text:
Lightwash Chambrey Denim Flowy Dress
- Regular
- $75.00
- Sale
- $75.00
- Regular
- Unit Price
- per
- Fabric - 100% Rayon. Oversized
US Shipping Rates (excludes Alaska & Hawaii)
We offer Free standard shipping for all orders $100+ so fill up that bag! Just a reminder your shipping is calculated off of your discounted subtotal (total AFTER sale items have been reduced and coupon codes have been applied!) and does not include tax.
3-5 business days
*Standard Shipping $7
*FREE SHIPPING for all orders over $100 FREE
*Local pick up is FREE ( you must pick up at the store)
For standard shipping: Once your order is submitted, our gals here at Country Lace Boutique will work fast to get your order packed and ready to ship to you within 1 business day. It should be in your hands in 3 to 5 additional business days!
We ship all orders as quickly as possible from Lawton, Oklahoma. Please note that there may be processing delays in shipping during sale events and holidays. If you need to receive your package by a specific date, you can always call/text us at 580-670-7009.
Tracking Your Order
Once your order is packaged for shipment, you will receive an email/text notification with your tracking number. If your order status reads "Open," then your order has been successfully submitted. If your order status reads "Shipped," your order is prepared for shipment and you will see the delivery tracking number assigned to your order.
Pick Up In-Store
Choose local pick up at checkout
Standard Orders
We need 1 business day to process and complete your order, but don't worry! You'll receive an email notification as soon as it's ready to go home with you!
Pickup Location:
Country Lace Boutique
101 SW B Ave
Lawton, Ok 73501
International Shipping
- Shipping prices to Canada are based on the total weight of the order. Standard shipping orders take 1-3 business days to be processed and packaged before they are shipped out of our storefront.
- UPS International Orders CANNOT be shipped to a P.O. Box. We will call you for a new address.
- You are responsible for all customs, duties, taxes, and fees charged by your government. Please contact your country's customs office for estimate on charges and rates on a package coming outside of your country. International customers (outside of the United States) are responsible for all import duties, customs, and local taxes charged by your country. We do not know the amount of that these fees might be & we recommend that you contact your country's customs office or tax agent for respective charges and rates on a package coming outside of your country.
- It is the buyer's responsibility to make sure that the address entered for the shipping address is correct. Country Lace is not responsible if a package is shipped back to us due to an incorrect or undeliverable address.
- If there is a problem with your tracking number or package delivery, please contact the carrier directly before contacting us. Please allow 1-4 business days for your tracking information to show. In some rare cases, tracking information may not update, but you will still receive your order. Please contact us after the estimated delivery time has passed if you have not received the package.
Country Lace is NOT responsible for:
- Delays with USPS or UPS shipping
- International Duties or Customs Charges
- Lost, damaged, or marked delivered items. Please file a claim with the carrier
Store Hours:
Mon - Fri: 10am - 6pm CST
Sat 10am - 5pm CST (June & July we close at 3pm)
Sun: Closed
At Country Lace Boutique, our biggest goal is to help our customers/friends build confidence in their outfits and in turn themselves. If you're not satisfied with your order, we will gladly do everything we can to try and make it better!
Please check your goodies as soon as you get them in your hands. If you think that you've received a defective item or the wrong item, contact us at 580-670-7009 within 3 business days of receipt of your order.
Here is a simple run-down of the procedures for returns:
- Items can be returned for store credit only. We cannot issue refunds.
- All returns must be received within 14 days* of the date that your order is received.
- Anything purchased at a discounted price is a FINAL SALE and is not eligible for return.
- Returned items must remain un-washed, unworn, and free of odor
- Include a note if you wish to switch sizes
- Shipping is non-refundable, unless there was a mistake on our end.
- Please allow our team 2-3 business days to process your return once it is received at our store.
- Items will not be exchange/returned UNTIL RETURNED ITEM IS RECEIVED
You can easily exchange for the SAME item but in a different SIZE! If you wish to exchange your item for a different size, please indicate that in a note. An exchange order for the new size will be processed and shipped out to you within 2-3 business days of us receiving the order. You will receive an order confirmation email to the email address on the original order. Please note that the exchange is subject to availability. If we do not have the item and size in stock when we receive your return, we will process the return as a gift card code.
Return Policy
We know that ordering things online can be a hard sometimes since you can't touch the items or try them on, and because of that we try our best to be very return-friendly. However, there are certain rules that must be followed so that we can continue to help all of our customers/friends out.
- Any goodies you purchased must be returned within 14 days of shipping and all items are only eligible for store credit
- Returned items must remain un-washed and unworn.
- Anything purchased at a discounted price is a FINAL SALE and is not eligible for return.
- Don't forget that your original shipping cost is non-refundable.
Changing or Cancelling Your Order
Sometimes stuff happens and you need to change or cancel your order. We totally understand and are here to help, but you must contact us immediately! The girls try to get item placed before 4pm to the mail by 5pm so you received your goodies as fast as possible. Once your item ships we will be unable to make any changes to your order.
Adding Items to an Order You Just Placed
In case you forget something we are her to help. First, contact us immediately (580-670-7009)! We will do our best to ship it out with your first order or waive the shipping fee on this additional order.


text:
Pistol Airbrush Gun BD-116B
Pistol Airbrush Gun BD-116B
Category: Single-Action
This basic airbrush is used for airbrush body art, automotive graphic, hobby amateur, fingernail beauty, fine arts and so on
This basic airbrush is used for airbrush body art, automotive graphic, hobby amateur, fingernail beauty, fine arts and so on
Airbrush Specifications:
Feed Type: Gravity
Mounted Needle Dia: 0.3mm Extra Needle Dia: 0.2mm&0.5mm
Mounted Nozzle Dia: 0.3mm Extra Nozzle Dia: 0.2mm&0.5mm
Metal Cup Capacity: 2cc&5cc&13cc
Air Hose: 1.8mt(6ft)
Adaptor: G1/8 Male-G1/4 Female
Working Pressure: 15-50psi
Carton Dimensions(cm): 51*39*31
Double-Action Trigger Air-paint Control
Durable, reliable, maintenance friendly
Airbrush Using
The airbrush has many uses and can be seen in advertising, book, album covers, and Photo retouching.
T- shirt art, fabric and clothing art are all successful with the use of the airbrush and special fabric and multi use paints, Createx Paint being just one example.
Cosmetic application of liquid foundations that have a high coverage but thin in texture can be applied with the airbrush for a full coverage without heavy build up.
Temporary tattooing, body art and spray tanning are now all very popular with the use of the airbrush.
Nail art, aided with hundreds of tiny stencils widely available for nail art creations.
Airbrushes are frequently used by scale modeling enthusiasts to achieve desired effects which would be hard to replicate by brush work alone.
The custom car industry, with murals, graphics and other artwork being also displayed on vans, lorries, boats, planes motorcycle tanks, helmets etc just to mention a few all enjoy the beautiful artistic and desired effects an airbrush can

subset: commoncrawl


text:
CORE - Pseudo-namespace for Perl's core routines
*CORE::GLOBAL::hex = sub { 1; };
print hex("0x50"),"\n"; # prints 1
print CORE::hex("0x50"),"\n"; # prints 80
The CORE
namespace gives access to the original built-in functions of Perl. There is no CORE
package, and therefore you do not need to use or require an hypothetical "CORE" module prior to accessing routines in this namespace.
A list of the built-in functions in Perl can be found in perlfunc.
To override a Perl built-in routine with your own version, you need to import it at compile-time. This can be conveniently achieved with the subs
pragma. This will affect only the package in which you've imported the said subroutine:
use subs 'chdir';
sub chdir { ... }
chdir $somewhere;
To override a built-in globally (that is, in all namespaces), you need to import your function into the CORE::GLOBAL
pseudo-namespace at compile time:
*CORE::GLOBAL::hex = sub {
# ... your code here
The new routine will be called whenever a built-in function is called without a qualifying package:
print hex("0x50"),"\n"; # prints 1
In both cases, if you want access to the original, unaltered routine, use the CORE::
print CORE::hex("0x50"),"\n"; # prints 80
This documentation provided by Tels <firstname.lastname@example.com> 2007.


text: Capitol Policeman John Cale has just been denied his dream job with the Secret Service of protecting President James Sawyer. Not wanting to let down his little girl with the news, he takes her on a tour of the White House, when the complex is overtaken by a heavily armed paramilitary group. Now, with the nation's government falling into chaos and time running out, it's up to Cale to save the president, his daughter, and the country.


text:
Replacing Your Medicare Card
If your red, white, and blue Original Medicare card is lost or stolen, or you can no longer use it because it is too faded or damaged, you can replace it by calling 1-800-MEDICARE (633-4227). You can also order or print a replacement card by logging into your mymedicare.gov account.
If you get Medicare health or drug benefits from a Medicare Advantage Plan, such as an HMO, PPO, or PDP, call your plan to get your card replaced.
If you get Medicare through the Railroad Retirement Board, call the Railroad Retirement Board to order a replacement Medicare card. You should get your new card in the mail within 30 days.
Your Medicare card, Social Security card, and other health insurance cards are very important documents. Make sure to keep a photocopy of your important identification and insurance cards, write down any important numbers (like your Medicare number), and keep everything in a safe place so that you have a record for future reference if anything gets lost.
Also, if your Medicare card has been lost or stolen, watch out for Medicare fraud. Check your Medicare Summary Notice (MSN) for services you did not receive, and if you spot any, report them to the Inspector General's fraud hotline at 800-HHS-TIPS (800-447-8477). You can also get help from your local Senior Medicare Patrol.
© Medicare Rights Center. Used with permission.
The content is developed from sources believed to be providing accurate information. The information in this material is not intended as tax or legal advice. It may not be used for the purpose of avoiding any federal tax penalties. Please consult legal or tax professionals for specific information regarding your individual situation. This material was developed and produced by FMG Suite to provide information on a topic that may be of interest. FMG, LLC, is not affiliated with the named broker-dealer, state- or SEC-registered investment advisory firm. The opinions expressed and material provided are for general information, and should not be considered a solicitation for the purchase or sale of any security. Copyright FMG Suite.


text:
Index | index by Group | index by Distribution | index by Vendor | index by creation date | index by Name | Mirrors | Help |
The search service can find package by either name (apache), provides(webserver), absolute file names (/usr/bin/apache), binaries (gprof) or shared libraries (libXm.so.2) in standard path. It does not support multiple arguments yet...
The System and Arch are optional added filters, for example System could be "redhat", "redhat-7.2", "mandrake" or "gnome", Arch could be "i386" or "src", etc. depending on your system.
This package provides debug sources for package yubihsm-shell. Debug sources are useful when developing applications that use this package or when debugging this package.
Generated by rpm2html 1.6


text:
HDI Arena concerts
We're sorry, we currently do not have any tickets on-sale for concerts in HDI Arena.
We're always adding events, so please check back soon!
Otherwise, try searching for the artist or venue you are interested in, using the search form above, or
ask us to add it. Thanks!


text:
Jamba Kapahulu Ave
Day of the Week | Hours |
Monday | 6:00 AM - 9:00 PM |
Tuesday | 6:00 AM - 9:00 PM |
Wednesday | 6:00 AM - 9:00 PM |
Thursday | 6:00 AM - 9:00 PM |
Friday | 6:00 AM - 9:00 PM |
Saturday | 6:00 AM - 9:00 PM |
Sunday | 6:00 AM - 9:00 PM |
Welcome to Jamba Kapahulu Ave
We're committed to making eating better easier and more fun. Try our plant-based smoothies, delicious bowls with fresh fruit toppings, to protein-packed food and on-the-go snacks. Come visit us at 625 Kapahulu Ave. in Honolulu (Oahu).
Have a question? Ask us today!
fast and easy delivery
let jamba come to you – wherever you are. get our whirld famous smoothies, food, bowls & juices delivered in just a few clicks. my jamba rewards members can also apply rewards & earn points on delivery orders when you order on jamba.com or the jamba app!
Start Earning Rewards
for the best experience download the Jamba app and start your pick-up or delivery order. earn points on every order and get exclusive perks. signing up is easy and fast 😉
Enter for a chance to win VIP tickets to see Disney Princess - The Concert!
Experience your favorite Disney Princess songs performed live by Broadway stars. Hurry, offer ends December 21, 2023. No Purchase necessary. See Official Rules at sweeps.jamba.com/concert/rules. Sponsor: Jamba Juice Franchisor SPV, LLC
Featured Menu Items
blended-to-order customizable masterpieces with all of your favorites in the mix: flavorful fruit, balanced ingredients and plant-based (dairy-free) options.start orderFood
protein-packed food that's good for breakfast, lunch or snack time. Perfect to pair with your favorite smoothie or bowl! It's soooo good!start orderBowls
Power your day with our delicious bowls' real whole fruit and an array of your favorite toppings.start orderGrab n' go
Explore our healthy gluten & nut-free snacks and Organic Honest Tea™ or Smartwater™. They pair perfectly with your favorite smoothie or bowl anytime, anywhere.start order
About Jamba Kapahulu Ave
fantastic flavor is always in season and nothing beats feeling your best. for over 30 years, jamba has brought the right, delicious ingredients to create whirl'd famous flavor. try our customizable blended-to-order smoothies including plant-based options, delicious bowls with fresh fruit toppings, protein-packed food that's good for breakfast, lunch or snack time, fresh juices or on-the-go snacks. getting your jamba is now easier and faster. download our app and order ahead online or get delivery. earn rewards on every order when you join jamba rewards. Come in and visit us today at 625 Kapahulu Ave. , Honolulu (Oahu), HI.


text:
Simple Unix tools
Simple Unix commandline tools written in Haskell.
This is intended as a beginner's tutorial for learning Haskell from a "Let's just solve things already!" point of view. The examples should help give a flavor of the beauty and expressiveness of Haskell programming.
import Control.Monad.Instances
import Data.List
import Data.Char
import Data.Maybe
import Text.Printf
import System.Environment
import Text.Regex.Posix
-- First, three helpers
io f = interact (unlines . f . lines)
showln = (++ "\n") . show
regexBool r l = l =~ r :: Bool -- simple boolean regex matching
-- remove duplicate lines from a file (like uniq)
uniq = nub -- Warning: Unix uniq discards *consecutive* dupes,
-- but 'nub' discards all dupes.
-- repeat the input file infinitely
rpt = cycle
-- Return the head -10 line of a file
take' = take 10
-- Remove the first 10 lines of a file
drop' = drop 10
-- Return the head -1 line of a file
head' = head
-- Return the tail -1 line of a file
tail' = last
-- return the last ten lines of a file
tail10 = drop =<< subtract 10 . length
-- Reverse lines in a file (tac)
tac = reverse
-- Reverse characters on each line (rev)
rev = map reverse
-- Reverse words on each line
rev_w = map (unwords . reverse . words)
-- Count number of characters in a file (like wc -c)
wc_c = showln . length
-- Count number of lines in a file, like wc -l
wc_l = showln . length . lines
-- Count number of words in a file (like wc -w)
wc_w = showln . length . words
-- double space a file
space = intersperse ""
-- undo double space
unspace = filter (not.null)
-- remove the first occurrence of the line "str"
remove = delete
-- make a string all upper case
upper = map toUpper
-- remove leading space from each line
clean = map (dropWhile isSpace)
-- remove trailing whitespace
clean' = map (reverse . dropWhile isSpace . reverse)
-- delete leading and trailing whitespace
clean'' = map (f . f)
where f = reverse . dropWhile isSpace
-- insert blank space at beginning of each line
blank = map (s ++)
where s = replicate 8 ' '
-- join lines of a file
join = return . concat
-- Translate the letter 'e' to '*', like tr 'e' '*' (or y// in sed)
tr a b = interact (map f)
where f c = if c == a then b else c
-- Delete characters from a string.
tr_d a = tr a ' '
-- lines matching the regular expression "[bf]oo" from a file
grep = filter (regexBool "[bf]oo")
-- lines not matching the regular expression "[bf]oo" from a file
grep_v = filter (not . regexBool "[bf]oo")
-- number each line of a file
num = zipWith (printf "%3d %s") [(1::Int)..]
-- Compute a simple cksum of a file
cksum = foldl' k 5381
where k h c = h * 33 + ord c
-- And our main wrapper
main = do
who <- getProgName
maybe (return ()) id $ lookup who $
[("blank", io blank )
,("cksum", interact (showln . cksum) )
,("clean", io clean'' )
,("echo" , interact id )
,("drop", interact drop' )
,("grep", io grep )
,("grep -v", io grep_v )
,("head", io (return . head') )
,("join", io join )
,("num", io num )
,("remove", io (remove "str") )
,("revw", io rev_w )
,("reverse", io rev )
,("reverseword", io rev_w )
,("rpt", io rpt )
,("sort", interact sort )
,("space", io space )
,("tac", interact tac )
,("take", io take' )
,("tail", io (return . tail') )
-- ,( "tr" , interact tr)
-- ,( "tr -d", interact (tr_d . unwords))
,("unspace", io unspace )
,("upper", interact upper )
,("uniq", interact uniq )
,("wc_c", interact wc_c )
,("wc_l", interact wc_l )
,("wc_w", interact wc_w )
How to run
These functions can be executed as one liners from a shell. For example, to use the Haskell version of 'wc':
$ cat file.txt | ghc -e 'wc_l' UnixTools.hs
Or, one could define 'main' to be a chosen tool/function (add a line to the effect that "main = wc_l") and then compile the tool with
$ ghc --make UnixTools.hs
The given Haskell codes presents yet a third way of doing things: much
like the BusyBox suite of Unix
tools, it is possible to compile a single monolithic binary and have it
detect what name it is run by and then act appropriately. This is the
approach the following code takes: you can compile it and then make
symbolic links (like "ln -s UnixTools echo; ln -s UnixTools cat"
) and then run those commands ("./echo foo | ./cat"
would produce output of "foo").
Where to now?
- Haskell.org
- The Haskell standard list library, with docs
- Alternative implementations of the wc program
- Learn how to test Haskell code
- More Haskell code
- Haskell for shell scripting
- Export list functions to the shell with h4sh
- Checking for correct invocation of a command line haskell program
- Poor man's here document


text:
Last year's lightweight Spring Statement focused on a raft of consultations on tax policy.
One year on, we take stock of how some of those consultations progressed, and reflect more generally on the role of consultations in fiscal policy decisions.
Why consult?
Cynics claim consultations rarely make a difference to the policy that emerges from the process.
The motivation is usually to build consensus behind a policy change, to identify and head off objections, and to pin down the technical details with input from those most likely to be affected.
All of the following consultations were announced in last year's Spring Statement on 13 March 2018.
Tackling the plastic problem
With single-use plastic a hot-button topic in 2018, this consultation received 162,000 responses – the largest number of submissions to a call for evidence in the history of the Treasury.
The proposed response in Budget 2018: a tax on all plastics with less than 30% recycled content, along with investing into research around plastic and recycling.
Subject to further consultation, the new tax will come into effect from 6 April 2022.
VAT-registration threshold
The Government was concerned the cliff-edge nature of the VAT-registration threshold might encourage some smaller businesses to take steps to avoid growing.
The call for evidence asked for input from affected businesses, insight into what might make them reluctant to grow above the threshold, and for suggestions on how it might be redesigned.
There were more than 50 responses, most supporting the introduction of a 'smoothing mechanism', but the Government's response, published alongside Budget 2018, kicked this can down the road, deferring a decision until after the terms of the UK's withdrawal from the EU are finalised.
Entrepreneurs' relief
The Government sought views on changes to entrepreneurs' relief (ER) to ensure "it does not discourage entrepreneurs from seeking external finance for their companies". The issue was that the entitlement to ER could have been lost where shareholdings were diluted below 5% as a result of the issue of new shares for commercial reasons.
Twenty-one responses were received, and the Government published draft legislation in July 2018.
This change was passed into law as part of Finance Act 2019, and comes into effect from 6 April 2019. A taxpayer will be able to elect to treat themselves as making a deemed disposal and reacquisition immediately before the dilution to secure ER. The gain shall also be able to be deferred.
Cash and digital payments
This review is part of the Government's programme to encourage British businesses to use electronic payments, which make money laundering and other forms of fraud more difficult.
Those organisations which made their responses public tended to reject the idea of a cashless society, and to echo a sentiment well-expressed by accountancy institute the ICAEW that "any move to digital should be at the pace and choice of those businesses and individuals affected and not mandated".
The period for submitting evidence ran until June 2018, but a response is yet to be published.


text:
Crown Lengthening
When decay occurs below the gumline, it may be necessary to remove a small amount of bone and gum tissue. Your dentist may ask for this procedure before he or she makes a new crown for your tooth.
Crown Lengthening procedures are done for both restorative dentistry and/or to improve the esthetics of your gum line. General practitioners often refer for crown lengthening procedures prior to restoration of broken or severely decayed teeth. This procedure adjusts the gum and bone level to expose more of the tooth so it can be restored.
Sometimes crown lengthening is done to improve a "gummy" smile because the teeth appear short. The teeth may actually be the proper length but excess gum tissue may be covering these teeth. During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth


text:
Disclaimer: The data relating to real estate on this web site comes in part from the MLS Reciprocity programe of the Real Estate Board of Greater Vancouver. Real estate listing held by participating real estate firms are marked with the MLS® logo and detailed information about the listing includes the name of the listing agent. This representation is based in whole or part ondata generated by the Real Estate Board of Greater Vancouver which assumes no responsibility for its accuracy. The materials contained on this page may not be reproduces without the express written consent of the Real Estate Board of Greater Vancouver.
© 2018 Network of Condos Enterprises Ltd. Privacy Policy. Site designed by dazil Internet Services Inc.


text:
BK 27 - Cookham Bridge, Berkshire
BK 27 - Cookham Bridge, Berkshire
This photograph is a copy of the original. The size of the print is 12 x 8 Inches (roughly A4 size)
The original image, from our own private collection, is scanned at high resolution, and the result then digitally enhanced to remove blemishes and to improve contrast & brightness. It is then professionally printed in a photo lab on superior quality, 280gsm Archival photo card, to ensure your image lasts a lifetime. The result is better than the original and closer to how the image would have appeared originally. Please look at the picture on screen carefully as this is an accurate representation of exactly what you will receive.
The Watermarks "This Text Will Not Be On Your Photo" and "Image Protection" will not be on your print.
All orders will be sent securely in acid free protected sleeves, in board backed envelopes stamped with 'Please Do Not Bend'
Please see below for our FAQ.
Combined Postage?
Our postage cost is just £1.25 regardless of how many items you order. Just click "Add To Cart" on each item, and then when you are done shopping click the cart icon (Top right of the page) Here you will find all the items in your cart, with automatically applied combined postage. Then simply pay for everything altogether to complete your purchase. All our items are sent by 1st class post as standard.
What date is the image from?
Whenever a date is known it will always be included in the item title. If you don't see a date in the title of this listing, then unfortunately this means we don't have one for this particular image.


text:
The domain within your query sequence starts at position 671 and ends at position 721; the E-value for the TSP1 domain shown below is 1.21e-12.
TSP1Thrombospondin type 1 repeats |
SMART accession number: | SM00209 |
Description: | Type 1 repeats in thrombospondin-1 bind and activate TGF-beta. |
Interpro abstract (IPR000884): | Thrombospondins are multimeric multidomain glycoproteins that function at cell surfaces and in the extracellular matrix milieu. They act as regulators of cell interactions in vertebrates. They are divided into two subfamilies, A and B, according to their overall molecular organisation. The subgroup A proteins TSP-1 and -2 contain an N-terminal domain, a VWFC domain, three TSP1 repeats, three EGF-like domains, TSP3 repeats and a C-terminal domain. They are assembled as trimer. The subgroup B thrombospondins, designated TSP-3, -4, and COMP (cartilage oligomeric matrix protein, also designated TSP-5) are distinct in that they contain unique N-terminal regions, lack the VWFC domain and TSP1 repeats, contain four copies of EGF-like domains, and are assembled as pentamers [ (PUBMED:11687483) ]. EGF, TSP3 repeats and the C-terminal domain are thus the hallmark of a thrombospondin. This repeat was first described in 1986 by Lawler and Hynes [ (PUBMED:2430973) ]. It was found in the thrombospondin protein where it is repeated 3 times. Now a number of proteins involved in the complement pathway (properdin, C6, C7, C8A, C8B, C9) [ (PUBMED:2459396) ] as well as extracellular matrix protein like mindin, F-spondin [ (PUBMED:10409509) ], SCO-spondin and even the circumsporozoite surface protein 2 and TRAP proteins of Plasmodium [ (PUBMED:10508153) (PUBMED:1501644) ] contain one or more instance of this repeat. It has been involved in cell-cell interaction, inhibition of angiogenesis [ (PUBMED:10500044) ] and apoptosis [ (PUBMED:9135017) ]. The intron-exon organisation of the properdin gene confirms the hypothesis that the repeat might have evolved by a process involving exon shuffling [ (PUBMED:1417780) ]. A study of properdin structure provides some information about the structure of the thrombospondin type I repeat [ (PUBMED:1868073) ]. |
Family alignment: |
There are 144158 TSP1 domains in 35805 proteins in SMART's nrdb database.
Click on the following links for more information.
- Evolution (species in which this domain is found)
- Literature (relevant references for this domain)
- Disease (disease genes where sequence variants are found in this domain)
- Metabolism (metabolic pathways involving proteins which contain this domain)
- Structure (3D structures containing this domain)
- Links (links to other resources describing this domain)


text:
Note: This section contains technical terms. If you are a non-technical user, you will be able to see what makes UPCsites.com a reliable place to keep your website, but you may not be familiar with all of the technical terms.
UPCsites.com guarantees 99.9% uptime and backs it up with:
Multiple Redundant Application Servers
Live backup computers that take over when another computer fails.
Equipment can fail at any time. It's a fact of life. To avoid problems with server failure, multiple identical copies of the computer that hosts your website are set up to run together. When one fails, several others take over flawlessly. Your visitors never see problems with your website if a server fails.
Multiple Redundant Load Balancers
In the rare event that a load balancer fails, there are multiple load balancers on standby to prevent downtime.
24/7 System Checking
Special computer programs automatically check the status of the servers 60 times per hour on each service. If a failed server is detected, an automatic repair routine runs to bring the server back online. If the program cannot restore the failed server, a technician is automatically notified.
Note: While the repairs are made, other servers seamlessly take over the duties of the failed server. Users will not notice a difference in service.
Facilities Located On An Internet Hub
Your website is hosted right on an Internet hub in a building designed to accommodate the special needs of high-tech. This helps to ensure that your website will load quickly and be readily available when you or your customers need it.
Secondary/Backup Mail Server
If a mail server fails, a secondary mail server will automatically take over the duties of the primary mail server. The failed mail server will automatically reboot and restore its systems function. Users will never see problems with a failed mail server.
Secondary/Backup Database Server
The database server is the computer where most of the website information is stored. If the primary database fails, the backup database automatically takes over the duties of the failed database server.
On-site backup Every 4 Hours
Servers are backed up to other servers on-site every four hours to protect important information and allow recovery of information in the rare event it's necessary.
Off-site Backup
Backed up information is taken off-site to protect data and prevent loss of information in the event of a catastrophe.
RAID (multiple backup hard drives within each server)
Redundant Array of Independent Drives
In RAID systems, important information is stored on at least two hard drives simultaneously. In the event of a drive failure, a backup drive automatically takes over the duties of failed drive. Server operations continue seamlessly. Technicians promptly replace the failed drive, and the data is immediately restored. RAID helps to ensure data integrity.
Enterprise Class Hard Drives
The main server hard drives are enterprise class, and all hard drives are in RAID format. An enterprise class hard drive costs two to four times as much as a typical home or office drive (desktop class), but has much higher MTBF. MTBF, or Mean Time Between Failures, is a manufacturer rating that estimates the average time between hard drive failures. Higher time between failures means that potential problems can occur less often.
Secondary/Backup Firewall
In the event that the firewall fails, a backup firewall is ready to take over the duties of the failed firewall. The firewall is designed to carefully protect important information from security breaches.
Secondary/Backup File Servers
In the event that a file server fails, a backup file server is ready to take over the duties of the failed file server.
Dedicated Server Facilities
Chilled server room dedicated to housing servers only.
Redundant Cooling Systems
Uninterruptible Power Supply (UPS)
All servers are equipped with uninterruptible power supplies. A UPS is a device that sits between the wall outlet and the computer to prevent power irregularities (outages, surges, etc.) from causing problems with the equipment. It also acts as a backup power supply and a surge protector.
Secondary/Backup Power
All servers are protected with backup power units.
Emergency On-site Power Generators


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WASHINGTON (AP) — Any day now, billions of cicadas with bulging red eyes will crawl out of the earth after 17 years underground and overrun the East Coast. The insects will arrive in such numbers that people from North Carolina to Connecticut will be outnumbered roughly 600-to-1. Maybe more.
Videos by Rare
Scientists even have a horror-movie name for the infestation: Brood II. But as ominous as that sounds, the insects are harmless. They won't hurt you or other animals. At worst, they might damage a few saplings or young shrubs. Mostly they will blanket certain pockets of the region, though lots of people won't ever see them.
"It's not like these hordes of cicadas suck blood or zombify people," says May Berenbaum, a University of Illinois entomologist.
They're looking for just one thing: sex. And they've been waiting quite a long time.
Since 1996, this group of 1-inch bugs, in wingless nymph form, has been a few feet underground, sucking on tree roots and biding their time. They will emerge only when the ground temperature reaches precisely 64 degrees. After a few weeks up in the trees, they will die and their offspring will go underground, not to return until 2030.
"It's just an amazing accomplishment," Berenbaum says. "How can anyone not be impressed?"
And they will make a big racket, too. The noise all the male cicadas make when they sing for sex can drown out your own thoughts, and maybe even rival a rock concert. In 2004, Gene Kritsky, an entomologist at the College of Mount St. Joseph in Cincinnati, measured cicadas at 94 decibels, saying it was so loud "you don't hear planes flying overhead."
There are ordinary cicadas that come out every year around the world, but these are different. They're called magicicadas — as in magic — and are red-eyed. And these magicicadas are seen only in the eastern half of the United States, nowhere else in the world.
There are 15 U.S. broods that emerge every 13 or 17 years, so that nearly every year, some place is overrun. Last year it was a small area, mostly around the Blue Ridge Mountains of Virginia, West Virginia and Tennessee. Next year, two places get hit: Iowa into Illinois and Missouri; and Louisiana and Mississippi. And it's possible to live in these locations and actually never see them.
This year's invasion, Brood II, is one of the bigger ones. Several experts say that they really don't have a handle on how many cicadas are lurking underground but that 30 billion seems like a good estimate. At the Smithsonian Institution, researcher Gary Hevel thinks it may be more like 1 trillion.
Even if it's merely 30 billion, if they were lined up head to tail, they'd reach the moon and back.
"There will be some places where it's wall-to-wall cicadas," says University of Maryland entomologist Mike Raupp.
Strength in numbers is the key to cicada survival: There are so many of them that the birds can't possibly eat them all, and those that are left over are free to multiply, Raupp says.
But why only every 13 or 17 years? Some scientists think they come out in these odd cycles so that predators can't match the timing and be waiting for them in huge numbers. Another theory is that the unusual cycles ensure that different broods don't compete with each other much.
And there's the mystery of just how these bugs know it's been 17 years and time to come out, not 15 or 16 years.
"These guys have evolved several mathematically clever tricks," Raupp says. "These guys are geniuses with little tiny brains."
Past cicada invasions have seen as many as 1.5 million bugs per acre. Of course, most places along the East Coast won't be so swamped, and some places, especially in cities, may see zero, says Chris Simon of the University of Connecticut. For example, Staten Island gets this brood of cicadas, but the rest of New York City and Long Island don't, she says. The cicadas also live beneath the metro areas of Philadelphia, Baltimore and Washington.
Scientists and ordinary people with a bug fetish travel to see them. Thomas Jefferson once wrote about an invasion of this very brood at Monticello, his home in Virginia.
While they stay underground, the bugs aren't asleep. As some of the world's longest-lived insects, they go through different growth stages and molt four times before ever getting to the surface. They feed on a tree fluid called xylem. Then they go aboveground, where they molt, leaving behind a crusty brown shell, and grow a half-inch bigger.
The timing of when they first come out depends purely on ground temperature. That means early May for southern areas and late May or even June for northern areas.
The males come out first — think of it as getting to the singles bar early, Raupp says. They come out first as nymphs, which are essentially wingless and silent juveniles, climb on to tree branches and molt one last time, becoming adult winged cicadas. They perch on tree branches and sing, individually or in a chorus. Then when a female comes close, the males change their song, they do a dance and mate, he explained.
The males keep mating ("That's what puts the 'cad' in 'cicada,'" Raupp jokes) and eventually the female lays 600 or so eggs on the tip of a branch. The offspring then dive-bomb out of the trees, bounce off the ground and eventually burrow into the earth, he says.
"It's a treacherous, precarious life," Raupp says. "But somehow they make it work."
Seth Borenstein can be followed at http://twitter.com/borenbears
Copyright 2013 The Associated Press.


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These stainless steel appliances show EVERY fingerprint!
Is that how much it'll cost to refinish our hardwood floors!?
I thought I'd love these granite countertops… but I'm so over them!
Ever experience a homebuyer's hangover? You're not alone. What seemed like a great feature during that walk-through gradually loses its sparkle when you're living with it every day.
Our latest national survey asked 500 U.S. homeowners what they would – and wouldn't – choose again if they were buying a home today.
Here's what we found out.
By a slight margin, the majority of homeowners said they wouldn't change anything. More than half of U.S. homeowners (53%) said they're happy with the features they chose. The rest (47%), however, admitted to some regrets.
Infographic: See More Results From Our Homeowner Hindsight Survey
The survey asked homeowners about features they wanted and got when they bought their home, but wouldn't get again if they were buying a home today. It also asked about features homeowners did not get but now wish they had.
Overall, homeowners are much more likely to regret not having something than getting it. For example, when asked what they wouldn't get again, the biggest percentage (9%) of survey respondents said they'd pass on hardwood floors.
However, when asked about what features top their wish list for their next home – a much larger percentage (16%) say they wished they had gotten hardwood floors.
Below are the top five features homeowners wanted and got, but would not choose again:
Feature | Percentage of homeowners who would not choose it again |
1. Hardwood flooring | 9.2% |
2. Granite countertops | 7.8% |
3. Stainless steel appliances | 7.6% |
4. Fireplace | 7.4% |
5. Deck | 7.2% |
Features like fireplaces and decks add character, but they also require routine upkeep and cleaning. Learn more about why you need to schedule an annual chimney inspection or how to get your deck ready for summer.
The granite always gleams brighter when it's in someone else's house – at least according to our survey.
Granite countertops were second on the list of features homeowners wanted and got but wouldn't choose again, with nearly 8% of homeowners saying they regret it. Curiously, more than twice as many homeowners (18%) without granite countertops said this feature is a must-have for their next home.
Is granite right for you? It's a big investment that can last for decades – for better or for worse. Learn more in our blog post about the pros and cons of granite countertops.
So, let's dig deeper into those regrets. Why did homeowners say they wouldn't get a certain feature again? Here are a few explanations we heard through the survey:
- Feature isn't worth the money
- It's outdated
- Just tired of it
- Too hard to keep clean (white kitchen cabinets, whirlpool tubs, and stainless steel appliances were big culprits here)
Some homeowners even regret getting plush features people might assume everyone would want, such as two sinks in the master bathroom. Four percent of homeowners said they regret that layout, saying they just don't need or use separate sinks. A few respondents added that they'd prefer to have more countertop or cupboard space.
In terms of features homeowners regret not getting, a walk-in pantry topped the list, with just under a third (30%) saying they wish they had one.
A fair number of people regret not getting green features in their homes, such as tankless water heaters (16% wish they had one) and solar panels (15%).
Related: 6 Reasons Why Water Heaters Fail
A few also wish they'd gotten a dedicated space to bathe Fido – 5% wish they had a dog washing station, though this feature is three times as coveted in the South as in the Northeast. A total of 7% of Southern homeowners regret not having a dog washing station, while only 2% of Northeasterners do.
Here are the top five features homeowners didn't get but wish they had:
Feature | Percentage of homeowners who now wish they had it |
1. Walk-in pantry | 30.2% |
2. Granite countertops | 17.8% |
3. Kitchen island | 16.8% |
4. Tankless water heater | 16.4% |
5. Finished basement | 16.2% |
Want more home design inspo? Check out these other blog stories on 7 smart and stylish ideas for your mudroom or 8 easy and affordable ways to upgrade your kitchen.
Regardless of how they feel about specific home features, an overwhelming number of people reported that they feel positively about their homes as a whole. In fact, 94.6% of homeowners said they like or love their home just as it is.
"It's heartwarming to see that the vast majority of people have very positive feelings about their homes," said Bob Buckel, vice president and product manager at Erie Insurance. "It feels good to know that we're protecting something that really matters to them."
The survey also asked questions to gauge people's knowledge about their homeowners insurance. Do they understand how their coverage works and what they need?
"One of the most important coverages a homeowner can have is what's called 'guaranteed replacement cost,' which would pay to replace a home regardless of what it would cost in today's dollars," Buckel said. "Unfortunately, more than four in 10 homeowners say they don't know whether their policy has this coverage or not. That tells us that we, and the industry at large, need to do a better job of educating consumers about the important coverages that are available to them."
At ERIE, every homeowners insurance policy comes with a local agent who's there to help you understand and feel confident about your policy. And, yes – we offer 100% guaranteed replacement cost* for worry-free coverage that protects you without surprises.
Contact your local agent to request a quote and get the conversation started.
Methodology: This survey of 500 U.S. homeowners ages 28 – 60 was conducted by Falls Communications on behalf of Erie Insurance from March 22 through March 26, 2019. While different sample sizes have different statistical margins of error, the estimated margin of error for any question with a sample size of 500 is +/-4.5%. Additional survey results, including breakdowns by age, gender, and geographic region, are available upon request.
*Guaranteed Replacement Cost applies to dwelling and requires home improvements over $5,000 to be reported within 90 days – not available with all policies and in all states. Coverage of costs to comply with laws or ordinances is subject to limits. Depreciation will be deducted until repair or replacement is made. Talk to an ERIE agent for more information.
A better insurance experience starts with ERIE.
Haven't heard of us? Erie Insurance started with humble beginnings in 1925 with a mission to emphasize customer service above all else. Though we've grown to reach the Fortune 500 list, we still haven't lost the human touch.
Contact Trent Insurance Agency today to experience the ERIE difference for yourself.


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Part#: 10040425
- Warranty Terms: 90-Day Warranty
- Quality Assurance Test: Passed
- Condition: Refurbished or Used & Tested
Part Search
Common Questions
What are your purchasing options for MRI & CT parts?
Buy Outright, Buy on Exchange, or do a Repair + Loaner. Contact us for a quote! We sell used MRI and CT Parts. We also offer repairs and full system sales.
Do you have a Loaner MRI Coil Program?
Yes. We offer temporary MRI Coil Loaners while your part or coil is being repaired. We can loan you system-tested and quality inspected parts to keep your imaging system running.
Is Tech Support and Warranty Offered?
Support: Our engineers work around the clock to help you troubleshoot and diagnose your MRI or CT system. Call us 24 hours 7 days a week! Please visit: MRI & CT Technical Support for more information.
Warranty: All of our repairs and exchanges come with a minimum 90-day warranty. Extended warranties are also available.
Do you offer Imaging Parts Repair Services?
MRI Coil repair is the most common service we perform.
The Services Overview Page outlines other services and parts we repair.
Common parts repaired include:
Gradient Amplifiers, ACGD, SGA, HFA, SGD, Quantum, Papillion, XL, XXL, Popeye, Gradient Power Supplies, Analogic, GE, Techron, Siemens, RF Amplifiers (Solid-state and tube types), Analogic, Erbtec, Colorado Med Tech, HEI, MKS, Siemens, Tele, Support Electronics, SSM, Driver Modules, Pin Drivers, MSHS, Transmitters, Receivers, Hybrid Splitters, Pre-Amplifiers, TALES, Body Tune Boxes, CODIBOX, CODIMUX, Coil Interface, & CT Parts and Assemblies, Controls & Inverters.
Full-list of repairable parts, visit: MRI & CT Parts Repairs
Where do you ship parts to?
Globally. We sell and ship MRI, CT and other imaging parts worldwide. The same goes for systems.
- San Diego, California – DirectMed Imaging Headquarters
- Appleton, Wisconsin - DirectMed Imaging Wisconsin (Formerly Technical Prospects)
- Omaha, Nebraska - ScanMed (MRI Coil Repairs)
- Aalborg, Denmark – LBN Medical (Parts and Systems for international markets)
US and EU based locations means parts are closer to you, so your systems are back online faster.
Get a Part Quote
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Featured Alternative Energy Products
Product Training
Featured Alternative Energy Resources
Alternative Energy Solutions & Technologies on element14 community
Every day the renewable industry improves our ability to maximize energy generation from solar, wind and other sources. This site will stimulate discussions on key topics and demonstrate how you can harvest the power of the sun and wind.
Texas Instruments: Solar Development with C2000™ 32-bit real-time MCUs
Jumpstart solar application designs with two new platforms from TI, based on C2000 microprocessors.
NXP's Smart Energy Solutions
Learn how NXP is enabling smart energy all over the world.
TI and National Semiconductor TOGETHER, An Intelligent Solar Micro-Inverter Solution
Check out a solar micro-inverter solution that maximizes power output, provides real time control and performance data and delivers a safer, more reliable next generation system.
Alternative Energy Applications
There are many viable reasons for considering an alternative energy solution to power new designs, especially for those with ultra-low power requirements. Lower total cost of ownership, environmental benefits, and ease of implementation are just some of the many benefits that alternative energy sources can bring.
A solar-powered home is probably the most economical and practical use for an alternative energy at this point in time. The long term savings of not having to constantly depend on the energy grid easily outweighs the initial setup costs.
Small scale wind power generation schemes have been used for household electricity generation in conjunction with battery storage over many decades, especially in remote areas. Nowadays, equipments such as wireless Internet gateways are being powered by wind turbines, replacing the need for a connection to the power grid.
It is easy to think of all alternative energy as giant wind farms or hydro plants, but many alternative energy sources can be as simple as a single solar cell powering a remote sensor and wireless transmitter. As well as solar power, piezoelectric and thermoelectric generators can harvest vibration and thermal energy to generate enough electricity to power a simple circuit. Such energy harvesting schemes have now been widely employed in environmental and geological data sensing applications.


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Odds are that you've heard of Achilles tendonitis. Maybe a friend or relative contracted it, or one of your favorite athletes was taken out of the game by this painful condition. If you yourself have started to feel the telltale ache of Achilles tendonitis, you may be concerned about treatment, or fear a dramatic rupture of the tendon.
There's no need to worry. The sooner you see a qualified podiatrist for diagnosis and treatment, the sooner you can start the healing process, and take precautions to prevent the worsening of your condition.
The Achilles tendon is the strongest and largest tendon in the body, connecting the leg to the foot as it stretches from the lower leg to the heel bone.This tendon is crucial to normal walking, as it allows the foot to rise up on the toes. If you are experiencing painful swelling in the back of your foot just above the heel, you may be suffering from Achilles tendonitis.
Achilles tendinitis is, at its most basic level, a strain of the Achilles tendon. The tendon naturally weakens with age, and strains are increasingly likely as you grow older, particularly if you suddenly increase the intensity of your workouts. Achilles tendonitis can also be caused by bone spurs and tight calf muscles.
How Do I Know I Have Achilles Tendonitis?
The sprain causes pain along the line of the Achilles tendon, particularly in the morning. The pain will also usually intensify after you run or participate in sports.
As Achilles tendonitis is best treated early in its development, speak with your trusted podiatrist if you are experiencing pain or swelling along the Achilles tendon. A consultation at our practice will give you the best chance possible for a full recovery.


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Levels of Evidence for Cancer Genetics Studies (PDQ®)–Health Professional Version
[Note: Many of the medical and scientific terms used in this summary are found in the NCI Dictionary of Genetics Terms. When a linked term is clicked, the definition will appear in a separate window.]
[Note: A concerted effort is being made within the genetics community to shift terminology used to describe genetic variation. The shift is to use the term "variant" rather than the term "mutation" to describe a difference that exists between the person or group being studied and the reference sequence. Variants can then be further classified as benign (harmless), likely benign, of uncertain significance, likely pathogenic, or pathogenic (disease causing). Throughout this summary, we will use the term pathogenic variant to describe a disease-causing mutation. Refer to the Cancer Genetics Overview summary for more information about variant classification.]
Creating evidence-based summaries on cancer genetics is challenging because the rapid evolution of new information often results in evidence that is incomplete or of limited quality. In addition, established methods for evaluating the quality of the evidence are available for some, but not all, aspects of cancer genetics. Varying levels of evidence are available for different topics, and PDQ summaries are subject to modification as new evidence becomes available. As in other areas of medicine, testing and treatment decisions must be based on information that sometimes falls short of the optimal level of evidence. Recognizing the limits inherent in certain observations will alter the weight given to recommendations based on that evidence and serves to keep minds open to new improved information as it comes along.
The quality of evidence depends on the appropriateness of the study in terms of the question being evaluated and on how well the study was designed, implemented, analyzed, and interpreted. For evaluating outcomes of both medical and social interventions, the strongest evidence is obtained from well-designed and well-conducted randomized clinical trials. For evaluating other questions, particularly those related to the prevalence of gene variants and inherited syndromes and determining the clinical validity of genetic tests, the strongest evidence is obtained from well-designed descriptive studies. Particular elements of study design, such as the nature of the population studied or the duration of observation, may be crucial to assessing the quality of a study.
During the early phases of research in a new area, information relevant to the needs of patients and clinicians may come from work at all levels of evidence, including well-designed quasi-experimental studies (nonrandomized, controlled single-group, pre/post, cohort, time, or matched case-control studies) or nonexperimental studies (case reports, clinical examples, qualitative or narrative studies, or theoretical work). Such research may yield information important to patients and clinicians, who must make treatment or risk management decisions before full data on the risks and benefits of cancer genetic testing are available. In addition, such work helps to inform future research using more rigorous designs.
Study Populations
The level of evidence required for informed decision making about genetic testing depends on the circumstances of testing. Evidence from a sample of high-risk families may be sufficient to provide useful information for testing decisions among people with similar family histories but is likely to be insufficient to make early recommendations for, or decisions about, testing in families with less dramatic histories or in the general population. Even among people with similar family histories, however, other contributing genes or different exposures could modify the effect of a genetic variant in different families. In evaluating evidence, the most important consideration is the relevance of the available data to the patient for whom a genetic assessment is being considered. In summaries addressing the cancer risk associated with genetic polymorphisms and variants, the study populations used for each risk assessment will be noted, according to the following categories.
- Population-based.
- Proxy for population-based. (The study population selected is assumed to be generally representative of the population from which it is drawn. For example, people participating in a community-based Tay-Sachs screening program, as a proxy for people of Jewish descent.)
- Public recruitment of volunteers (e.g., using a newspaper advertisement).
- Sequential case series.
- Convenience sample.
- An affected family or several families.
Use of Levels of Evidence
The PDQ Editorial Boards use a ranking system of levels of evidence to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. For any given therapy, results of prevention and treatment studies can be ranked on each of the following two scales:
- Strength of the study design.
- Strength of the endpoints.
Together, the two rankings provide a measure of the overall level of evidence. Screening studies are ranked on strength of study design alone. Depending on perspective, different expert panels, professional organizations, or individual physicians may use different cutoff points related to overall strength of evidence in formulating therapeutic guidelines or in taking action; however, a formal description of the level of evidence provides a uniform framework for the data, leading to specific recommendations.
There are varying levels of evidence related to screening, prevention, and treatment that support a given summary. The summaries are subject to modification as new evidence becomes available. The strongest evidence would be that obtained from a well-designed and well-conducted randomized controlled trial. It is not always practical, however to conduct such a trial to address every question in the fields of cancer screening, prevention, and treatment.
Evidence Related to Screening
The PDQ Cancer Genetics Editorial Board has adopted the following definitions related to screening:
- Screening is a means of accomplishing early detection of disease in people without symptoms of the disease being sought.
- Examinations, tests, or procedures used in cancer screening are often not definitive but sort out persons suspected of harboring a clinically occult cancer from those in whom a cancer is not likely to be present.
- Diagnosis of disease is made after a workup, biopsy, or other tests are completed in pursuing symptoms or following positive detection procedures.
The five requirements that should be met before it is considered appropriate to screen for a particular medical condition as part of routine medical practice are as follows:[1,2]
- The medical condition being sought must cause a substantial burden of suffering, measured both as mortality and as the frequency and severity of morbidity and loss of function.
- A screening test or procedure exists that will detect cancers earlier in their natural history than when diagnosis is prompted by symptoms, and this test must be acceptable to patients and society in terms of convenience, comfort, risk, and cost.
- Strong evidence exists that early detection and treatment improve disease outcomes, particularly disease-specific survival.
- The harms of screening must be known and acceptable.
- Screening must be judged to do more good than harm, considering all benefits and harms it induces in addition to the cost and cost-effectiveness of the screening program.
In descending order of strength of evidence, the five levels for screening studies are as follows:
- Evidence obtained from at least one well-designed and well-conducted randomized controlled trial.
- Evidence obtained from well-designed and well-conducted nonrandomized controlled trials.
- Evidence obtained from well-designed and well-conducted cohort or case-control analytic studies, preferably from more than one center or research group.
- Evidence obtained from multiple time series, with or without intervention.
- Opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees.
Evidence Related to Cancer Prevention
Prevention is defined as a reduction in the incidence (or the rate) of new cancer, with the goal of reducing cancer-related morbidity and mortality. Examples of prevention strategies include smoking cessation, avoidance of excessive exposure to sunlight (ultraviolet) or ionizing radiation, surgical removal of an at-risk target organ before cancer develops, and use of medications (e.g., tamoxifen for breast cancer risk reduction).
For each prevention-related summary of evidence statement, the associated levels of evidence are listed. In descending order of strength of evidence, the five levels are as follows:
- Evidence obtained from at least one well-designed and well-conducted randomized controlled trial that has:
- A cancer endpoint.
- Mortality.
- Incidence.
- A generally accepted intermediate endpoint (e.g., large adenomatous polyps for studies of colorectal cancer prevention).
- A cancer endpoint.
- Evidence obtained from well-designed and well-conducted nonrandomized controlled trials that have:
- A cancer endpoint.
- Mortality.
- Incidence.
- A generally accepted intermediate endpoint (e.g., large adenomatous polyps for studies of colorectal cancer prevention).
- A cancer endpoint.
- Evidence obtained from well-designed and well-conducted cohort or case-control studies, preferably from more than one center or research group, that have:
- A cancer endpoint.
- Mortality.
- Incidence.
- A generally accepted intermediate endpoint (e.g., large adenomatous polyps for studies of colorectal cancer prevention).
- A cancer endpoint.
- Ecologic (descriptive) studies (e.g., international patterns studies and migration studies) that have:
- A cancer endpoint.
- Mortality.
- Incidence.
- A generally accepted intermediate endpoint (e.g., large adenomatous polyps for studies of colorectal cancer prevention).
- A cancer endpoint.
- Opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees (e.g., any of the above study designs using invalidated surrogate endpoints).
In assessing a genetic test (or other method of genetic assessment, including family history), the analytic validity, clinical validity, and clinical utility of the test need to be considered.[3]
Evidence Related to Treatment
For each treatment-related summary of evidence statement, the associated levels of evidence are listed. In descending order of strength of evidence, 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.
- Total mortality (or overall survival from a defined time).
- Cause-specific mortality (or cause-specific mortality from a defined time).
- Carefully assessed quality of life.
- Indirect surrogates.
- Disease-free survival.
- Progression-free survival.
- Tumor response rate.
- Evidence from ecological, natural history, or descriptive studies.
- Opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees.
- Woolf SH: Screening for prostate cancer with prostate-specific antigen. An examination of the evidence. N Engl J Med 333 (21): 1401-5, 1995. [PUBMED Abstract]
- Winawer S, Fletcher R, Rex D, et al.: Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. Gastroenterology 124 (2): 544-60, 2003. [PUBMED Abstract]
- Holtzman NA, Watson MS, eds.: Promoting Safe and Effective Genetic Testing in the United States: Final Report of the Task Force on Genetic Testing. Johns Hopkins Press, 1998. Also available online. Last accessed November 5, 2020.
Analytic Validity
Analytic validity refers to how well a genetic assessment measures the property or characteristic it is intended to measure. In the case of family history, analytic validity refers to the accuracy of the reported family history information. In the case of a test for a specific pathogenic variant, analytic validity refers to the accuracy of a genetic test in identifying the presence or absence of the variant. The technical accuracy and reliability of the testing procedure and the quality of the laboratory processes (including specimen handling) affect the analytic validity of a genetic assessment.
Assessing analytic validity is complex for some genetic tests. For example, in a panel test, which is designed to evaluate a particular set of variants (e.g., the Ashkenazi founder pathogenic variants in the BRCA1 and BRCA2 genes), the analytic validity of the different components of the test may vary. Some genetic tests involve evaluating the DNA sequence of portions of a gene to determine whether any pathogenic variants are present (including variants not previously identified). The sensitivity and specificity of these sequencing tests may vary with the laboratory techniques employed, the proportion of the gene tested, and the structural nature of the pathogenic variants present in the gene.
Clinical Validity
Clinical validity refers to the predictive value of a test for a given clinical outcome (e.g., the likelihood that cancer will develop in someone with a positive test). It is primarily determined by the sensitivity and specificity with which a test identifies people with a defined clinical condition within a given population. Sensitivity of a test refers to the proportion of people who test positive for a clinical condition among those who actually have the clinical condition; specificity refers to the proportion of people who test negative for a clinical condition among those who do not have the clinical condition. In the case of genetic susceptibility to cancer, clinical validity can be considered at two levels:
- Does a positive test identify a person as having an increased risk of cancer?
- If so, how high is the cancer risk associated with a positive test?
Thus, the clinical validity of a genetic test is the likelihood that cancer will develop in someone with a positive test result. This likelihood is affected not only by the presence of the genetic variant itself but also by any other modifying factors that might affect the penetrance of the variant (e.g., the carrier's environmental exposures or personal behaviors) or by the presence or absence of variants in other genes. For this reason, the clinical validity of a genetic test for a specific genetic variant may vary in different populations. If the cancer risk associated with a given variant is unknown or variable, a test for the variant will have uncertain clinical validity. A summary of definitions of concepts relevant to understanding clinical validity and other aspects of cancer genetics testing has been published.[1] The test should be evaluated in the population in which the test will be used.
Clues to whether a particular familial cancer syndrome has a genetic basis can be derived informally, by inspecting the pattern of affected and unaffected people in a series of families; or formally, using an analytic technique known as segregation analysis. Segregation analysis provides quantitative data in support of, or against, the likelihood that a particular genetic mode of inheritance might explain the patterns observed in the study families.
Evidence that a particular gene might explain a specific cancer predisposition syndrome often derives initially from linkage studies that use collections of families meeting stringent clinical criteria for a specific cancer susceptibility syndrome. The demonstration of strong linkage of cancer susceptibility to a gene or genetic region in a pattern consistent with autosomal dominant inheritance provides evidence in support of both the mode of inheritance and the particular gene that might underlie the risk. Once linkage is established, a strong case for association between the genetic trait and disease can be made, even though the families used in the study may not be representative of the general population. The genetic trait measured in linkage studies is not always the causal factor itself but may be a genetic trait closely linked to it. Additional molecular studies are required to identify the specific gene associated with inherited risk, after linkage studies have determined its general chromosomal location.
Linkage studies, however, provide only limited evidence concerning either the range of cancer types associated with a pathogenic variant or the magnitude of risk and lifetime probability of cancer conferred by a pathogenic variant in less selected populations. In addressing these questions, the best information for clinical decisions comes from naturally occurring populations in which people with all degrees of risk are represented, similar to those in which clinical or public health decisions must be made. Thus, observations about cancer risk in families having multiple members with early breast cancer are applicable only to other families meeting those same clinical criteria. Ideally, the families tested should also have similar exposures to factors that can modify the expression of the gene(s) being studied. The risk associated with a pathogenic variant in other populations, such as families with less dramatic cancer aggregation, or in the general population can best be assessed by direct study of those populations.
- Grann VR, Jacobson JS: Population screening for cancer-related germline gene mutations. Lancet Oncol 3 (6): 341-8, 2002. [PUBMED Abstract]
Clinical Utility
The clinical utility of the test refers to the likelihood that the test will, by prompting an intervention, result in an improved health outcome. The clinical utility of a genetic test is based on the health benefits related to the interventions offered to people with positive test results. Theoretically, there are at least five strategies that might improve the health outcome of people with a genetic susceptibility to cancer:
- Correction of the underlying genetic defect (not currently available).
- Interventions to reduce the risk of developing cancer.
- Screening to detect early cancer or precancerous lesions.
- Specific treatment for syndrome-related cancers that differs from the treatment generally applied to the sporadic versions of the same cancer (not currently available).
- Interventions to improve quality of life.
Efficacy (capacity to produce an improved health outcome) and effectiveness (likelihood that the improved outcome will occur, taking into account actual use of the intervention and recommended follow-up) should be considered when evaluating interventions. Sometimes genetic information may lead clinicians to consider changes in their approach to clinical management, based on expert opinion, in the absence of proof of clinical utility.
Changes to This Summary (11/05/2020)
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.
Editorial changes were made to this summary.
This summary is written and maintained by the PDQ Cancer Genetics 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 the formal ranking system used by the PDQ Editorial Boards to assess evidence supporting the use of specific interventions or approaches. It is intended as a resource to inform and assist clinicians in the care of their 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 Cancer Genetics 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).
Board members review recently published articles each month to determine whether an article should:
- be discussed at a meeting,
- be cited with text, or
- replace or update an existing article that is already cited.
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's Email Us. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
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 Cancer Genetics Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."
The preferred citation for this PDQ summary is:
PDQ® Cancer Genetics Editorial Board. PDQ Levels of Evidence for Cancer Genetics Studies. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/publications/pdq/levels-evidence/genetics. Accessed <MM/DD/YYYY>. [PMID: 26389250]
Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.
The information in these summaries should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
Contact Us
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website's Email Us.
Source URL: https://www.cancer.gov/node/6690/syndication
Source Agency: National Cancer Institute (NCI)
Captured Date: 2013-09-14 09:03:37.0


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