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Median page load times have risen 9% since 2011, a report says.
Amy Dusto
The median page load time for e-commerce sites viewed on Internet Explorer 9 is 6.50 seconds, 9% slower than last year's median of 5.94 seconds, according to data from web optimization company Strangeloop Networks Inc. For the second view of a page, which is often faster since most web browsers, including Internet Explorer 9, temporarily save some files, median load time was 2.16 seconds, 15% slower than 1.83 seconds in 2011. For retailers, this means business: studies show that page load times affect site views, customer satisfaction and conversions.
Strangeloop's report, which has been conducted annually since 2010, measures web performance among the top 2,000 e-commerce web sites as ranked by web analytics vendor Alexa Internet Inc., a subsidiary of Amazon.com Inc., on a simulator that mimics the browsing experience of users around the world. The browsers in the latest report include Internet Explorer versions 7-10, Google Inc.'s Chrome 20 and Firefox 13; Strangeloop does not have comparative data for last year's load times on the browsers besides Internet Explorer 9, it says.
Behind the slower load times are increasingly content-rich retail web sites. Pages load slower when they have more content, including pictures, videos and ads, because each of those items requires a separate call to a server which takes 20 to 50 milliseconds. The report found that page sizes, on average, increased 5% this year, with the median page requiring 77 server round trips, up from 73 last year.
Those effects are compounded by server calls made by third-parties that add features such as a Facebook Like button, or post their own content, such as a product recommendation from a vendor on a retailer's site.
This means retailers don't always have full control of their site performance, says Joshua Bixby, Strangeloop CEO. He advises they make service-level agreements, or SVAs, with vendors they employ to guarantee a minimum load time for any services their pages use. "Don't just throw up your hands and say, 'My recommendation engine is slow,'" he says. "Really push those vendors."
Retailers should also regularly monitor how each page element loads and make sure that there isn't one culprit—for example, a Twitter widget—that brings down the whole page when it crashes, he says.
The report also found that the median page load time for sites viewed on Internet Explorer 10 is 6.392 seconds, versus 6.906 seconds for Chrome 20 and 6.395 seconds for Firefox 13. However, that difference doesn't signify much; Bixby stresses that today most web browsers are equal in terms of customer experience. "If you use a modern web browser, which tool you select is not a big deal," he says. Strangeloop only looked at the performance of various browsers because the media is interested, he says.
Regardless of the browser, retailers have to be concerned about slower load times, which can produce profound results, he says. In February, Wal-Mart Stores Inc., No. 4 in the Internet Retailer Top 500 Guide, reported a sharp decline in conversion rates, without revealing exact numbers, when its page load times increased from one to four seconds. Every one second improvement, however, increased conversions by up to 2%, with every 100 milliseconds of improvement increasing incremental revenue by up to 1%, the retailer says. Other large e-commerce sites have reported similar findings.
"This data tell us that when it comes to performance, many retailers are still leaving money on the table," says Bixby. "Site owners should be conducting routine tests across a variety of browsers. They should be measuring performance using a variety of metrics, and they need to ensure third-party scripts have been optimized. Implementing these basic performance tenets will drastically improve revenue."
Within five years, Bixby expects that all web pages will load in 100 milliseconds, which he says is plenty fast for consumers. Although this report shows the opposite, he says a 9% decrease in page load times is just "a blip on the radar and I have confidence in the ingenuity of man- and womankind."
Beginning with this report, Strangeloop will begin to benchmark web performance quarterly instead of annually, he says.


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Prostate cancer is a malignant tumor that arises in the prostate gland. As with any cancer, if it is advanced or left untreated in early stages, it may eventually spread through the blood and lymph fluid to other organs. Fortunately, prostate cancer tends to be slow growing compared to other cancers. As many as 90% of all prostate cancers remain dormant and clinically unimportant for decades. Most older men eventually develop at least microscopic evidence of prostate cancer, but it often grows so slowly that, many men with prostate cancer "die with it, rather than from it."
Description of the Prostate Gland
The prostate is a walnut-shaped gland located below the bladder and in front of the rectum. It wraps around the urethra (the tube that carries urine through the penis). The central area of the prostate that wraps around the urethra is called the transition zone. The entire prostate gland is surrounded by a dense, fibrous capsule.
Functions of the Prostate Gland
The prostate gland provides the following functions:
Changes During the Lifespan
The prostate gland undergoes many changes during the course of a man's life. At birth, the prostate is about the size of a pea. It grows only slightly until puberty, when it begins to enlarge rapidly, attaining normal adult size and shape, about that of a walnut, when a man reaches his early 20s. The gland generally remains stable until men reach their mid-40s, when, in most men, the prostate begins to enlarge again through a process of cell multiplication.
The major risk factors for prostate cancer are age, family history, and ethnicity.
Prostate cancer occurs almost exclusively in men over age 40 and most often after age 50. Two-thirds of prostate cancers are found in men over age 65. By age 70, about 65% of men have at least microscopic evidence of prostate cancers. Fortunately, the cancer is usually very slow growing and older men with the cancer typically die of something else.
Heredity plays a role in some types of prostate cancers. Men with a family history of the disease have a higher risk of developing prostate cancer. Having one family member with prostate cancer doubles a man's own risk, and having three family members increases risk by 11-fold. A specific gene, named HPC1 (for "hereditary prostate cancer") is associated with this inherited type of the disease.
Scientists are researching other genetic variations that may increase prostate cancer risk.
African-American men have higher rates of prostate cancer than men of other races. They are also more likely to develop prostate cancer at a younger age and to have more aggressive forms of the disease. However, race alone does fully explain this difference. Prostate cancer is more common in North America and northern Europe, and less common in Africa, Latin America, and Asia. Diet and other factors may play a role. For example, Asians who live in the United States have a higher rate of prostate cancer than those who live in Asia.
Male hormones (androgens), particularly testosterone, may play a role in the development or aggressiveness of prostate cancer. Other types of hormones, such as the growth hormone insulin-like growth factor-1 (IGF-1), may also be associated with some types of prostate cancer.
Researchers are studying whether prostatitis (inflammation of the prostate gland) may be associated with increased prostate cancer risk. They are also examining the possible relationship between prostate cancer and sexually transmitted infections, such as herpes virus and human papillomavirus , but no definite association has yet been found.
Because a Western lifestyle is associated with prostate cancer, so dietary factors have been intensively studied. Results have been inconsistent and inconclusive, however.
Fats. Some studies have found an association between high fat-intake and prostate cancer. In particular, high consumption of red meat and high-fat dairy products has been linked to increased risk for prostate cancer. In contrast, the omega-3 fats in fish may be protective.
Vegetables and Fruits. A diet rich in vegetables, fruits, and legumes appears to protect against prostate cancer. However, it is not clear whether this is due to the nutrients contained in these foods, or the fact that these foods are low in fat. No specific vegetable or fruit has been proven to decrease risk. Lycopene, which is found in tomatoes, has been a target of research interest, but the evidence for its protective benefit is still inconclusive.
Vitamins and Minerals . Major clinical studies have found that vitamin and mineral supplements (vitamin E, vitamin C, vitamin D, and selenium) do not prevent prostate cancer. Nutritious foods that are part of a healthy diet are the best sources for vitamins and minerals. A high intake of calcium has been linked to an increased risk of prostate cancer in some studies.
Finasteride (Proscar, generic) and dutasteride (Avodart) are drugs used to treat benign prostatic hyperplasia (BPH). They block an enzyme that converts testosterone to dehydroepiandrosterone (DHEA), the form of the male hormone that stimulates the prostate. These medications belong to a drug class called 5-alpha-reductase (5-ARI) inhibitors.
In 2009, the American Society of Clinical Oncology (ASCO) and the American Urological Association (AUA) issued a joint guideline recommending that doctors discuss the pros and cons of the use of 5-ARIs for prostate cancer prevention with men who:
ASCO/AUA also recommended that patients who already take finasteride or dutasteride for controlling urinary symptoms of BPH should talk with their doctors about continuing to take the drug for prostate cancer prevention.
The guideline is the first to recommend drug therapy for preventing prostate cancer. It was based on results of a large 7-year clinical trial that showed that finasteride reduced the overall relative risk of developing prostate cancer by about 25%. However, in this study, a few more men who took finasteride developed a high-grade aggressive form of prostate cancer than the men who did not take finasteride. More recent studies have suggested that 5-ARI drugs may not increase the risk of developing aggressive cancer. It is still unclear if finasteride is an appropriate preventive approach, and not all doctors agree with the ASCO/AUA guideline.
Finasteride and dutasteride may cause reduced sexual drive and problems with erection during the first 1 - 2 years of use. It is not yet known what the long-term effects of 5-ARIs are if they are taken for longer than 7 years.
Prostate cancer is the most common male cancer in the U.S. Only lung cancer causes more cancer deaths in American men. The lifetime probability of developing prostate cancer is about 16%. Each year, nearly 200,000 men in the United States are diagnosed with prostate cancer, and about 27,000 die from the disease.
A survival rate indicates the percentage of patients who live a specific number of years after the cancer is diagnosed. For prostate cancer, the 10-year survival rate is about 93% and the 15-year survival rate is about 77%. After 15 years, survival rates stabilize. Research indicates that men who are diagnosed with low-grade prostate cancers have a minimal risk of dying from prostate cancer up to 20 years after diagnosis. However, men diagnosed with more severe forms of prostate cancer have a higher risk of dying within 10 years.
Because so many prostate tumors are low-grade and slow growing, survival rates are excellent when prostate cancer is detected in its early stages.
Locally Advanced. If the disease is at the locally-advanced stage, in which it has spread beyond the prostate but only to nearby regions, it is more difficult to cure, but survival rates can be prolonged for years in many men. (When cancer has metastasized to the pelvic lymph nodes, the outlook is worse than if it has spread to other areas.)
Metastasized Cancer. If prostate cancer has spread to distant organs (metastasized), average survival time is 1 - 3 years, but some of these patients may live much longer.
If cancer recurs after initial treatment for early-stage tumors, it is still potentially curable if it is contained within the prostate, although in most cases the cancer has spread. Hormone treatments for such recurring cancers can often prolong survival for years, although the cancer almost always returns again.
Prostate cancer usually causes no symptoms in the early stages. As the malignancy spreads, it may constrict the urethra and cause urinary problems.
Later-stage urinary symptoms typically include:
Significant pain in one or more bones may indicate the occurrence of metastases (spread of disease). This chronic pain occurs most often in the spine and sometimes flares in the pelvis, the lower back, the hips, or the bones of the upper legs. It may be accompanied by significant unexplained weight loss and fatigue.
Benign Prostatic Hyperplasia (BPH). BPH is a urinary condition that can develop into an enlarged prostate, which puts pressure on the urethra and causes urinary problems. BPH is not a cancerous or precancerous condition, but its symptoms can mimic late-stage prostate cancer.
Prostatitis . Prostatitis is an inflammation of the prostate, often caused by bacterial infections. Symptoms include urgency, frequency, and pain in urination, sometimes accompanied by fever or blood in the urine.
There is great uncertainty and controversy over whether the benefits of regular screening for prostate cancer outweigh the risks for most men. Prostate cancer is often slow growing. Doctors cannot yet determine which early-stage tumors pose a risk of being aggressive and need treatment, and which tumors should be left alone. The concern is that routine screening for early detection of tumors may lead to invasive and unnecessary treatment.
In general, the current consensus is that there is no "one size fits all" guideline for who should receive prostate cancer screening and at what age. Before deciding to be tested, men need to discuss the pros and cons of screening with their doctors.
Candidates for Annual Screening. The best age to start annual screening is under debate. Major medical organizations generally recommend that:
Two standard tests are used for early detection of prostate cancer:
PSA Test Limitations . Prostate specific antigen (PSA) is a protein produced in the prostate gland that keeps semen in liquid form. Prostate cancer cells appear to produce this protein in elevated quantities. Measuring PSA levels increases the chance for detecting the presence of cancer when it is microscopic. There are many unresolved questions surrounding PSA testing. The test is not accurate enough to either rule out or confirm the presence of cancer. PSA levels can be increased by various factors other than prostate cancer, including benign prostatic hyperplasia, prostatitis, advanced age, and ejaculation within 48 hours of the test. Relying too much on the test can lead to unnecessary biopsies. Not relying on it enough may miss cancers.
PSA screening may result in the detection of some possible cancers that would never have bothered the patient and would never have posed a threat to his life. Two major studies published in 2009 found that PSA screening saves few if any lives. As a result, the American Cancer Society does not recommend routine PSA testing, although individual men may choose to be tested.
Biopsy. If cancer is suspected, the doctor will order a biopsy. Only a biopsy, in which a tiny sample of prostate tissue is surgically removed, can actually confirm a diagnosis of prostate cancer. A biopsy is usually performed to confirm or rule out cancer based on a combination of PSA test levels, findings on the DRE, family history, and patient's age and ethnicity. If a biopsy gives a negative result but the doctor still suspects cancer, repeat biopsies may be performed.
An ultrasound procedure called transrectal ultrasonography (TRUS) may be used to help the doctor see where to take the needle biopsy. Ultrasound is not effective as a diagnostic tool by itself because it cannot differentiate very well between benign inflammations and cancer.
PSA Levels and Velocity . Once cancer is diagnosed, PSA levels may help to determine its extent. If PSA levels are lower than 20 ng/mL, it is likely that the cancer has not spread to distant sites. PSA levels over 40 ng/mL are a strong indicator that cancer has metastasized (spread throughout the body). PSA levels are also monitored after treatments begin. Changes in the level can show if a treatment is working or if the cancer has come back.
Doctors also monitor how quickly PSA levels rise over time. This rate is called PSA velocity (PSAV). The PSAV may help determine when treatment should begin and which treatment should be used. A high rate of PSAV is considered to be 2 ng/mL a year. Recent research suggests that men with early-stage prostate cancer who have a slow PSAV are more likely to live longer than men with rapidly rising PSA levels.
Test for Metastasis . If the biopsy indicates cancer, the doctor will order other tests to determine whether or how far the cancer has spread:
A pathologist will read the biopsy report and assign a grade to the tumor cells. The Gleason system classifies and scores the cancers cells based on their microscopic appearance. Based on the grade, PSA test, digital rectal exam, and possibly imaging tests, the doctor stages the cancer. Staging refers to how far the cancer has spread. The stage and grade of cancer can help the doctor advise on treatment options.
A tumor's stage is an indication of how far it has spread from its original site. Cancers are staged according to whether they are still localized (still within the prostate gland) or have spread beyond the original site. The current prostate cancer staging system is the TNM system.
The TNM system refers to clinical tumor stages as:
T followed by numbers 0 through 4 refers to the size and extent of the tumor itself.
Stage, T1 - T4
The tumor cannot be felt or seen using imaging techniques.
T1a. Cancer cells are incidentally found in 5% or less of tissue samples from prostate surgery unrelated to cancer.
T1b. Cancer cells found in more than 5% of samples.
T1c. Cancer cells identified by needle biopsy, which is performed because of high PSA levels.
The cancer is confined to the prostate but can be felt as a small well-defined nodule.
T2a. Tumors are in half a prostate lobe.
T2b. Tumors are in more than half a lobe.
T2c. Tumors in both lobes.
The tumor extends through the prostate capsule.
The tumor is fixed to or invades adjacent structures.
N followed by 0 through 3 refers to whether the cancer has reached the regional lymph nodes, which are located next to the prostate in the pelvic region.
Stage, N0 - N3
Regional lymph nodes are still cancer-free.
A small tumor is in a single pelvic node.
A medium-size tumor is in one node, or small tumors are in several nodes.
A large tumor is in one or more nodes.
M stages refer to metastasis (tumors developing outside the prostate).
Metastasis has not occurred (cancer has not spread beyond the regional lymph nodes).
Cancer has spread to lymph nodes beyond the regional lymph nodes.
Cancer has invaded the bones.
Cancer has spread to other sites.
Tumors are assigned scores according to a scale known as the Gleason system, which measure how well or how poorly organized the cancer cells are under the microscope. The first step is to grade the tumors:
Two-thirds of prostate cancers have a mix of tumor grades. To determine a prognosis, two numbers are assigned, representing the dominant grade and then the minor grade. The cancer is then "scored" by adding the dominant grade plus the minor grade. For example, a tumor with a dominant grade of 3 and a minor grade of 4 are given a Gleason score of 7. The following scores are often used to suggest how well or poorly the tumor is differentiated. The higher the score, the more severe the break-down of their cellular structure and the more likely they are to spread aggressively:
Treatment choices are generally based on the patient's age, the stage and grade of the cancer, overall health status, and the patient's personal preferences for the risks and benefits of each therapy.
Patients should be aware that doctors may be biased to prefer a specific treatment depending on their specialty, with urologists tending to recommend surgery and radiation oncologists recommending radiation therapy. It is always wise to seek a second opinion. Delaying treatment, while having the cancer monitored for signs of progression, is also an acceptable option.
Stages indicate the extent of the cancer:
Depending on the cancer stage and other factors, patients have four main treatment options:
The U.S. National Cancer Institute recommends the following treatment options by cancer stage:
Tumors: T1a, N0, M0, G1, Stage A
Tumors: T1a - c, N0, M0, any G, Stage A2, B1, or B2
Overview of Treatment Options for Localized Prostate Cancer . To date, neither treatment nor active surveillance has emerged with a definitive survival advantage for localized prostate cancer. However, several recent studies have suggested that treatment provides a survival advantage over watchful waiting for some men with early-stage prostate cancer.
Recent guidelines recommend that patients with localized cancer should be classified as low, intermediate, or high risk. Doctors determine the risk category by using criteria such as PSA tests, tumor aggressiveness, and the clinical stage of the tumor. Based on these risk groups, evidence indicates that:
Tumors: T3, N0, M0, any G, Stage C
Tumors: Any T, any N, any M, any G, Stage D1 - D2
If prostate cancer has been eliminated after initial treatment, PSA levels should drop after surgery. After radiation, they may not drop as far because some of the prostate gland may remain. A sudden rise or persistently elevated PSA levels after treatment are often indications that prostate cancer persists.
It is common for PSA levels to temporarily rise following radiation seed implantation without signaling cancer recurrence. Rising PSA levels do not necessarily mean that the cancer has spread or even that clinical cancer will recur during a man's lifetime.
Treatment options for recurrent cancer depend on various factors, including prior treatment, site of recurrence, coexistent illnesses, and individual patient considerations.
Prostate cancer treatments can cause distressing side effects by impairing sexual function (erectile dysfunction), urination (incontinence or difficulty urinating), bowel function (incontinence), and energy levels (fatigue). A man must weigh his own emotional responses to the possibility of these side effects versus the possible stress of active surveillance.
Side effects vary among patients and it is difficult to predict how an individual patient will respond. In general, the side effects most likely to occur by treatment modality are:
Watchful waiting involves lifestyle change and careful monitoring for cancer progression. Over the last several years, watchful waiting has evolved into a strategy called "active surveillance," or "delayed surgical intervention." With this approach, patients have a digital rectal exam and PSA blood test every 6 - 12 months. If test results indicate cancer progression, doctor and patient consider treatment options (surgery, radiation, or drugs). Patients should exercise and eat healthy foods. Patients should report symptoms such as weight loss, pain, urinary problems, fatigue, or impotence to their doctors.
Candidates. Active surveillance may be most appropriate for the following patients:
Some doctors think that because prostate cancer grows so slowly, it is likely that older men will die from causes unrelated to the cancer. There is therefore little potential benefit from surgery or radiation, with both posing a risk for erectile dysfunction and incontinence. The choice is a difficult one. It is important that patients find a doctor who can provide them with all the necessary information so that they can make an informed decision.
In men whose cancer is confined to the prostate, surgical resection (radical prostatectomy) offers the potential for cure. Cure rates from initial surgery in men with localized cancer are about 90%, depending on tumor stage, tumor grade, PSA levels, and overall health of the patient. Research suggests that surgery provides long-term cancer control. Most patients can consider themselves disease-free if their PSA levels remain undetectable 10 years after surgery.
Radical prostatectomy is the surgical removal of the entire prostate gland along with the seminal vesicles (the vessels that carry semen) and surrounding tissue. The surgeon may also remove the pelvic lymph nodes. The incision can be made in one of the following regions:
The gland and other structures are then removed. The operation lasts 2 - 4 hours.
Laparoscopic Prostatectomy . Less invasive surgical techniques using laparoscopy have been developed for radical prostatectomy. These techniques use smaller incisions and allow faster recovery, but they require special surgical training. Laparoscopic surgery may also be done using a robotic system, which involves the surgeon directing a robotic arm through a computer monitor. Not every hospital can do robotic-assisted laparoscopic prostatectomy and these procedures are difficult to perform.
Nerve-Sparing Techniques . In the retropubic approach, the surgeon will attempt to spare the nerves that control erection:
Nerve-sparing techniques can improve quality of life, by decreasing the occurrence of incontinence and erectile dysfunction. In cases where the tumor lies too closely to the nerve, nerve-sparing techniques may not be possible.
Convalescence. Patients remain hospitalized for about 3 days after an open procedure or 2 days after less invasive procedure. Full recovery at home takes about 3 - 5 weeks. A temporary catheter used to pass urine is kept in place when the patient is sent home and is usually removed about 3 weeks after the open operation or 1 week after their robotic procedure. In general, younger patients with early-stage cancers recover fastest and experience the fewest side effects.
The main complications from radical prostatectomy are urinary incontinence and erectile dysfunction. Other complications include the usual risks of any surgery, such as blood clots, heart problems, infection, and bleeding.
Urinary Incontinence. Urinary incontinence is a common complication. When the urinary catheter is first removed following surgery, nearly all patients lack control of urinary function and will leak urine for at least a few days and sometimes for months. Normal urinary function usually returns within about 18 months. A percentage of men will continue to have small amounts of leakage with heavier exertion or possibly sexual activity.
If incontinence persists beyond a year, patients may require drug therapy or surgery.
Erectile Dysfunction. Erectile dysfunction after radical prostatectomy is caused by nerves that were damaged or removed during the surgery. Virtually all men will have problems with erectile dysfunction after surgery. It can take up to one to two years to recover erectile function after surgery. Because seminal glands are removed along with the prostate gland during surgery, men who regain sexual function will not produce semen during orgasm ("dry ejaculation").
With the use of effective nerve-sparing techniques, men who were sexually active before surgery and are involved in an ongoing relationship seem to have a better chance of returned sexual function. Drugs such as sildenafil (Viagra) may help some men regain erectile function. Use of these drugs three times a week accompanied by sexual stimulation is now commonly recommended. Other treatments for erectile dysfunction (alprostadil injections, vaccum devices, penile implants) may also be options.
Radiation therapy may be used as an initial treatment for localized prostate cancer. It may also be used as treatment for cancer that has not been fully removed or has recurred after surgery. In advanced cancer, radiation therapy is used to shrink the size of the tumor and relieve symptoms.
Radiation therapy used to be reserved for older men (over age 70) with locally advanced prostate cancer who had a life expectancy of 15 years or less. However, it is now being used more frequently in younger and healthier men.
The two main radiation treatments for prostate cancer are:
Both treatments have generally equal success rates. In some cases, both techniques may be used in high-risk patients.
In external beam radiation therapy, a doctor focuses a beam of radiation directly on the tumor for 35 3-minute treatments given 5 times a week over 7 weeks. 3-D conformal techniques use computers and a three-dimensional image of the prostate to target the tumor precisely, using high-dose radiation beams. It poses a lower risk for inflammation.
Patients considering external beam radiation should be aware that higher radiation doses may reduce the risk for cancer recurrence and improve survival outcome.
Brachytherapy is a technique that implants radioactive "seeds" directly into the prostate. Implants can be temporary or permanent. Temporary implants are usually accompanied by external beam radiation. This procedure requires more skill than external beam radiation therapy. Even with experienced doctors, the distribution of radioactive seeds may be uneven, increasing the risk for insufficient doses. In addition, in some cases the seeds can migrate through the bloodstream to other parts of the body.
It is common for PSA levels to temporarily rise, or "bounce," following seed implantation. This effect is not necessarily a sign of cancer recurrence.
Brachytherapy is mainly used for men who have early stage prostate cancer that is relatively slow growing. It is also used in combination with external beam radiation to treat intermediate-risk localized prostate cancer. Poorer candidates for brachytherapy include men who have had transurethral resection of the prostate (TURP) and patients with advanced cancer, high-grade tumors, or very enlarged prostate glands.
Fatigue is a common side effect for several months following radiation therapy. Other complications include:
Gastrointestinal and Bowel Complications. Complications in the gastrointestinal tract are common. Short-term effects include nausea and loss of appetite. Diarrhea is a very common side effect and can last for the duration of therapy. It is usually treated with Lomotil. It usually goes away eventually, but a few patients have diarrhea flare-ups for years afterwards.
Urinary Problems. Many patients experience a need for frequent urination shortly after radiation therapy, and urgency persists longterm for about some patients.
Erectile Dysfunction. Unlike surgery, erectile dysfunction does not usually occur immediately following radiation therapy. However, the risk for this complication increases after a year or more. External beam radiation may be better at preserving sexual function than brachytherapy. Drug therapies for erectile dysfunction may help.
Radiation may help select patients who still show detectable levels of PSA after surgery (generally 2 ng/mL or less). It may even be useful years after surgery if PSA levels rise.
Depending on timing, radiation after treatment failure is referred to as either:
Cryosurgery is an alternative to standard prostatectomy for men with localized prostate cancer who do not want or who are not appropriate candidates for radical prostatectomy. It is also an alternative to radiation therapy. The goal of cryosurgery is destruction of the entire prostate gland and possibly surrounding tissue. Steel probes are inserted through the skin between the anus and the rectum and into the prostate. Liquid nitrogen is pumped through the probes to freeze all prostate cells, both healthy and cancerous. For success, cryosurgery requires a uniformly frozen area. The dead cells are absorbed and eliminated by the body.
Cryosurgery is typically a 2-hour outpatient procedure, although some patients may need to stay in the hospital overnight. Cryosurgery may also be used as a salvage procedure for patients who have undergone radiation therapy and have had cancer recurrence detected early.
Nearly all patients experience erectile dysfunction after cryosurgery, and urinary incontinence is also common. Other complications of cryosurgery include urinary retention, swelling, and fistula formation. Incontinence and fistulas tend to occur more when cryosurgery is used as a salvage procedure than when it is used as a primary procedure.
This therapy is still considered experimental by some doctors, and there are no long-term data to compare its effectiveness with standard prostatectomy. For this reason, cryosurgery is generally not considered as a first-line initial treatment.
Male hormones (called androgens), particularly testosterone and dihydrotestosterone, determine male secondary sex characteristics and stimulate prostate cell growth. When prostate cells, both healthy and cancerous, are deprived of androgens, they no longer proliferate and eventually die.
Androgen deprivation therapy (also called androgen suppression therapy or hormone therapy) uses drugs or surgery to suppress or block male hormones, particularly testosterone and dihydrotestosterone, that stimulate the growth of prostate cells. Androgen deprivation therapy is not a cure for prostate cancer, but it can help control symptoms and disease progression.
Androgen deprivation therapy is used for advanced and metastatic cancer and may be used if treatment for localized prostate cancer has failed and cancer recurs (as indicated by rising PSA levels).
There has been some debate about when to start androgen deprivation therapy. In 2007, the American Society of Clinical Oncology (ASCO) published clinical guidelines for androgen deprivation therapy in patients with recurrent, progressive, or advanced prostate cancer. The guidelines recommend that hormone therapy should, in general, be delayed until patients begin to experience symptoms from their cancer. However, when therapy is deferred, patients should regularly visit their doctors every 3 - 6 months for careful monitoring of their condition.
ASCO recommends either removal of both testicles (bilateral orchiectomy) or injections with luteinizing hormone-releasing hormone (LHRH) as initial androgen deprivation treatments. Combining antiandrogen drug therapy with orchiectomy or LHRH may also be considered.
When prescribing hormone therapy drugs, some doctors recommend periodically stopping and restarting treatment (intermittent therapy). This approach may help men avoid the loss of sexual function. More research needs to be conducted to determine the effectiveness of intermittent therapy.
Orchiectomy is the surgical removal of the testicles (surgical castration). It is the single most effective method of reducing androgen hormones, but because it is permanent it is not suitable for intermittent or temporary androgen deprivation. Orchiectomy plus radical prostatectomy may delay progression in patients with cancers that have spread only to the pelvic lymph nodes.
Men who have orchiectomy have reduced sexual function and desire. Patients do not experience a reversal of sex characteristics and the voice does not change. Like all androgen deprivation therapies, orchiectomy increases the risk for osteoporosis.
The primary drugs used for suppressing androgens are called luteinizing hormone-releasing hormones (LHRH) agonists. LHRH drugs block the pituitary gland from producing hormones that stimulate testosterone production. They include leuprolide (Lupron, Leuprogel), goserelin (Zoladex), and buserelin.
Treatment with LHRH agonists produces a testosterone surge in the first week, which may actually intensify symptoms. After this phase, testosterone levels drop to near zero. LHRH agonists can also cause PSA levels to rise temporarily.
Side Effects. Side effects include hot flashes and occasionally nipple and breast tenderness.
Anti-androgens are drugs used to block the effects of testosterone. They are generally used in combination with LHRH agonists or orchiectomy to completely block androgen hormones. This combination approach is called combined androgen blockade (CAB) in the U.S., and maximal androgen blockade (MAB) in Europe.
The main anti-androgen drugs include flutamide (Eulexin, Drogenil), nilutamide (Nilandron), and bicalutamide (Casodex). Diarrhea is the most common side effect.
If patients do not respond to standard hormonal medications, other drugs may be tried. They include estrogen therapy and ketoconazole (Nizoral), an anti-fungal drug that blocks testosterone production.
In 2008, the FDA approved degarelix as a hormonal drug treatment for advanced prostate cancer. Degarelix belongs to a class of drugs called gonadotropin releasing hormone (GnRH) receptor inhibitors. It works by suppressing testosterone and thereby slowing the growth and progression of prostate cancer. Degarelix is given by injection. It is the first new drug approved in several years for treatment of prostate cancer.
Androgen Deprivation Therapy Before or With Radiation . Hormonal drugs combined with radiation therapy may improve survival rates in moderate- or high-risk groups. Patients may need to take these drugs long-term to improve outcomes. Hormonal drugs before radiation (neoadjuvant therapy) may be helpful in shrinking enlarged glands so that brachytherapy (radiation implants) can be used.
Androgen Deprivation Therapy Before or After Surgery . Some studies suggest benefits from using hormone therapy before surgery (neoadjuvant therapy) to reduce the tumor size, but this approach does not appear to increase survival.
Men often experience fatigue, loss of energy, and emotional distress from androgen suppression treatment. Hormonal therapy may significantly impair quality of life, particularly in men who had no symptoms beforehand and whose cancer has not metastasized. Common side effects of androgen suppression drugs include:
In addition, there is growing evidence that androgen deprivation therapy increases the risks for heart attack, stroke, and diabetes.
Prostate cancer that does not respond to hormonal treatment is called hormone-resistant, or hormone-refractory, cancer. Chemotherapy may be used to treat hormone-resistant cancer.
Chemotherapy drugs for prostate cancer include docetaxel (Taxotere), mitoxantrone (Novantrone), estramustine (Emcyt), and various platinum-based drugs, such as carboplatin. These drugs are often combined with other cancer drugs (such as 5-fluorouacil) or corticosteroids (such as prednisone).
Docetaxel-based drug regimens are emerging as the main chemotherapy treatment for hormone-refractory prostate cancer. In 2004, the FDA approved docetaxel injection in combination with prednisone for treatment of patients with hormone-resistant prostate cancer. Patients who received this drug combination survived on average 2.5 months longer than patients who received mitoxantrone and prednisone. Side effects can be serious and may include gastrointestinal problems (nausea, vomiting, or diarrhea), fatigue, low blood cell counts, and increased risk for blood clots.
Researchers are continuing to investigate docetaxel combinations and compare them to other chemotherapy regimens.
Agency for Healthcare Research and Quality. Comparative effectiveness of therapies for clinically localized prostate cancer: executive summary no. 13. AHRQ Pub. No. 08-EHC010-1. February 2008.
American Urological Association. Prostate-specific antigen best practice statement: 2009 update. April 2009.
Andriole GL, Crawford ED, Grubb RL 3rd, Buys SS, Chia D, Church TR, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med . 2009 Mar 26;360(13):1310-9. Epub 2009 Mar 18.
Babaian RJ, Donnelly B, Bahn D, Baust JG, Dineen M, Ellis D, et al. Best practice statement on cryosurgery for the treatment of localized prostate cancer. J Urol . 2008 Nov;180(5):1993-2004. Epub 2008 Sep 25.
D'Amico AV, Chen MH, Renshaw AA, Loffredo M, Kantoff PW. Androgen suppression and radiation vs radiation alone for prostate cancer: a randomized trial. JAMA . 2008 Jan 23;299(3):289-95.
Gaziano JM, Glynn RJ, Christen WG, Kurth T, Belanger C, MacFadyen J, et al. Vitamins E and C in the prevention of prostate and total cancer in men: the Physicians' Health Study II randomized controlled trial. JAMA . 2009 Jan 7;301(1):52-62. Epub 2008 Dec 9.
Keating NL, O'Malley AJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol. 2006 Sep 20;24(27):4448-56.
Kramer BS, Hagerty KL, Justman S, Somerfield MR, Albertsen PC, Blot WJ, et al. Use of 5-alpha-reductase inhibitors for prostate cancer chemoprevention: American Society of Clinical Oncology/American Urological Association 2008 Clinical Practice Guideline. J Clin Oncol . 2009 Mar 20;27(9):1502-16. Epub 2009 Feb 24.
Lawson KA, Wright ME, Subar A, Mouw T, Hollenbeck A, Schatzkin A, et al. Multivitamin use and risk of prostate cancer in the National Institutes of Health-AARP Diet and Health Study. J Natl Cancer Inst . 2007 May 16;99(10):754-64.
Lim LS, Sherin K; ACPM Prevention Practice Committee. Screening for prostate cancer in U.S. men ACPM position statement on preventive practice. Am J Prev Med . 2008 Feb;34(2):164-70.
Lin K, Lipsitz R, Miller T, Janakiraman S; U.S. Preventive Services Task Force. Benefits and harms of prostate-specific antigen screening for prostate cancer: an evidence update for the U.S. Preventive Services Task Force. Ann Intern Med . 2008 Aug 5;149(3):192-9.
Lippman SM, Klein EA, Goodman PJ, Lucia MS, Thompson IM, Ford LG, et al. Effect of selenium and vitamin E on risk of prostate cancer and other cancers: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA . 2009 Jan 7;301(1):39-51. Epub 2008 Dec 9.
Litwin MS, Gore JL, Kwan L, Brandeis JM, Lee SP, Withers HR, et al. Quality of life after surgery, external beam irradiation, or brachytherapy for early-stage prostate cancer. Cancer . 2007 Jun 1;109(11):2239-47.
Loblaw DA, Virgo KS, Nam R, Somerfield MR, Ben-Josef E, Mendelson DS, et al. Initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2006 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol . 2007 Apr 20;25(12):1596-605. Epub 2007 Apr 2.
Lu-Yao GL, Albertsen PC, Moore DF, Shih W, Lin Y, DiPaola RS, et al. Survival following primary androgen deprivation therapy among men with localized prostate cancer. JAMA . 2008 Jul 9;300(2):173-81.
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: prostate cancer . V.2.2009.
Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med . 2008 Mar 20;358(12):1250-61.
Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med . 2009 Mar 26;360(13):1320-8. Epub 2009 Mar 18.
Shelley M, Wilt TJ, Coles B, Mason MD. Cryotherapy for localised prostate cancer. Cochrane Database Syst Rev . 2007 Jul 18;(3):CD005010.
Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2009: a review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin . 2009 Jan-Feb;59(1):27-41.
Thompson I, Thrasher JB, Aus G, Burnett AL, Canby-Hagino ED, et al. Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol . 2007 Jun;177(6):2106-31.
U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med . 2008 Aug 5;149(3):185-91.
Van Patten CL, de Boer JG, Tomlinson Guns ES. Diet and dietary supplement intervention trials for the prevention of prostate cancer recurrence: a review of the randomized controlled trial evidence. J Urol . 2008 Dec;180(6):2314-21; discussion 2721-2. Epub 2008 Oct 18.
Walsh PC, DeWeese TL, Eisenberger MA. Clinical practice. Localized prostate cancer. N Engl J Med . 2007 Dec 27;357(26):2696-705.
Walter LC, Bertenthal D, Lindquist K, Konety BR. PSA screening among elderly men with limited life expectancies. JAMA . 2006 Nov 15;296(19):2336-42.
Wilt TJ, MacDonald R, Hagerty K, Schellhammer P, Kramer BS.Five-alpha-reductase inhibitors for prostate cancer prevention. Cochrane Database Syst Rev . 2008 Apr 16;(2):CD007091.
Wilt TJ, MacDonald R, Rutks I, Shamliyan TA, Taylor BC, Kane RL. Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med . 2008 Mar 18;148(6):435-48. Epub 2008 Feb 4.

subset: commoncrawl


text:
Attorney & Radio Show Host Mark Levin Goes Birther on David Gregory and Chris Matthews...
Video: Attorney and radio show host Mark Levin goes birther on "Meet the Press" host David Gregory and "Hardball" host Chris Matthews. Levin touches on Michele Bachmann's upcoming appearance on "Meet the Press", Rev. Wright, Bill Ayers, Obama's not so clean nose and the "rogue" & "lawless" administration. The segment aired on 3/4/2011. [image source]
Hypocrisy at work: "But didn't Hillary dump on Obama a few days ago for playing up his Indonesian roots? So, what is she up to here? Is she pushing how great he is for having been born in Indonesia, or what, or simply reminding everybody about his background, his Islamic background?" - Chris Matthews - 12/18/2007 -Source.
FLASHBACK: Chris Matthews; Apparently Obama Does Not Have Hawaii Long-Form Birth Certificate - 1/31/11 - Source.
Just a reminder, the Obama records hidden from the American people; Passport records, Obama kindergarten records, Punahou School records, Occidental College records, Columbia University records, Columbia thesis, Harvard Law School records, Harvard Law Review articles, University of Chicago scholarly articles, Illinois State Bar Association records, Illinois State Senate records/schedules(said to be lost), Medical records, Obama/Dunham marriage license, Obama/Dunham divorce documents, Soetoro/Dunham marriage license, Adoption records and of course the long-form Certificate of Live Birth.
Visit the Birther Vault for the long list of evidence against Hawaii officials and all of the people questioning Obama's eligibility; [http://obamareleaseyourrecords.blogspot.com/2010/08/video-ltc-terry-lakins-attorney-on-cnn.html].
A Catalog of Evidence-Concerned Americans Have Good Reason to Doubt Putative Pres Obama Born in HI


text:
Updated 16/02/2017
Terms of employment
Employment contracts
EU rules lay down your obligations with regards to information you have to give to your staff as regards employment contracts.
In some EU countries the rules below may not apply to employees working maximum 1 month for you or to employees working fewer than 8 hours per week.
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- Germanydeen
- Greece *
- Hungaryenhu
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- Italyenit
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* Information not yet provided by national authorities
Information obligations
You must provide at least the following information to employees when they first come to work for you:
- parties of the employment contract
- place of work - if there is no fixed place of work, you should highlight that the employee will work in various locations and say where your business is registered
- title, grade, category of the work or brief specification/description
- start date
- expected duration of the employment relationship, if the contract is temporary
- number of paid annual holidays
- length of notice periods for you and the employee if one of you terminates the contract
- initial basic salary, any other components of remuneration, frequency of payment
- length of the normal working day or working week
- rules of any collective agreements governing the employee's conditions of work, if appropriate.
For annual holidays, length of notice periods, working time and remuneration, it is enough to refer employees to any relevant laws and administrative provisions.
If your employees will be required to work in a different country (see 'Posting of workers'), you must also inform them in advance of the following:
- duration of the employment abroad
- currency to be used for payment of their salary
- any allowances they will be eligible for while abroad
- conditions regarding their return.
Providing information - by when and how?
You must give the information above to new employees in writing no later than 2 months after they begin working for you.
The information can take the form of:
- a written employment contract
- a letter of commitment
- one or more written documents containing the information above.
Modification of employment relationships
You must inform employees in writing of any change to their work contracts no later than 1 month after the date the change takes effect. If the change is necessary because of a change in laws or administrative provisions, there is no need for a written document modifying the original contract.
Informing and consulting your staff
If your company has over 50 employees (or 20 if it is a unit of a larger business), you are legally obliged to inform them about:
- recent and probable future developments in company activities and economic situation
- employment situation
- likely substantial changes to the way work is organised or in contractual relations.
You must also make sure you give the information in time for employee representatives to prepare for official consultation with you on the related issues.
Employee representatives (or any experts assisting them) are prohibited by law from divulging to staff any information you give them in confidence.
How long can your staff work?
If you employ staff, you need to know the basic rules about working hours. These rules cover minimum periods of daily and weekly rest, as well as annual leave and maximum weekly working time. EU countries also have the option to apply rules that are more favourable.
Maximum weekly working time, weekly and daily rest
As an employer, you must ensure that the average weekly working time for your staff - including overtime - does not exceed 48 hours. Your employees must rest for at least 11 consecutive hours daily. On top of it, in any 7 days you must also give your staff at least 24 hours of uninterrupted rest.
Breaks, annual leave
If your staff works more than 6 hours a day, you must ensure that they get a break (of a duration specified in collective agreements or by national law).
Beyond the daily and weekly rest periods each worker is entitled to at least 4 weeks of paid holidays every year. You cannot replace these holidays by a payment, unless the employment relationship has ended before the staff member has taken all their annual leave.
Night work
Night work is at least a 7-hour shift, at least 3 hours of which must be between midnight and 5.00 am.
Night workers may not work more than 8 hours per 24 hours on average. If the work involves special hazards or heavy physical or mental strain, the daily limit of 8 hours may not be exceeded.
Night workers are entitled to a free health assessment before they start the night work and are entitled to a free, regular health check afterwards (that must respect medical confidentiality). If your night workers suffer from health problems related to the fact that they work nights, they must be transferred to day work whenever possible.
When working hours are not measured or predetermined, as in the case of managing executives or family workers, the working time obligations may not apply.
Further exemptions from the rules are possible in the following fields:
- security and surveillance
- industries where work cannot be interrupted for technical reasons
- rail transport
- agriculture
- tourism
Mobile workers
Mobile workers are staff members operating transport services for passengers or goods by road, rail, air or waterway. Their working time is regulated differently.
- Working time for mobile road transport activities (EU directive)
- Working hours in civil aviation (EU directive)
- Working hours in the railways sector (EU directive)
- Working hours for seafarers (EU directive)
Employing young people
If you would like to employ young people, the minimum employment age is 15 (higher where compulsory full-time schooling continues after age 15).
Young people under 15 years may be employed in cultural, artistic, sports or advertising activities with prior authorisation from the competent authority.
Children who are at least 14 (but not yet 15) can also work as part of a work/training scheme or a work-experience scheme. Children who are at least 14 (in certain cases 13) can also perform light work. The rules on working time, night work, and rest are quite strict for young people. The EU countries can set stricter rules than the minimum requirements.
Contact a local business support partner
Your enquiry will be sent to a support partner from the Enterprise Europe Network. To assist the advisor to respond in a timely and correct manner to this free service, please provide as much information as possible.Local business support
Help & advice
Get in touch with specialised assistance servicesHelp & advice
Help & advice
Your EURES Adviser can inform you on working conditions as well as assist you in the recruitment procedures in your country or your cross-border region.


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Psalm 37
David counsels, Trust in the Lord and do good—Rest in the Lord and wait patiently for Him—Cease from anger and forsake wrath—The meek will inherit the earth—The Lord loves justice and does not forsake His Saints.
1 Fret not thyself because of evildoers, neither be thou
2 For they shall soon be
4 Delight thyself also in the Lord; and he shall give thee the
6 And he shall
7 Rest in the Lord, and wait
9 For evildoers shall be
10 For yet a
11 But the
12 The wicked plotteth against the just, and gnasheth upon him with his teeth.
13 The Lord shall
14 The wicked have drawn out the sword, and have bent their bow, to cast down the poor and needy, and to slay such as be of upright conversation.
15 Their sword shall enter into their own heart, and their bows shall be broken.
17 For the arms of the wicked shall be broken: but the Lord upholdeth the righteous.
18 The Lord knoweth the days of the upright: and their
19 They shall not be ashamed in the evil time: and in the days of
20 But the wicked shall perish, and the enemies of the Lord shall be as the fat of lambs: they shall consume; into smoke shall they consume away.
21 The wicked
22 For such as be blessed of him shall inherit the
23 The steps of a good man are ordered by the Lord: and he delighteth in his way.
24 Though he fall, he shall not be utterly cast down: for the Lord upholdeth him with his hand.
25 I have been young, and now am old; yet have I not seen the
26 He is ever merciful, and lendeth; and his seed is blessed.
27 Depart from evil, and do good; and dwell for evermore.
28 For the Lord loveth
29 The righteous shall inherit the land, and dwell therein for ever.
30 The mouth of the
31 The
32 The wicked watcheth the righteous, and seeketh to slay him.
33 The Lord will not leave him in his hand, nor condemn him when he is judged.
35 I have seen the wicked in great power, and spreading himself like a green bay tree.
36 Yet he passed away, and, lo, he was not: yea, I sought him, but he could not be found.
37 Mark the
38 But the transgressors shall be destroyed together: the
39 But the
40 And the Lord shall help them, and deliver them: he shall deliver them from the wicked, and save them, because they trust in him.


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In the last Legislative session, passenger vehicle registration fees in the state of Utah were increased by $2 per transaction. This increase becomes effective Nov. 1. If you have any questions contact Jodi Monaco at (801) 297-3910.
Castle Dale Elementary will hold its book fair Nov. 19-21. Look day and open house to be held on Nov. 19. Donuts with Dad will be held Nov. 21 in conjunction with the book fair.
A Christmas Festival will be held at the Emery Recreation Center building on Nov. 7 from 1-9 p.m. and Nov. 8 from 10 a.m.-4 p.m. For information call 381-2222 or 748-2357. Craft, entertainment, food and booths will be available.
The students and faculty announce the annual Veterans Day Program. All veterans, whether currently serving or have past service, are welcome to join the school in a salute to the veterans, including Charles Durrant, a teacher who is currently serving. The program will be presented at 8:30 and 9:30 a.m. on Nov. 11 at the school.
The Carbon/Emery chapter of Pheasant Forever will hold a membership banquet on Nov. 8 from 6-9 p.m. at the Greenwell Convention Center in Price. Raffle tickets are available, for information call 636-1505.
The Melon Vine Store in Green River will host the ribbon cutting ceremony in conjunction with the grand opening of the newly remodeled facility. There will be shopping sprees, drawings, balloons, popcorn, pop and candy. The ceremony will be held Nov. 14 at 10 a.m.
College of Eastern Utah will host Bread and Soup Night every Monday night through November from 5-6:30 p.m. Proceeds will go to the Carbon County Food Bank. The event will be held in the Jennifer Leavitt Student Center.
The American Legion has re-launched a free, easy way to thank the troops for their service this Veterans Day, Nov. 11. Create the card at the American Legion website www.legion.org. This free service is being offered through Nov. 12.
The Holiday Quilt show will run through Nov. 6 with the dinner and auction to be held on Nov. 7. The show and auction will be held in the Little America Hotel and Towers. There is an admission fee required. Contact the Deseret Foundation with additional questions at 1-801-314-2785.
Applications are now being accepted for city/county titleholders to compete for the title of Miss Teen Utah International to be held May 7-8, 2004 at Bingham High School in South Jordan. Call or write: Miss Teen International Pageant, Box 459, Riverton, Ut. 84065, or 1-801-254-4616, fax 1-801-254-8547, or email email@example.com.
There will be food handlers' classes for all persons working in food handling establishments. Classes will be taught in Price Nov. 12 and Dec. 10 at 9 a.m. and 4 p.m. and in Castle Dale Nov. 20 and Dec.18 at 4 and 7 p.m. For more information contact Dr. Claron Bjork at 637-3671 or Terri at 381-2252.
Utah's youth anti-tobacco advocacy group, the Phoenix Alliance, encourages youth to fight big tobacco by entering the seventh annual Truth From Youth Anti-Tobacco Advertising contest. Entries are grouped in elementary, junior and senior high categories with cash prizes. Contest deadine is March 22, 2004. Create anti-tobacco radio, TV or billboard ads to enter. For more information call 1-801-256-4924 or visit www.youthagainsttobacco.com.
Utahns who need help quitting tobacco may call the Utah Tobacco Quit Line at 1-888-567-TRUTH. The quit line offers live tobacco cessation counseling, as well as referrals to additional services, state-of-the-art cessation booklets and kits with quitting aids. The quit line operates Monday-Thursday from 6 a.m.-10 p.m., Friday from 6 a.m.-8 p.m., and Saturday and Sunday from 7 a.m.-6 p.m. Also visit www.utahquitnet.com which offers 24 hour help.
A statewide summit "Eliminating Inequalities in Health" will be held Nov. 13 from 8:30 a.m.-5 p.m. at the Salt Lake City Main Library Auditorium. The purpose of the summit is to build connections between the Utah Department of Health and the community to better address social inequalities in health as well as develop long term strategies to reduce health inequalities. Register on line by Nov. 7 at www.utahissues.org or call Jennifer at 1-801-521-2035, ext. 100.
If you have suffered a stroke or been diagnosed with arthritis, Parkinson's disease, a respiratory disorder, or any other condition which causes you to be unable to walk or self propel a manual wheelchair, you may be eliglible to receive a motorized wheelchair at no out of pocket expense. Call Independent Senior toll free at 1-800-383-8435.
A field service officer from the Veterans of Foreign Wars, Department Service Office in Salt Lake City will be at the Price Workforce Service Center from 8:30-10:30 a.m. on Nov. 6 to assist in understanding and applying for rightful VA benefits. This is a free service.
The Log Home and Timber Frame Expo is coming to the South Towne Exposition Center in Salt Lake City Nov. 7-9. The Expo will feature more than 100 exhibitors. For more information log on to www.logexpo.com.
Donations are needed from Emery County residents to the Emery Chapter of the Salvation Army which provides emergency assistance for the people of Emery County as well as people traveling through the area. Mail donations to the Emery County Sheriff's Office, Box 281, Green River, Utah 84525 or Emery County Sheriff's Office, Box 817, Castle Dale, Utah 84513. For information, contact Cheryl Keener at 435-564-3432.
The Lily of the Valley Camp DUP will host its annual fund raising Pheasant Hunter's Breakfast and Luncheon Nov. 8 beginning at 7 a.m. The festivities will be held at 55 South 100 East in Elmo. Drawing for the quilt and other items will be held at 3 p.m.
College-bound high school students who want to take the ACT test for college addmissions have two chances to register before the Dec. 13 national test date. The postmark registration deadline is Nov. 7. An additional fee will be required for the late postmark deadline of Nov. 20. For more information contact Ken at 319-337-1028 of email email@example.com.
The Homeownership Challenge is to increase minority homeownership by 5.5 million by the end of the decade. The American Dream Downpayment Initiative made significant progress as the US House of Representatives passed a $400 million bill to assist 80,000 low income families to become homeowners. For more information visit www.hud.gov.
Castle Dale, Ferron and Huntington Stakes are pleased to host a special fireside. Brother Thurl Bailey will be the guest speaker. He was baptized a member of the Church of Jesus Christ of Latter-day Saints in 1996. He is very talented in many ways. This fireside is Latter-day Saint standard and dress. Everyone from 12 to 100 is welcome to attend. No small children or babies.
Bailey will be available for autographs, pictures, and he will also have CDs, and tapes available for those interested. The date for this is Nov. 15 at 6:30 p.m. at the Spartan Center in Castle Dale.
Relay Utah launched relayutah.gov, making information about its toll free service and other resources easier to access by Utah's deaf, hard of hearing, speech disabled communites and their friends and families. Visit this website to learn more.
US Equal Employment Opportunity Commission is presenting the Technical Assistance Program Seminar Nov. 7 at the Wyndham Hotel in Salt Lake City. For registration and information call 1-202-663-7071 email email@example.com.
The Old Mill Camp of the DUP is offering a unique collection of over 200 pictures on CD. There are group pictures and pictures of past and present buildings in Ferron. The CD is being pre-sold to help raise money for the publishing of the book. Can be used as a screen saver or viewed as a picture album. The Old Mill Camp also has an afghan for sale. Contact Irene Williams at 384-2902 or Ferron City Hall.
Story Time for pre-schoolers will be held every Friday at 11 a.m. Will be held every Friday except. Nov. 28, Dec. 26 and Jan. 2.
Emery County Care and Rehab is currently looking for volunteers to perform for one hour per month, providing musical entertainment for the residents. Any instrument is welcome. Any single person or group is welcome. Any age. Please call Tracy at 384-2301.
"Free & Low Cost Prescription Drugs - 7th edition," a book that lists drugs available through patient assistance programs, either free or for very low cost directly from the manufacturer, is published by the Cost Containment Research Institute in Washington, DC. The book explains how to find out if you qualify, and suggests 17 ways to reduce your medicine costs.
Consumers may receive the book by sending a fee which covers printing, postage and handling, to: Institute Fulfillment Center, Book #: PD-75, P.O. Box 210, Dallas, PA 18612-0210. The website is www.institutedc.org, and the information number is (202) 478-0481.


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To Court Millennials, Hotels Are Rolling Out the Yoga Mat
February 27, 2017,
The LH blood test measures the amount of luteinizing hormone (LH) in blood. LH is a hormone released by the pituitary gland, located on the underside of the brain.
ICSH - blood test; Luteinizing hormone - blood test; Interstitial cell stimulating hormone - blood test
A blood sample is needed.
Your health care provider will ask you to temporarily stop medicines that may affect the test results. Be sure to tell your provider about all the medicines you take. These include:
If you are a woman of childbearing age, the test may need to be done on a specific day of your menstrual cycle. Tell your provider if you have recently been exposed to radioisotopes, such as during a nuclear medicine test.
When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging sensation. Afterward, there may be some throbbing or a slight bruise. These soone go away.
In women, an increase in LH level at mid-cycle causes release of eggs (ovulation). Your doctor will order this test to see if:
If you are a man, the test may be ordered if you have signs of infertility or lowered sex drive. The test may be ordered if you have signs of a pituitary gland problem.
Normal result for an adult women are:
LH levels are normally low during childhood.
Normal result for men over 18 years of age is around 1.8 to 8.6 IU/L.
IU/L stands for international unit per liter.
Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test result.
In women, a higher than normal level of LH is seen:
In men, a higher than normal level of LH may be due to:
In children, a higher than normal level is seen in early (precocious) puberty.
A lower than normal level of LH may be due to the pituitary gland not making enough hormone (hypopituitarism).
Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.
Other risks associated with having blood drawn are slight but may include:
Borawski D, Bluth MH. Reproductive function and pregnancy. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods . 22nd ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 25.
Melmed S, Kleinberg D, Ho K. Pituitary physiology and diagnostic evaluation. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 12th ed. Philadelphia, Pa: Elsevier Saunders; 2011: chap 8.


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Naughty Monkey Gingerbread Sandal
Sorry, this item is sold out!
Looks like you've got more shoe shopping to do - have fun!
Looks like you've got more shoe shopping to do - have fun!
Item # 274622
It's all in the details with this sweet braided sandal from Naught Monkey. The Gingerbread sandal has a strappy silhouette with a uniquely-detailed platform and heel that will have all eyes on you.
- Woven faux leather upper
- Slingback strap with adjustable buckle
- 1" platform, 5" metallic and cork flecked heel
- Synthetic sole
- Imported
- View more Women's Naughty Monkey Shoes
By: boozhee1
Location: Chicago
April 03, 2014
Cute show......but not a tight fit!
"The straps around the foot and ankle are very loose. The shoe runs very short......my heel is overlapping the heel of the shoe (not cute!). The crystals (Gingerbread looking crumbs) on the heel of the shoe was coming off in the bag it came in. The quality & fit could be better. Looks better on the site, dull and blah in person!"
By: RobinLeslie
Location: Atlanta
September 20, 2013
Comfy and Cute, but odd fit
"This shoe is comfortable and the sizing is perfect, however the straps that cross over the top of my foot were very loose and there was no way to adjust them."
By: Never2manyDSWshoes
Location: Maryland
July 04, 2013
Hot hot hot
"I love these shoes. I saw them in a DSW store, tried them on and waited until they went on sale. They fit perfectly and even with the height, they are very easy to walk in. Gorgeous!"
Click anywhere to close this.


text:
News // Brother Ali
2.15.13 Brother Ali speaking and performing at Nobel Peace Prize Forum on March 9th
We're proud to announce that Brother Ali will be a keynote presenter at this year's Nobel Peace Prize Forum in Minneapolis. His presentation will combine lecture and musical performance regarding Hip Hop's role in the global struggle for peace, justice and human dignity.
Tickets are on sale now for this year's event. Last year sold out in advance so don't waste any time picking yours up! More Information.
Check out a feature article on City Pages, and then listen to an interview on KFAI Radio!
Mourning in America and Dreaming in Color is now available for purchase on iTunes (Deluxe version with two bonus songs), from Fifth Element, Amazon, and your favorite local independent or chain music retailer.
Brother Ali: BrotherAli.com | Facebook | Twitter | Google+ | Instagram | Myspace
Rhymesayers: Facebook | Twitter | YouTube | Google+ | Instagram | Flickr | Soundcloud | Myspace
2.20.13 Atmosphere's Welcome To Minnesot…
There's only ONE show left on the third annual Welcome To Minnesota Tour with any available …← Newer Post
2.14.13 Brother Ali added to 2013 Treefo…
Just announced! If you're anywhere near Boise, ID you know where to be in late March. Brother…Older Post →


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There are two camps when it comes to issues of harassment, bullying, diversity, and making inclusive communities, especially when the medium is online or in the tech industry. Without trying to let my own bias tilt my presentation, I think these two camps can be summed up with the following sayings:
"I've taken worse and haven't been bruised. You need to learn how to take a punch."
If you don't think the low rates of women and minorities participating in the tech industry is fundamentally a problem that should be corrected, you can stop reading now and save yourself a few minutes. But software developers are in high demand. There's a lot of great software out there waiting to be written. And while the current generation is much more technically literate than say, 30 years ago, raising the general level of technical expertise would blossom the possibilities for more sophisticated products and avenues of communication. We should get as many people across all demographics on board as possible.
I'm not going to talk solely about sexism itself in the tech industry (though at the front of my views on that are pointing out how widely the Internet blames Adria Richards for the dongle-joker's firing rather than Play Haven, who did the actual firing.) But I also want to talk about inclusion and how to build community, and the attitudes that tear community down.