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Executive Summary – Feb. 5, 2008
Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer
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Archived: This report has been updated.
Table of Contents
Background and Key Questions
Prostate cancer is the most common nondermatologic cancer in men. In 2007 an estimated 218,890 men were diagnosed with, and 27,050 deaths were attributed to, prostate cancer in the United States. Approximately 90 percent of men with prostate cancer have disease considered confined to the prostate gland (clinically localized disease). Reported prostate cancer incidence has increased with introduction of the prostate-specific antigen (PSA) blood test. Disease-specific mortality rates have declined, and an estimated 1.8 million men living in the United States have a diagnosis of prostate cancer.
Clinically detected prostate cancer is primarily a disease of elderly men. Prostate cancer frequently has a relatively protracted course even if left untreated, and many men die with, rather than from, prostate cancer. Largely because of widespread PSA testing, the lifetime risk of being detected with prostate cancer in the United States has nearly doubled to 20 percent. However, the risk of dying of prostate cancer has remained at approximately 3 percent. Therefore, considerable overdetection and treatment may exist.
The primary goal of treatment is to target the men most likely to need intervention in order to prevent prostate cancer death and disability while minimizing intervention-related complications. Common treatments include watchful waiting (active surveillance), surgery to remove the prostate gland (radical prostatectomy), external beam radiotherapy (EBRT) and interstitial radiotherapy (brachytherapy), freezing the prostate (cryotherapy), and androgen deprivation therapy (ADT). (Treatment options are outlined in Table A.) All treatments have risks of complications, although frequency and severity may vary. Patient treatment decisionmaking incorporates physician recommendations and estimated likelihood of cancer progression without treatment, as well as treatment-related convenience, costs, and potential for eradication and adverse effects (AEs). Patient characteristics, including race/ethnicity, age, and comorbidities, have an important role in predicting mortality; the likelihood of treatment-related urinary, bowel, and sexual dysfunction; treatment tradeoff preferences; and selection. However, little is known about how these characteristics modify the effect of treatment.
|Treatment option
|Treatment Description
|Radical retropubic or perineal prostatectomy (RP)
|Complete surgical removal of prostate gland with seminal vesicles, ampulla of vas, and sometimes pelvic lymph nodes. Sometimes done laparoscopically or with robotic assistance and attempt to preserve nerves for erectile function.
|External beam radiotherapy (EBRT)
|Multiple doses of radiation from an external source applied over several weeks. Dose and physical characteristics of beam may vary. Conformal radiotherapy uses 3D planning systems to maximize dose to prostate cancer and attempt to spare normal tissue.
Intensity modulated radiation therapy (IMRT) provides the precise adjusted dose of radiation to target organs, with less irradiation of healthy tissues than conformal radiation therapy.
Proton radiation therapy is a form of EBRT in which protons rather than photons are directed in a conformal fashion to a tumor site. The use of the heavier single proton beam (vs. photon therapy) allows for a low entrance dose and maximal dose at the desired tumor location with no exit dose. This theoretically permits improved dose distribution (delivering higher dose to the tumor with lower dose to normal tissue) than other EBRT techniques. May be used alone or in combination with proton and photon-beam radiation therapy.
|Radioactive implants placed under anesthesia using radiologic guidance. Lower dose/permanent implants typically used. External beam "boost" radiotherapy and/or androgen deprivation sometimes recommended.
|Destruction of cells through rapid freezing and thawing using transrectal guided placement of probes and injection of freezing/thawing gases.
|Androgen deprivation therapy
|Oral or injection medications or surgical removal of testicles to lower or block circulating androgens.
|Watchful waiting (active surveillance)
|Active plan to postpone intervention. May involve monitoring with digital rectal exam/prostate-specific antigen test and repeat prostate biopsy with further therapy (either curative or palliative) based on patient preference, symptoms, and/or clinical findings.
|Laparoscopic radical prostatectomy (LRP) and robotic assisted radical prostatectomy (RLRP)
|Video-assisted, minimally invasive surgical method to remove the prostate.
|High-intensity focused ultrasound therapy (HIFU)
|High-intensity focused ultrasound therapy has been used as a primary therapy in patients with localized prostate cancer not suitable for radical prostatectomy. Tissue ablation of the prostate is achieved by intense heat focused on the identified cancerous area.
Prior to the advent of widespread PSA testing, most prostate cancers were detected based on abnormalities on the digital rectal examination (DRE) or incidentally from tissue obtained at surgery for treatment of symptoms due to benign prostatic obstruction. The vast majority of prostate cancers currently detected in the United States are asymptomatic, clinically localized, and found on routine PSA testing. PSA testing detects more tumors, at an earlier stage, with smaller volume within each stage, and at an earlier period in a man's life than nonscreen-detected tumors. The clinical significance, natural history, and comparative effectiveness of treatments in PSA-detected cancers are not known but likely differ from those detected and treated in the pre-PSA era (before the late 1980s to early 1990s).
The primary measure of tumor aggressiveness is the Gleason histologic score, although efforts are underway to identify more reliable prognostic factors. A classification currently recommended incorporates PSA levels, Gleason histologic score, and tumor volume to identify low-, intermediate-, and high-risk tumors based on their likelihood of progressing with no treatment as well as recurring (or failing to be eradicated) following early intervention. In addition to patient and provider factors, it is important to determine how tumor characteristics (e.g., Gleason score, tumor volume, screen vs. clinically detected tumors) affect the outcomes of interventions.
Provider and hospital characteristics may affect treatment selection and outcomes. The effect of provider volumes on clinical outcomes in men with localized prostate cancer is not well established. Specialty and geographical location of providers influence diagnostic strategies and the management of localized prostate cancer. Variability in the management of localized prostate cancer is often based on physician opinions and specialty. Diagnosis of localized disease is based primarily on a screening of asymptomatic patients. Therefore, differences in screening practices may be associated with differences in the stage of tumors detected and recommendations for intervention. Physician recommendations play an important role in patient decisions on treatment preferences. Recent studies showed that patient and physician treatment preferences reflect perceived personal factors more than evidence-based recommendations.
This report summarizes evidence comparing the relative effectiveness and safety of treatment options for clinically localized prostate cancer. The report addresses the following questions:
- What are the comparative risks, benefits, short- and long-term outcomes of therapies for clinically localized prostate cancer?
- How do specific patient characteristics, e.g., age, race/ethnicity, presence or absence of comorbid illness, preferences (e.g., tradeoff of treatment-related adverse effects vs. potential for disease progression), affect the outcomes of these therapies, overall and differentially?
- How do provider/hospital characteristics affect outcomes overall and differentially (e.g., geographic region and volume)?
- How do tumor characteristics, e.g., Gleason score, tumor volume, screen vs. clinically detected tumors, affect the outcomes of these therapies, overall and differentially?
The findings covered in this report are summarized in Table B.
Key Question 1. What are the comparative risks, benefits, and outcomes of therapies?
No one therapy can be considered the preferred treatment for localized prostate cancer due to limitations in the body of evidence as well as the likely tradeoffs an individual patient must make between estimated treatment effectiveness, necessity, and adverse effects. All treatment options result in adverse effects (primarily urinary, bowel, and sexual), although the severity and frequency may vary between treatments. Even if differences in therapeutic effectiveness exist, differences in adverse effects, convenience, and costs are likely to be important factors in individual patient decisionmaking. Patient satisfaction with therapy is high and associated with several clinically relevant outcome measures. Data from nonrandomized trials are inadequate to reliably assess comparative effectiveness and adverse effects. Additional randomized controlled trials (RCTs) are needed.
Limitations in the existing evidence include the following:
- Few randomized trials directly compared the relative effectiveness between (rather than within) major treatment categories.
- Many randomized trials are inadequately powered to provide long-term survival outcomes, with the majority reporting biochemical progression or recurrence as the main outcomes.
- Some randomized trials were old, conducted prior to prostate cancer detection with PSA testing (i.e., studies before the current era, when tumors are diagnosed in an earlier stage, giving more lead time, and there is a higher percentage of benign tumors, resulting in length bias and overdiagnosis), and used technical aspects of treatment that may not reflect current practice; therefore, their results may not be generalizable to modern practice settings.
- Wide variation existed in reporting and definitions of outcomes.
- There was little reporting of outcomes according to major patient and tumor characteristics.
- Emerging technologies have not been evaluated in randomized trials.
Randomized comparisons across primary treatment categories
- Radical prostatectomy compared with watchful waiting (2 RCTs). Compared with men who used watchful waiting (WW), men with clinically localized prostate cancer detected by methods other than PSA testing and treated with radical prostatectomy (RP) experienced fewer deaths from prostate cancer, marginally fewer deaths from any cause, and fewer distant metastases. The greater benefit of RP on cancer-specific and overall mortality appears to be limited to men under 65 years of age but is not dependent on baseline PSA level or histologic grade. Two RCTs compared WW with RP. The Scandinavian Prostate Cancer Group (SPCG) trial found significantly lower incidences of all-cause deaths (24 vs. 30 percent), disease-specific deaths (10 vs. 15 percent), and distant metastases (14 vs. 23 percent) for subjects treated with RP than for subjects assigned WW after a median followup of 8.2 years. Surgery was associated with greater urinary and sexual dysfunction than WW. An older trial of 142 men found no significant differences in overall survival between RP and WW after a median followup of 23 years, although small sample size limited study power.
- Radical prostatectomy vs. external beam radiotherapy (1 RCT). One small (N=106), older trial indicated that, compared with EBRT, RP was more effective in preventing progression, recurrence, or distant metastases in men with clinically localized prostate cancer detected by methods other then PSA testing. Treatment failure at 5 years of followup, defined as acid phosphatase elevation on two consecutive followup visits or appearance of bone or parenchymal disease with or without concomitant acid phosphatase elevation, occurred in 39 percent for EBRT compared with 14 percent for RP.
- Cryotherapy, laparoscopic or robotic assisted radical prostatectomy, primary androgen deprivation therapy, high-intensity focused ultrasound (HIFU), proton beam radiation therapy, or intensity modulated radiation therapy (IMRT) (0 RCTs). It is not known whether these therapies are better or worse than other treatments for localized prostate cancer because these options have not been evaluated in RCTs.
Randomized comparisons within primary treatment categories
- Radical prostatectomy combined with neoadjuvant androgen deprivation therapy (5 RCTs). The addition of neoadjuvant hormonal therapy to RP did not improve survival or cancer recurrence rates, defined by PSA recurrence, but increased AEs. One small RCT comparing RP alone and RP combined with neoadjuvant ADT found no overall or disease-specific survival benefit with the addition of neoadjuvant ADT after a median followup of 6 years. The addition of neoadjuvant ADT did not prevent biochemical progression compared with RP alone in any of the four trials. The trial comparing 3 months and 8 months neoadjuvant ADT with RP reported greater AEs in the 8-month group than the 3-month group (4.5 percent vs. 2.9 percent) and higher incidence of hot flashes (87 percent vs. 72 percent).
- External beam radiotherapy: comparison of EBRT regimens (5 RCTs). No RCTs compared EBRT and WW. It is not known if using higher doses of EBRT by increasing either the total amount or type of radiation (e.g., via high-dose intensity modulated or proton beam or by adding brachytherapy) improves overall or disease-specific survival compared with other therapies. No EBRT regimen, whether conventional, high-dose conformal, dose fractionation, or hypofractionation, was superior in reducing overall or disease-specific mortality. Increasing the total amount of radiation or adding brachytherapy after EBRT decreased cancer recurrence compared with lower doses of radiation. One trial (N=936) found that the probability of biochemical or clinical progression at 5 years was lower in the long-arm group (66 Gy in 33 fractions) than the short-arm group (52.5 Gy in 20 fractions). Conventional-dose EBRT (64 Gy in 32 fractions) and hypofractionated EBRT (55 Gy in 20 fractions) resulted in similar PSA relapse. One trial (N=104) found that brachytherapy combined with EBRT reduced biochemical or clinical progression compared with EBRT alone. One trial (N=303) found that high-dose EBRT (79.2 Gy that included 3D conformal proton 50.4 Gy with 28.8 Gy proton boost) was more effective than conventional-dose EBRT (70 Gy that included 19.8 Gy proton boost) in the percentage of men free from biochemical failure at 5 years (80 percent in the high-dose group and 61 percent in the conventional-dose group). Effectiveness was evident in low-risk disease (PSA <10 ng/ml, stage ≤T2a tumors, or ≤Gleason 6) and higher risk disease. Acute combined gastrointestinal (GI) and genitourinary (GU) toxicity was lower in the long arm (7.0 percent) than in the short arm (11.4 percent). Late toxicity was similar. There were no significant differences between conventional and hypofractionated EBRT with the exception of rectal bleeding at 2 years after therapy, which had a higher prevalence in the hypofractionated group. Acute GI or GU symptoms of at least moderate severity were similar in the trial comparing high and conventional doses.
- External beam radiotherapy combined with androgen deprivation therapy compared with EBRT alone (3 RCTs). ADT combined with EBRT (ADT + EBRT) may decrease overall and disease-specific mortality but increase AEs compared with EBRT alone in high-risk patients defined by PSA levels and Gleason histologic score (PSA >10 ng/ml or Gleason >6). One RCT (N=216) found that conformal EBRT combined with 6 months of ADT reduced all-cause mortality, disease-specific mortality, and PSA failure compared with conformal EBRT alone after a median followup of 4.5 years. There were significant increases in gynecomastia and impotence in the ADT + EBRT group compared with EBRT alone. One RCT (N=206) found that 6 months of ADT + EBRT did not significantly reduce disease-specific mortality compared with conformal EBRT alone in T2b and T2c subjects after a median followup of 5.9 years. Six months of combination therapy reduced clinical failure, biochemical failure, or death from any cause compared with EBRT alone in subjects with T2c disease but not in T2b subjects.
- Different doses of adjuvant external beam radiotherapy combined with brachytherapy (1 RCT). One small trial comparing different doses of supplemental EBRT, 20 Gy (N=83) vs. 44 Gy (N=76), adjuvant to brachytherapy (103Pd) implant found no significant differences in the number of biochemical failure events and freedom from biochemical progression at 3 years.
- Brachytherapy compared with brachytherapy (1 RCT). No RCTs compared brachytherapy alone with other major treatment options. Preliminary results from one small trial (N=126) comparing 125I with 103Pd brachytherapy found similar biochemical control at 3 years. There was a trend toward more radiation proctitis, defined as persistent bleeding, with 125I.
- Adjuvant androgen deprivation therapy with bicalutamide combined with standard care: RP, EBRT, or WW (3 RCTs). Androgen deprivation with bicalutamide alone or in addition to RP or EBRT did not reduce cancer recurrence or mortality. There was no difference in total number of deaths between the bicalutamide and placebo groups for men receiving RP or EBRT at the median followup of 5.4 years. Among WW subjects, there were significantly more deaths with bicalutamide compared with placebo. The addition of bicalutamide to standard care did not reduce progression.
Comparative outcomes data from nonrandomized reports
To supplement RCT findings and summarize the literature on treatment for localized prostate cancer, we used the database of the Clinical Guideline Panel for Treatment of Clinically Localized Prostate Cancer of the American Urological Association. This work relied on data extracted from 436 articles published between 1991 and April 2004 on T1-T2 prostate cancer. Over 80 percent were case series and only 6 percent were controlled trials. Data interpretation is limited by variability in result reporting, lack of controls, and likelihood that the database contained results from multiple publications using identical or nearly identical populations. Overall and disease-specific mortality were infrequently reported. When reported, there was extremely wide variation within and between treatments, making overall estimates of outcomes difficult. There was not standardized reporting of biochemical outcomes, with more than 200 definitions of "biochemical no evidence of disease (bNED)" reported. Results demonstrated extremely wide and overlapping ranges of outcomes at 5 and 10 years within and between treatments.
Adverse effects were reported, but definitions and severity varied widely. It was not possible to provide precise estimates regarding comparative effectiveness or specific AEs for each treatment option. Urinary dysfunction appeared to be more common in men treated with RP than in men treated with EBRT. Sexual dysfunction was common following all treatments. Impotence rates ranged from less than 5 percent to approximately 60 percent in the few studies reporting on men undergoing nerve-sparing RP.
Additional estimates for U.S. population-based AEs at 5 years following treatment were obtained from a large survey of Medicare-eligible men who had undergone treatment for localized prostate cancer. Urinary dysfunction, defined as no control or frequent leaking of urine, occurred in 14 percent of men undergoing RP and 5 percent undergoing EBRT. Use of pads to stay dry was greater after RP (29 percent) than EBRT (4 percent). Bowel dysfunction was lower in men receiving RP than EBRT, although the only significant difference was related to bowel urgency (18 percent vs. 33 percent). Erection insufficient for intercourse occurred in approximately three-quarters of men regardless of treatment. When adjusting for baseline factors, erectile dysfunction (ED) was greater with RP (odds ratio=2.5, 95-percent confidence interval=1.6, 3.8).
Cryosurgery. No randomized trials evaluated cryosurgery, and the majority of reports included patients with T3-T4 stages. Overall or prostate-cancer-specific survival was not reported. Progression-free survival in patients with T1-T2 stages ranged from 29 to 100 percent. AEs were often not reported but, when described, included bladder outlet obstruction (3 to 21 percent), tissue sloughing (4 to 15 percent), and impotence (40 to 100 percent). Outcomes may be biased by patient and provider characteristics.
Laparoscopic and robotic assisted prostatectomy. Three reviews estimated the effectiveness and AEs of laparoscopic and robotic assisted prostatectomy from 21 nonrandomized trials and case series. Most originated from centers outside of the United States. Median followup was 8 months. Laparoscopic RP had longer operative time but lower blood loss and improved wound healing compared with open retropubic RP. Reintervention rates were similar. Results from eight nonrandomized reports suggested that total complications, continence rates, positive surgical margins, and operative time were similar for robotic assisted and open RP. Median length of hospital stay (1.2 vs. 2.7 days) and median length of catheterization (7 vs. 13 days) were shorter after robotic assisted RP than open RP.
Intensity modulated radiation therapy. There was no direct evidence that IMRT results in better survival or disease-free survival than other therapies for localized prostate cancer. Based on nonrandomized data, the absolute risks of clinical and biochemical outcomes (including tumor recurrence), toxicity, and quality of life after IMRT are comparable with conformal radiation. There is low-level evidence that IMRT provides at least as good a radiation dose to the prostate with less radiation to the surrounding tissues compared with conformal radiation therapy.
Proton EBRT. There were no data from randomized trials comparing EBRT using protons vs. conventional EBRT or other primary treatment options. In one randomized trial, men with localized prostate cancer had statistically significantly lower odds of biochemical failure (increase in PSA) 5 years after the higher dose of EBRT with a combination of conformal photon and proton beams without increased risk of adverse effects. Based on nonrandomized reports, the rates of clinical outcomes and toxicity after proton therapy may be comparable with conformal radiation. There was no direct evidence that proton EBRT results in better overall or disease-free survival than other therapies.
High-intensity focused ultrasound therapy. There were no data from randomized trials comparing HIFU with other primary treatment options. Biochemical progression-free survival rates of 66 to 87 percent and negative biopsy rates of 66 to 93 percent were reported from noncontrolled studies. The absolute risk of impotence and treatment-related morbidity appeared to be similar to other treatments. Followup duration was <10 years.
Health status, quality of life, and treatment satisfaction. Eight studies of health status and quality of life, including a U.S. population-based survey, were eligible. Bother due to dripping or leaking of urine was more than sixfold greater in RP-treated men than in men treated with EBRT after adjusting for baseline factors. Bother due to bowel dysfunction (4 vs. 5 percent) or sexual dysfunction (47 vs. 42 percent) was similar for RP and EBRT. In a subgroup of men ages 70 and over, bother due to urine, bowel, or sexual dysfunction was 5.1, 2.4, and 2.8 times higher, respectively, for aggressive (RP/EBRT) vs. conservative (WW/ADT) therapy. Satisfaction with treatment was high, with less than 5 percent reporting dissatisfaction, unhappiness, or feeling terrible about their treatment, although the highest percent was among those treated with RP. Treatment satisfaction was highly correlated with bowel, bladder, and erectile function; general health status; belief that the respondent was free of prostate cancer; and whether cancer treatments limited activity or relationships. More than 90 percent said they would make the same treatment decision again, regardless of treatment received.
Key Question 2. How do patient characteristics affect outcomes?
No RCTs reported head-to-head comparisons of treatment outcomes stratified by race/ethnicity, and most did not provide baseline racial characteristics. Available data were largely from case series. Few studies reported head-to-head comparisons, and there was limited adjustment for confounding factors. Modest treatment differences reported in some nonrandomized studies have not been consistently reported in well-powered studies. There was little evidence of a differential effect of treatments based on age. While differences exist in the incidence and morbidity of prostate cancer based on patient age and there are differences in the treatments offered to men at different age ranges, few studies directly compared the treatment effects of different therapies across age groups. Most RCTs did not have age exclusion criteria. The mean/median age ranged from a low of 63 years for trials of RP to 72 years for trials of EBRT. Only one RCT provided subgroup analysis according to age. Results suggest that survival benefits of RP compared with WW may be limited to men under 65 years of age. Practice patterns from observational studies show that RP is the most common treatment option in younger men with localized prostate cancer.
Key Question 3. How do provider and hospital characteristics affect outcomes?
Results from national administrative databases and surveys suggested that provider/hospital characteristics, including RP procedure volume, physician specialty, and geographic region, affect outcomes. (There was no information on volume and outcomes for brachytherapy, cryotherapy, or EBRT.) Patient outcomes varied in different locations and were associated with provider and hospital volume independent of patient and disease characteristics. Screening practices can influence the characteristics of patients diagnosed and tumors detected. Screening practices and treatment choices varied by physician specialty and across regions of the United States. These did not correlate with clinician availability. Clinicians were more likely to recommend procedures they performed regardless of tumor grades and PSA levels.
Regional variation existed in physician availability, ratio of urologists and radiation oncologists per 100,000 adult citizens based on surveys conducted by the American Medical Association, screening practice, incidence, mortality, and treatment selection. The direction of regional variation was not always consistent. Several studies reported geographic variation at the county, State, or U.S. Census region level. Overall, many different methods were used to report geographic variation, so pooling of results was difficult; when results were pooled, the geographic regions used were quite large.
Surgeon RP volume was not associated with RP-related mortality and positive surgical margins. However, the relative risk of surgery-related complications adjusted for patient age, race, and comorbidity and for hospital type and location was lower in patients treated by higher volume surgeons. Urinary complications and incontinence were lower for patients whose surgeons performed more than 40 RPs per year. The length of hospital stay was shorter in patients operated on by surgeons who performed more RPs per year. Cost was not associated with surgeon volume. Surgeon volume of robotic laparoscopic RP was marginally associated with lower adjusted odds of extensive (but not any or focal) positive margins.
Hospital volume and teaching status were associated with patient outcomes. Despite different definitions of "high" and "low" hospital volumes in individual studies, pooled analysis showed that surgery-related mortality and late urinary complications were lower and length of stay was shorter in hospitals that performed more RPs per year. Hospital readmission rates were lower in hospitals with greater volume. Teaching hospitals had a lower rate of surgery-related complications and higher scores of operative quality. Several studies found differences in treatment and outcome based on whether the patient was seen in an HMO (health maintenance organization) or fee-for-service organization and whether the patient was a Medicare beneficiary. Variability in the use of ADT was more attributable to individual differences among urologists than tumor or patient characteristics.
Key Question 4. How do tumor characteristics affect outcomes?
Little data existed on the comparative effectiveness of treatments based on PSA levels, histologic score, and tumor volume to identify low-, intermediate-, and high-risk tumors. We focused on baseline PSA levels and Gleason histologic score. The natural history of PSA-detected tumors is not known because few men remain untreated for a long period. One report assessed 20-year outcomes in the United States from a cohort of 767 men with prostate cancer detected prior to PSA testing and treated with WW. Histologic grade was associated with overall and prostate-cancer-specific survival. Men with low-grade prostate cancers had a minimal risk of dying from prostate cancer (7 percent with Gleason score 2-4 died due to prostate cancer). Men with high-grade prostate cancers had a high probability of dying from their disease within 10 years of diagnosis, regardless of their age at diagnosis (53 percent with Gleason score 8-10 died due to prostate cancer). Estimates from large ongoing screening trials suggest that PSA increases the time of detection by 5-15 years. Therefore, it is likely that men with PSA-detected tumors will have better 20-year disease-specific survival than this cohort.
Most RCTs did not exclude participants based on PSA levels or tumor histology, and few provided comparative analysis according to these factors. Secondary analysis of one randomized trial concluded that disease-specific mortality at 10 years for men having RP compared with WW differed according to age but not baseline PSA level or Gleason score. Men with Gleason scores 8-10 were more likely to have evidence of biochemical recurrence than men with Gleason scores 2-6, regardless of whether treatment was RP alone or RP combined with neoadjuvant hormonal therapy (NHT). High-dose EBRT was more effective in controlling biochemical failure than conventional dose therapy in both low-risk disease (PSA <10 ng/ml, stage ≤T2a tumors, or Gleason ≤6) and higher risk disease. When the higher risk subjects were further divided into intermediate risk and high-risk groups, the benefit of high-dose therapy remained for the intermediate-risk but not for the high-risk patients.
Based on very limited nonrandomized trial data, disease-specific survival was similar for men treated with EBRT or with RP in men with baseline PSA >10 ng/ml. Men with Gleason scores 8-10 were more likely to have biochemical recurrence than men with Gleason scores 2-6, regardless of type of treatment.
Remaining Issues
Uncertainty about the comparative effectiveness and harms of the primary treatments for localized prostate cancer is the major gap in knowledge. This is mainly due to the paucity of direct head-to-head RCTs and the excess reliance on nonrandomized data to compare the most common treatment options: WW, RP, EBRT, brachytherapy, and ADT. Emerging technologies such as IMRT, proton beam radiation, laparoscopic and robotic assisted prostatectomy, and cryotherapy are increasingly being used despite the absence of long-term comparative RCTs.
Initiation and completion of long-term, adequately powered randomized trials (particularly comparative trials across, rather than within, primary treatment modalities) are needed. Where randomized trials have been conducted, confirmation (or refutation) of findings with additional randomized trials is needed because evidence is often based on results from a single relatively small study. These trials should standardize reporting of key clinically relevant outcomes, including overall, disease-specific, and metastatic-free survival; bNED; adverse effects; and disease-specific quality of life/health status. Ideally, relative effectiveness and adverse effects would be stratified according to tumor (PSA, stage, histologic grade) and patient (age, race, comorbidity) characteristics. A previous RCT comparing RP and brachytherapy was discontinued due to inadequate recruitment. However, several trials are ongoing, including comparisons of RP vs. WW, RP vs. EBRT or WW, cryotherapy vs. EBRT, and active surveillance with delayed intervention vs. early intervention with RP. Results will not be available for several years. Patients and their support groups, clinicians, researchers, and funders need to ensure successful initiation and completion.
High-quality, large prospective cohort studies or cancer registries that identify men at the time of diagnosis and proceed to collect comprehensive patient, tumor, and treatment decision selection characteristics could help target future RCTs to the most promising research questions. These may be able to provide information related to important patient characteristics (age, race, comorbidities) or tumor characteristics (PSA, stage, histologic grade) that may not be adequately addressed in RCTs currently in progress due to sample size limitations. Nonrandomized studies should report head-to-head comparisons, adjust for confounding factors, and use standardized definitions of disease-specific and biochemical survival, adverse effects, and patient/tumor characteristics.
Identification of biomarkers to provide reliable estimates about prostate cancer aggressiveness and the relative effectiveness of treatments is needed. This would reduce unnecessary interventions while focusing treatment on men most likely to benefit. A new generation of educational materials is required to provide balanced information about the risks and benefits of treatments and assist in patient decisionmaking and incorporation of patient-centric values (tumor eradication, impact of AEs, anxiety, costs, convenience, etc.). It is hoped that these materials incorporate findings from comprehensive systematic reviews that use methods to limit bias and assess quality of evidence. The resulting patient and provider guides can be developed to summarize these findings in a format that is understandable and useful for consumers. Structure and process measures are associated with quality of prostate cancer care. Research across nationally representative databases using methods of risk adjustment is needed to clarify geographical differences in patient outcomes. Identification of factors associated with outcomes and development of systemwide methods for implementation or improvement are needed.
Full Report
This executive summary is part of the following document: Wilt TJ, Shamliyan T, Taylor B, MacDonald R, Tacklind J, Rutks I, Koeneman K, Cho C-S, Kane RL. Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer. Comparative Effectiveness Review No. 13. (Prepared by Minnesota Evidence-based Practice Center under Contract No. 290-02-00009.) Rockville, MD: Agency for Healthcare Research and Quality. February 2008.
For Print Copies
For print copies of Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer: Executive Summary No. 13 (AHRQ Pub. No. 08-EHC010-1), please call the AHRQ Clearinghouse at 1-800-358-9295.
|Key Question
|Quality of Evidence
|Summary, conclusion, comments
|Radical prostatectomy compared with watchful waiting
|There were 2 head-to-head comparisons, 1 with an adequate method of allocation and 1 unclear. Few enrolled men had prostate cancers detected by PSA testing. The Veterans Administration Cooperative Urological Research Group (VACURG) trial was underpowered to detect large differences. The Scandinavian Prostate Cancer Group Study 4 (SPCG-4) randomized men with a life expectancy of >10 years.
|RP with neoadjuvant androgen deprivation therapy compared with RP alone
|4 head-to-head comparisons, 1 with an adequate method of allocation. 2 trials enrolled subjects with locally advanced disease.
|RP with ADT, comparison of different regimens
|1 trial with an unclear method of allocation. No effectiveness outcomes reported.
|RP compared with external beam radiotherapy
|1 head-to-head comparison from a small American trial with an unclear method of allocation.
|EBRT, comparison of different regimens
|5 head-to-head comparisons.
|a. Long (conventional) arm (66 Gy in 33 fractions) compared with short (hypofractionated) arm (52.5 Gy in 20 fractions)
|1 trial with an adequate method of allocation.
|b. Iridium brachytherapy implant + EBRT compared with EBRT alone
|1 small trial with an adequate method of allocation. The trial enrolled T3 stage subjects (not included in findings below).
|c. Conventional EBRT (64 Gy in 32 fractions over 6.5 weeks) compared with hypofractionated EBRT group (55 Gy in 20 fractions in 4 weeks)
|1 trial with an adequate method of allocation.
|d. Trial 1. Conventional-dose (70 Gy) compared with high-dose EBRT (79.2 Gy)
|2 trials: Trial 1, Trial 2 (low-risk subgroup only, defined as T1/2, Gleason ≤6, PSA ≤10), both with an unclear method of allocation.
|e. Trial 2. Conventional dose (68 Gy) compared with high-dose EBRT (78 Gy)
|EBRT with ADT compared with EBRT alone
|2 trials with an adequate method of allocation:
|Shorter (3-months) EBRT with ADT compared with longer (8-months) EBRT with ADT
|1 trial (N=378) with an adequate method of allocation. The trial included T3 stage subjects (not included in findings below).
|Brachytherapy: 125I (144 Gy) compared with 103Pd (125 Gy)
|1 trial (N=126) with an adequate method of allocation.
|Adjuvant EBRT combined with brachytherapy, comparison of different regimens
|1 trial with an adequate method of allocation.
|Adjuvant bicalutamide vs. placebo; both treatment arms combined with standard care (RP/EBRT or WW)
|Analysis of 3 RCTs with unclear methods of allocation. The report included T3 stage (not included in findings below).
|Vaccine vs. nilutamide
|1 very small study: Phase II trial in men with hormone refractory PC.
|Key Question
|Quality of Evidence
|Summary, conclusion, comments
|Low to medium
|Comparative effectiveness of primary treatments
|Adverse effects of primary treatments
|Bother and satisfaction with primary treatments
|Laparoscopic and robotic assisted RP
|Primary androgen deprivation therapy
|High-intensity focused ultrasound
|Proton beam radiation therapy
|Intensity modulated radiation therapy
|Key Question
|Quality of Evidence
|Summary, conclusion, comments
|Key Question
|Quality of Evidence
|Summary, conclusion, comments
|Physician specialty and preferences
|Regional differences
|Hospital volume/type
|Surgeon volume
|Key Question
|Quality of Evidence
|Summary, conclusion, comments
|Gleason score
|PSA level
|Screen vs. nonscreen detected prostate cancer
|Tumor volume
Abbreviations: ADT=androgen deprivation therapy; AE=adverse effect; EBRT=external beam radiotherapy; ED=erectile dysfunction; GI=gastrointestinal; GU=genitourinary; HIFU=high-intensity focused ultrasound; HMO=health maintenance organization; IMRT=intensity modulated radiation therapy; LHRH=luteinizing hormone-releasing hormone; PC=prostate cancer; PSA=prostate-specific antigen; RCT=randomized controlled trial; RP=radical prostatectomy; SPCG-4=Scandinavian Prostate Cancer Group Study 4; VACURG=Veterans Administration Cooperative Urological Research Group; WW=watchful waiting.


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Stay informed on our latest news!
Here is some background information on the development of the Loudness War and related technical facts
These companies support the Pleasurize Music Foundation. Their names stand for a better and more dynamic sound! Thank you very much!
The Pleasurize Music Foundation is supported by this magazines and media:

subset: commoncrawl


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When faced by difficulties, many people figuratively bend and break under the pressure. A few people seem to dig in their heals, hang on tight, find ways to resolve their problems, and they survive. Some ever thrive in the midst of difficulties.
Whenever I have flow out of the Burbank, California, airport for speaking engagements across the country, I've always driven by a certain park on the way to that airport.
There is something very unique about that park. I would always notice that many of the trees were bent over as if strong winds, over time, kept pushing them over.
However, in looking around the park, I didn't notice any tree stumps. Apparently the trees in this particular park, had developed strong and deep roots, the type that would serve them well in the face of strong winds.
The other day I make it a point to go to that park and take a walk around.
The name of the park is Griffith Park, named either after or before the world-famous Griffith Observatory, which is on the top of the hill to the south.
The park is large and welcoming. There are equestrian trails where, on many occasions, people on horseback can be seen along its trails. There are also people having picnics, people walking their dogs, and others just enjoying the peaceful atmosphere.
Nearby, in the Burbank area, are some of the major television and radio studios of the country. Among them are Warner Brothers, Disney, ABC, and NBC.
But the main point that strikes me about Griffith Park is all of the leaning trees. There is a correlation between them and the goals and habits of our lives.
If we follow bad or destructive habits, we will never create strong roots that will help us in difficult times. Being overweight and not eating healthy foods, can figuratively cause our lives to fall down at some point. Just like a tree in a strong wind without deep roots.
Not being wise with our money, overspending, and not having a monthly budget can do the same thing.
Perpetuating habits such as smoking and drinking to excess can do the same thing. My sister, who smoked all her life, died from Emphysema and heart failure.
Not letting the people we love the most know how much we love them on a regular basis, can also put stress on the branches of our relationships.
May I suggest, if you do not have strong, positive roots in these directions, that you take a hit from the trees in Griffith Park. Write down three habits that you would like to improve and then write positive affirmations as if they were already achieved.
Read those affirmations the first thing each morning and the last thing each night, for at least 30 days, and watch what happens. I believe you will then get to the "root" of your great future success.
An Affirmation of Positive Habits
I am identifying the positive habits that I need in my life and affirming them every day.
See more Boaz Power TV here


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By Ben Levisohn
The Federal Reserve hasn't even begun to slow down its bond purchases, but that hasn't stopped everyone from having an opinion on what it will mean for emerging markets.
I suppose that's unavoidable, considering the way developing-world stocks have been hammered by the speculation: the iShares MSCI Emerging Markets Index ETF (EEM), for instance, has fallen 10% during the past three months.
Today's entrant in "the Who Gets Hit by the Fed" contest: Fitch Ratings.
Prospective Fed tightening will increase risks facing weaker EMs including those with large external financing requirements (current account deficits and maturing external debts) and low foreign reserves, high levels of leverage, vulnerable debt structures (foreign currency, short maturity and non-resident creditors), those that have seen strong inflows of hot money and bank credit growth, or have weak policy macroeconomic frameworks or credit fundamentals.
They also make a broader point, one I flicked at in my column this weekend: EM credit ratings, in aggregate aren't getting better.
The upward trend for EM ratings appears to have stalled. H113 saw six EM upgrades: Lithuania, Mexico, Thailand, Philippines and Uruguay – the latter two to investment grade – and Jamaica from default. Some three-quarters of the J.P.Morgan EMBI is now rated investment grade by Fitch, up from one-third in 2008. However there were downgrades for Egypt, Jamaica (by four notches) and South Africa, as well as China (local currency rating). EM Negative Outlooks now outnumber Positives by 12 to seven.
Not that equity investors have cared one way or the other. The iShares FTSE China 25 Index (FXI) has dropped 9.5% during the past three months, while the iShares MSCI South Africa Index ETF (EZA) has fallen 11%. The iShares MSCI Mexico Capped Investable Market ETF (EWW) has dropped 12% during that period, while the iShares MSCI Thailand Capped Investable Market ETF (THD) has fallen 15%.
Still, not everyone thinks the end of Fed bond buying will be that big a deal. Deutsche Bank's John-Paul Smith, who correctly called the peak in emerging-market stocks, believes that a slowing China and worsening corporate governance–not the Fed–will keep emerging markets under pressure. Capital Economics, meanwhile, doesn't think the Fed's tapering will result in an emerging market crisis. Its economists write:


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/ example 32.1 - IR receiver code repeater// http://tronixstuff.com/tutorials > chapter 32// based on code by Ken Shirriff - http://arcfn.com#include <IRremote.h> // use the libraryint receiver = 11; // pin 1 of IR receiver to Arduino digital pin 11IRrecv irrecv(receiver); // create instance of 'irrecv'decode_results results;void setup(){ Serial.begin(9600); // for serial monitor output irrecv.enableIRIn(); // Start the receiver}void loop(){ if (irrecv.decode(&results)) // have we received an IR signal? { Serial.println(results.value, HEX); // display it on serial monitor in hexadecimal irrecv.resume(); // receive the next value } // Your loop can do other things while waiting for an IR command}
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I am trying to use the IRremote library
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Ingredients:Water, condensed skim milk, sugar (sucrose), modified cornstarch, partially hydrogenated soy oil, fructooligosaccharides (NutraFlora� FOS), soy oil, sodium stearoyl lactylate, artificial flavor, FD&C yellow #5 and FD&C yellow #6. Chocolate flavor contains 3.4 mg of caffeine per 4 oz serving.
Nutritional Information: Vanilla (4 oz.)
Product information and values listed are subject to change. Please refer to product label or packaging for the most current information.
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Web Stories
Thatcher adviser speaks on faith and politics
Posted September 17, 2008; 05:31 p.m.
A policy adviser to former British Prime Minister Margaret Thatcher will deliver a talk titled "'Doing God in 10 Downing Street': The Relationship between Faith and Politics in a Postmodern World" at 4:30 p.m. Wednesday, Sept. 24, in McCosh 50.
Lord Griffiths of Fforestfach was a key domestic policy adviser to Thatcher from 1985 to 1990 and was a chief architect of the British government's privatization and deregulation programs. He is currently vice chairman of Goldman Sachs International, focusing on issues relating to private equity, U.K. and Asian operations, and business development activities worldwide.
Griffiths chairs the Archbishop of Canterbury's Lambeth Fund and Christian Responsibility in Public Affairs, two charitable trusts. The author of several books on monetary policy and Christian ethics, he has written and lectured extensively on economic issues and the relationship of the Christian faith to politics and business.
The talk is designated as the Princeton Lecture in Religion and Ethics and is sponsored by the Center for the Study of Religion.


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Results 1 to 11 of 11
Thread: Placenta Encapsulation
19th November 2012 02:26 AM #1
Placenta Encapsulation
Have any of you tried placenta encapsulation? Do you think you would try it with future pregnancies?
I am a doula offering multiple services to clients, and one of these services is the encapsulation of placenta. In a nutshell, the placenta is boiled, dehydrated, and place in tablets following the birth. The practice is based on Traditional Chinese Medicine. However, eating of the placenta, in one form or another, is a deeply rooted tradition in many cultures.
The consumption of placenta, dehydrated or raw, is believed to replenish the body of valuable hormones and iron lost during the process of labour and delivery. Since it is developed within a woman's body it is packed with specially-formulated essential nutrients created just for her body. It is a great way to fight postpartum depression, dysmorphic milk ejection reflex, and general baby blues naturally and effectively. It can also help to increase and maintain breastmilk supply and quality.
End the end the pills produced through encapsulation look just like any other herbal remedy tablet. There is no strange aftertaste, the product is dry, etc. The mother begins by taking a few a day, sometimes with a glass of wine, and then gradually decreasing the dose. Some women opt to store placenta pills in the freezer for usage during menopause or other blue times. The average placenta will produce around 150 pills.
29th November 2012 08:53 AM #2
This is the first time I have heard of Placenta Encapsulation. I would probably try it as it seems to have a lot of positive benefits to it. I know that drinking your own urine offers many of the same types of benefits (hormones, nutrients specific to your body). I have taken drops of urine, but have not actually drunk greater quantities of it.
I've also created my own capsules full of various things, and find it much easier to take in capsule form.
Will be interested in learning more if you every do this.
Warm Regards,
30th November 2012 09:43 AM #3
I recently did a placenta for a client that seemed tiny to me at first, but ended up yielding 208 capsules, a pretty big haul. The mum's mum was there with me and very interested. She actually helped with much of prep. =)
27th January 2013 05:05 PM #4
I can't speak highly enough of it!
I did it with my daughter and felt amazing afterwards while taking them.
30th January 2013 09:48 AM #5
I wish I had known about Placenta Encapsulation when I had my babies as I could have used all those extra nutrients after birth.
30th January 2013 11:54 AM #6
I've heard many positives about this and certainly in many cultures it is the norm so why not!Hidden Content
Dr Roger Kingston DO
Osteopath & Cranial Osteopath
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19th July 2013 10:43 AM #7
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- Jul 2013
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Wow! I will try to do this after my next pregnancy, if I get pregnant again. I just don't know if doctors would allow it or agree to give me the placenta.
24th July 2013 11:46 AM #8
The easiest way to have access to your placenta is by either giving birth at home, or giving birth in a birthing center with a midwife or doctor.
Home births have a much lower C-Section rate and much lower rate of intervention. Sadly, one one intervention is started, it often leads to another, and another.
Do you know anyone who has had a home birth? I had 5 homebirths, and my last was just a month before my 41st birthday.
I will read your other posts and see if I can give you some insight on how to increase your fertility and ability to carry a healthy baby to term.
Here's part 3 of a video that shows the encapsulation of placenta process.
Warm Regards,
25th July 2013 12:17 AM #9
There is some more information about Placenta Encapsulation at the Independent Placenta Encapsulation Network here. Many doulas offer this as an additional service - this may be something to consider if you are concerned about not having access to your placenta after birth. I would have thought it was your right to have your placenta encapsulated (provided it is healthy) wherever you choose to give birth.
Best wishes,
25th July 2013 03:04 PM #10
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Thanks. I will try to find a doula and I'll talk of home birth with my husband. How will I know that my placenta is healthy?
4th August 2013 01:04 AM #11
The midwife or doctor will check your placenta after you have given birth. They check it carefully to make sure it is complete.
Best wishes,


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I cant find the clip. Anyone have it or did anyone see it?
Anyhoo, Will Cain was on the show last week and he gave almost the identical argument I posed to you tree hugging hippies. It was great. I forget the guys name that Maher had on who was supposedly some leading environmentalist.
Cain completely destroyed him. It was great how he didnt dodge the science behind the environmentalists movement. The guy threw a couple of jabs Cain's way which of course had the socialists in the crowd applauding, but Cain still crushed him with logic. My favorite line was "You dont need to put a touiquet around your neck when you get a nosebleed." Couldnt have said it better. He also destroyed the environmentalist with "Unlike you I have humility and can admit that we dont know whats going to happen in 100 years."
Heres a little clip from the show, the only one I could find. It deals with affirmative action. The environmentalist comes on shortly afterwards.


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Perhaps one of the greatest hurdles to really becoming an everyday bicycle rider is rain.
No one wants to show up to work soaked to the bone, but on a humid, rainy day, taking the TTC can feel like giving up, and if you have to wait for a bus or streetcar you're still going to get wet.
I started rain riding by accident. Riding home I knew I was racing a storm. About half way through my ride the sky opened and within seconds I was soaked.
But I was also smiling, ear to ear. After a long day in an office a rain ride is refreshing, invigorating. It's like going for a jog in your shower (if that was even possible). Rain riding feels great and you'll be the envy of your workplace, soaked and smiling and buzzing all day. Sure, you can take to rain riding cold turkey, but a little preparation can help you really enjoy the ride. Here's what to do:
1) Accept that you will get wet: Fact, you will get wet riding when the rain starts to fall and there's nothing you can do about it. Some people will ride faster, as if trying to outrun the falling rain, and rushing can lead to poor decision making. Pedestrians will be dashing across streets heading for the nearest shelter and drivers will be distracted and nervous. If you're rushing, trying to outrun the falling rain, you're more likely to put yourself in dangerous situations. Slow down and accept getting a little wet, you'll be safer for it.
2) Dress for a mess: You can go out and purchase rain shells to wear over your work clothes, but in my experience these keep the rain water out and also keep your sweat in, still leaving you soaked. Shelling out for rain gear can help you stay a little drier and more comfortable, but during warm summer rains simply wearing clothing you don't mind getting wet and dirty works great. Quick drying fabrics will make storing your riding clothes at work less problematic, so a thick cotton t-shirt that takes a day to air dry may not be the best option.
3) Get the right equipment: Fenders! Get fenders for your bicycle. If you don't have them they are probably keeping you from rain riding because no one wants that "skunk stain" running up their back. You can buy a set at your local bike shop for around $25 or $30 and pay a little extra to have them installed (or learn how to do it yourself). A decent set of panniers or backpack will keep your change of clothes dry. I have a set from Mountain Equipment Co-op that are water-resistant, so on wetter days I would place my clothes in a plastic bag first to keep out the little moisture that would seep in. Reusable lunch bags can be used for valuables like your phone and wallet. A plastic grocery bag can be used to cover your seat and keep it dry during the day. Also, bring your lights and use them, anything to make you stand out on the road is going to benefit your safety.
4) Slow your roll: Wet rims and brakes take longer to slow you down and wet roads increase your chance of skidding. And when there's a lot of rain, you can even start to hydroplane slide on water-covered streets, which reduces your control. So simply slow down and enjoy the water streaming down your face, it's wonderful.
5) Take the lane: Beware the gutter. Puddles can conceal potholes and uneven sewer coverings. Moving into the lane, ideally where the right side wheels of cars would typically roll, can save you from the unexpected and will force drivers to pass you with less speed and greater caution.
6) Use extra caution near streetcar tracks and crosswalks: Streetcar tracks can be a nightmare for some even during the best conditions. In the rain, not only are the tracks more slippery, but the smooth concrete surrounding them becomes a sliding hazard as well. Same goes for crosswalks that use paving stones as smooth surfaces mean less traction for narrow bicycle tires. When turning left on roads with streetcar tracks you can perform an "indirect left turn" to allow you to cross the tracks at a 90 degree angle. Or simply dismount from your bicycle and use the crosswalks.
7) Think "muti-modal" transportation: The TTC is currently installing better bicycle parking at subway stations around town. If you're not comfortable riding in the rain for your entire commute you can still skip waiting for buses and streetcars and simply head to the nearest subway station. You may be a little wet on the subway, but you certainly won't be the only one.
8) Have fun: Always remember, enjoy yourself. Getting wet may seem like a pain, but if you pack dry clothes and a small towel and once you get comfortable changing at work, you can simply start to enjoy the rain and beauty of a soaking wet city. You may also feel a little super-human for braving the rains, so don't let that go to your head!
Photo via the BikingToronto Flickr Pool


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This site really needs comments on the blogs as well.
I read in one of the articles that was posted that a patch had been sent in to allow commenting of this sort, but it wasn't applied because there were other things higher on the todo list. I don't understand, though, what this has to do with not applying it. Is it because something else needs to be done in order for it to work, or because there are security/stability issues involved, or perhaps the person in charge just doesn't have the time for it? I'd actually kind of like to know...
Anyway, the reason that I have found this is that I'd really like to comment on certain people's posts, but I don't want to fill up the recentlog with these replies. Only the people interested in the original post would want to know about any discussion about that post, I would think.
It's also nice to be able to see where the discussion about this post lead. Right now there's no way of knowing who replies to what really. This also makes it harder to look up older comments, I have to remember who replied to me to be able to look it up.
I wouldn't mind having a look at implementing such a thing, but knowing that someone already has and it hasn't been accepted makes me wonder what else can be done. So far I really like it here, and forking over something like this seems rather extreme, so I blog.


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Until there are none.....Rescue one!!! There are many great rescue places around the country that you should contact directly for rescue, surrender, volunteer work, or to donate supplies and food. If interested in adopting a Bulldog or have any questions or comments, visit any of the links below. To surrender a Bulldog click on any link below. Let's help the Bullies!
Eastern USA
Heavensent Bulldog Rescue
BCA RESCUE - Most of the U.S.A
Bulldog Transport Only
BulldogsWorld Rescue Railroad
Or contact your local Bulldog Club about Rescues
Ontario, Canada Rescue- phone 905-473-9111


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Our oldest son and his fiancee have asked me if I would do a photo presentation for their wedding in May. Photos of them as kids, teens, etc. This will be shown at some point (not sure when yet) but I want to make sure it's all on the up and up. May I use the Presentation products that I already own (for personal use) or do I need to purchase the commercial versions? It's not for distribution, except to them.
Personal Or Commercial?
Started by Becster, Dec 05 2012 08:27 AM
3 replies to this topic
Posted 05 December 2012 - 08:27 AM
Posted 05 December 2012 - 09:34 AM
I think personal use would be ok as long as you aren't selling it, or they aren't making money off of it. What a great idea!!
Posted 05 December 2012 - 10:09 AM
Thanks Carla!
Posted 05 December 2012 - 07:29 PM
You can check with someone "official", but it seems to me that's the main point of presentation products: to show photos to friends and relatives. I'll be curious to find out if I'm right.
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0 members, 0 guests, 0 anonymous users


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How can I transfer the Avira license to a new computer?
If you wish to transfer your Avira license to a new computer, please download and save the respective Anitvirus product on your new device.
Avira Legacy Software
Once the product is stored on your computer, double-click the downloaded installation file and follow the installation wizard.
Enter your 25-digit activation code into the License Wizard. If you have lost your activation code, this article will explain how to obtain it..
Thereafter, follow the installation wizard until the installation is complete. Please restart your computer and perform an update afterwards.
To ensure that there won't be a conflict with your license in case you e.g. give away or sell your old computer, we recommend to either uninstall your Avira product on the old computer or format the entire hard drive if you are not using it anymore. The Avira license will be deleted in both cases.
Affected products
- Avira Antivirus Pro [Windows]
- Avira Internet Security [Windows]
- Avira Internet Security Plus [Windows]
- Avira Internet Security Suite [Windows]
- Avira Ultimate Protection Suite [Windows]
- Created : Thursday, May 10, 2012
- Last updated: Tuesday, July 28, 2015


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I thought I mentioned it here already, but my blog move to LiveJournal.
I thought I mentioned it here already, but my blog move to LiveJournal.
A blank text entry field, like a field of snow (cf Calvin & Hobbes, last Panel "lets go exploring").
I find it hard to write things, because only frustrating happens in my field of work right now. Which is mostly due to the basic nature of "Security" which is like Sysiphos rolling the same stone uphill again and again.
Spent quite some time polishing up my openSUSE buildservice presence.
One week of vacation.
Watching butterflies flutter over a meadow.
Relaxing in the sunshine.
Nothing good to report happened for several weeks, so no entry.
Did not get interviewed from Novell Open Audio. This time.
Met my old class mates last weekend, the 15th anniversary of us leaving high school. Nice to see some of them 5 years after our last meeting. Pictures here.
I went by the new Berlin Mainstation and took pictures there too.
While you can now rip your private CDs to MP3 again with SUSE Linux 10.1 or SUSE Linux Enterprise Desktop 10 (no additional RPMs required), I recommend ripping to OGG.
Why? Because the format is free. Advocate OGG today!
I hate Mozilla.
I hate Acrobat Reader.
Both are not maintainable on products that have lifetimes longer than 1 year. Because then is the time when upstream will be releasing new versions that are no longer working with the older products.
Did you know that we have products with lifetimes of 7 years now? Guess what is on them ... Acrobat Reader and Mozilla *.
The weather however continues fine.
Not much mentionable done over the last week.
We released the updated update stack for SUSE Linux 10.1, fixing most of the bugs present in the GA version. Run YaST Online Update to install it.
This has actually cost most of my time this week :/
Provided Wine 0.9.15 packages, but no gphoto news however.
People are not happy with 10.1 quality and asking why we shipped it...
If you know project management, well, at one point in time you have to ship or you will never ship it (because of they delay you could just add these other important features). What is worse?
And yes, I readily admit that 10.1 has definitely problems in package management and drivers. But a fatalist attitude as in "should not have shipped" is not good.
Picasa for Linux was released, WINE based. And yours truly got mentioned on slashdot even though I did not do that much compared to CodeWeavers.
Happy Towel Day!
Wine 0.9.14 is out and SUSE rpms got build by yours truly.
Week is over for me, since we have a public holiday here today (Christ ascension) and I took overtime comp off tomorrow.
Spent some time to help with testing the update for the packagemanagement framework for 10.1, hopefully out soon. Also helped releasing the kernel update, with ... some problems.
Sad weather for a public holiday. Why is it always sunny when one has to work?
Oh, and I am part of Summer of Code ... As Mentor ;)
New glibc security things: Pointer obfuscation
glibc 2.4 (in SUSE Linux 10.1) introduces pointer obfuscation. On program startup a random value is read from /dev/urandom, and several pointers are xor'ed with this value when storing them to data structure and when restoring them.
This goes for:
New HTML Parser: The long-awaited libxml2 based HTML parser code is live. It needs further work but already handles most markup better than the original parser.
Keep up with the latest Advogato features by reading the Advogato status blog.
If you're a C programmer with some spare time, take a look at the mod_virgule project page and help us with one of the tasks on the ToDo list!


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Web Stories
Spring farmers market runs through May 18
Posted April 15, 2010; 01:24 p.m.
The Greening Princeton Farmers Market at Firestone Plaza will return this spring for six weeks, open from 11 a.m. to 3 p.m. Tuesdays from April 13 through May 18.
Members of the University and local communities will have an opportunity to purchase fresh locally grown produce and other goods from area farmers and businesses that use sustainable practices. Expected vendors will provide a range of items including organic fruits and vegetables, grass-fed beef and lamb, free-range poultry and eggs, cheeses, breads, baked goods, ice cream and coffee.
The farmers market was launched in 2007 and runs in the fall and spring. It is an initiative of Greening Princeton, a student organization devoted to improving environmental sustainability, and is staffed by volunteers from the group. It is cosponsored by the Department of Dining Services, the Office of Community and Regional Affairs, the Office of Sustainability, the Department of Building Services, the Department of Grounds and Building Maintenance, the Office of the Dean of Undergraduate Students and the Undergraduate Student Government Projects Board.


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Sing Yan
Sing Y. Yan, 84, of Madison, Wisconsin, died Wednesday February 13, 2013.
He was born in China April 29, 1929 to the late Chun Cha Tau and Hui Yan.
Sing began his career as a police officer for the Hong Kong Police Department. He immigrated to the USA spring of 1964 with his young family and supportive mother. His entrepreneurial passion coupled with market opportunity earned him retirement as a business owner.
Sing is survived by four children, Sue Yan, So (Louis) Chiang, Siu (Lian) Yan and Warren Yan; four grandchildren, Nicole and Calvin Chiang, Christina and Alex Yan; a sister, Wai Young; and many cousins, nieces and nephews.
A viewing will be held from 10 a.m. to 1:00 p.m. on Monday, February 18 at Cress Funeral Home, 3610 Speedway Road, Madison. Burial will be held at 2 p.m. at Sunset Memorial Garden Cemetery.


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Beneath the elevated train tracks and under the jurisdiction of the Metropolitan Transit Authority, this playground shares the property with Elton Playground on the other side of the tracks.
To the Dutch settlers who first laid out village streets in East New York, this area was known as Ostwout, meaning "east woods." In the 1670s, English farmers began to settle the area as well, intermingling with the Dutch and giving the land the name of New Lots. The area remained primarily rural until 1835, when John Pitkin, a merchant from Connecticut, bought the Ostwout land north of New Lots Avenue and named it East New York in a marketing effort intended to suggest a connection with the metropolis to the west. Linwood Street, formerly known as Monroe Street, was probably laid out in the early- to mid-1800s, and named for President James Monroe (1758-1831).


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We're moving
Posted on October 8, 2012
I am the consummate consolidator, a decadent disposophile whose favorite treat is getting everything together under the proverbial umbrella. With that said, I've created ericafirpo.com, a digital profile detailing who I am and what I do. My blog moscerina will also be basking in the shade of my website, so pop the champagne and please click on over to enjoy all past, present and future posts. Shortly, moscerina will redirect you to ericafirpo.com to save the time and effort of clicking.
Tagged: Archeology, Architecture, art, Culture, Fashion, food, Italy, Travel


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Swan Lake is ballet's prima ballerina because, 131 years after its Moscow premiere, it's still poised on pointe. You have a woman who's the object of two men (though Rothbart as Odette's lover always get short shrift) and a man who pledges his troth to two women (played by the same ballerina). You wonder what Siegfried is thinking when, as he's about to be auctioned off to his mother's choice of princess bride, Rothbart runs on with Odile — does he think she's Odette in a sexy black negligee? It's a ballet that anticipates Tchaikovsky's own life: the year after Siegfried first said no to conventional marriage, the homosexual composer made the mistake of saying yes to Antonina Milyukova. It's a ballet with two endings: there's the traditional one, where Siegfried and Odette throw themselves into the lake (since he can no longer break her spell) and free the other swans from Rothbart's magic, and the Soviet happy one, where Siegfried, never mind his philandering, beats up Rothbart in a fair fight, frees everyone, and lives happily ever after with Odette in the palace rather than in some misty swan heaven. From the first note you're not sure where you are: the oboe's F-sharp could belong to B minor or B major. When it's over, you're not sure where you've been, whether it's all Siegfried's dream or yours.
Swan Lake is also the ballet to end your season with, and this season that's what both Festival Ballet Providence and Boston Ballet are doing. (Boston Ballet is appending a "Three Masterpieces" coda, but the Swan Lake feels like the big finish.) FBP gave three performances April 25-27, with choreography by artistic director Mihailo Djuric and ballet mistress Milica Bijelic (after Ivanov and Petipa, of course), a set (from Pittsburgh Ballet Theatre) that looked very much like the one Boston Ballet used to have, and an Odette/Odile (in the performance I saw Sunday), Vilia Putrius, who used to be a member of the Boston Ballet corps. You might wonder how Putrius could go from not being offered a new contract in Boston to dancing ballet's prima ballerina role in Providence, and what that says about the two companies. (Providence makes do with Boston corps leftovers? Boston overlooks rising star?) Putrius gave a creditable performance that was emotionally nervous and technically unstable; she didn't let the side down, but it wouldn't pass muster in Boston.
Of greater interest were the innovations in the story line. In most productions, the curtain remains down during the overture, rising to reveal Siegfried and his friends celebrating his birthday outside in the garden or park. Here it rose on Putrius as a young girl clad in a white shift and wandering through the forest. Rothbart swoops, and after a brief struggle the girl vanishes through the back curtain and re-emerges as a swan. At the end, after Odette has run off, Siegfried wrestle with Rothbart, breaks a wing, and breaks the spell, whereupon Odette runs back on in her shift, a girl again, and embraces him. It's an engaging tableau and one that makes the story clearer to the audience; the drawback is that if Siegfried's going to defeat Rothbart, he needs to do so with love, not muscle. Which means Odette has to be with him on stage, defying Rothbart and proclaiming that love that's not perfect is still love. Here she has to be off stage changing out of her tutu.
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This program is part of the Cultural Science Department.
Western Civilization has been a reliable means to understand world cultures for many generations, but the rapidly changing demography of the United States requires a more profound awareness of cultural resources by thinkers of color.
Ethnic Studies is the interdisciplinary study of the history, cultural impact, socioeconomic concerns, politics, and achievements of racialized peoples in the United States and elsewhere. As a discipline, it was created to study the stories, histories, struggles, and triumphs of people of color on their own terms. Our program encourages students to test traditional assumptions about race in order to make more enlightened choices for themselves and their civilization.
The Ethnic Studies program at MCC contains three distinct study tracks:
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Before signing up for classes, you'll want to meet with an academic advisor. Together, you'll lay out an academic plan that suits you best. This step is essential to your academic success.
Advising for the Ethnic Studies program is available through the Cultural Science department. They will help you determine the exact courses you need to get the education you're looking for.
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Next month, graphic designer and engraving expert extraordinaire Nancy Sharon Collins will publish The Complete Engraver, an informative and elegant homage to the classic art. Seeing as how said classic art and our paper go together like Fred and Ginger, we thought Collins a perfect addition to our Post Script Q&A series. Here, the former New Yorker (and current Louisianan) shares stories of her parents' notes, a New Orleans estate filled with paper and a small stack of treasured love letters.
When did your interest in social stationery engraving begin?
1976 during graduate school at the Hartford Art School. I was introduced to Lehman Brothers in New Haven and I fell in love with commercial engraving: going on press knocks my socks off; I love the smell of ink and paper and the sound of small presses (metal against metal, fly wheels, iron and steel.)
What inspired you to write this book?
My inspiration for writing this book was my love for social stationery engraving and realizing, over the years, that almost no one younger than me really knows about it anymore, even though it shares much of the same history as letterpress.
Why do you enjoy writing about letters and/or correspondence?
I enjoy writing about letter writing and correspondence for several reasons:
- I am a graphic designer by trade and most of graphic design is visual communication. Personal letters are just mini-bits of graphic design, so they're fun and compelling subjects to compare to the principles of good graphic design and typographic practice.
- Growing up I had great difficulty learning to write — a current elementary teacher cousin of mine wonders if maybe I had dysgraphia; as a child I reverted to pictograms in my letters rather than suffering through trying to compose words and phrases. Overcoming and learning to write pretty much everything has grown to be a major fascination of mine.
- I love the technology of handwriting and paper. There's a fantastic book, Hamlett's Blackberry, by William Powell, in which he talks about the technology of paper.
- Both my mom and dad were big time note and letter writers. Not long letters, just enough correspondence to convey whatever message was on their mind. Up until the time they could no longer manage a pen or see well enough to compose a letter, they both dispatched personal correspondence every evening before starting dinner. I fondly remember this discipline and like to share the gifts that are letter writing and receiving letters.
What is your favorite step in the process of written correspondence?
The interaction of my writing instrument against the surface of the paper. I would say 60 or 70 percent of the card stock and letter papers I specify for clients is Crane's Kid Finish. Currently my own correspondence cards are on Lettra. I enjoy the Pilot Varsity disposable fountain pens for when I travel. At home I use a Namiki fountain pen.
If you could be pen pals with anyone in history, to whom would you write and what would you say?
Edith Rosenwald Stern (1895-1980), wife of Edgar Bloom Stern and daughter of Julius Rosenwald, who became chief executive of Sears, Roebuck and Company. She was an outspoken supporter of civil rights and an intrepid promoter of pretty much anything in which she believed, helping to build many cultural institutions in her adopted home of New Orleans.
Both Edgar and Edith were inveterate letter writers. The extant archives in their gorgeous country-like estate, Longue Vue, hold boxes filled with their written correspondence. Many of the sitting and private rooms have padded stacks of parchment and onion skin paper on which to take copious notes and jot down thoughts. Edith appears to have been a very proper lady but in all endeavors, she forged her own way.
To whom do you most often write?
Friends and acquaintances, I write loads of thank you notes.
Describe the most memorable letter or postcard you have ever received.
I have a small, lovely stack of letters tied with a red ribbon, on Crane & Co., hand-written from my late husband who courted me long distance before moving to New York for me. The small letter sheets are pale gray, laid finish air mail paper that is no longer made.
What makes a particular letter stand out from a stack of cards?
The originality, thoughtfulness or sincerity of the message. Though I love fine papers and writing instruments — good ink, really — an earnest note, sensitively worded, is the most heart stopping, welcome and memorable.
Do you have a favorite stamp or stamp series?
At the moment, the "Forever" stamp with the Statue of Liberty's face (though I am less fond of the American Flag that comes on the roll with it.) I also like the Purple Heart stamp when I can find it.
What makes your correspondence distinct?
My messy handwriting and that it doesn't matter how messy it appears. To me, the most gracious form of personal correspondence is handwritten, on the envelope as well. I never engrave my address on any of my own envelopes and suggest that my clients to hand write their return addresses as well.
What is the one etiquette rule you will never break?
See below (there are 10).
What do you think classic correspondence will look like in a decade or two?
Pretty much the same as now. With the current trend back toward handwritten notes and cards and all things haptic, I think personal correspondence on card stock and letter paper, delivered in envelopes, will not significantly change.
1. The Complete Engraver by Nancy Sharon Collins. 2. A red ribbon ties together her most cherished letters. 3. Lehman Brothers in New Haven inspired her love of engraving. 4. A Kid Finish Crane & Co. note is perfect for correspondence. 5. As is a Namiki fountain pen. 6. 10 etiquette rules she never breaks. 7. The postage stamp she adores at the moment. 8. The home of her dream pen pal.


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Hyoscyamine is used to control symptoms associated with disorders of the gastrointestinal (GI) tract. It works by decreasing the motion of the stomach and intestines and the secretion of stomach fluids, including acid. Hyoscyamine is also used in the treatment of bladder spasms, peptic ulcer disease, diverticulitis, colic, irritable bowel syndrome, cystitis, and pancreatitis. Hyoscyamine may also be used to treat certain heart conditions, to control the symptoms of Parkinson's disease and rhinitis (runny nose), and to reduce excess saliva production.
Hyoscyamine comes as a tablet, an extended-release (long-acting) capsule, and a liquid to take by mouth. The tablets and liquid are usually taken three or four times a day. The extended-release capsules are usually taken twice a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take hyoscyamine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Swallow the extended-release tablets whole; do not split, chew, or crush them.
Hyoscyamine controls symptoms associated with disorders of the GI tract, but it does not cure the disorders. Continue to take hyoscyamine even if you feel well. Do not stop taking hyoscyamine without talking to your doctor.
This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.
Before taking hyoscyamine,
Unless your doctor tells you otherwise, continue your normal diet.
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
Hyoscyamine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
Hyoscyamine may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online ( Web Site) or by phone (1-800-332-1088).
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Keep all appointments with your doctor and the laboratory.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
§These products are not currently approved by the FDA for safety, effectiveness, and quality. Federal law generally requires that prescription drugs in the U.S. be shown to be both safe and effective prior to marketing. Please see the FDA website for more information on unapproved drugs ( Web Site ) and the approval process ( Web Site ).
AHFS® Consumer Medication Information. © Copyright, The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.
Selected Revisions: May 15, 2014.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.


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Welcome to the Department of Public Policy's advising and student services. We have an academic advisor available to you as you explore the majors and minors in this department. Both you and your advisor have responsibilities in this relationship, but the ultimate responsibility for completing the degree requirements rests with you. Successful students take advantage of the advising offered by the department to avoid errors and delays in their academic progress. Call the office today and make an appointment.
Leslie C. Clark, M.A.
Coordinator of Advising and Student Services
Important Information
"Meeting with an advisor is always extremely important to students. I have always found my advisor extremely helpful and willing to take the time to discuss each and every item that I did not fully understand. We are always reminded when it is time to register and the opportunity to meet with our advisor is always extended. Activities within the Public Policy Department along with internship opportunities are always announced and provided to each student. I have appreciated and admired everything that the Public Policy Department has offered to me as a student at IPFW."
Morgan Miller, Class of 2015


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is anybody using this dog food? looking to get some opinions about this food.
is anybody using this dog food? looking to get some opinions about this food.
I was using Victor High Energy on my 2 labs. It's a 4-star rated food. I switched over to Blue Buffalo Wilderness. Not because Victor is a bad food but I wanted to go grain-free. I did however notice a significant difference in the shine of their coats and less dander. I think Victor is a good food for the price. I just wanted to go grain free and wasn't concerned with the difference in cost.
I have fed the hi-pro version of Victor (30/20) pretty extensively. My dog has done as well on it as she has on any other food I've tried. The ingredient list is better than most of the others that cost about twice as much.
Terrie Tomlinson
Frontier Retrievers
HR Frontier's True Grit With a Cause "Rooster"
Frontier's Gossip Girl With A Cause "Gabby"
Boykin Spaniels: Max, Rummy, Luna, Jewels, Bella, Maisie, Pepper, Wager, Ruby
In Memory:
HRCH Frontier's Cherokee Rebel MH (5-9-2000 to 12-6-2011)
Moonstone's Little Girl Found MH (3-20-1998 to 5-2-2008)
HR Five Star Winning Sue SH (4-16-2006 to 9-11-2016)
Calebri's Take the Money and Run JH (3-3-2008 to 6-20-2012)
Love it so much got my dad on as a dealer. It's a great feed and at stores around here I can get hi pro plus 30/20 for 32 bucks (40#) great food and less filler means smaller portions which helps the pocket book. Went from 5.5 cups of eukanuba to 3.5 victor for my 11 month old CLM
during the offseason I fed the purple bag $26 40# but now that we are in thick of training again he's back on teal bag.
donbrou curious why u didn't try victors grain free if you liked their regular gluten free formula?
I tried it and it didn't work for me. After 2 months of loose stools I had to give that cheap stuff up and get back on the good stuff.. My dogs do very well on PP!!


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Results 1 to 10 of 12
Thread: Aquarium Rack setup
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Aquarium Rack setup
Hello ladies and gentlemen of Aquatic Community. I am new here and this is my first thread aside from my introduction. :)
I am in the process of designing and building a rack to house several aquariums in my basement. I was just going to set up 1 tank but then I remembered how there are so many kinds of fish I would like to keep. I have kept many kinds in the past but have been on hiatus for the past couple of years due to moving too much to keep aquariums. I have a few ideas of how I would like to build the racks but I would love to have input and suggestions from the experts and newbies and everywhere in between. Especially people who have experience with racks. As of now I am not sure exactly how many tanks I will have but I will get as many as the wife will let me have, mostly ranging from 10-20 gallons. I am hoping nothing larger then a 40 breeder.
a few things to consider before suggestions
1) all fish will be small peaceful species. largest fish will be apisto's or GBR.
2) I have a reverse osmosis unit so water chemistry shouldn't be too much a problem despite the fact we have liquid rock here in Edmonton.
3) I would love to rear fry if I am ever so fortunate to have the opportunity. This is one of the major reason for multiple tanks. I have had fish spawn many times on me in the past but never had the means to raise any fry being always limited to 1 tank at a time. To me this would be the most rewarding part of the hobby.
4) I would like only 1 community tank and the rest to be species tanks, aside from amano shrimp in every tank.
So with that being said I am hoping people can suggest either
a) species of fish to keep - They must be small and peaceful. Breeding in the home aquarium is a major plus or any kind of fascinating behavior
b) tank sizes for specific species - input on already selected species would be great!
c) tank configurations for the aquarium racks - this would be super awesome to have suggestions for.
So far species I know I would like to keep for sure in their common names:
German Blue Rams
Cherry barbs
Celestial Pearl Danios or Galaxy Raspboras
any dwarf species of corydoras.
Amano Shrimp
Cherry red shrimp
All tanks will be using sand and or fine gravel as a substrate with hamburg mattenfilters or general breeder sponge filters. Dirftwood and low maintenance plants also like java ferns and mosses.
As for rack configurations I have a few ideas in mind. Tanks that seem to fit nicely together and could easily build 2 columns of these.
40 breeder on top with 3 15 gallon tanks underneath turned sideways. I think the 40 breeder would well accomodate a breeding pair of gbr's or apistos with some dithers and the 15 gallons can be species specific or for rearing fry. Of course I would need 2 of these setups at least or else 2 rows of 15 gallons.
20 gallon long on top with 3 10 gallon tanks underneath turned sideways. I think the 20 gallon long would be sufficient for a pair of dwarf cichlids but I am not sure. I would like to keep them with dithers for their comfort. Also think the 10g tanks will be a little small for my chosen speciess so far. On the side note I have a few free 10g tanks coming as donations from local aquarists I had dealt with in the past.
Aside from this I really don't have any other ideas. Space isn't much of an issue but I would love to create the illusion that it is smaller then it is for the sake of the wife :)
I know this is a lot and kind of all over the place but I am on meds recovering from a surgery a few days ago so forgive me but I am going crazy sitting here with nothing to do :P
Thanks in advance,
My three tier rack was built for a 20L and a 15g on top.
Five 10g size foot print tanks on middle and bottom.
... I have a number of half 10s, that are great for fry.
I put the bottom row high enough up to easily get a siphon working for water changes. My goal was to spawn egg layers and move from easy to harder. Realistically, yeah, right. I usually have various live bearers in the middle tanks and I swapped two 18 x 24 breeder tanks into the bottom row for plecos.
What I'll add someday - fixed PVC tubing with individual fill valves over each tank.
Check out this link, for a fry rearing setup
Thanks for the reply dbosman!
Great tip for having the bottom row high enough for siphon action :) I would have definitely overlooked that.
Does anyone have any input on what type of pump I should use to power approximately 8 tanks with air driven filters? I'm guessing the cheapo 30-40 dollar ones from the LFS won't cut it?
Luft pump.
Hope that helps.
I had an air drive pump attached to PVC pipes with airline tubes running to all individual sponge filters in my old set up. I am about to rebuild the same thing. I have a ceramic piston pump that ran my old room of 10's-300's good and now its going to run 6 75s and a group of 10's-29's.
I liked how jacko did his shrimp tank racks if your sole purpose is for fry. As far as aesthetics though, i like to keep same size all the way down so I would do a 40 40 40 then 3 20s on down, etc. easier to keep space correctly.
seems like http://www.google.com/imgres?q=fish+...9,r:1,s:0,i:88 is what you are trying to do.,


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Fri 12/07: Dodge Caravan
Uploaded by Arizona Girl, Dec 08 2012 06:34 PM
- Owner:
- Uploaded: Dec 08 2012 06:34 PM
- Views: 801
- Category: Scraplift Challenge
I decided to focus on one car. the first I remember my parents buying.
Angie Briggs "Count the Ways", COL_Directional
What a great photo and memory! I love your layered photo mat.
Love the layered mat and how the background matches the gold in the clothes in the photo.
Great photo! I love the perpective and being able to see out the back window to another oldie car. Fun colors and patterns, too. Great layout
Fun photo! I really like the way you anchored the photo with the three buttons. Great paper piecing under the photo. Thanks for joining the challenge!
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AVANTI MICROWAVE, white, ideal for college students, unused. $20 (727)906-6393
CERAMIC COLLECTABLE BASKET, white, w/fruit images, would make great home decor! $30. 727-771-2877
WEAVE CERAMIC COLLECTABLE BASKET, w/top, with apples on the basket, round, $30. 727-771-2877
BISSELL LITTLE GREEN COMPACT MULTI PURPOSE CLEANER, for task large or small, Used 2/times, $50. 727-797-4286
ROOM AIR CONDITIONER, large, wall unit, Kenmore Powersaver, works great! $125. (727)442-4032 (Clearwater)
WHIRLPOOL DISHWASHER, Bisque, in good condition, available after July 29th, $50. 727-394-9705
CHAMPION JUICER also grating, homogenizing, sherbet, nutbutter, w/all standard, parts, instruction manual & recipe. Excellent condition. $60. (727)799-3207
KITCHEN EQUIPMENT, "Kitchenaid" 5/ct mixer, black, like new, never used, with attachments, $100/OBO 727-238-3547
(2) WINDOW A/C, Samsung, with remote control, excellent condition, work perfect. $200/both, OBO, 727-725-2776
TOASTER OVEN, Black & Decker under cabinet model, white, bake/ broil, 4 slice toast, $15. 727-441-4322
HUMIDIFIER, almost new, $25, (727)548-1486
LARGE MICROWAVE Gold Star 12watt, cooks really quick. $30 (813)785-0226
MICROWAVE, Whirlpool, white, very good condition, $25. 727-781-0540
DRYER Estate, Whirlpool. Automatic, Heavy duty, Super capacity dry. In excellent condition. $149. 727-781-0540
BREAD BOX, never used $5. 727-781-0540
JUICER, "Moulinex" excellent working condition, $10. 727-781-0540
CUISINART BLENDER, like new, glass jar, $35. 727-641-9049
ELECTRIC HEATER, never used $20. 727-678-9730
WASHER AND DRYER, "Samsung" white, top of the line stainless steel top, large capacity, dryer has steam attachment, like new, $650/both 727-584-3999


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Web Stories
Geologist to talk about prehistoric Wisconsin petroforms, April 5
Posted March 29, 2002; 04:00 p.m.
Herman Bender, president of the Mid-America Geographic Foundation , will present a lecture on "Star Beings and Stones: Reflections of Ancient Native American Cosmology in Wisconsin" at 4:30 p.m. Friday, April 5, in 106 McCormick Hall.
The foundation is an archaeological and cultural preservation group in Wisconsin. A professional geologist and archaeoastronomer, Bender will discuss a giant human-like petroform effigy found at the Kolterman earthen effigy mound site in Wisconsin. The petroform is a mirror image of the constellation Scorpius.
Petroforms are purposeful arrangements of rocks into various shapes, including circles, lines, animals and humans. The one at the Kolterman site is thought to date to the Archaic Period, approximately 4,000 years ago -- much earlier than the earthen effigies that surround it.
Recent field surveys indicate that there are many more petroforms at the site than were previously thought to exist. An article on Bender's discoveries will appear this summer in Astronomy magazine. For more information, contact Norman Muller in the University Art Museum at 258-5211.
Contact: Marilyn Marks (609) 258-3601