he was ready to meet opposition leaders and that he had been suggesting talks in public or in private for weeks. But he said his foes rejected the offers.
Ricardo Patino, Ecuador's foreign minister, welcomed the decision to hold a preparatory meeting and said he hoped it would result in an agreement to hold weightier talks.
Venezuelan media said Maduro would attend the discussions, due to take place at the Foreign Ministry.
Protesters are calling for Maduro to resign and complain about a litany of problems from rampant crime to food shortages. The government says they are seeking a coup like the one in 2002 that briefly toppled Maduro's late predecessor, Hugo Chavez.
The fatalities have included supporters of the government, opposition protesters and several members of security forces.
(This story fixes spelling error in headline)
(Writing by Daniel Wallis; Editing by Cynthia Osterman)


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Kansas City hired Andy Reid to replace Romeo Crennel. From one Walrus to another.
I spent most of my time working on this comic neglecting it to look up Walrus facts on the internet. Did you know Walruses are very cuddly and social? and like to flop on each other? Now you do. They are also capable of weighing over 4000 lbs and are pretty good at coaching football teams.
Walruses are neat. If Chip Kelly decides to stop teasing us next year he better grow a Mustache, because he'd make a good Walrus. In the meantime, all we have are Reid, Crennel, Fisher, and Holmgren.


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I am confused. How can I encrypt a file using 128-bit Advanced Encryption Standard?
Do I need only to encrypt the file name and it's content or is there something that I need to do to encrypt it? Is there something that I will need to extract to the file to encrypt it?
For example, I want to encrypt an MS Word file or a PDF file.
It is easy to encrypt a file if the file only contains text, but what if there is a image in a file? How do I go about that?


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If you have a table without a good candidate field or fields for a clustered index (stable, sequential), is it better to have a clustered index on a bad field or is it better to make all table indices non-clustered? What's the rule of thumb?
As per feedback, here is a very specific example to make the question more concrete. Assume I have a 'PlayerStatsView' table, that looks like the following:
CREATE TABLE [PlayerStatsView](
[PlayerId] [uniqueidentifier] NOT NULL,
[TeamId] [uniqueidentifier] NOT NULL,
[FirstName] [nvarchar](255) NOT NULL,
[LastName] [nvarchar](255) NOT NULL,
[Status] [nvarchar](255) NOT NULL,
[BattingAvg] [int] NOT NULL,
[RBIs] [int] NOT NULL,
[HomeRuns] [int] NOT NULL,
[PercentageOnBase] [int] NOT NULL,
CONSTRAINT [PK_PlayerStatsView] PRIMARY KEY NONCLUSTERED ([PlayerId] ASC)
So in more concrete terms...
PlayerId, the primary key, is a GUID, as is TeamId. FirstName and LastName combined are unique (or just about), but will be nowhere near sequential, not to mention they're too big to both include in a single index. (For the purpose of this exercise, assume that player names change occasionally - not often, but from time to time.) The rest of the fields will be updated with every write.
I'm mainly going to be querying by PlayerId and TeamId, I will have a non-clustered index on each.
The table currently contains tens of thousands of records, and will eventually hit hundreds of thousands.
Back to the question:
Am I better off without a clustered index, or should I add a clustered index even though there are no fields that are really suitable for one?


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Coventry is a town rich with history in Kent County, Rhode Island. Incorporated in 1741, Coventry was mainly a farming town and wasn't modernized until the 20th century. Today, the western part of town remains somewhat rural, while the eastern section has been suburbanized. The history of Coventry hasn't been lost, however, with many of the historical buildings still standing in town. Coventry is the home to the General Nathanael Greene Homestead which housed the Revolutionary War general from 1770 to 1776. The Homestead is still preserved today and has been opened as a museum for residents and visitors to enjoy since 1924. Because of its diverse landscape, there are an array of outdoor activities to do in Coventry. The town has parks, fields and a public beach as well as playgrounds and picnic areas. Water activities are popular in the town and residents have access to canoe and boat launches. Johnson's Pond, a waterfront neighborhood in Coventry, is a popular fishing spot and has been voted by Wakeboarding Magazine as the best location in Rhode Island for wakeboarding. With its mix of rural and suburban, Coventry has a wide variety of real estate throughout the community. Classic and contemporary homes are for sale around the town-some are waterfront properties with large landscapes and gorgeous views. Homes in more rural areas are available as well for those who enjoy peace and quiet. The many housing options in Coventry make it easy to meet any architectural preference and budget.
57 (21.28% )
Coventry retains its original character as an old textile mill village. While the western portion of the town remains rural in nature, the eastern section is one of the most rapidly growing Rhode Island residential communities.
The city is often lauded for its youth sports programs, as well as for the numerous recreational opportunities at the Coventry Greenway, a former railway converted into five miles of natural paths for biking, hiking and exploration. With its mills, lake-side fishing, and leafy environs, Coventry provides those golden, fleeting touches of authentic rural life. The town's main commerce locations exist in convenient shopping areas with easy parking access. Housing consists of multi-family in the older sections of town, and single family in newly developed areas.
The town is made up of the villages of Anthony, Arkwright, Greene, Harris, Hopkins Hollow, Potterville, Quidneck, Rice City, Spring Lake, Summit, Tiogue, Washington, and Whitman.
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Related links:
The forming Aurora
This picture illustrates the streaming of particles into and out of the auroral zone, as Field-aligned currents (FAC's) short-circuit through the ionosphere.
Some of the particles entering the auroral zone will collide with atmospheric particles to create the aurora. After the collision, these particles leave the magnetosphere and become part of the atmosphere.
The impacts of these particles can have a significant effect on the atmosphere as a whole, causing it to wobble for hours.


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Grounded in Excellence
About L&H-
Thorough & precise
Our experts have the know-how and tools to meet your most demanding specs for component materials, manufacturing and field performance. Our goal: get it right the first time, every time.
First & always
The safety of our employees and customers is our top priority in the shop and in the field—no exceptions. Our belief: people matter most.
Fueled by field insights
L&H Industrial has 50 years of field experience, deep expertise in industrial equipment engineering, and state-of-the-art manufacturing facilities. Our objective: make heavy machines Honestly Better.
Remarkable & reliable
The experienced, knowledgeable, proactive people on our team go above-and-beyond. We are truly at your service, when and where you need us. Our motto: do the right thing.


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You have a passion for the sport. And so do we. That's what's made us the world's leading fishing tackle company. Passion. Berkley is the premium brand of fishing tackle that fuels your passion for fishing, offering the broadest array of innovative solutions developed by anglers who share your commitment to the sport.
At Berkley, our goal remains surprisingly simple - to make fishing fun and help anglers everywhere to Catch More Fish! Our leading edge technology has resulted in performance advances in fishing lines, soft baits, hard baits, fishing rods and terminal tackle.
Berkley makes good anglers GREAT and great anglers the BEST! At Berkley we take fishing seriously because we are first and foremost - anglers ourselves.
Berkley's commitment to conservation is reflected in our Berkley Conservation Institute (BCI). The BCI was created to put Berkley science and technology into action to help protect the health and well being of the worldwide fish population. In sharing the angler's passion for fishing, Berkley Conservation Institute's mission is to ensure fishable waters for angler generations to come. That is why the BCI is "Dedicated to the Future of Fishing".


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ORLANDO -- Immediate radiation therapy after radical prostatectomy led to a 50% increase in long-term biochemical progression-free survival (bNED) for patients with locally advanced prostate cancer, according to a study reported here.
After a median follow-up of almost 10 years, patients who received immediate adjuvant radiotherapy had a bNED rate of 61% compared with 40% for patients randomized to a "wait-and-see" strategy that depended on a return of detectable PSA levels, Thomas Wiegel, MD, said at the Genitourinary Cancers Symposium.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
- In this randomized study, adjuvant radiotherapy after radical prostatectomy compared with wait-and-see was safe in pT3 prostate cancer. At 10 years' median follow-up, adjuvant radiotherapy was associated with significantly better biochemical control, but the study was not powered to detect differences in overall survival.
Patients with positive surgical margins benefited the most from immediate radiotherapy, reflected in a bNED rate of 55% versus 27% for patients randomized to the wait-and-see (salvage) approach.
Overall survival and distant metastasis-free survival did not differ between groups, primarily because of low rates of qualifying events in both groups, said Wiegel, of the University of Ulm in Germany.
"The greatest impact was observed in patients who had positive surgical margins and those with pT3a/b disease," said Wiegel. "Adjuvant radiation therapy had no influence on overall survival, but the trial was not statistically powered for a survival analysis.
"There was a low rate of late side effects, and a low rate of overtreatment of patients with locally advanced disease and positive surgical margins."
The findings corroborated but also clarified the benefits of adjuvant radiation therapy for locally advanced prostate cancer (pT3 R1/0).
A European cooperative-group trial showed a 20% improvement in bNED 10 years after diagnosis, but no effect on overall or metastasis-free survival (Lancet 2012; 380: 2018-2027). In contrast, investigators in the U.S. found that immediate radiation therapy improved all three outcomes after 12 years of follow-up (J Urol 2009; 181: 956-962).
Wiegel and colleagues previously reported improved 5-year bNED with immediate radiation therapy but no difference in overall or metastasis-free survival (J Clin Oncol 2009; 27: 2924-2930). The results remained unchanged after another 5 years of follow-up.
The trial initially involved 395 men with locally advanced disease, all of whom underwent radical prostatectomy. Within 2 weeks of surgery (before PSA had fallen to undetectable levels), the men were randomized to radiation therapy or the wait-and-see strategy.
Subsequently, 78 patients did not achieve undetectable PSA levels (<0.05 ng/mL) after surgery, and they were excluded from the trial. Additionally, 34 patients allocated to radiation therapy did not receive treatment, and they also were excluded, leaving 273 patients for follow-up.
Eligible patients had prostate cancer with extracapsular extension or seminal vesicle involvement but no nodal involvement or metastases. Patients randomized to immediate treatment received 3D conformal radiation at a total dose of 60 Gy.
Investigators defined progression as the first detectable PSA measurement that was confirmed by a follow-up test. The primary endpoint was bNED.
The 5-year data showed bNED rates of 72% with immediate radiation therapy and 54% with the wait-and-see strategy. Though rates declined in both arms between 5 and 10 years, the magnitude of the difference favoring immediate treatment increased. The hazard ratio for progression was 0.53 after 5 years and 0.51 after 10 years (P=0.000022).
Metastasis-free survival did not differ between groups, but Wiegel noted that qualifying events had occurred in only 17% of patients. Similarly, overall survival did not differ, as the rate of qualifying events was 15% in the two treatment arms combined.
Subgroup analysis showed consistently higher progression-free survival with radiation therapy, including patients with Gleason score ≤6 or >6, preoperative PSA level >10 ng/mL, and pT3b/c disease.
Multivariate analysis identified three significant predictors of increased risk of progression, whereas radiation therapy was the only significant predictor of a decreased risk of progression:
- Gleason score >6 -- RR 1.44, P=0.038
- ≥pT3c -- RR 1.80, P=0.00037
- Positive surgical margins -- RR 1.59, P=0.0092
- Immediate radiotherapy -- RR 0.46, P=0.000005
The 5-year data showed low rates of acute radiation toxicity, and the favorable profile persisted with late toxicity, including grade III bladder toxicity in 1% of patients, stricture in 3% (versus 1% of the wait-and-see group), and no grade III rectal toxicity (1% grade II).
Wiegel also addressed the criticism that adjuvant radiation therapy is overtreatment. The persistent and increasing disparity in progression-free survival between treatment groups provided a strong argument against overtreatment.
"We also know that 30% to 40% of patients will not profit from salvage radiotherapy," said Wiegel. "It is incorrect to say that, for our best patients, adjuvant radiotherapy is overtreatment."
Invited discussant Anthony D'Amico, MD, of Harvard, sought to explain the discordant results between the findings of the U.S. study (improved overall and metastasis-free survival) versus the European and German trials. He suggested the timing of salvage radiation therapy could account for the difference.
More patients in the observation arms of the European and German trials received early salvage radiation therapy compared with those in the U.S. trial. For example, 33% of the observation group in the European trial received early salvage therapy, whereas 20% did so in the U.S. trial.
"Delayed salvage radiation therapy occurring in 13% more patients in the [U.S.] trial as compared to the [European/German] participants on the watchful waiting arm could explain the discordant results," said D'Amico.
"Early salvage radiation therapy, when the PSA level is greater than 0.1, may produce the same result as adjuvant (immediate) radiation therapy," he added. "We are awaiting results of randomized trials to determine that. Until then, we can consider adjuvant radiation therapy based on the number of risk factors in order to reduce overtreatment."
The Genitourinary Cancers Symposium is cosponsored by the American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Urologic Oncology.
The study was supported by German Cancer Aid.
Wiegel and co-investigators had no relevant disclosures.
D'Amico had no relevant disclosures.
Primary Source
Genitourinary Cancers Symposium
Source Reference: Wiegel T, et al "Phase III results of adjuvant radiotherapy (RT) versus wait-and-see (WS) in patients with pT3 prostate cancer following radical prostatectomy (RP)(ARO 96-02/AUO AP 09/05): Ten years follow-up" GuCS 2013. Abstract 4.