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Gov. Jerry Brown scored a win Monday in his maneuvering to place his tax initiative, now officially known as Proposition 30, at the top of the November ballot.
Sacramento Superior Court Judge Michael Kenny ruled that California's Secretary of State had acted properly in re-numbering the ballot order so that Brown's tax proposal will appear at the top.
That decision dealt a blow to Los Angeles attorney Molly Munger, who is sponsoring a competing tax measure.
U.S. & World
News from around the country and around the globe
Her measure is Prop 38. She challenged a move by elections officials to place Brown's plan in the top slot.
Brown signed an urgency bill last month that designated the ballot measure as budget-related, allowing it to be passed by a majority vote. Munger argued that it was a manipulation of the process.
But the judge was skeptical, telling lawyers Monday he was not inclined to micromanage election procedures.
It's easy to see why the governor wants his measure atop the ballot. He's looking for every advantage he can get, given the difficulty of convincing voters to raise taxes.
Recent polls show his measure, to raise the sales tax for everybody and the income tax on California's most well-off citizens, has an approval rating of 54 percent.
That's a precarious spot, since support typically erodes during the campaign combat that leads up to Election Day.
But in placing his measure atop the ballot, Brown is also allowing opponents to accuse him of manipulating the process.
Normally, initiatives are placed on the ballot in the order in which they qualify.
Brown's team is striking back, issuing a statement calling for Munger to stop the "scorched-earth attacks."
Given the low levels of trust voters already have in Sacramento politicians, Brown may have won this round.
But it's the type of move that generates more suspicion among voters.
Author Kevin Riggs, an Emmy-winning former TV reporter in Sacramento, is Senior Vice President at Randle Communications.
Send us your thoughts via Twitter @PropZero or add your comment to our Facebook page.


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Enter Stage Right Site of the Month
Conservatives don't like to admit it but The New York Times matters. The newspaper serves millions of readers and influences the reporting of other newspapers and television networks. Even scandals like those involving Jayson Blair and Rick Bragg -- while diminishing some of the newspaper's luster -- will do little to harm its long-term prospects. As the National Review pointed out in a column, The New York Times "is fated to become bigger, richer, and worse."
Given that importance, it's vital that the newspaper's agenda be exposed for what it really is. The New York Times is less about reporting than it is about promoting anti-American left-wing politics. That left-wing agenda has only become more pronounced under Howell Raines.
Enter Times Watch, a web site operated by Media Research Center. MRC hopes that the web site compels "paper to provide balanced reporting, or risk forfeiting its standing as the 'newspaper of record.'" It's manner of doing this is rather simple but very effective. The staff at the web site merely read through the newspaper every day and post examples of blatant bias and errors.
It's difficult to compel a course change for an entity as powerful as The New York Times and whether Times Watch will be successful is only something that time will be able to tell. That said, it's a web site that's doing some very important work.
Past Sites of the Month
Know of a site that you think should be spotlighted? Write and tell us!
� 1996-2020, Enter Stage Right and/or its creators. All rights reserved.

subset: commoncrawl


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Exploration Project
Department of
School of
Earth Sciences
| Stanford
Page Maintainer: firstname.lastname@example.com
Copyright © 2009 SEP.
This page is for SEP users. It reflects an actual e-mail correspondence.
This is a little backward compatibility problem. Previously, you could use something like \activesideplot{plot}{2in}{}{Caption}, where 2in was taken as the plot height. Now you have to say \activesideplot{plot}{height=2in}{Caption} explicitly. You can use either one or both or none of width and height. If you use only one of them, the aspect ratio should be preserved by default. Some other possible keys in the argument to activeplot (supplied by the graphicx package) are:
A more complete documentation is in $TEXMF/doc/latex/graphics/grfguide.dvi.
If you have a file called file.f90, \listing{file.f90} will do. If you want to reference it in a different place, try \progblock{label}{file.f90} and reference it with \ref{prog:label}. For cross-referencing among different chapters in a book there is also \gprogblock{label}{file.f90}. These are referenced with \ref{/prog:label}. You can find more information in the standard documentation on SEP2e.
If you create a dvi file with SEP2e, xtex will not display figures in it. This is also true for non-SEP latex files that don't use xtex macro. If you really want to use xtex, try make xtex. It will creates a dvi file using the old macros. Xtex has been declared obsolete, and we expect it to move slowly out of usage…
By the makerule default, xdvi starts with -nopostscript option. To activate a display of encapsulated postscript figures, press the View PS button on the right menu bar. If you see a file name in a box instead of a figure, check if this figure is listed in your makefile's RESULTSER, RESULTSCR, or RESULTSNR list.
It has never been easier (though it probably should be). The system of book maintenance, described below, has been tested on SEP reports (from SEP-92 to SEP-94), SEPHELP document, Jon's books (from FGDP to TDF), and Biondo's lecture notes.
To build a book, you need to create a directory tree, with each sister directory containing a makefile and a paper.tex file. The requirement for the directory names to start with a small letter is not essential. The requirement for the directories to be in a sister tree will be lifted eventually, but is assumed currently by the system.
One of the directories (traditionally, Adm) is designated for general controls. It should contain Makefile (the capital "M" is important) with the usual include ${SEPINC}/SEP.top and include ${SEPINC}/SEP.bottom. Before include ${SEPINC}/SEP.bottom, put include ${SEPINC}/Doc.rules.book. Somewhere in the Makefile put LATOPTS = option=book for books or LATOPTS = option=report for a reports. LATOPTS (arguments to Latify) can include additional arguments. For example, style=makeidx is needed for Index.
This is the bare minimum you need to build a book. Running gmake read in the administration directory will create a dvi file and display it with xdvi, gmake print will print it out, etc. When you are satisfied with the dvi, run gmake install to move it into the Dvi directory. gmake clean will clean the machine-generated files in the adm. directory, gmake distclean will also clean the relevant directories in the tree. Additionally, gmake papername.readit (e.g. gmake sergey10.readit) will display an individual chapter papername (with correct page numbers!), and gmake papername.printit will print it. The chapters will appear in a random order unless you define a sorted list with Makefile's PAPERS variable. This list will also allow you to exclude chapters from the book or to include capital-letter directories.
The top file in the adm. directory (formerly known as all.tex) is called paper.tex to comply with the makerule defaults. It is created by four perl scripts: SEPdocTPG, SEPdocBIO, SEPdocTOC, SEPdocALL (not good names, according to Matt, but they are actually hidden in the make rules).
SEPdocTPG creates a title page (tpg.tex). It accepts a number of arguments, which you can list in Makefile's TPGOPTS variable. For books, the author name and the book title are supplied in the Makefile with AUTHOR = and TITLE=. Use "\n" (C-style syntax) to indicate new lines. For reports, the author information is picked automatically from the included papers. If the automatic picking fails, you can redefine the author information for any paper by including AUTHOR.papername = in the Makefile.
SEPdocBIO creates a list of biographies (bio.tex), which normally appears at the end of a book or a report. The biographies are picked from a simple database. The database currently lives in /usr/local/share/TEX/database. This directory contains files of the form user.bio and user.ps, where user is a login name (e.g. christin), user.bio contains a biography (in the LaTeX format), and user.ps is a postscript picture. The database itself contains pointers "FirstName LastName" → user (e.g. Matthias Schwab → matt), where "FirstName LastName" is the author name as it would appear on the title page of a report. Two simple scripts, CreateDB and TestDB, are provided to maintain and expand the database.
SEPdocTOC will do nothing for books, but will create an artificial table of contents (toc.tex) for reports. Again, the author and title information are picked automatically, and if it fails, you can redefine any author or title in the Makefile with AUTHOR.papername = and TITLE.papername =. To divide the table of contents into sections ("3-D seismic","Unimportant computer stuff", etc.), put SECTION.papername =, where papername is the first paper of the section.
Finally, SEPdocALL compiles paper.tex. Additionally to (automatically generated) tpg.tex, bio.tex, and toc.tex, you can have the following two files in the adm. directory: preface.tex for the text that goes between tpg and toc, and intro.tex for the text between toc.tex and the main body of the book (roman pagenumbering.) Reports also include pub.tex with a list of recent publications.
The pstogif script does break sometimes, especially with non-vplot figures. I haven't seen enough examples to notice the pattern, but, for example, none of my Mathematica figures could convert to GIF. I hope we will find a way around it after getting more experience. You may try converting postscript to GIF with xv.
Include files like file1.tex, file2.tex in your paper with \input{file1}, \input{file2}. Additionally, put paper.tex: file1.tex file2.tex … in your makefile to let make touch paper.tex for you each time one of those files changes.
The old macros still exist on our system. If you really want to use them, put LATOPTS = class=old in your makefile or simply run gmake xtex.
Feel free to do that. The makerules are in $SEPINC, the tex macros are in $TEXMF/tex/latex/sep2e, the tex-related perl scripts are in /usr/local/share/TEX/bin. Please use RCS if you make any changes.
To get the most current version of the tex macros, scripts, and makerules, run ~sergey/tarit and ftp the sep2e.tar.gz file. This file contains everything you need for tex processing. Unpack it from the root directory with tar xvzf sep2e.tar.gz. You may need to run rehash and texconfig rehash to update the system. This distribution doesn't contain yet the scripts and extra programs required by gmake html.
Check your ~/.netscape/preferences file. It should say something like
MIME_TYPES: /usr/local/lib/netscape/mime.types PERSONAL_MIME_TYPES: ~/.mime.types MAILCAP: /usr/local/lib/netscape/mailcap PERSONAL_MAILCAP: ~/.mailcap
Either of the files /usr/local/lib/netscape/mime.types or ~/.mime.types should have the lines
application/sepshell sepsh application/sepclean clean
Either of the files /usr/local/lib/netscape/mailcap or ~/.mailcap should have the lines
application/sepshell;xterm -e sepshell %s application/sepclean; sepshell %s
If for some reason you don't want to use make, run Latify paper.tex > paper.ltx to create a valid latex file and latex2dvi paper.ltx to process it with LaTeX. For figures to show up in the DVI file, you need to use \plot (\sideplot) instead of \activeplot (\activesideplot).
To add or update your biography and/or picture in the report, follow the following procedure:
TestDB | grep user
The output should look like **FirstName LastName => user**. For example, 356 spur> TestDB | grep berryman James Berryman=>berryman 357 spur> **FirstName LastName** is your name as it will appear on the report title page. - If **TestDB** doesn't show your name or if you want to change your database entry, run CreateDB user 'FirstName LastName' For example, 359 spur> CreateDB berryman 'James Berryman' CreateDB: added James Berryman 360 spur>
According to this scheme, non-SEP co-authors who don't have SEP login accounts, should not have their photos in the report. Their names, however, will appear on the title page.
Simply put LATOPTS = class=seg97 into your makefile (or run gmake LATOPTS=class=seg97 paper.ps). After you create a postscript file, you need to take it to Adobe Distiller. The result will be a PDF file, ready for electronic submission.
Several people pointed out to me that the font size in SEG abstracts turns out smaller than usual. You shouldn't worry about it, because this size complies precisely with the sample abstract, distributed by SEG.
The seg97 class is designed to fit the SEP style. That is, it knows about all the macros we use in our papers and translates them accordingly. There is a smaller export version, called seg-99.
A simple command for doublespace is
This line has to be in the preamble (before \begin{document}.) If you use SEP's scripts, put include='\renewcommand{\baselinestretch}{2.0}' in the arguments of Latify (or put
LATOPTS = include='\renewcommand{\baselinestretch}{2.0}'
in the makefile.)
They are back! In the "old days", we used those buttons with xtex (now obsolete). Now \syscall{comm} will translate into a link to comm.sepsh and allow you to execute virtually any make command from the HTML version of your document. To create the sepshell files automatically, put a list of the buttons in your makefile under SYSCALLS variable. This is mostly useful for TAs, preparing interactive exercises.
Yes! The sep2e class has now a thesis option, connected with the standard LaTeX2e package for Stanford University theses.
February 2007, Brad Artman made some updates, to include the latest suthesis2e.sty style file. Check out an entire Thesis/Adm directory of files that will build (in Make) your thesis in 3 formats.
BE CAREFUL!! The book definitions contain a rule to make a paper.tex file in your Adm directory. Get the whole directory to make things go smoothly (/net/sepwww/sepwww/pub/software/softtex/Thesis).
Basically, follow the instructions on book maintainence. with these additional definitions:
\principaladviser{Jon F. Claerbout}
\firstreader{Biondo Biondi} \secondreader{Norman Sleep} \thirdreader{Donald Knuth} %\figurespagefalse %\tablespagefalse \beforepreface \prefacesection{Preface} blah, blah, blah... \prefacesection{Acknowledgements} Thank you, Sergey! \afterpreface
You should be able to put your SEP papers as chapters in your thesis without any technical change.
Use geophysics, a LaTeX2e class. Check out the RSF SEGtex website for the latest. \old{} and \new{} commands are great for sending in marked revisions. Makeing the pdf with and without the LATOPTS option=revised statement will either include only the things in \new{}, or both with strike-out and color changes.
Put LATOPTS = class=geophysics in your makefile, run the usual make commands (make read, make print, etc), and your SEP report paper will appear in the form ready for submission to Geophysics.
Use can also use the geophysics class supplimented with some changes in the style of bibliography references. Put the following in your makefile:
LATOPTS = class=geophysics include='\bibpunct{(}{)}{;}{a}{}{\,}' bibstyle=eage
The usual make commands (make read, make print, etc) will prepare your SEP report paper for submission to Geophysical Prospecting.
Use the html LaTeX2e package, provided together with LaTeX2HTML.
To do that, put LATOPTS = style=html in your makefile. The commands to use in your LaTeX file are
makes text appear normally in the DVI file, but as a hyperlink in HTML
includes an image (ignored completely by LaTEX)
like htmladdnormallink but makes URL a footnote in the DVI version. There is a more complete documentation of these commands.
Additionally, you can use the rawhtml environment to include an arbitrary piece of HTML code (useful for forms, Java applets, etc.)
For system calls, read Question 17.
Look under
for several available examples. (You can also submit your own example there.)
Run swish-e -c congiffile on the web server. Here configfile is a configuration file. The configuration file for SEP reports is in
The SEP bibtex databases are located in
. The most useful ones are SEP.bib - SEP reports and theses, SEG.bib - SEG cumulative database, and MISC.bib - miscellaneous items. To use bibtex references in your paper, include something like
\bibliographystyle{sep} \bibliography{SEP,SEG,paper}
where paper.bib is your own database in the paper directory. To search databases, run
bibindex [keyword] [database] bibindex stolt SEG
or use the web search
Exploration Project
Department of
School of
Earth Sciences
| Stanford
Page Maintainer: email@example.com
Copyright © 2009 SEP.


text:
Search the Rhubosphere!
Buy me coffee!I do this for the love, but if you like something I've written you can now:
The Rhubosphere RSS feed
Tag Archives: Jean Grey
Serene Slumber Party 3: X-Men: Season One, by K V Taylor
Please put your hands together to warmly welcome the most awesomesauce K V Taylor. Particularly so as I have been a bad Womble and utterly failed to upload the review she kindly sent to me weeks ago. The reasons are … Continue reading
Posted in Art, Comics, K V Taylor, Review, Serene Slumber Party, X-Men: Season One Tagged Angel, Beast, comics, Cyclops, Hank, Iceman, Jean Grey, K V Taylor, Marvel Girl, review, Scott, superheroes, Warren, X-men, X-Men: Season One 7 Comments


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Get the jump on new items at Anthony's Comic Book Art! Join our mailing list today!
Outrage (Webcomic) #9 p.1 - Outrage Shot At - 2018 Signed
There are blue line copy layouts on here but Reilly says he would do the finished live pencils on top of those and then they were inked.
11" x 17"


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I particularly love what they have to say about letting the students have their own iTunes accounts and letting them load their music and apps on the devices and the learning opportunities those decisions have created in regards to responsibility and balancing appropriate use of the devices. Another interesting point - technology integration has increased because teachers can no longer say that there is an issue with student access to technology.
I'm posting to my blog to share with you and so I do not lose track of it for future reference. Hat tip to Tom Whitby of the Educator's PLN for bringing my attention to this by posting and Tweeting the video.
Do you have similar resources bookmarked or curated somewhere on the web? Please share links in the comments so we can all learn together!


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Today we're thrilled to introduce to you a brand new offering – Adobe Shadow Labs Release 1, which enables Web developers and designers to work faster and more efficiently by streamlining preview and customization of websites for mobile devices.
Adobe Shadow aims to alleviate the time and stress of working on websites across mobile browsers. Web pros can wirelessly pair multiple smartphones and tablets with their computer and simultaneously view real-time previews of Web content across multiple iOS and Android devices, quickly seeing refreshed website designs with live updates. Adobe Shadow's synchronized browsing nearly eliminates the need to touch the device, but still provides a true, on-device experience.
We're really excited to deliver Shadow and start simplifying the pain points of previewing, inspecting and presenting mobile Web content. We encourage Web Pros to download the free Labs Release 1 of Adobe Shadow available now at http://adobe.com/go/shadow and provide the team with feedback. To learn more about Adobe Shadow, visit the blog.
Catch Adobe Shadow in action below.


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Author: Adrianna Noton
The environmental trend is stealing headlines all over the world. People are finally realizing the damage that is being done to the environment and are starting to change the way things are done at home and the business world. The travel industry is no different and a positive environmental trend is sweeping through the hotel industry as a whole.
Not so long ago using renewable energy and having a recycling program were not profitable things to do. Because of this Corporate America was not willing to jump in with both feet. While there were some companies that did this anyway (and they should be applauded), others were waiting to see where the environmental trend would lead before they started to make changes.
The travel industry, specifically the hotel niche of it, was infamous for literally pouring money down the drain. There was literally tons of unnecessary laundry being done every day that was not only costing the hotel owners a lot of money, but was using unnecessary energy and water as well. Over the last few years, this whole process has changed for the better.
When a guest checks into their room today, they are going to see something that is not even close to what it was as little as 10 years ago. Hotels will now usually have signs up that suggests to guests to keep their towels for an extra day or to keep the sheets on instead of having them changed out every day. It is impossible to understand the impact that this immediately has on energy and water consumption.
Energy savings is always as hot topic and one that was always assumed to be wasted in hotels. Lights were left on all the time and bulbs were bright and energy wasting. Today, hotels rarely have unused rooms lit up and have gone the way of energy efficient lighting to try and cut down on their bills. This all adds up to enormous amounts of energy that is now being saved instead of wasted.
While most neighborhoods started recycling years ago, not all hotels were with the program. There was a time when the back of a hotel looked more like a trash dump than anything else. Unless you have worked in one, it is hard to imagine the amount of waste that is generated each and every day. Drive in the back of the hotel today and it is an organized area that has all of their trash separated for recycling.
Hotels have always had brightly lit parking lots and extra signage up to let people know that they are open for business. While this is understandable, it has also been excessive. Solar trees are popping up all over the place to replace standard parking lot lighting and more and more hotels are making use of perimeter solar lighting to light pool areas and such that used to burn standard bulbs.
When the corporate world steps up and makes a statement that it is time to start saving energy, people tend to take notice. The trickledown effect is enormous as ideas get put into the heads of guests and staff alike. It is great to finally see the travel industry have and promote a healthier environmental trend.
Article Source: ArticlesBase.com - Hotels Are Finally Catching on to the Environment Trend


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At All High Stadium in Buffalo
Class AA
Matchup with state rankings: No. 8 Orchard Park (9-1) vs. No. 12 Aquinas (7-3). When: 6 p.m. Saturday.
Snaps: Orchard Park seems to show up each year in this round with a team capable of pushing around opponents. The Quakers ran for 476 yards last week against Jamestown, another team proud of its running game. Jamestown was held to 103. Senior quarterback Ben Holmes was a receiver on last season's state champion team, but is back at the position he played through the program.
The last two opposing offenses, including high-scoring Rush-Henrietta, scored 20 points combined against the Aquinas defense. While the Little Irish held back those opponents, the Aquinas offense put together at least one long scoring drive that seemed to give the team control of the game. How much headway will Aquinas running back Billy Lombardi and his teammates make against Orchard Park?
Class A
Matchup with state rankings: No. 2 Sweet Home (10-0) vs. No. 4 East Irondequoit Eastridge (10-0). When: 8 p.m. Friday.
Snaps: Sweet Home is the team that renewed its rivlary with Aquinas during five consecutive state quarterfinals. The winner often won the state title. This is senior Mike Torrillo's first season as the Panthers' quarterback, but his father is a coach. Torrillo also has small, quick running backs to work with and the Panthers know how to make Plan B work when the original fails.
A win by the Eastridge Lancers would get attention around the state, put them at another level, at least temporarily. Records were set as Iroquois scored 67 points during Eastridge's last appearance in this quarterfinal, but that was seven years ago. This is the round where a team's passing game begins to gain importance. Will Eastridge's have to pass the test?
Class B
Matchup with state rankings: No. 2 Alden (10-0) vs. No. 6 East Rochester/Gananda (9-1). When: 3 p.m. Saturday.
Snaps: Maine-Endwell, the 2011 Class A state champ, is the only team ahead of Alden in the rankings. That's how big and bad the Bulldogs have been. Win No. 242 for Section V Hall of Famer Dick Diminuco would finally push Alden into the semifinals after two losses to Hornell in the last three years. It will become clear quickly that junior quarterback Brian Stoldt knows what he's doing. Alden's go-to-player? Probably senior Corey Barczykowski (24 touchdowns).
East Rochester/Gananda must stand firm against the run or plan to score on each of its possessions. The Bombers may be able to hold their own against the run with lineman Ryan Fountain, linebacker Brian Delgado, lineman Jordan Trabalzi and lineman/linebacker Sam Beckenbach. East Rochester/Gananda has five defensive touchdowns.
Class C
Matchup with state rankings: No. 10 Cleveland Hill (8-2) vs. No. 1 Hornell (10-0).
When: Noon Saturday.
Snaps: This might be the only regional in which the Section V team is the favorite, without a doubt. Cleveland Hill can sting a defense with plays for big gains. The Eagles scored three touchdowns of 55 or more yards last week. And what if the Cheektowaga-based Eagles can force Hornell to throw often?
That may be easier said than done. Hornell left no doubt last week that it's willing to keep handing the ball to Zack Bacon, even if a team knows he's coming and is good enough to stop him. The Red Raiders defense not only is physical, but flexible to the point that some players are allowed to adjust on the field for results.
Class D
Matchup with state rankings: No. 4 Randolph (7-2) vs. No. 2 Avon (9-1).
When: 5:30 p.m. Friday.
Snaps: Randolph began the season 1-2, then transformed into something impressive. The Cardinals shut out Maple Grove, the No. 1 ranked team in the state, last week. Avon can expect to see plenty of senior Jordan Dowiasz (24 TDs), who also is a standout defensive back.
This is a new round for the Avon Braves, who have a tough quarterback in senior TJ Crye, who also is a capable passer. Jake Martinez made Batavia Notre Dame pay for too much attention for Crye. The Braves did OK against an effective ground game last week. Randolph junior quarterback Mitch Maycock can hurt defenses with play-action passes, a fake handoff, followed by a throw downfield.


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It doesn't get much better than this! The Playmate of the Month from August 2001 has an amazing smile and a perfect body, and we have a great slideshow of her courtesy of our friends at RegalModels.com. She has always been one of our favorite Playmates and we're thrilled to feature this slideshow.
You can see much more of her at JenniferWalcott.com, so check it out!
Also, we have this super hot video of Jennifer as well in her sexy referee outfit.
Related Posts
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Posted in: Models
Tags: babes blog, best glamour models, bikini models, bikinis, cut abs, fit abs, free Jennifer Walcott, glamor models, glamour models, Internet models, Jennifer Walcott, Jennifer Walcott gallery, Jennifer Walcott slideshow, model abs, model gallery, sexy refereee, sexy slideshows, sexy videos, slideshows, swimsuit models, swimsuits, tight abs


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Being married to Carlos over these past 15 years, one thing I've learned is that American birthday cake and Salvadoran birthday cake are very different.
Carlos will eat American birthday cake, but he doesn't really like it.
Today was Carlos's birthday and for the past few weeks, all he's been talking about is Salvadoran birthday cake. I got the hint and asked him plenty of questions about it so I could make him one. Carlos says that growing up in El Salvador he always got a cake from a bakery called Flor de Trigo on his birthday. The cake part was moist but didn't have a strong flavor, the frosting was only very slightly sweet. The cakes were usually layer cakes with fruit decorating the top.
I did some research, (even found the Flor de Trigo website!) and this is what I came up with.
The cake is a white cake (from a box mix just to save some time), and the "frosting" is a homemade whipped cream. Sliced almonds decorate the sides, and the fruits I chose were strawberries and apricot. Carlos gave me muchos besos and said it's just like a Salvadoran birthday cake. Here's the recipe if you want to give it a try!
Salvadoran-style Birthday Cake
1 box white cake mix (I used Duncan Hines Classic White)
1 quart heavy whipping cream
1/2 to 3/4 cup white sugar (more if you prefer sweeter)
1/2 teaspoon vanilla extract
1 to 2 cups sliced almonds
1 pint fresh strawberries, washed and sliced
1 can apricot halves, drained and sliced
1 can (12 oz.) "apricot cake & pastry filling" (I used "Solo" brand)
1. Make cake according to package directions. If you have two round pans, use those. If not, you can do what I did – Put it all in a well greased 13 x 9 glass baking dish. Once baked and cooled, carefully turn onto a clean surface and slice in half to create 2 square layers. (Since the edges get browned while baking, slice those off so it's uniform on all sides.)
2. This is how you make homemade whipped cream. (I recommend making this and assembling the cake the same day you plan to eat it.) First, it's best if you have a large stainless steel bowl, but a plastic mixing bowl will work. Metal is better because you can get it nice and cold. Cold is your friend when making whipped cream! … Whichever bowl you're using, stick it in the freezer along with the metal beater(s) from your electric mixer. The heavy whipping cream should be kept in the refrigerator until you're ready to use it. To make the whipped cream – pour the quart of whipping cream into the bowl. Turn your mixer on high and beat until stiff peaks form. Add a 1/2 teaspoon vanilla extract and sugar according to your tastes, (1/2 cup to 3/4 cups makes it just barely sweet by American standards.)
3. Put one cake layer on a base – this will be the bottom layer. (Ideally your base would be the bottom of a cake container which you can cover with a dome lid.) Spread the can of "apricot cake & pastry filling" on the top of the bottom cake layer. On top of the "apricot cake & pastry filling", spread a layer of whipped cream. Top with the top cake layer.
4. Frost the entire outside of the cake with the whipped cream. Carefully toss the sliced almonds onto the sides of the cake.
5. Decorate the top of the cake with the sliced apricots and strawberries. (This recipe will work great if you decide to use different fruits or a different "cake & pastry filling" – so get creative! Other options include fresh or canned pineapple, fresh kiwi, canned fruit cocktail, and other kinds of berries.)
6. Cover cake and refrigerate for a couple hours then serve!
¡Feliz Cumpleaños! (or as I like to say, Sapo Verde!)


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Major Requirements
Admission Requirements
A student wishing to major in mathematics should have a strong interest in the field and normally a background of four years of high school mathematics (two years of algebra, one year of geometry, and one year of pre-calculus or equivalent). Students fufill the Area B requirement of the pre-2012 general education requirements with the courses required for the math major or minor.
Major Requirements
The Department of Mathematics and Computer Science offers three tracks within the mathematics major:
1. Pure Track
2. Applied Track
3. Computer Science Track
All tracks are Bachelor of Science degrees.
Lower Division
The following lower-division classes are required for all tracks in the mathematics major.
- Math 27, 38, 39
- Computer Science 21
- Physics 1, 2 (lab), 3, 4 (lab) or Chemistry 8, 9 (lab), 10, 11 (lab)
Upper Division
Pure Track
The pure track is designed for students considering graduate study in mathematics or secondary mathematics teaching.
- Math 103, 111, 120, 150, and 196
- Two additional courses from Math 115, 131, and 183
- Three upper division mathematics courses (excluding Math 101)
Applied Track
The applied track is designed for students planning on entering industry directly from college.
- Math 103, 120, 196
- Math 111 or 150
- Three additional courses from 113, 114, 134, and CS 102
- Two upper division electives at most one of which is a CS course (exluding Math 101)
Computer Science Track
The Computer Science track is designed for students interested in an emphasis in Computer Science.
- Math 103, 120, 140, and 196
- Math 111 or 150
- Three upper division electives at least two of which are CS courses (exluding Math 101)
Secondary Teaching
All students in California planning to enroll in a teaching credential program in mathematics after earning their undergraduate degree are required to demonstrate subject matter competency in mathematics prior to admission to a credential program. Students at Saint Mary's College exhibit this competency by taking and passing the CSET (California Subject Exam for Teachers) in mathematics. Students interested in becoming a secondary mathematics teacher are advised to complete the following upper-division courses to prepare for the CSET while fufilling the mathematics major:
Math 103, 111, 113, 115, 120, 131, 150, 196
The California Commision on Teacher Credentialling (CCTC) also requires students to obtain "pre-professional experience" before entering a credential program. This requirement is satisfied by the course EDUC 122: Field Experience, offered in the January Term at SMC. Students are required to contact the School of Education in September of their sophomore or junior year to meet with the faculty member teaching EDUC 122. Students should also speak with a representative of the School of Education to learn of any other requirements of the state of California for prospective secondary teachers.
Suggested Four Year Program
A suggested four-year program of study for a major in mathematics is available from any department member. First-year students should take Math 27 and Math 38 and CS 21. Failure to take these courses in the first year may make it impossible to complete the major in four years. Students wishing to concentrate in computer science should take both CS 21 and 102 in thei first or second year. It is also recommended for students to enroll in Physics 1, 2 (lab), 3, 4 (lab), or Chemistry 8, 9 (lab), 10, 11 (lab) in the first year.


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"The Hunger Games," which is being hailed as the next "Twilight," is looking for a leading lady, and she needs to be pretty white, regardless of how she's describe in the book.
Jennifer Lawrence, Hailee Steinfeld and Abigail Breslin are in the mix for the lead role of Katniss Everdeen for "The Hunger Games," reported Variety, based on Suzanne Collins' bestselling books about a dystopian future where children are pitted against one another in battles to the death.
In the book, the first of a trilogy (hello, franchise!) Everdeen is described as having olive skin, dark hair, and gray eyes. And yet, the casting notice for the role says the actress "should be Caucasian, between ages 15 and 20, who could portray someone 'underfed but strong,' and 'naturally pretty underneath her tomboyishness,' notes Vulture.
U.S. & World
Look, Lawrence, Steinfeld and Breslin are all fine actresses, each with an Oscar nomination on her resume, but isn't it about time Hollywood stops whitening everything? Haven't we learned anything from "The Last Airbender"?
Director Gary Ross plans to start shooting this spring, so an announcement should be coming soon.


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After 25 year absence, event may float back to Iowa
After a 25 year absence, the National Balloon Championship could be returning to Indianola.
The event was held in Indianola for 18 years from 1970 to 1988 before being moved out of state.
The town still boasts a balloon event each year, The National Balloon Classic, and hold its hot air passion despite losing the event.
"You know, it's definitely something that makes Indianola unique," said Al Appenzeller, an Indianola balloon pilot.
Appenzeller is excited about the possibility of the event returning to Iowa.
"It just seems like I never get over the awe," said Appenzeller.
Indianola must now decide if it will bid for the 2016 National Balloon Championship, the event's 50th anniversary.
The president of the Balloon Classic's board Drew Bracken told KCCI that over the next few months, the board will weigh whether adding 50 extra competitive balloons to the 100 they already have for the Classics in 2014, 2015, and 2016 will be considered.


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London, Central London
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Elegant, Winter
Real weddings by county
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All wedding suppliers
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- says the new study: "FOOD CONSUMPTION AND THE ACTUAL STATISTICS OF CARDIOVASCULAR DISEASES: AN EPIDEMIOLOGICAL COMPARISON OF 42 EUROPEAN COUNTRIES" .
Results: ...The most significant dietary correlate of low CVD risk was high total fat and animal protein consumption. Additional statistical analyses further highlighted citrus fruits, high-fat dairy (cheese) and tree nuts. ... The major correlate of high CVD risk was the proportion of energy from carbohydrates and alcohol, or from potato and cereal carbohydrates.
Conclusion: Our results do not support the association between CVDs and saturated fat, which is still contained in official dietary guidelines. Instead, they agree with data accumulated from recent studies that link CVD risk with the high glycaemic index/load of carbohydrate-based diets. In the absence of any scientific evidence connecting saturated fat with CVDs, these findings show that current dietary recommendations regarding CVDs should be seriously reconsidered.
(CVD stands for "Cardio Vascular Disease")
|by Cecilia Bleszynski (C) 2017
The first graph published in the paper:
is the most interesting in conjunction with the rest of the results, showing that the high consumption of animal fat and protein correlates very well with high blood cholesterol level and at the same time (see for example Fig.4 and 7) the high cholesterol and high consumption of animal fat and protein correlate consistently and strongly with the low cardiovascular and other diseases' risk! That is yet another nail to the coffin of the cholesterol-heart hypothesis and an indication that the blood cholesterol correlation with cardiovascular disease (+ or -) is secondary and spurious while the primary risk factor appears to be related to the carbohydrate contents of the diet! Note that some of the graphs refer to women some for men but the actual correlation factors are similar for men and momen (see Table 1) with the exception of correlations involving BMI and smoking which are opposite for women and men (that is another interesting subject).
Most of the results point consistently and strongly, see for example Fig.10 towards the carbohydrates contents of the diet as being the strongest positive correlator with the cardiovascular disease risk, where as the animal and most plant fats correlate most negatively (that is being protective) against cardiovascular disease, see Table 1, with the notable exception of sunflower oil which correlates strongly and positively with the CVD.
It is also interestingly to notice a strong linear correlation graph with very low data scatter, between the prevalence of raised blood glucose and consumption of carbohydrates plus alcohol ('CA' variable), on Fig.9:
Although diabetes risk was not directly measured in the study, Fig.9 appears to indicate that diabetes risk may be steeply correlated to the total consumption of carbohydrates plus alcohol, and strongly inversely correlated with the consumption of animal fat and protein (see Table 1). For example an increase of the dietary carbohydrate+alcohol contents from 42% to 68% seems to increase the prevalence of high blood glucose (and thus probably diabetes risk as well) by a factor of 3!
The overall results of this study are also remarkably consistent with the original China Study data as published on the Oxford University web site and discussed on this blog (see my previous posts).
The study is also discussed in the following journalistic article:
"Potatoes and cereals are health risk, while dairy is good for you, says new study".


text: Today Apple announced iTunes 11—a huge update with a totally new look. To tide you over until its release, which isn't until October, Apple this afternoon released iTunes 10.7, which includes support for iOS 6 and new iPod Nanos and Shuffles. Obviously it's an smaller, albeit necessary update, but we know there's a huge one coming next month. [Apple via 9to5Mac]


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Morning Prayer
Morning Prayer (every Wednesday at 8 AM) comprises the prayers of the synagogue and the church that have been prayed daily for thousands of years. It includes recitation of sacred Scripture, silence, and prayers for the church and the world.
During the Middle Ages, these daily services (called the Daily Office or Liturgy of the Hours) came to be largely professionalized as the preserve of monks and the clergy, but Thomas Cranmer, author of the first Book of Common Prayer, reformed and restored Morning and Evening Prayer (aka Evensong) as popular daily services. While they are often sung or led by trained choirs, especially on Sundays in cathedrals, every priest of the Church of England has been expected, for hundreds of years up to the present, to lead or attend public Morning and Evening Prayer services in church seven days a week with whatever resources s/he has at hand. This pattern of daily services (which may be led by lay folk as well as clergy) remains at the core of Anglican spirituality, and in particular of the 1979 Book of Common Prayer.
In the space of half an hour we read psalms and passages from the Old and New Testaments (systematically reading through the entire Bible) as well as offer prayers for the Church, the world, and for our own personal needs. We also keep several minutes of silence. Please consider joining us for a mid-week moment of peace and reflection!


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I just got my voice back. At least I'm told it's my voice. A surgeon did a couple of hours' work on one of my vocal cords, removing a papilloma, and on Christmas Day, after two weeks of silence, I spoke.
For 20 years, my voice has sounded the way hickory bark looks. Now it sounds like I don't know what. My brother tells me I sound like my old self. My ears tell me that what comes out of my mouth is now ungravelled, pure in tone, if still uncertain in pitch. It's also unfamiliar. And yet it's authentic. The photos show that my vocal cords now look completely normal, with nothing to damp or obstruct their vibration. I walk around the house playing myself like a new bassoon.
What strikes me is that I have only one brief recording — a minute or two — of the way I sounded 20 years ago, before my voice got smoky, though there are plenty of photos from that time. I remember the regret I felt after my mom died, years ago, that we had no recording of her voice on tape. And yet when my dad died in 2008 — same thing. Plenty of photographs, but no record of the sound of his voice. I'm glad to have the photos, but I miss the immediacy of those voices, the way that even a recorded voice captures the movement of time and the resonance of the body with extraordinary intimacy.
The recording of sound has always lagged behind the recording of images. There is a gap of more than 40 years between the first practical photographs, taken in the 1830s, and the first practical sound recordings, made in the late 1870s, and a gap between "The Great Train Robbery" in 1903, the earliest narrative silent movie, and "The Jazz Singer" in 1927, the first successful talking movie.
For most of us, the gap that really matters is the one between the first consumer camera, the Brownie, which was introduced in 1900, and the audio equivalent of the Brownie, the recordable cassette tape, in the 1960s.
Now, it's every bit as easy to record sound on a smartphone as it is to record images. And yet because sound is always a function of time, most of us still prefer to capture digital snapshots instead of digital audio samples, even in the form of video. There is still a kind of documentary formality in setting out to record the sound of your parents' voices — a formality that has vanished entirely from photography.
The present is the place where sound thrives. After all, sound is motion, nearly life itself, and compared with the roar of the present, the silence of the past is deafening. Work your way back to the early 20th century, and the thicket of recorded voices (almost none of them the voices of ordinary people) grows ever thinner. In the late 19th century, there is Florence Nightingale and Alfred Lord Tennyson, William Gladstone and P. T. Barnum. Go back further and you reach 1877, the year Edison invented his phonograph cylinder. And before that, there is silence, except for a few stray sounds captured from phonautograms made in the 1850s but first heard only a few years ago.
In that silence, there are only descriptions of voices. Lincoln was said to be a tenor, with a voice capable of expressing a fervor we have never seen in photographs of him. Of Dickens's voice we learn how mobile it was — like the rest of him — and how readily it captured the spirit of his characters. Wordsworth spoke with "a deep and roughish but not unpleasing voice," said his contemporary Leigh Hunt. Boswell tells us that when Samuel Johnson spoke, his mode was "very impressive," "sonorous," with "a firm manly manner." What we can hear in such descriptions is the impression these voices created in those who heard them but nothing of the physical vocalization itself. It is as if the voice were a kind of psychological posture, not a matter of timbre, pitch and resonance.
What would we know if we could hear the voice of Cleopatra? How odd would Napoleon's Corsican accent sound to modern French speakers? And what if we had two minutes of the voice of Shakespeare, who managed to leave so little of his personal self behind?
We might feel awe at hearing these voices, but very likely the recordings would be mere artifacts, overwhelmed by legend, deed and word. And these figures would still be strangers. It would be nothing like hearing again the intimate sound of a voice that has gone missing in your own life, a voice that recovers memory and emotion and loss itself.
As for me, I'm getting used to this new old voice. Soon, I'm afraid, I won't hear any difference in it, and the sense of having traveled in time will go away. And if I really could go back to an earlier self, here's what I'd say: While capturing sound is now so easy, make sure you record the voices you will want to hear again. The sound alone will say everything someday.


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|Southeast Spotlight
USS Juneau Memorial rededicated
Published: 11/15/2012 13:15:00
Last Tuesday was November 13th, seventy years to the day after our Capital City's namesake; The USS Juneau, was lost in the battle of Guadalcanal. A memorial to that vessel, and the lives lost upon it, now stands in a new location along Juneau's waterfront, and was rededicated on the anniversary of that fateful day.
VIDEO: We pay honor to the USS Juneau, lost in the battle of Guadalcanal 70 years ago. (Image: Rik Pruett)
"Just as the original memorial honored the crew of the USS Juneau, we hope this new memorial will continue to remind the citizens of Juneau and our many visitors of the sacrifice that was made to keep our country strong and free."
Port Engineer Gary Gillette
"Seventy years ago today the sailors on the USS Juneau and the other ships that were in the area of operations fought the naval battle of their lives. The battle of Guadalcanal was one of the most ferocious naval conflicts of WWII, and is said to be the turning point of the war. Today we commemorate the great sailors on the USS Juneau, and their ultimate dedication to our country and the Navy core values of honor, commitment and courage. They gave their all, so that we can continue to live the lives that we live today."
Petty Officer Gregory Cazemier Jr. USN
By: Rik Pruett - firstname.lastname@example.com


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Fast-Forwarding with Audiovisual Translation Edited by: Jorge Díaz Cintas, Kristijan Nikolic
- Price: £20.00
- Price: $35.00
- Price: €25.00
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This edited collection offers a rounded vision of some of the ways in which audiovisual translation (AVT) can be approached from an academic, professional and educational point of view. The studies provide a stimulating and thought-provoking account of some of the most representative themes that are currently being researched in the field of AVT, while also highlighting new directions of potential research from a cognitive perspective. A conscious effort has been made to cover not only cultural and linguistic approaches to traditional domains of AVT (such as dubbing and subtitling), but also to look into lesser known areas of research that are attracting substantial interest from various stakeholders and gradually becoming part of the remit of AVT (including subtitling for the deaf and audio description for the blind). In this respect, the chapters of this book tackle the field of AVT from a plural, comprehensive and up-to-date perspective; speak of a rich and complex academic subject in the making; broaden our existing knowledge on AVT; reflect the many crossroads and junctions it currently faces and outline some of the issues that will become topical in the near future in this fascinating, flourishing discipline.
Fast Forwarding with Audiovisual Translation is a splendid volume which encompasses research reports with compelling insights and is an up-to-the-minute documentation of AVT research advances. The volume enriches the current discussions in the field and promotes further research in some areas.- Translation and Translanguaging in Multilingual Contexts 5:3 - Saeed Ameri and Masood Khoshsaligheh, Ferdowsi University of Mashhad, Iran
An updated and thorough collection of complementary and discerning articles, written by eminent scholars, that reveals how to approach audiovisual translation in the age of digital transformation. This illuminating publication provides a wide-ranging and insightful snapshot of audiovisual translation research today and analyzes a number of substantial changes that are having a considerable impact on the way in which we understand this complex activity.- Frederic Chaume, Universitat Jaume I, Spain
Fast-Forwarding with Audiovisual Translation takes the reader on a journey into the future of the discipline of AVT and related domains. With contributions on state-of-the-art experimental research, on new professional and didactic competences, and on the rapidly changing requirements shaping the field worldwide, this book goes well beyond the traditional case studies approach and paves the way for further research.- Aline Remael, University of Antwerp, Belgium
Anyone wishing to know the direction Audiovisual Translation Studies is taking needs only to read this volume to conclude the field is now fully established and thriving. This collection presents new and established topics with rigour and enthusiasm to show how advances in technology, education, the profession and reception are stimulating multi-disciplinary research that derives from both the social and the exact sciences.- Josélia Neves, Hamad bin Khalifa University, Qatar
Fast-Forwarding with Audiovisual Translation provides a comprehensive collection of innovative, invaluable research that contributes to our understanding of major issues in the field and constitutes essential reading for scholars of AVT.- The Journal of Specialised Translation, Issue 31, January 2019 - Sharon Black, Queen's University Belfast, UK
Jorge Díaz Cintas is Professor of Translation Studies at University College London, UK. He has published extensively in the field of audiovisual translation, subtitling and dubbing and is the editor of New Trends in Audiovisual Translation (2009, Multilingual Matters).
Kristijan Nikolic is Senior Lecturer in Translation at the University of Zagreb, Croatia. He has been a practising subtitler for over 15 years and carries out academic research in the areas of audiovisual translation and interlingual subtitling.


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National Cancer Institute
Post Date: Apr 21, 2017
Information about measuring the effectiveness of cancer screening tests and about weighing the strength of the evidence obtained from cancer screening research studies.
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about cancer screening. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
This summary is reviewed regularly and updated as necessary by the PDQ Screening and Prevention Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Cancer Screening Overview–for health professionals
Cancer Screening Overview
Cancer Screening
Potential Benefits and Harms
In 2017, an estimated 1,688,780 people in the United States will be diagnosed with cancer, and 600,920 will die of cancer. Estimates of the premature deaths that could have been avoided through screening vary from 3% to 35%, depending on a variety of assumptions. Beyond the potential for avoiding death, screening may reduce cancer morbidity since treatment for earlier-stage cancers is often less aggressive than that for more advanced-stage cancers.
Several potential harms must be considered against any potential benefit of screening for cancer. Although most cancer screening tests are noninvasive or minimally invasive, some involve small risks of serious complications that may be immediate (e.g., perforation with colonoscopy) or delayed (e.g., potential carcinogenesis from radiation). Another harm is the false-positive test result, which may lead to anxiety and unnecessary invasive diagnostic procedures. These invasive diagnostic procedures carry the risk of serious complications. A less familiar harm is overdiagnosis, i.e., the diagnosis of a condition that would not have become clinically important had it not been detected by screening. This harm is becoming more common as screening tests become more sensitive at detecting tiny tumors. Finally, a false-negative screening test may falsely reassure an individual with subsequent clinical signs or symptoms of cancer and thereby actually delay diagnosis and effective treatment.
A 2009 publication of preliminary results of a cancer screening project in Japan using multiple whole-body screening technologies illustrates clearly the problems of false-positive screening results and potential overdiagnosis.
The project enrolled 1,217 healthy volunteers, aged 35 years and older between August 2003 and July 2004. The volunteers were employees of Hamamatsu Photonics K.K. and affiliated companies in Japan. Participants were enrolled in a company-wide health insurance program and most received mandatory annual employee's health check-ups for many years, including chest x-ray, fecal occult blood (FOB) testing, upper gastrointestinal series, and mammography screening. Twenty applicants with a prior history of cancer were excluded, leaving 1,197 participants in the evaluation. All enrollees could be considered at low risk for screen-detected cancer.
All participants were offered annual whole body screening by fluorodeoxyglucose positron emission tomography, chest and abdominal computed tomography (CT), brain and pelvic magnetic resonance imaging (MRI), analyses of serum tumor markers including carcinoembryonic antigen, cancer antigen 19-9 (CA19-9), squamous cell carcinoma antigen, prostate specific antigen for men older than aged 50 years, cancer antigen 125 (CA-125) for women, and FOB testing.
Specific clinically relevant classifications were standardized for all test results and imaging tests received three independent readings with consensus resolution (for details refer to ). A screen was classified positive if any test was suggestive of malignancy, and in these cases, the subject was referred to a local hospital for further testing or retesting at the screening center. Interval cancer events were ascertained at subsequent screenings or by interview.
Twenty-two primary cancers were pathologically confirmed, including 18 at the initial screen and one in the second round. Three cancers were diagnosed because of clinical signs and symptoms. The multitest whole body testing overall sensitivity was reported as 81.8% with a specificity of 70.6% (false-positive rate 29.4%) when the results were considered suggestive of malignancy or malignancy could not be definitively ruled out and 68.2% versus 87.4%, respectively, for the more restricted screen classification suggestive of malignancy only.
The incidence of cancers found on the initial screen exceeded the estimated age-matched annual incidence of cancer in Japan by three to four times. Several cancers found on screening were known to be indolent and might be harmless for a long period without affecting cancer mortality.
The possible harms of repeated multimodal cancer screening programs were also assessed using data from the intervention arm of the randomized, controlled Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. A total of 68,436 participants received screening for three cancers, depending on sex, using prostate-specific antigen (PSA), digital rectal exam, transvaginal ultrasound, serum CA-125, chest x-ray, and/or flexible sigmoidoscopy. The study found that after four screening tests (which occurred within a 1-day period in the trial), the cumulative probability of an individual receiving at least one false-positive result was 37% for men and 26% for women. After 14 tests (or 3 years of screening), the probability rose to 60% for men and 49% for women. The cumulative probability of undergoing an invasive procedure as a direct result of a false-positive exam was 29% for men and 22% for women after 14 tests.
The harms of screening are of particular concern in the case of overdiagnosis, as the individual cannot, by definition, reap any potential benefit of screening, but may experience the associated adverse effects, including those of unnecessary treatments. There are two forms of overdiagnosis: 1) the detection of a lesion with essentially no malignant potential (sometimes called "pseudodisease"); and 2) the detection of a lesion that is slow-growing enough that the individual will go on to die of a competing cause of death first. The use of screening tests in individuals with limited life expectancies can therefore be an important cause of overdiagnosis. Studies of current U.S. practice patterns have demonstrated considerable utilization of cancer screening tests in situations where the likelihood of overdiagnosis is high, and benefit very low. For example, investigators linked data from the Surveillance, Epidemiology, and End Results (SEER) cancer registry to Medicare claims in order to evaluate the use of routine cancer screening in persons aged 65 years and older with a known advanced cancer diagnosis (including stage IIIB–IV lung cancer, stage IV colorectal cancer, stage IV gastroesophageal cancer, stage IV breast cancer, and advanced-stage pancreatic cancer). They found 9% of women with established advanced cancer diagnoses received routine screening mammographies and 6% received routine Pap smears; 15% of men with established advanced cancer diagnoses still received routine PSA screening. The strongest individual predictor of routine screening in the setting of advanced cancer was a history of recent screening prior to diagnosis.
There is an association between cancer diagnosis and suicide behavior (either completed or attempted) in the first year after diagnosis. This association has been seen in both adults and young individuals, with relative risk (RR) ranging from 1.6 to 2.0.
In developing the cancer screening summaries, the PDQ Screening and Prevention Editorial Board uses the following definitions:
- Screening is a means of detecting disease early in asymptomatic people.
- Positive results of examinations, tests, or procedures used in screening are usually not diagnostic but identify persons at increased risk for the presence of cancer who warrant further evaluation.
- Diagnosis is confirmation of disease by biopsy or tissue examination in the work-up following positive screening tests. (Following a positive screening result, cancer can often be ruled out by procedures other than biopsy or tissue examination.)
The purpose of this summary is to present an explicit evidence-based approach used in the development of the screening summaries. In reaching conclusions, evidence on the balance of risks and benefits is weighed. Cost and cost-effectiveness, however, is not taken into account. Assignment of levels of evidence associated with such screening tests is also discussed.
By design, the PDQ does not issue any clinical practice guidelines. Although many public health organizations present guidelines for health care and screening activities, the quality of these guidelines vary widely, partly because they are opinion based and rely on systematic reviews of evidence that are of varying quality. The best guidelines as assessed by the Appraisal of Guidelines for Research and Evaluation (AGREE) are those based on the best systematic reviews as evaluated by the Assessment of Multiple Systematic Reviews (AMSTAR).
Informed and Shared Medical Decision Making
Guidelines for cancer screening increasingly mention the importance of individuals making informed decisions about participating in screening and sharing in decision making. Unbiased and balanced information about the potential benefits and harms of cancer prevention, screening, and treatment plays an important role in informed decision making by the patient.
In a nationwide survey of informed decision making during patient-provider discussions about colorectal, breast, and prostate cancer screening, patients considered themselves informed but often were not knowledgeable about the risks and benefits of screening. Patients reported that they were usually not asked about their preferences for cancer screening; and although more than 90% of the discussions addressed the pros of screening, 30% or fewer addressed the cons of screening.
For many cancer screening decisions, shared decision making is suggested, whereby the provider helps the patient make an informed, values-based choice from among two or more medically reasonable alternatives. This is especially important when screening presents potential harms and limited benefits. There are three components of shared decision making:
- The provider shares screening options with evidence-based information about benefits, harms, and uncertainties.
- The patient shares preferences with the provider, who helps the patient evaluate these options and preferences and make a decision.
- The provider assists with recording and implementing the patient's preferences.
Patient decision aids can be useful in providing information and helping patients make a decision. They encourage patients to interpret evidence in the context of their own goals and concerns. Decision aids are available in many different formats, including leaflets, booklets, videos, and websites. Some decision aids also include patient stories. Different patients may prefer some formats over others. Most formats encourage patients to make decisions with their physicians. The International Patient Decision Aid Standards (IPDAS) Collaboration has developed a method for evaluating the quality of decision aids.
A Cochrane review of 115 randomized controlled trials of shared decision making supported by decision aids indicated that, in general, decision aids improve patient knowledge about options and risks; reduce decisional conflict related to feeling uninformed or unclear about personal values; and stimulate patients to take more active roles in decision making. In some cases, decisions aids have also been noted to reduce the number of patients choosing major elective invasive surgery over more conservative options, and in fewer patients choosing cancer screening. The effect of using decision aids on the length of consultation varies, ranging from shortening consult time, to no change, to lengthening consult time.
After using a decision aid that included information about breast cancer overdetection, more women made an informed decision about whether they should be screened, and met the threshold for adequate overall knowledge. Compared with controls whose decision aids did not include information about overdetection, fewer women expressed positive attitudes toward screening or intended to be screened in the future. Better-informed individuals may be less likely to choose to participate in cancer screening.
Summary Development
The cancer screening summaries are based on various levels of published scientific evidence and collective clinical experience. The highest level of evidence is taken as mortality reduction in controlled, randomized clinical trials. The results of clinical studies, case-control studies, cohort studies, and other information are also considered in formulating the summaries. In addition, the incidence of cancer, stage distribution, treatment, and mortality rates are considered. The summaries are subject to modification as new evidence becomes available.
The Scientific Basis
At least two requirements must be met for screening to be efficacious:
- A test or procedure must be available to detect cancers earlier than if the cancer were detected as a result of the development of symptoms.
- Evidence must be available that treatment initiated earlier as a consequence of screening results in an improved outcome.
These requirements are necessary but not sufficient to prove the efficacy of screening, which requires a decrease in cause-specific mortality. For example, only one of these two criteria was met in the case of screening for childhood neuroblastoma by the assessment of urinary catecholamine metabolites. A mass screening program was conducted in Saitama Prefecture, Japan, between 1981 and 1992 for 6-month-old infants. During that 12-year period, the annual incidence of neuroblastoma in children younger than 1 year increased from about 28 per million to 260 per million but without a significant reduction in incidence in children older than 1 year. Because there also was no reduction in mortality for the disease, this experience provided strong evidence of overdiagnosis—diagnosis of some neuroblastomas detectable by screening, which would not have been clinically diagnosed later. Similar experiences have been reported elsewhere in Japan and in the Quebec Neuroblastoma Screening Project (QNSP) in Canada. The history of screening for neuroblastoma also provides a useful illustration of the benefit of undertaking well-designed evaluations of emerging screening technologies before implementing screening programs. Although such studies are very costly, it has been shown that the QNSP itself averted unnecessary morbidity for thousands of children and did so while returning a yield plausibly estimated at a cost savings 64.5 times the investment in the study.
Direct or assisted visual observation is the most widely available examination for the detection of cancer. It is useful in identifying suspicious lesions in the skin, retina, lip, mouth, larynx, external genitalia, and cervix.
The second most available detection procedure is palpation to detect lumps, nodules, or tumors in the breast, mouth, salivary glands, thyroid, subcutaneous tissues, anus, rectum, prostate, testes, ovaries, and uterus and enlarged lymph nodes in the neck, axilla, or groin.
Internal cancers require procedures and tests such as endoscopy, x-rays, MRI, or ultrasound. Laboratory tests, such as the Pap smear or the FOB test have been employed for detection of specific cancers.
The performance of screening tests is usually measured in terms of sensitivity, specificity, and positive-predictive values (PPV) and negative-predictive values (NPV). Sensitivity is the chance that a person with cancer has a positive test. Specificity is the chance a person without cancer has a negative test. PPV is the chance that a person with a positive test has cancer. NPV is the chance that a person with a negative test does not have cancer. PPV and to a lesser degree, NPV are affected by the prevalence of disease in the screened population. For a given sensitivity and specificity, the higher the prevalence, the higher the PPV.
High-Risk Populations
Some individuals are known to be at high risk for cancer, such as those with a personal history of cancer or a strong family history of cancer; increasingly, as genetic mutations and polymorphisms are found to be associated with specific cancers, high-risk individuals will be identified through genetic testing. The type, periodicity, and commencement of screening in high-risk populations for most cancers reflect the judgment of practitioners rather than evidence from scientifically conducted studies. Physician judgment is needed in such circumstances to determine the most appropriate application of available screening methods. Prudence suggests increased vigilance in the higher-risk populations. At a minimum, this means that the high-risk person is identified, is counseled appropriately, and regularly undergoes those screening procedures that have been shown to be of benefit to the general population.
Cancer Recurrence
Please refer to the PDQ Adult Treatment summaries for information on cancer recurrence.
Improved Outcomes
For nearly all cancers, treatment options and survival are related to stage, which is generally characterized by the anatomic extent of disease. On this basis, it is assumed that early detection of cancer at an earlier stage may yield better outcomes. In the 1940s, a generalized staging classification of localized, regional, and distant disease was developed to show long-term trends, and it is still useful. In the more detailed TNM system, which has been periodically modified, the (T)umor size, the status of the lymph (N)odes, and the status of distant (M)etastases are also categorized. These elements are grouped into stages 0, I, II, III, and IV according to their association with survival. In general, larger primary malignant tumors have a higher incidence of metastasis to regional lymph nodes and to distant sites. Stage has such a profound effect on outcome that all randomized treatment trials require the comparison of similar stages in evaluating differences in outcome. Shifts in stage may also herald improved survival and decreased mortality, though stage shift alone does not establish benefit.
Biologic cellular characteristics of cancer, such as grade, hormone sensitivity, and gene overexpression are recognized as important predictors of cancer behaviors. For example, high-grade cancer may be fast growing and quick to metastasize regardless of stage at the time of diagnosis. Therefore, detection of these cancers when they are small may not affect outcome. Randomized controlled trials are most definitive in determining screening benefits.
Observed Patterns of Cancer Stage at Diagnosis
The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute gathers cancer incidence data from 11 geographic areas, covering approximately 14% of the U.S. population. These population-based data of long duration (1973–present) are a unique and important resource in monitoring stage-related survival.
Interpreting Changes in Relative Survival Over Time
Increases in survival over time, however, even when based on data from tumor registries, such as SEER that include all cases in a given population, are difficult to interpret. They may reflect the benefits of early detection or improved treatment or both, but they may also result from lead-time bias and overdiagnosis, both of which occur commonly with screening.
Lead-time bias will result in longer estimated survival of people with cancers that have been identified through screening because the time preceding the clinical diagnosis of the cancer is included in the calculation of survival.
Overdiagnosis may result from finding cancers that would never have become manifest clinically. By definition, these cancers have a good prognosis. For example, autopsy series have shown a high percentage of occult early prostate carcinomas in elderly men who died of causes unrelated to prostate cancer. The discovery of these cancers through screening could increase the number of cases and give the appearance of stage shift, and of increases in survival or cure rates, without necessarily reducing mortality. An analysis of data reported by the SEER program between 1950 and 1996 found that changes over time in 5-year relative survival rates for 20 major cancers were essentially unrelated to trends in mortality rates for those cancers over the same period. The authors suggest that changes in 5-year survival rates are largely due to earlier diagnosis and to detection of subclinical cases that might never have surfaced clinically. They conclude that inferences about the effectiveness of early diagnosis or treatment should not be drawn from temporal changes in 5-year survival rates, but rather should be based on changes in mortality rates. Thus, changes in 5-year survival rates or stage shifts are not appropriate measures of the effectiveness of screening for early disease. Reductions in incidence rates for late-stage tumors represent a better measure of progress due to screening than 5-year survival trends, although such evidence is less compelling than reductions in mortality.
Study Designs
Findings from studies carried out using various study designs may be available to support a given summary. The strongest design is the randomized controlled trial. It is, however, not always practical to conduct such a trial to address every question surrounding the field of screening. For each summary of evidence statement, the associated strength of study designs are listed. There are five study designs that are generally used in judging the evidence. In order of strength of design, the five levels are as follows:
- Evidence obtained from randomized controlled trials.
- Evidence obtained from nonrandomized controlled trials.
- Evidence obtained from cohort or case-control studies.
- Evidence obtained from ecologic and descriptive studies (e.g., international patterns studies, time series).
- Opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees.
Experimental trials are designed to correct for or eliminate selection, lead-time, length, healthy volunteer, and other biases when prospectively testing a detection procedure to determine its effect on health outcome. The highest level of evidence and greatest benefit from screening is mortality reduction in a randomized controlled trial. For most sites, such evidence is not available. Theoretically it is possible to conduct randomized trials for most interventions, but the sample size that is needed, the expense, and the duration of such trials for most cancers, frequently make this approach impractical. Therefore, evidence obtained by other methods is often used.
In certain cases, a preliminary alternative to using mortality reduction to evaluate a new screening modality could be a relatively short-term (e.g., several years) comparison of interval cancer rates observed in a randomized trial comparing the new test and the "standard" screening modality. If the new screening test has the potential to improve disease-specific mortality, repeated applications over a discrete period of time should result in a lower proportion of patients in the intervention arm presenting with symptomatic cancer (of the type screened for) between negative screens. That is, through increased early detection and resulting treatment, the new screening test prevents a higher percentage of clinically important asymptomatic lesions from progressing to overt cancer. Unlike cross-sectional sensitivity comparisons in which study participants receive both new and older screening modalities, this trial design allows for an estimation of the degree of overdiagnosis generated by a screening test. This comparison should take place within the context of a randomized controlled trial.
Case-control and cohort studies provide indirect evidence for the effectiveness of screening, but it is difficult to eliminate the contribution of selection bias and healthy volunteer bias evident in these studies.
Ecological studies can demonstrate association between the use of screening and a stage shift in cancer that can provide indirect evidence of the value of screening. Such evidence is particularly compelling for the effectiveness of screening for cervical cancer. Ecological correlation of mortality and intensity of screening has been used in this context. Such studies do not prove a mortality-reduction effect, and the potential for bias to invalidate inferences from nonexperimental studies or to give misleading results can be substantial.
Descriptive uncontrolled studies based on the experience of individual physicians, hospitals, and nonpopulation-based registries may yield some information about screening. The performance characteristics of various detection tests, such as sensitivity, specificity, and PPVs are generally first reported in such descriptive studies. The first evidence that screening may be successful is an increase in the incidence of early cancers and a decreased incidence of late-stage metastatic cancers (stage shift); later, a reduction in deaths may occur. These descriptive studies do not establish efficacy because of the absence of an appropriate control group.
A more detailed description of how the overall evidence regarding benefits and harms of screening tests is graded by the PDQ Screening and Prevention Editorial Board can be found in the PDQ summary on Levels of Evidence for Cancer Screening and Prevention Studies.
Simulation Models
Another approach to formulating data about cancer screening is modeling. Models offer the possibility of generating information about cancer screening in circumstances where empiric evidence does not exist. A number of probabilistic and computer simulation models have been developed to do the following:
- Analyze trends in cancer detection and compare these trends with those reported in national or regional databases.
- Investigate the cost-effectiveness of various screening strategies.
- Attempt to estimate overdiagnosis resulting from screening.
A major effort in this area is simulation modeling from the National Cancer Institute's Cancer Intervention and Surveillance Modeling Network (CISNET) program. Models have been developed to investigate the impact of screening for breast, colorectal, lung, prostate, cervical, and esophageal cancers. Examples include a model for prostate screening, which suggests that a combination of changes in prostate cancer treatment, improvements in disease management after primary therapy, and screening contributed to a drop in prostate cancer mortality. Another example models the benefits and harms of breast cancer screening strategies after eight strategies were investigated that included differences by age for the start of screening (40, 45, or 50 years) and screening intervals (annual, biennial, or hybrid). Additionally, an investigation of the benefits and harms of CT lung cancer screening compared 576 different scenarios with varying eligibility criteria (age, pack-years of smoking, years since quitting), screening intervals (1, 2, or 3 years), and the ages of starting (45, 50, 55, or 60 years) and stopping (75, 80, or 85 years) screening.
A serious caveat with all models is that they are only as good as the assumptions upon which they are based, particularly those assumptions about the unknown natural history of the target disease. Many models are complex, so it is difficult to understand how the components interact and how the results are generated. Further, models often do not appropriately account for lead time and length biases and therefore overestimate screening benefit. In addition, models often produce results that are extrapolations beyond the range of the data input to the models. Thus, caution is necessary in interpreting model findings.
Disease-Specific and All-Cause Mortality Endpoints
Disease-specific mortality has been the most widely accepted endpoint in randomized clinical trials of cancer screening; however, the validity of this endpoint rests on the fundamental assumptions that the cause of death can be accurately determined and that the screening and subsequent treatments have negligible effects on other causes of death. Recent reviews of randomized clinical trials of cancer screening suggest that misclassification in cause of death has been a major problem and that misclassification has led to an overestimation of the effectiveness (or an underestimation of the harms) of screening. In contrast to disease-specific mortality, all-cause mortality depends only on an accurate ascertainment of deaths and when they occur and therefore is not affected by misclassification in cause of death. One major limitation of the all-cause mortality endpoint, however, is that it is unlikely to reveal a statistically significant effect of cancer screening because this intervention is usually targeted to a disease that causes only a small proportion of all deaths. Nevertheless, all-cause mortality should be considered in conjunction with disease-specific mortality to reduce the possibility that a major harm (or benefit) from screening is hidden by misclassification in cause of death.
An important question, which can be addressed by investigating both endpoints, is whether screening actually saves lives. A systematic review of meta-analyses and randomized trials was performed for diseases in which mortality is a common outcome, including several cancers, to determine whether screening reduced all-cause mortality. Mammography for breast cancer and sigmoidoscopy and fecal occult blood testing for colorectal cancer were the only cancer screening interventions that led to reductions in disease-specific mortality, but there was no test that led to a reduction in all-cause mortality.
Measures of Risk
Several measures of risk are used in cancer research. Absolute risk or absolute rate measures the actual cancer risk or rate in a population or subgroup (e.g., U.S. population, or whites or African Americans). For example, the SEER Program reports risk and rate of cancer in specific geographic areas of the United States.
Rates are often adjusted (e.g., age-adjusted rates) to allow a more accurate comparison of rates over time or among groups. The purpose of the adjustment is to make the groups more alike with respect to important characteristics that may affect the conclusions. For example, when the SEER Program compares cancer rates over time in the United States, the rates are adjusted to one age distribution. If this were not done, cancer rates would seem to increase over time simply because the U.S. population is getting older and the risk of cancer is higher in older age groups.
Relative risk (RR) compares the risk of developing cancer among those who have a particular characteristic or exposure with those who do not. RR is expressed as a ratio of risks or rates; it ranges from infinity to the inverse of infinity (i.e., zero). If the RR is greater than one, the exposure or characteristic is associated with a higher cancer risk; if the RR is one, the exposure and cancer are not associated with one another; if the RR is less than one, the exposure is associated with a lower cancer risk (i.e., the exposure is protective). RR is often used in clinical trials of cancer prevention and screening to estimate the reduction in cancer risk or risk of death, respectively.
An odds ratio (OR) is often used as an estimate of the RR. It, too, indicates whether there is an association between an exposure or characteristic and cancer. It compares the odds of an exposure or characteristic among cancer cases with the odds among a comparison group without cancer. Although not as intuitively understood as rates or risk, OR is used because it is statistically more valid in some settings when other measures of risk are not valid. For relatively uncommon events/diseases such as a cancer diagnosis, it can be interpreted like a RR is interpreted; however, it becomes a progressively inaccurate estimate of the RR as the underlying absolute risk of disease in the population under study rises above 10%. ORs are typically used in case-control studies to identify potential risk factors or protective factors for cancer.
Risk or rate difference (or excess risk) compares the actual cancer risk or rate among at least two groups of people, based on an important characteristic or exposure, by subtracting the risks or rates from one another (e.g., subtracting lung cancer rates among nonsmokers from that of cigarette smokers estimates the excess risk of lung cancer due to smoking). This can be used in public health to estimate the number of cancer cases that could be avoided if an exposure were reduced or eliminated in the population.
Population-attributable risk measures the proportion of cancers that can be attributed to a particular exposure or characteristic. It combines information about the RR of cancer associated with a particular exposure and the prevalence of that exposure in the population, and estimates the proportion of cancer cases in a population that could be avoided if an exposure were reduced or eliminated.
Number needed to screen estimates the number of people that must participate in a screening program for one death to be prevented over a defined time interval.
Average life-years saved estimates the number of years that an intervention saves, on average, for an individual who receives the intervention. This reflects mortality reduction and life extension (or avoidance of premature deaths).
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Changes to This Summary (04/21/2017)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Cancer Screening
Updated statistics with estimated new cases and deaths for 2017 (cited American Cancer Society as reference 1).
Added text to state that three cancers were diagnosed because of clinical signs and symptoms.
This summary is written and maintained by the PDQ Screening and Prevention Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.
About This PDQ Summary
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about cancer screening. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Screening and Prevention Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
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Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Screening and Prevention Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
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PDQ® Screening and Prevention Editorial Board. PDQ Cancer Screening Overview. Bethesda, MD: National Cancer Institute. Updated
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