text:
Huge 4-bed Home on Half Rai Plot
This house has been built as a real home to live in by a European gent to very high European standards with the foundations offering 24 footings alone.
Built on a large land plot of half of one Rai, this home offers extensive garden areas with an option to add a very large private pool should one wish. There is a large covered parking area, and further uncovered area on flag stones. The gardens and plot are surrounded by high concrete walls.
Inside and out there is an extensive use of teakwood that cost the owner over 6 Million Baht when building this home just over a year ago. The quality of build and finishing is apparent on entry to an enormous open plan living area which has a large open plan fitted and equipped kitchen, all teakwood units. Also on this floor is one guest's room with en-suite bathroom, and guest's toilet.
On the first floor there is another very large hallway and open living area which the current owner uses as his study and office area. Just off of here is a lovely large teakwood balcony with views over the adjoining rubber tree plantation. All three bedrooms on this level come with en-suite bathrooms.
The maids quarters can be found at the rear of the house and are accessed a separate entrance, so the owners are never disturbed when the maid comes and goes.
This home is truly in a different class in terms of its finishing's and build quality and is perfect for anyone wishing to live in Phuket as opposed to anyone looking for an investment.
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Property Details
- Bedrooms3 - 4
- Bathrooms4
- ViewMountain View
- TypeVilla
- Parking5 cars
- Land Area800 sqm.
- Building Area440 sqm.
- Ownership StructureThai Freehold
- Construction DateApril 2008
- Total Units1
- Land TitleChanote
- FeaturesFully-furnished


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You Are Here: U.S. Preventive Services Task Force > Topic Index > Screening: Lung Cancer > Update
Lung Cancer Screening with Sputum Cytologic Examination, Chest Radiography, and Computed Tomography
Update for the U.S. Preventive Services Task Force
Linda L. Humphrey, M.D., M.P.H.;a,b Steven Teutsch, M.D., M.P.H.;c Mark S. Johnson, M.D., M.P.H.d
The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or Merck and Co., Inc.
Address correspondence to: Linda Humphrey, M.D., M.P.H.; Oregon Health & Science University; Mail code: BICC; 3181 SW Sam Jackson Park Road; Portland, OR 97239-3098.
Select for copyright information. The USPSTF recommendations based on this review are online.
The summaries of the evidence briefly present evidence of effectiveness for preventive health services used in primary care clinical settings, including screening tests, counseling, and chemoprevention. They summarize the more detailed Systematic Evidence Reviews, which are used by the U.S. Preventive Services Task Force (USPSTF) to make recommendations.
Data Synthesis
Role of the Funding Source
Background: Lung cancer is the leading cause of cancer-related death in the United States and worldwide. No major professional organizations, including the U.S. Preventive Services Task Force (USPSTF), currently recommend screening for lung cancer.
Purpose: To examine the evidence evaluating screening for lung cancer with chest x-ray, sputum cytology, and low-dose computerized tomography (CT) to aid the USPSTF in updating its recommendation on lung cancer screening.
Data Sources: MEDLINE®, the Cochrane Library, reviews, editorials, and experts.
Study Selection: Studies that evaluated mass-screening programs for lung cancer involving the tests of interest. All studies were reviewed, but only studies with control groups were rated in quality since these would most directly influence the USPSTF screening recommendation.
Data Extraction: Data were abstracted to data collection forms. Studies were graded according to criteria developed by the USPSTF.
Data Synthesis: None of the 6 randomized trials of screening for lung cancer with chest x-ray alone or with sputum cytology have been shown to benefit those screened. All studies were limited by some level of screening occurring in the control population. Five case-control studies from Japan have suggested benefit to both high- and low-risk men and women. All studies are limited by potential healthy screenee bias. Six cohort studies evaluated screening CT and showed that when CT is used to screen for lung cancer, lung cancer was diagnosed at an earlier stage than in usual clinical care. However, these studies did not have control groups, making mortality evaluation difficult. In addition, the studies demonstrated a high rate of false-positive findings.
Conclusions: Current data do not support screening for lung cancer with any method. These data, however, are also insufficient to conclude that screening does not work, particularly in women. Two randomized trials of screening with chest x-ray or low-dose CT are currently underway and will better inform lung cancer screening decisions.
Screening for lung cancer is not currently recommended by any major medical professional organization. The U.S. Preventive Services Task Force (USPSTF) gave lung cancer screening a "D" recommendation in both 1985 and 1996, meaning that there were fair-quality data to recommend against screening for lung cancer1 based largely on 3 negative trials conducted in the United States in the 1970s. Since the last Task Force review, several new studies of lung cancer screening have been reported, and greater attention has been directed toward the limitations of existing literature. This review was conducted to aid the current USPSTF in updating its lung cancer screening recommendation.
Lung cancer is the leading cause of cancer-related death among men and women in the United States; in 2003, approximately 171,900 new cases and 157,200 lung cancer-associated deaths were predicted in the United States.2 Worldwide, lung cancer and lung cancer-related deaths have been increasing in epidemic proportions,3,4 with an estimated 1 million deaths in the year 2000.5
Although there are other important risk factors for lung cancer,3,6-10 cigarette smoking is the major risk factor; approximately 87% of all lung, bronchial, and tracheal cancer are attributed to smoking.3 Consequently, the most important public health intervention that could reduce lung cancer incidence and deaths is changing smoking habits. Unfortunately, although overall prevalence rates of smoking in the United States have decreased over the past 2 decades, the prevalence of current adult smokers remains high at 24%.10,11 In the clinical setting, smoking cessation programs, even in conjunction with drug therapy, have long-term smoking cessation rates of only approximately 20% to 35% at 1 year among motivated volunteers in good-quality studies.12-14 In addition, in 1999, approximately 45.7 million adults (23.1%) were former smokers; currently a high percentage of lung cancer cases occur in former smokers, since the risk for lung cancer does not decrease for many years following smoking cessation.15-17 Household exposure to secondhand smoke is substantial and also associated with lung cancer.18 These smoking exposure rates, in addition to large numbers of persons with past or passive exposure to smoking, indicate that lung cancer will continue to be a major public health problem in the United States and worldwide.
Lung cancer is the cause of death in more than 90% of affected persons.19 Survival is directly related to the stage of lung cancer at the time of diagnosis, ranging from 70% for stage I disease to less than 5% for stage IV disease.20,21 Seventy-five percent of patients with lung cancer present with symptoms due to advanced local or metastatic disease that is incurable.19 Since lung cancer mortality is closely associated with disease stage at the time of diagnosis, it is believed (based primarily on indirect evidence)22-28 that early surgical resection is associated with better outcomes. Therefore, the current standard of practice is to resect most non-small-cell lung cancer without evidence of metastic spread. For many of these reasons, screening for and treating early lung cancer is intuitively appealing.
This review discusses studies of chest x-ray, sputum cytology, and low-dose computerized tomography (CT) for lung cancer screening and focuses on the outcomes of screening in populations. We reviewed the MEDLINE® and Cochrane databases from their inception through January 2003 using the search terms lung neoplasms, lung cancer, and any screening. The search strategy is detailed in Appendix Table 1. To ensure complete ascertainment, we reviewed the bibliographies of reviews, editorials, book chapters, and letters discussing lung cancer screening, as well as a recent Cochrane review and analysis.29 We sought studies evaluating screening in the general population, as well as in high-risk populations, and included observational studies and clinical trials. Observational studies with control groups and controlled trials evaluating disease-specific mortality were evaluated for quality according to criteria created by the USPSTF30 (Appendix Table 2). For the purposes of this review, high-risk populations include those who currently or have ever smoked and low-risk populations include those who have never smoked. To rate each of these studies, we reviewed all original articles discussing the study's methods or findings. We also used studies of the various screening methods to estimate the screening test characteristics of chest x-ray and low-dose CT. Finally, we used data from screening studies, when available, as well as clinical series, to evaluate the harms associated with screening and treatment. For completeness, all studies are described in the tables; however, only studies rated of fair or better quality are described in the text.
Methodological issues relevant to understanding screening studies include lead-time bias (when the time of diagnosis is advanced by screening but the time of death is unchanged), length bias (bias toward detecting less aggressive tumors in a population being periodically screened),31 and volunteer bias (a type of selection bias in which volunteers are compared with non-volunteers).32 Over-diagnosis occurs when cancer that would never have been important during an individual's lifetime is diagnosed and treated. These biases can be eliminated in randomized controlled trials (RCTs) with mortality as an outcome. Therefore, most emphasis in public health guideline and in this review is placed on information from RCTs.
Data Synthesis
In our searches, we identified 809 citations and abstracts; 149 full-text papers were reviewed. Of these, 1 randomized trial of chest x-ray, in conjunction with a multiphasic screening program,33,34 and 5 RCTs35-40 of chest x-ray and/or sputum cytology screening for lung cancer were reviewed. In addition, 6 case-control studies,41-46 1 non-RCT47 and 4 older cohort studies (Appendix Table 3)48-52 were reviewed. Finally, we reviewed 6 recent cohort studies of lung cancer screening with CT.53-62
Lung Cancer Screening with Chest X-Ray with or without Sputum Cytology
Controlled Trials
Table 1 and Table 2 summarize the methods and quality of the 6 RCTs and 1 non-RCT of lung cancer screening.33-40,47,63-85 Figure 1 shows the relative risks and confidence intervals (CIs) of these randomized trials. In the 1960s, a cluster randomized trial of chest x-ray screening involving approximately 55,000 men older than age 40 was conducted by the Northwest London Mass Radiography Service.35,36 In this trial, 29,723 male factory workers from 75 randomly identified firms were offered chest x-ray every 6 months and were compared with 25,300 controls from other factories who were offered screening at baseline and at 3 years. After 3 years, the annual mortality rate from lung cancer in the intervention group was 0.7/1,000; the rate was 0.8/1,000 in the control population, not different statistically.
Three National Cancer Institute (NCI)-sponsored RCTs of lung cancer screening in male smokers were conducted in the United States in the 1970s.37-39,63,64,68,73-75,80 The Memorial Sloan-Kettering (MSK)37,63-67 and the Johns Hopkins (JH) studies38,68-72 were identical in design and were conducted to evaluate the incremental benefit of adding sputum cytology to annual chest x-ray. Of the 20,427 male smokers (> 20 pack-years of smoking) aged 45 and older who volunteered for these 2 studies, 10,234 were randomized into a dual-screening group that was offered screening with annual chest x-ray and sputum cytology every 4 months for 5 years; 10,233 were assigned to a chest x-ray group that was offered annual chest x-ray screening for 5 years. Each group was followed for 5 to 8 years.
In the MSK study, the baseline screen identified 30 (6.0/1,000) lung malignancies in the dual-screening group and 23 (4.6/1,000) in the chest x-ray group.63 Following the prevalence screen, 114 subsequent (incident) lung cancer cases were identified in the dual-screening group and 121 in the annual x-ray group during the screening period, with 33 and 32 cases, respectively, diagnosed in the 2 years following screening. Combining the incidence and prevalence tumors, 144 cases of lung cancer were detected in each group during the study37,64,67; 40% of all lung cancer detected was stage I. The mortality rate was 2.7/1,000 person-years in both the chest x-ray and dual-screening groups.
In the JH study, the prevalence screen identified 39 malignancies in the dual-screening group and 40 in the chest x-ray group.38,71 After 8 years of followup, 194 incident cases of cancer were identified in the dual-screening group and 202 in the chest x-ray group. The mortality rates were 3.4/1,000 person-years in the dual-screening group and 3.8/1,000 person-years in the control group (not statistically significant differences) and were similar to community lung cancer mortality rates at the time.71,72
The first trial to evaluate the value of intense screening with chest x-ray was the Mayo Lung Project (MLP) involving 10,933 male smokers aged 45 or older.39,73-83 All participants underwent a prevalence screen with sputum cytology and chest x-ray, and 91 cases of cancer were identified (prevalence 0.83%).39,73,75 After the prevalence screen, 4,618 men were randomized to a study group screened with chest x-ray and pooled 3-day sputum cytology every 4 months for 6 years, and 4,593 to a control group were advised to have annual chest x-ray and sputum cytology. During the study period, 206 incident cases of lung cancer were identified in the dual-screening group and 160 in the control group. After 20 years of followup, lung cancer death rates were 4.4 (95% CI, 3.9-4.9) and 3.9 (95% CI, 3.5-4.4) per 1,000 person-years in the dual-screening and control groups, respectively.80
The MLP was the first individual RCT to specifically evaluate the role of chest x-ray in lung cancer screening, and was the most influential in determining current public health policy. Although it is rated as fair quality by USPSTF criteria, there are several limitations of the study. First, a prevalence screen detected 91 cases of lung cancer (0.83%). Thus, there was no completely unscreened control group. Also, these cases were followed separately and were not evaluated in the randomized comparison. Thus, any effect of these cases on mortality could not be determined. Second, nearly half of the controls obtained annual chest x-rays during the course of the study, with one-third of the malignancies in the control group discovered by screening chest x-ray; 73% of the controls received chest x-rays during the study's last 2 years. Third, compliance of the intervention group was 75%, reducing the study's power.73
The incidence of lung cancer in the MLP intervention group was approximately 22% higher than in the control group.73 The possibility of nonrandom distribution of lung cancer risk factors was evaluated by Marcus and Prorok81; the distribution was not found to vary significantly between the intervention and control groups. Although little detailed information is provided, there is evidence on review of the MLP publications that not all patients were asymptomatic,39,73 which could alter the findings of the screening study if patients with symptoms were disproportionately enrolled in the intervention group. However, there is no evidence to support this. The radiation exposure associated with chest x-ray in the MLP is generally thought insufficient to increase lung cancer incidence.86 Finally, another possibility is that the higher incidence of lung cancer in the screened population may represent the diagnosis of insignificant disease, e.g., over-diagnosis.
Case-Control Studies
Five fair-quality case-control studies were conducted in Japan between 1992 and 2001 (Table 3).42-46 As a generalization, the cases were comprised of fatal lung cancer and included high-risk men and low- or unknown-risk women. All cases were matched to controls by age, gender, and health insurance status. Some studies included adjustment for geographic region, number of prior health examinations, or both, and all accounted for smoking either by matching or statistical adjustment. For screening with chest x-ray, with or without sputum cytology occurring within 1 year of diagnosis, the odds ratios ranged from 0.40 to 0.72, 4 with statistically significant findings.
Lung Cancer Screening with Low-Dose CT
Several recent cohort studies, all without control groups, have evaluated screening for lung cancer with CT. The details of these studies are shown in Table 4. The Early Lung Cancer Action Project (ELCAP)54 involved 1,000 asymptomatic volunteers (46% female) aged 60 or older, with a median of 45 pack-years of smoking, and no prior malignancy, who were evaluated as medically fit for surgery and who each underwent chest x-ray and CT. Baseline chest x-ray identified 68 persons with concerning nodules, of which 33 were confirmed by CT; 7 patients were malignant, and all were resectable. Baseline CT identified 233 persons with nodules. After followup of 30 recommended biopsies, 27 malignancies were identified, of which 26 were resectable and 23 were stage I.54 Four other cases of lung cancer were also diagnosed based on non-nodule CT abnormalities. Approximately 1,184 subsequent annual examinations resulted in 40 persons (4%) requiring further evaluation, usually high-resolution CT, 9 biopsies, and 9 lung cancer diagnoses (7.2/1,000) (6 stage IA).55 There are no mortality data available yet on this cohort.
Three CT studies conducted in Japan involved large numbers of both high- and low-risk men and women aged 40 and older.56,58,59 Each study used a different protocol but also included chest x-ray and sputum cytology; at least 2 were conducted in areas where lung cancer screening with chest x-ray and sputum cytology had been conducted for many years. Among 15,050 baseline screens, 993 (6.6%) had abnormalities requiring high-resolution CT, at least 21 underwent biopsy; 71 lung tumors were identified (prevalence 0.47%), 63 of them stage I (89%). Researchers performed 21,762 incidence screens that resulted in at least 1,166 subsequent high-resolution CTs and identified 60 lung cancer cases (2.76/1,000), of which 45 were stage I (Table 4).
A study conducted at the Mayo Clinic involved 1,520 men and women aged 50 and older with 20 or more pack-years of smoking.60-62 A baseline screen identified 782 (51.4%) persons with 1 or more nodules requiring further evaluation; 26 (1.7%) were diagnosed with primary lung cancer based on CT alone. Among this cohort, 2,916 annual incidence screens identified 336 persons (12%) with new nodules; 10 new diagnoses of lung cancer (6.7/1,000) were made with CT alone. There were 2 cases of interval cancer and 2 diagnosed with sputum cytology only. Of the 40 persons with malignancies, 36 were non-small-cell lung cancer, of which 31 (86%) were resected for cure; 8 patients underwent surgery for benign disease.
Finally, a German study53 involving 817 asymptomatic volunteers aged 40 and older, with at least 20 pack-years of smoking, was conducted between November 1995 and July 1999. Baseline CT identified 350 persons with nodules, 269 of these persons underwent high-resolution CT, ultimately identifying nodules in 29 persons. Thirteen of the 29 persons with nodules underwent biopsy; malignancy was diagnosed in 10 of the persons, as well as 1 interval cancer. After an average of 2.7 years of followup, 6 patients are alive without evidence of recurrence.
Lung Cancer Screening among Women
Lung cancer is the leading cause of cancer-related death among women in the United States, and most cases are attributed to smoking.2 In addition, women have substantial exposure to passive smoking, and a significant proportion of lung cancer in nonsmoking women is attributed to passive smoking.18 Furthermore, although controversial, some studies suggest that for any level of smoking, women are at higher risk for developing lung cancer than men.4,87,88 For unknown reasons, women also tend to develop adenocarcinoma of the lung disproportionately to men,17,88,89 and adenocarcinoma is also found more commonly among nonsmokers.17 This cell type tends to occur peripherally89,90 and may be more apt to be detected with chest x-ray, CT, or both than other cell types. Consequently, radiological imaging and screening for lung cancer may perform differently among women. Unfortunately, no randomized trials of lung cancer screening have included women. The only data evaluating screening among women and including control populations come from 4 Japanese case-control studies evaluating screening among primarily nonsmoking women (passive smoking not assessed).43-46 These studies are summarized in Table 5 and show lung cancer mortality odds ratios for screening conducted within 12 months of lung cancer diagnosis ranging from 0.39 to 0.61; 2 studies found statistically significant differences; however, interpretation is limited by the screening biases discussed in this review. Five studies of CT have included women; mortality data are not yet available. In addition, randomized trials of lung cancer screening with chest x-ray and/or low-dose CT involving women are currently underway.
The personal and public health importance of lung cancer in the United States and worldwide is enormous, and even a small benefit associated with screening could save many lives. However, the outcomes of screening, as shown in this report, are mixed, with some lower grades of evidence evaluating chest x-ray with or without sputum cytology (case-control studies) showing benefit, and higher-grade evidence (RCTs) not showing benefit. The CT screening studies show that lung cancer can be diagnosed at an earlier stage than in usual clinical practice, but little is known about patient outcomes. Unfortunately, none of the existing randomized trials answer the question faced by clinicians: Should patients be screened for lung cancer at all?
The case-control studies from Japan give some support to chest x-ray screening for lung cancer. Although case-control studies are not considered the gold standard in evaluating screening efficacy and effectiveness, several authors believe they can be a useful and efficient way to evaluate a screening method.31,91,92 However, it is very difficult to overcome the possibility of volunteer/healthy screenee bias in case-control studies, even well-conducted ones; this might bias the study toward benefit, since persons choosing screening may differ from those not being screened in factors which of themselves influence lung cancer mortality.93
The CT cohort studies indicate that earlier-stage lung cancer can be detected. However, drawing conclusions from the uncontrolled CT studies is difficult because of the methodological biases discussed earlier. It is possible, based on the stage distribution of the detected tumors, that mortality may be reduced. However, because of lead-time and length bias, survival may be prolonged but mortality unchanged. Randomized trials of CT with mortality as an outcome are needed to definitively evaluate this issue. The higher rate of abnormal CT findings and lung cancer in U.S. and German studies compared with Japanese studies most likely result from (1) higher-risk populations being screened in the U.S. and Germany; (2) prior population lung cancer screening has been conducted in Japan; (3) different CT methods among studies; and (4) possible higher rates of histoplasmosis in the U.S.
The hope of benefit from lung cancer screening is high; however, the implications of screening, especially in the absence of proven benefit, are also great. Evaluating harm or potential harm associated with screening for lung cancer is difficult. One approach to this issue is to evaluate the 4 possible outcomes of screening: false-positive, false-negative, true-positive, and true-negative findings. The best data about outcomes from chest x-ray screening come from the recent CT studies, since data from the chest x-ray trials accumulated prior to the use of CT for evaluation of x-ray abnormalities, and many patients previously underwent thoracotomy or biopsy than would have in current clinical practice. Table 4 shows positive chest x-ray rates and the diagnostic outcomes associated with chest x-ray from the CT studies; most chest x-ray abnormalities are resolved or found to be false-positive results when evaluated by CT.54,59 For x-rays identified as suspicious for cancer in the NCI studies, the positive predictive value for cancer ranged from 41% to 60%.29
In the CT studies, the false-positive rate was the number of patients with CTs requiring further evaluation who did not have cancer. Using this criterion, the false-positive rates in the CT studies ranged from 5% to 50% in prevalence screens and 3% to 12% in incidence screens; most abnormalities were resolved with high-resolution CT. Among the CT studies reporting referral rates, 4.8% to 14.5% of patients undergoing high-resolution CT were referred for biopsy, from which most (63% to 90%) were diagnosed with cancer. These data are shown in Table 4. For comparison, in U.S. and European clinical practices, approximately half of patients undergoing surgical biopsy of indeterminate nodules subsequently receive a benign diagnosis.61,94 In the current practice setting, positron emission tomography scans are commonly used as a noninvasive means of discriminating between malignant and nonmalignant lesions95 and may reduce the rate of invasive procedures performed to evaluate indeterminate nodules.
Persons with false-positive results can experience a period of time potentially associated with high anxiety and concern, and for those pursuing further evaluation, the cost and risk associated with it. Although the false-positive rate is high in the lung cancer screening studies, the meaning of a false-positive lung cancer screening study (either chest x-ray or CT) to a patient may be different than for other types of cancer screening tests, since patients who currently smoke potentially have some control over their subsequent risk and may be able to more effectively modify their high-risk behavior. Data from the ELCAP study suggest that CT scan results, in combination with smoking cessation counseling, improved smoking cessation rates among all participants54 and that an abnormal CT finding was associated with nearly 2-fold greater odds of decreased smoking or cessation among current smokers.96 It is reasonable to assume that an abnormal screening chest x-ray might also influence smoking behavior.
An important and controversial issue in lung cancer screening is the question of over-diagnosis (and consequent over-treatment). The relatively high prevalence of unrecognized lung cancer in several studies suggests that there is a significant preclinical pool of lung cancer in high-risk populations.38,54,97 Whether all of these tumors would eventually present clinically is uncertain. Supporting over-diagnosis are data from the MLP showing increased rates of early tumors in the screened group compared with the control group without a change in the number of advanced tumors or subsequent mortality rates, suggesting diagnosis of a pool of indolent tumors.98 Although the higher lung cancer mortality rate among the intervention group in the MLP was not statistically significant, a major concern is that the increase in mortality might not be due to chance and may be a consequence of screening (e.g., more persons undergo evaluation and treatment in the screened group and with treatments-associated risk, result in a true increase in mortality). Alternatively, an increase in lung cancer mortality rates among screened persons may be a consequence of misclassification of cause of death or "sticky-diagnosis bias,"98 meaning that in the absence of autopsy data, there is a propensity to label any diagnosed malignancy as the cause of death, regardless of the tumor's clinical course, which results in bias against screening when evaluating disease-specific mortality.99 Black et al100 noted that the excess lung cancer mortality observed among the screened group in the MLP, particularly death from metastatic adenocarcinoma, was probably at least partially a consequence of this type of differential misclassification.
Arguments against an important role for over-diagnosis in lung cancer are based on autopsy studies showing low rates (0.8%) of unrecognized lung cancer.101 Whether autopsy data are generalizable to living populations is questionable, particularly given selection biases for autopsy. Further data against over-diagnosis come from 2 natural history studies of both screen- and symptom-detected unresected stage I non-small-cell lung cancer that have shown that almost all patients die of lung cancer over 5 to 10 years.25,26 Whether a strong case for over-diagnosis should be made on the basis of current data is uncertain. However, it is possible that with an increasingly sensitive detection tool, such as CT, over-diagnosis may occur. The issue of over-diagnosis is particularly relevant to the harm associated with lung resection for cancer, where there is significant mortality and morbidity associated with treatment. More data are needed to definitively evaluate this issue.
Another potential harm of screening is false-negative findings with possible false reassurance. In current practice, the best estimate of the rate of false-negative results on chest x-rays comes from the CT studies, where false-negative rates as high as 75% were shown.54,59 Clinical series of chest x-ray suggest retrospective identification of lung cancer ranges from 12% to 90%.102,103 While CT is considered the gold standard for evaluating nodules, it has also been shown to have false-negative results62; and the potential for false reassurance with CT certainly exists, particularly if those screened believe that they are undergoing a definitive examination.
The rate of complications associated with biopsy was not described in the CT studies. The morbidity and/or mortality associated with thoracotomy for positive test results (true or false) is also difficult to evaluate. Studies of symptomatic patients suggest that the more lung tissue removed the greater the morbidity and mortality. Overall, mortality rates range from 1.3% to 11.6% and morbidity rates from 8.8% to 44% among several series reviewed, with lower rates among patients undergoing smaller resections, less comorbidity, and centers with greater surgical volume.28,47,104-110 Complication rates from studies among symptomatic patients are likely to be greater than complication rates among asymptomatic persons in screening programs directed at those judged healthy enough to undergo surgery.
Currently, most patients in the United States are not screened for lung cancer.111 However, because conclusions about lung cancer screening have been based on limited data and no trials have compared screening with no screening or screening among women, the issue is being reevaluated. Routine annual chest x-ray is being compared with usual care in the Prostate, Lung, Ovarian, and Colorectal Cancer trial (PLCO), which involves over 100,000 men and women aged 55 to 74.112,113 Data from this study should be available in 2010. The National Lung Screening Trial (NLST) will compare routine screening CT with chest x-ray in high-risk men and women aged 55 to 74.114
New technologies may also contribute to the early detection of lung cancer and potentially screening for lung cancer. Some currently being investigated include: immunocytochemical analysis of sputum with monoclonal antibodies115; identification of genetic mutations116; abnormal DNA methylation117,118; abnormal patterns of immunostaining, and other molecular changes.119-122 There are several other potential targets in sputum, bronchial fluid, and expired air that may have a role in early lung cancer detection and are currently being investigated.123,124
In summary, studies evaluating chest x-ray screening for lung cancer have had mixed findings, with stronger types of evidence from 30-year-old trials suggesting no benefit among male smokers and possible over-diagnosis, and weaker study designs suggesting benefit to men and women. There are important methodological limitations to all of these studies. The studies of CT have demonstrated that lung cancer can be diagnosed at a significantly earlier stage than what currently occurs in clinical practice. However, whether this will translate to a mortality benefit is unclear. In addition, even if CT is shown to be effective, the issue of cost-effectiveness remains.125 Critical information will come from the current RCTs of screening CT. Given the uncertainty associated with chest x-ray screening, it is unfortunate that the NLST does not include non-screened control groups. However, data will be available on chest x-ray screening from the PLCO trial in the next 5 to 8 years. In the meantime, other approaches for evaluation of screening should be considered, such as rigorously conducted case-control studies of chest x-ray and/or screening CT. We hope that new methods of screening for lung cancer will be developed and refined. Even a small decrease in lung cancer mortality attributed to screening would save thousands of lives each year.
Role of the Funding Source
This research was funded by the Agency for Healthcare Research and Quality (AHRQ). AHRQ staff and USPSTF members reviewed interim analyses and the final report. Prior to preparation of this manuscript, the full report was reviewed by 17 content experts in the area of lung cancer screening and revised accordingly.
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Oxfordshire's Lawrence Clarke qualified for the 110m hurdles final at the Sainsburys British Championships when he won his heat in 13.42 secs Edi Okoro took the second qualifying spot in that heat.
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Daniel Stabrawa Violin, Christian Stadelmann Violin, Neithard Resa Viola, Dietmar Schwalke Cello
Lena Neudauer Violin, Anna Knopp Violin, Milan Milojicic Viola, Leonhard Roczek Cello
»Felix Mendelssohn's first visit to Goethe«
Music by Felix Mendelssohn
Texts by Johann Wolfgang von Goethe, Carl Friedrich Zelter, Ludwig Rellstab, Fanny and Felix Mendelssohn and other authors
Introduction: 15:00
Introduction: 15:00
"Goethe," wrote Ludwig Rellstab in his autobiography Aus meinem Leben, "was a great admirer of Bach's fugues [...]. So Felix Mendelssohn was also requested to play a fugue by the great master. Zelter chose from the book of Bach's fugues which was brought, and the boy played the same totally unprepared, with perfect security." In 1821, Felix Mendelssohn visited Johann Wolfgang von Goethe for the first time: Together with his teacher Carl Friedrich Zelter, the then 12-year-old spent more than two weeks in Weimar – a period from which arose a friendship which lasted until the death of the 60 year older poet. "Here," wrote Mendelssohn in a letter dated 10 November 1821, "I play much more than at home, rarely under four hours, sometimes 6, probably even 8 hours. Every afternoon Goethe opens the Streicher piano with the words, ʻI have not heard you today – now make a little noise for me,' and then he would sit down at my side [...]. His hair is not yet white, his step firm, his way of speaking mild." In his Philharmonic Salon, Götz Teutsch explores the time that Mendelssohn spent together with the thinker and humanist in Weimar – with literary texts by Carl Friedrich Zelter, Ludwig Rellstab, and Fanny and Felix Mendelssohn Bartholdy, read by Maria Schrader. The musical framework is provided by the Philharmonia Quartet, the Minetti Quartet and the pianist Cordelia Höfer.


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UT freshman outfielder Ben Johnson makes it look easy.
The Westwood alum was a three-sport star in high school, starring in countless Friday night highlight reels as one of the state's top quarterbacks. Fortunately for the Longhorn baseball program, the 6'1" 190 pound athlete didn't pursue a college football career.
"I've always wanted to play a sport at Texas," said the homegrown talent, "and it's happened to be baseball and I'm glad I made the decision."
Longhorn baseball coach Augie Garrido says Johnson has the mental makeup and physical talent to be a Major Leaguer one day.
"You start watching him run - (he's) kind of like a guy who stole a million dollars from a bank and they're after him," said Garrido. "You can't catch him. Can't catch him. He's awesome!"
Johnson says his time playing football under the Friday night lights helped prepare him for the diamond on the 40 Acres.
"I'm not used to playing baseball games in front of six or seven thousand people," said Johnson. "Football I'm used to playing in front of that, so that definitely helped."
His family genes didn't hurt either. His father played football at Maine, his granddad ran track at Notre Dame, and his brother played baseball at Vanderbilt. Most D-1 baseball players are the best athlete in the family. Johnson is still trying to prove he's not the worst.
"I have no idea where I fall!" said Johnson. "We're all pretty decent athletes. I'm just having fun with it now."
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Also, maybe you could add a sort command for the VIN#'s
Haha. Yea I noticed this morning that I forgot that. VIN sorting is added now
Definitely some good ideas there from yourself and ResumeSpeed. Regardiing the Location thing I was just unsure about how much time I was willing to put into generating dropdowns for location if this wasn't going to be used much by folks. Looks like a decent amount of people have added their cars in already and it's not even 24-hours since I posted about it. I'll get working on adding in those features as I can. For the '08, '09, '10 tracking I'm still undecided on how I want to handle that. Since they'll have a lot of different features than just Sunroof/Nav/Tires it might make sense to make a 'separate' site for them so they're all separated. However, it would be cool to have ALL challengers on one page, too -- kind of like an 2008+ generation challenger registry. We'll see. I'll get some of the other features implemented first and I'll brainstorm more later about implementing additional model years.
Glad to see you guys like it =)
Got a link to the Shelby Registry? I'll take a look. It looks like it's getting pretty popular (72 cars). Makes me want to expand it to, as was recommended, a Challenger Registry for all model years/trims.
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Atheists Do It Better: Why Leaving Religion Leads to Better Sex
Stay up to date with the latest headlines via email.
Do atheists have better sex? Yes. According to science, that is -- and more specifically, according to the recently released "Sex and Secularism" study.
In January 2011, organizational psychologist Darrel Ray, Ed.D. (psychologist for 30 years and author of The God Virus as well as two books on psychology) and Amanda Brown (undergraduate at Kansas University, focused on sexuality and sex therapy) conducted a sex survey of over 14,500 people -- atheists, agnostics, and other people in the secular community. The survey was looking at religion, atheism, and sex: how religion affects sex, how leaving religion affects sex, whether lifelong atheists feel differently about sex than people who have recently deconverted, and so on. The report -- "Sex and Secularism: What Happens When You Leave Religion?" -- is on the Internet, and if you want all 46 pages of the naughty details, including the charts and graphs and personal stories, you can download it free (you just need to register on the site).
But if you just want to know the gist?
Leaving religion improves people's sex lives.
A lot.
Atheists and other non-believers, as a whole, experience a lot more satisfaction in their sex lives than they did when they were believers. They feel much less guilt about their sex lives and their sexuality. The sexual guilt instilled by so many religions tends to fade, and indeed disappear, when people leave religion -- much more thoroughly than you might expect. And according to the respondents of this study, non-believers give significantly better sex education to their kids than believers do.
Now, when it comes to people's actual sexual behavior, religion doesn't have nearly as much impact as you might think. Religious and non-religious people have pretty much the same kinds of sex, at pretty much the same age of onset, and at pretty much the same rate. Believers are just as likely to masturbate, watch porn, have oral sex, have sex outside marriage, and so on, as non-believers are, and they start at about the same ages. So it's not like religious sexual guilt is actually making people abstain from forbidden sexual activity. All it's doing is making people feel crummy about it. And when people leave religion, this crumminess decreases -- at a dramatic rate. Believers and atheists are having pretty much the same kinds of sex... but when it comes to the pleasure and satisfaction experienced during this sex, it's like night and day.
Okay. Before anyone squawks, I'll start the squawking myself: There are some demographic problems with this study, and it shouldn't be relied on as the absolute final word on this topic. In particular, the participants in the study aren't statistically representative of the population: they're statistically representative of whoever heard about it on the Internet, and they're disproportionately represented by readers of the hugely popular atheist blog, Pharyngula. (In fact, in several places throughout the report, the researchers themselves freely acknowledge the limitations of their research.)
But that being said: The results of this report that aren't new? They're entirely consistent with the results of other research. Lots of other research, both on human sexuality and on religion/ atheism. And that makes those results a whole lot more plausible. As researcher Darrel Ray told me, "Our data is virtually identical to other national surveys on the basics of when and how people start sexual behavior." (Citations of those studies are in the report.) Yes, it's virtually impossible to get completely accurate, statistically representative information about human sexuality under any circumstances: there's not really any ethical way to get information about sex other than relying on people's self-reporting, and it's a topic that people tend to, you know, lie about. But on the reliability scale of human sex research, this report seems to rank on the higher end.
Stay up to date with the latest headlines via email


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Dec 05, 2011 | 06:10 AM
The proposal to ban the use of cash for scrap metal purchases has been attacked by many that are still involved in the "door trade", under which sellers may just turn up at the scrapyard gates with material to sell.
Sources polled by Metal Bulletin are broadly in agreement with MP Graham Jones' proposed private member's bill, but the issue of cashless payment is a sticking point.
"The cashless system would just drive things underground," one alloys producer and scrap buyer said.
"In the system we're operating at the moment, we work closely with police and transport authorities; we take registered identification for all sellers; and....
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Are you stocking more inventory today than 18 months ago?
We actually don't know who his investors are. At the point when we are ready, we will investigate further. There are just so many things to handle and there are a lot of items to be considered with the project."
-- Charles C. Mitchell, Barstow city manager


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Holy hell! Unless I'm off my nut, the latest information from Forbes suggests the Edmonton Oilers are in fact a license to print money–when they suck!
Incredible. The story is here, I'm not going to post the graph (click through and it is there) but the Edmonton Oilers are a money maker and it is an incredible story. During the elevator drop seasons 2009-10, 2010-11 and 2011-12, the Oilers were 8th, 5th and 7th in league income.
That's bullet proof, baby. Am I wrong?


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VELCRO Classic Super Size Plus Rollers-2pk 3" 76.2mm
VELCRO Classic Super Size Plus Rollers-2pk 3" 76.2mm straighten curly or frizzy hair for normal or thick hair.
Features & Benefits:
- Long-Lasting, Self-Gripping Rollers - No Pins needed
- Can be used on wet or dry hair
- For Perms & Sets
- Can Straighten or Curl
- 50% Lighter than comparable rollers
- Hundreds of tiny holes for fast drying
- Can be sterilized
Folica stands behind the authenticity of everything we sell. Since 1998, Folica has made it our mission to provide you with an outstanding selection of hair and beauty products at highly competitive prices.
Share your hair know-how - be the first to rate and review this product.
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What's Happening in the Central Indiana Area???
A lot. And FunCityFinder.com is where you'll find it. From news, things-to-do, restaurant reviews, photos, video and so much more, FunCityFinder is your one-stop shop for everything fun and interesting in Central Indiana.
Indianapolis, Indiana
There's so much to do and see in Indy, from truly world-class attractions to small, independent establishments.
More Indianapolis News. Or View Indianapolis Photos.
● Girlmore Girls on Netflix and 7 Reasons Westfield Is Like Stars Hollow
● Movember Indy 2014 Takes over Indy One Mustache at a Time
Avon, Indiana
Located just 13 miles of Indy, Avon enjoys all the benefits of a small town, with convenient access to a large metro area.
More Avon News. Or View Avon Photos.
● Review: Thai Thai Restaurant
● Review: Cherry Delight at Frost Bite
Brownsburg, Indiana
Just 17 miles from downtown Indy, Brownsburg a great place for anyone who cherishes a quiet, small-town atmosphere.
More Brownsburg News. Or View Brownsburg Photos.
● Four Ideas for a Brownsburg Staycation
● Visit: Brownsburg Farmers Market (Thursdays, June-September)
Carmel, Indiana
Carmel is an affluent suburb just north of Indy, known for it's great real estate market and famous Arts & Design district.
More Carmel News. Or View Carmel Photos.
● Big News for Big Families: Kids Eat Free at Earth Fare
● International Festival Brings Art and Diversity to Carmel
Danville, Indiana
The County Seat Hendricks County, the small city of Danville is home to numerous attractions and other cool historical sites.
More Danville News. Or View Danville Photos.
● National Powwow Takes Local Stage This Weekend
● Game On Brings Giant Fun to Downtown Danville
Fishers, Indiana
Fishers offers great schools, a strong real estate market, a old-time downtown area with mom-and-pop shops, and more.
More Fishers News. Or View Fishers Photos.
● New Sun King Brewery Location To Open in Fishers
● Bub's Burgers & Ice Cream Set To Open in Fishers
Franklin, Indiana
The home of Franklin college, Franklin has a rich history dating back to 1822, and still retains much of the period's architecture.
More Franklin News. Or View Franklin Photos.
● Strawberries on Franklin's Square
● Franklin Guide to Vintage Shopping Part II
Geist, Indiana
Located on the northeast side, Geist is best known for its massive reservoir–that and its many desirable lake homes.
More Geist News. Or View Geist Photos.
● The Beauty Bar at Geist Serves Up Relaxation
● Geist Park: A Hidden Hamilton County Oasis
Greenfield, Indiana
Greenfield is the county seat of Hancock County, and offers a great school system and many charming neighborhoods.
More Greenfield News. Or View Greenfield Photos.
● Free Trees Available for Arbor Day
● Bikes in Bloom Brings Color to Greenfield Main Street
Greenwood, Indiana
Greenwood is one of the larger suburbs of Indy, and offers plenty to do, including shopping, dining, parks and more.
More Greenwood News. Or View Greenwood Photos.
● A Tale of Two Health Food Stores
Lebanon, Indiana
Lebanon is part of Boone County's vast art and cultural district, and offers several attractions and recreational events.
More Lebanon News. Or View Lebanon Photos.
● Donaldson's Offers World-Class Chocolate in Small Town Indiana
● Sigler's: Where a Taste of the Past Is a Real Present
Martinsville, Indiana
Local fisheries have been a part of the city's history since 1899, and to this day, contribute millions to the local economy.
More Martinsville News. Or View Martinsville Photos.
● Martinsville Real Market Improves by 8 Percent in 2012
● Martinsville Home Sales Rise 48 Percent in October, 2012
Mooresville, Indiana
The birth place of John Dillinger, Mooresville is a town with a storied history. It's located just 10 miles southwest of Indy.
More Mooresville News. Or View Mooresville Photos.
● Mooresville Home Sales Up 20 Percent in 2012
● Mooresville Market Shows Healthy Signs in October, 2012
Noblesville, Indiana
Noblesville is an electric, upscale town, full of attractions. It is just a hop, skip and jump away from Indy's northeast side.
More Noblesville News. Or View Noblesville Photos.
● Historic Downtown Noblesville in Photos
● Red Robin Burgers and the Bottomless Fries
Plainfield, Indiana
Plainfield is located just west of Indy. Things to do include wine tasting at the famous Chateau Thomas Winery, plus much more.
More Plainfield News. Or View Plainfield Photos.
● Four Ideas for a Plainfield Staycation
● Four Tips for Shopping at Gilley's Antique Mall
Westfield, Indiana
Westfield is an accurate representation of its motto, "Old town charm, new city style." Visit it once, and you'll see why.
More Westfield News. Or View Westfield Photos.
● Girlmore Girls on Netflix and 7 Reasons Westfield Is Like Stars Hollow
● Plans For Grand Park Fieldhouse Announced
Zionsville, Indiana
The small town of Zionsville is an affluent suburb of Indy, with a variety of attractions, arts, shopping, hotels and more.
More Zionsville News. Or View Zionsville Photos.
● Salty Cowboy Serves Up Tex-Mex Spice in Zionsville
● Zionsville Named Safest Small Town in America
A-Z List of Central Indiana Cities
There's a lot going on in Central Indiana, and FunCityFinder's handy list of cities is your starting point!
See a List of Cities Here.


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Chase Utley homered, tripled and plated three runs, leading the Phillies offensive onslaught in Friday's 13-8 victory over the Mets.
Yankees placed INF/OF Martin Prado on the 60-day disabled list with appendicitis.
Michael Morse (oblique) should be ready to return by Friday.
Matt Shoemaker will undergo an MRI after leaving Monday's start with a "little" discomfort on the left side of his rib cage.
Andrew Cashner spun a two-hit shutout on Monday in a 1-0 win versus the Phillies.
Anthony Rizzo hit a walkoff homer off Pedro Villarreal in the bottom of the ninth as the Cubs beat the Reds 1-0 on Monday.
Albert Pujols left Monday's game against the Mariners with a left hamstring cramp.
Jacob deGrom struck out the first eight batters he faced and 13 overall while allowing three runs over seven innings Monday in a no-decision against the Marlins.
Bryce Harper is dealing with the flu.
Collin McHugh left Monday's start versus the Indians with a bruised left forearm.
Giants activated 1B Brandon Belt from the 15-day disabled list.
Jonathan Papelbon has been suspended seven games by Major League Baseball for his actions following Sunday's appearance.


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SOUTH ORANGE, N.J. (AP) -- Jordan Theodore scored 21 points, Herb Pope had 20 and Seton Hall snapped an 11-game losing streak in the NIT by holding off Stony Brook 63-61 Tuesday night.
The win is the first for the top-seeded Pirates (21-12) in the event since 1956.
Stony Brook, the two-time regular-season champions of the American East Conference, didn't make it easy. Bryan Dougher had a 3-pointer bounce off the rim with about :02 to go, and Tommy Brenton had a rebound follow roll off the rim at the buzzer.
Dallas Joyner had 14 points and nine rebounds for the Seawolves (22-10). Marcus Rouse added 13, and Dougher had 12.
Seton Hall will play Mississippi State in the second round. The Bulldogs edged Massachusetts 75-72 earlier in the night.


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( 2 of 2 customers found this review helpful)
GREAT product
By MMForever
from Edmonton
Cellex-C will always get 5 Stars. It's expensive but worth every penny. Once this order is complete however I will consider buying elsewhere. (Yes even at a higher cost and no easy pays) as I have had nothing but problems with this order and absolutely NO help from TSC.First of all the order was placed on a Sunday and Monday night was still 'authorizing cc'. I called TSC who advised the order probably missed the daily run and I would have to wait until tomorrow (Tuesday) for the next run. Fine. Tuesday comes and nothing. Called Wednesday and CSR advised me that product was out of stock so system was waiting for product to come in to authorize CC. System showed product IN STOCK as both auto delivery and single order to which I WAS THE ONE WHO HAD TO ADVISE THE CSR of this who THEN advised me that it could take up to 72 hours for a credit card to go through. I asked her to check into this further because I was tired of the inconsistent explanations and have never had this issue before. She put me on hold and came back to inform me that she and I.T. had to issue a ticket on this issue as there clearly was a problem with the system. She advised that the order had been sent directly to the warehouse to be released from there. So Wednesday and Thursday item is sitting on the status of 'continuity active' which I had never seen, thought it might have something to do with auto delivery so called TSC on Friday whose CSR had no idea what continuity active meant. Another long back and forth (never a final answer) but advised that order is ready to be picked so left it alone. I then advised her that one easy pay went through on my credit card when I had wanted 2 (and she advised the system showed 2 easy pays requested but yes, 1 of 4 went through) and I asked her to change it so it will be completely paid when shipped.In short I have no idea if/when I'm getting this product, one payment has gone through on my credit card, will definitely be keeping my eye on my credit card transactions on this one. My single shipment order on this item I placed on Sunday is still sitting in the warehouse (it's Friday). Shipping from TSC is getting ridiculous.I will only buy items that are a great savings or good easy pays on higher priced items but I already buy quite a few of TSC products elsewhere as I know I will get them in a timely manner and at times even a better price.So I would absolutely recommend this product to a friend but TSC Customer Service has really gone downhill for me. Don't be in a rush to get your items as you'll be disappointed.
Bottom Line No, I would not recommend this to a friend
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Hunters can enter Super Tag Lottery
LINCOLN, Neb. (AP) _ Beginning this week, Nebraska hunters can enter the Nebraska Super Tag Lottery for a shot at a four-species permit.
The nonrefundable lottery application fee costs $25. The tag is valid in 2013 and 2014 and has a bag limit of one elk of either sex, one deer of either sex, one antelope of either sex and two turkeys (only toms and bearded hens may be taken in the spring).
The application deadline is July 5. Each hunter is limited to one entry, and only Nebraska residents are eligible. The winner will be drawn later in July.
The winner will be allowed to hunt with any legal weapon in any open hunting unit during the general hunting season for each species.
Visit OutdoorNebraska.org to enter the lottery.
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Keyword: hydrogen sulfide ×
Industry: Chemical & Pharmaceuticals ×
Location: Europe ×
Location: Netherlands ×
Tethys Instruments SAS
Tethys Instruments is a leading global provider of gas and water online analysers for environmental applications. Headquartered in France, our distributors worldwide and us provide top-class service and instrumentation for environmental monitoring.
Bioconservacion SA
Bioconservacion provides Air Purification system and Odour Control Filters. We manufacture and service Gas Phase Filtration systems to eliminate H2S and other gases from air flows. We have a unique Laboratory in europe capable of providing solutions to any Air Filtration need. Our filter system and Filter Media are used for Odour Control, Corrosion Control, Biogas H2S ...
Lenzing Technik GmbH
LENZING TECHNIK GMBH - We are an experienced partner for YOU! We offer comprehensive competence with expert status in the fields of engineering and contracting, industrial plant design and construction, industrial services, as well as automation and mechatronics. ENVIRONMENTAL TECHNOLOGY - Collecting and treating waste gas emission with different types of technologies in ...
AEREON, headquartered in Austin, Texas, is a global leader in the supply of high-quality technologies and services for gas and vapor handling, combustion and recovery for the oil and gas industries. AEREON was formed in 2012 when Flare Industries, LLC acquired Jordan Technologies. Under the two brands, AEREON offers the broadest product line of engineered flare systems, ...
ASK EHS Engineering & Consultants Pvt. Ltd.
ASK EHS specialize in all area of Environment, Health and Safety Services, with an emphasis on safety consulting. ASK-EHS is capable of catering quality and state-of-the-art services in the field of Environment, Health & Safety to the emerged and emerging construction projects and operation industries in India and abroad.
General Monitors
General Monitors is dedicated to benefiting society through leading-edge combustible gas, toxic gas, and flame detection monitoring products of the highest quality that protect life and property. With over 50 sales representatives around the globe, we provide exceptional service and after-sales support. Combining advanced sensing technology with superior service, General ...
Adedge Water Technologies, LLC
Adedge Water Technologies, LLC specializes in the development and supply of innovative technologies, adsorbent-based products, and systems that remove contaminants from process or aqueous steams. We are an organization based on solid deliverable, scalable, scientifically proven technology and experience for the removal of arsenic and other contaminants from water. Our ...
Genesis Water Technologies, Inc
Genesis Water Technologies, Inc. is a innovative US wholesale supplier and manufacturer of sustainable water treatment, filtration and purification solutions, serving the needs of water treatment dealers/distributors, engineering consulting firms, OEM clients, commercial and governmental clients. Genesis Water Technologies is dedicated to providing superior customer ...
Crowcon Detection Instruments Ltd
Crowcon Detection Instruments develop, manufacture and market a complete range of portable and fixed gas detection products you can trust to protect people and plant against gas hazards. Established over 40 years the company has strong regional centres in North America, Singapore, The Netherlands and India, with a mature network of trained distributors covering almost ...
HydroThane STP BV
HydroThane is a group of companies specialized in industrial waste water treatment, water recycling, solid waste digestion and biogas treatment.HydroThane is a company with more than 30 years of practical experience in the design, engineering and construction of biological waste water treatment plants for industrial applications.HydroThane has an excellent reputation and ...


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Dear Forum Posters and Posers -
Due to Tom's schedule the number of monthly queries accepted has been cut down, so hurry and get those questions submitted. Also, the sooner you do, the quicker we can all begin our discussion of them.
PS: And just a friendly reminder to all who may be in need of it:
We, like, have only three basic instructions for The Posting of Your Question:
1) ASK ONE brief, interesting question [lengthly, fan letter-type greetings and comments can be freely posted elsewhere on Tom's website forum]
2) Do not ASK certain things [Qs already answered, Qs about other Dr Whos, personal Qs, Qs about appearances/upcoming projects]
3) And do not reply to other people's question in Tom's Question Room [the questions and answers are meant to be personal, one-on-one time with/for the poster.]
And if anyone has any questions about the above comments, just PM me and I will cheerfully try to answer you as best I can, and will without argument, walk you through our GUIDELINES yet again.


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Taylor Swift has one of the most squeaky-clean images of any young celebrity out there these days. She never wears scandalous outfits, she's never had any run-ins with the law, she's never been photographed stumbling out a nightclub drunk, and she's not known to do drugs, either. But the singer says because of all that, she's frequently misunderstood.
Speaking to Glamour magazine -- she graces the cover of its new issue -- Taylor laments, "I think some people think it's just apple pie and sunshine and sprinkles and ponies. Which is just funny."
However, Taylor says she isn't tempted to do something outrageous to change people's minds, either. "I never feel the need to go out and make some grand statement that I'm dark and twisty and complicated, because I'm not that either," she explains. "It's just not as simple as ponies and rainbows, though I do love ponies and rainbows."
Taylor also opens up about her relationship with her female friends, telling Glamour, "They are so important in my life right now. I'm the kind of girl who needs to tell her friends everything."
Noting that two of her best friends are actress Emma Stone and singer/actress Selena Gomez , Taylor explains, "I met Emma when I was 17, and I met Selena when I was 18. So they've experienced all of this with me, and they've also experienced their own amazing success, and somehow through all of it, we've stayed close."
Copyright 2012 ABC News Radio


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A vehicle is any non-living device that is used to move people and goods. Unlike the infrastructure, the vehicle moves along with the cargo and riders. Vehicles that do not operate on land, are usually called crafts. Unless being pulled by a cable or muscle-power, the vehicle must provide its own propulsion; this is most commonly done through a steam engine, combustion engine, electric motor, a jet engine or a rocket, though other means of propulsion also exist. Vehicles also need a system of converting the energy into movement; this is most commonly done through wheels,propellers and pressure.
Vehicles are most commonly staffed by a driver. However, some systems, such as people moversand some rapid transits, are fully automated. For passenger transport, the vehicle must have a compartment for the passengers. Simple vehicles, such as automobiles, bicycles or simple aircraft, may have one of the passengers as a driver.
Hope this explanation and example of our topic for the week will give you much Inspiration for the challenge ,Sure you can find some interesting photo and Article. HAPPY SUNDAY POST.
New to Word press? Whether you're a beginner or a professional, you're invited to get involved in my Weekly Competition to help you meet your blogging goals and give you another way to take part in 2012 Water Dragon Event. Everyone is welcome to participate, if your blog is about photography,Videography, Graphic Artwork Or Writing .
Here's how the weekly photo Competition works:
1. Each week, we'll provide a theme for creative inspiration. Show the world based on your interpretation what you have in mind for the theme, and post them on your blog anytime before the following Sunday when the next photo theme will be announced.
2. Subscribe to jakesprinter so that you don't miss out on weekly challenge announcements. Sign up via the email subscription link in the sidebar or RSS.
Make sure to have the image link to http://jakesprinters.wordpress.com/ so that others can learn about the challenge, too.


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Tavros Nitram, a young farmboy who just can't get it right, despite acres and acres of fertile land left by his father and a legacy heavier than the expectations bestowed upon him by his strict and explosive paternal guardian. Tavros takes after his father in only one way; cattle raising. No other man could raise a heifer like he could. Although his stables are full of prize winning bovine, stallions, swines, and hens, he won't sell or eat a single one, leaving him penniless more often than not, for growing crops was never a strong suit of his. But luck must be on his side, for a secret admirer seems to be leaving him various sums of money whenever Tavros seems to be most in need.
Aradia Megido is young but her future is already set out before her, clear as the crystal she's destined to polish, dust, clean, but never own. Growing up with little money and a father constantly away for one reason or another left Aradia to develop her own skills pertaining to her own interests, but ones that would never present much of a practical use for someone in her class. Her house was located a hop, skip, and a jump from the catacombs and an even longer hop from an old battlefield, allowing for full, unattended exploration. The lass scampered around the ruins and learned much about the human body, the earth, the rocks and plants, and most importantly, how to get mud out of one's clothing. And so she grew to work as a maid in the castle, for all time.
Castlestuck. This AU is happening. More will be posted later. ~o~
oh man, so many great AUs are HAPP—-EPING!! i am so excited


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Authorities say the bodies of seven men were found in plastic chairs placed along the side of a street in the drug-plagued Mexican state of Michoacan, while another seven people, including three federal agents, were killed in neighboring Guerrero.
Michoacan's Attorney General's Office said in a statement Saturday that the seven bodies had bullet wounds and had been placed individually in the sitting position in chairs near a traffic circle in the city of Uruapan. The office did not provide a motive for killings.
In Guerrero state, authorities said armed men opened fire in a bar in Ciudad Altamirano late Friday. Four civilians and three off-duty federal agents were killed.
Both states on Mexico's western coast have seen a surge of violence in recent years attributed to drug cartels.
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Event Marketing Staff!! Work Live Events
KC Event Marketing, Inc. — Elmhurst, IL
EVENT MARKETING STAFF.ENTRY LEVEL REPS FULL TRAINING PROVIDED. KC Event Marketing, Inc. is one of the areas top event marketing and promotional advertising firms located in Elmhurst, IL. We conduct al…
Application Deadline: Available Year-round
VERA WANG Retail (Chicago) Internship
VERA WANG — Chicago, IL
The Retail Department at Vera Wang is seeking a Retail intern at the Chicago store location for Fall 2014. We are looking for an applicant that can start immediately. Students must be currently enroll…
Application Deadline: 9/29/2014
Fashion/Retail/Marketing Intern for the school year
moon voyage inc — Chicago, IL
Moon Voyage is looking for a fashion intern asap for the school year or just out of school. We are looking for a responsible, organized, happy, hard-working individual that needs to gain insight in th…
Application Deadline: Available Year-round
Customer Service and Retail Sales
KC Event Marketing, Inc. — Elmhurst, IL
Immediate Entry-Level Openings Are you ready to get your career started, or perhaps just ready for a career change in 2014? KC Event Marketing is one the fastest growing marketing firms in the Chicago…
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Marketing and Business Management Internship
Shure Pets — Chicago, IL
Andrew Shure, founder of Shure Pets (see andrewshure.com), is working on a new pet industry initiative focusing on the service sector. We are developing a unique national platform that will location ,…
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Full Time / Part Time for Fall!
KC Event Marketing, Inc. — Elmhurst, IL
Got the spark? The smile? Come on in! Its more than a job! More than a place to work and collect a check! Its a state of mind! Who says you cant have fun at work? Fun, excitement, and great times! The…
Application Deadline: Available Year-round
KC Event Marketing, Inc. — Elmhurst, IL
Marketing, sales, advertising, management, promotions. Do any of these words spark your ambition? How about energetic, fast-paced, growth opportunities, promotions from within, management opportunitie…
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Fashion Merchandising Design Internship at Anastasia
Anastasia — Chicago, IL
Everyone wants that special garment in their closet that makes them feel empowered; Anastasia Chatzkas garments give women that sensation. Anastasia conceives highly innovative garments that are alway…
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Promotional Marketing & Sales – Paid Training – Entry Level
KC Event Marketing, Inc. — Elmhurst, IL
We are now accepting applications & interviewing for marketing and sales positions within our company. KC Event Marketing is a leading provider of marketing and sales professionals in the Chicagoland …
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Insurance Intern
Guaranteed Rate — Chicago, IL
Guaranteed Rate is one of the ten largest retail mortgage lenders in the U.S. The company has become The Home Purchase Experts® by offering industry-leading self-service tools and low rate, low fee mo…
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5 Stocks That Insiders Love Right Now
In the printing services complex, insiders are loading up on a large amount of stock in VistaPrint (VPRT), which operates as an online provider of marketing products and services to micro businesses worldwide. Insiders are buying into some solid strength here since the stock is up over 20% so far in 2012.
VistaPrint has a market cap of $1.37 billion and an enterprise value of $1.41 billion. This stock trades at a reasonable valuation, with a trailing price-to-earnings of 20.32 and a forward price-to-earnings of 18.15. Its estimated growth rate for this year is -23%, and for next year it's pegged at 15.3%. This is not a cash-rich company, since the total cash position on its balance sheet is $67.47 million and its total debt is $146.50 million. After you back out the cash, VistaPrint has $79.03 million in debt on its books.A beneficial owner just bought 100,000 shares, or around $3.95 million worth of stock, at $38.67 per share. From a technical perspective, VPRT is currently trading below its 50-day moving average and above its 200-day moving average, which is neutral trendwise. This stock has been struggling during the past two months whenever it's traded above $40 a share. Each time it's traded over $40 the stock has run into sellers, and it's now started to make lower highs. Lower highs are a bearish technical pattern and it shows that sellers are dumping the stock into any strength. If you're bullish on VPRT, I would only look for long-biased trades once this stock breaks out above $38.05 and its 50-day moving average of $39.20 a share with high-volume. Look for volume on a move above those levels that hits near or well above its three-month average action of 513,258 shares. If we get that action soon, look for VPRT to run back into the $40s.I would only look for an extended up move if $41.92 was taken out with volume. Traders should avoid this stock entirely from the long side if VPRT drops back below its near-term support at $35.88 and then back below its 200-day moving average of $34.29 with volume. A high-volume move below those levels could set this stock up for some serious downside. To see more stocks with notable insider buying, including Great Wolf Resorts (WOLF), Opko Health (OPK) and Sunrise Senior Living (SRZ), check out the Stocks With Big Insider Buying portfolio on Stockpickr. -- Written by Roberto Pedone in Winderemere, Fla.
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IdeaBlob is the name of a monthly contest put together by a group of small business owners and entrepreneurs. Contestants submit business ideas, and the ideas with the most votes win $10,000 in cash to start up their venture. Incidentally, it's a great place to browse through some cool green ideas.
Take Seven Rivers, for example, one of the ideas up for this month's prize. Seven Rivers (subtitle: "Water without the waste") is a plan to provide clean, cheap, filtered water to people who don't have clean tap water to drink, or people who don't like tap water, and would otherwise buy bottled. They want to build a "water vending machine" – essentially a large water filter which will dispense clean, fresh drinking water for a small price.
They envision their customers using eco-friendly, reusable cups, as well. If people started using a system like Seven Rivers instead of generic cialis mexico buying bottled water, lots of good things would happen. We would cut down on waste, because less plastic bottles would be thrown out. We'd help reduce our consumption of petroproducts. And we'd save all the energy that goes into shipping water all over the 5 mg viagra world.
Other green ideas on levitra doses IdeaBlob include local food programs for schools, green design competitions and green education for coffee growers.
written by Tal, March 27, 2009
I encourage anyone who is also a fan of reducing waste to vote for Seven Rivers on IdeaBlob and help them secure the funding to widen their impact.
it takes 2 minutes and you could directly create jobs for engineering students
written by MD, March 27, 2009
written by Devin Griffin, March 27, 2009
As university students, we so often see people toting around reusable bottles by Sigg or Nalgene. It just so happens that these same people frequently complain that they don't like refilling at water fountains because they're dirty or unreliable. So, we thought that it would make sense to provide an option that is generic cialis india akin to giving consumers a Brita filter-like experience when they're away from the home or office by providing a single-serve purified water vending machine. Hope this clarifies things!
written by Tristan, March 27, 2009
Thanks, I was really confused, and I hope you have good luck, and then go out of business.
As a graduate student who carries around a water that I refill with campus water all the time, I see the need. By I'm always asking my self WHY doesn't the university just make their water not suck. I mean if your going to http://www.enshift.com/cheap-levitra-uk provide water fountains that cool the water for you, can't they just add a filter also!!!
written by Pau, March 28, 2009
written by Rajiv Malholtra, March 28, 2009
written by water_geek, March 29, 2009
written by net97surferx, March 30, 2009
Around town were moderate sized kiosks which did reverse osmosis, charcoal filtering and ultraviolet exposure for treating water and dispensing to bottles one would bring. They took coins or dollars and put out from pints to buy 100mg tramadol online gallons so you could choose how little or much you needed.
Would not be a huge leap to mod them to dispense 'one shot bottle' sized units also.
Can see how this might be a 'smaller' unit for office or mall use for those who are constantly guzzling from their plastic bottles though.
written by Alex Diaz, March 30, 2009
We have combined water, super chilling technology and ice.
Alex Diaz
Founder and Director of Research
written by Gary Kolesar, March 04, 2010
written by Bill Jones, July 15, 2010
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Yaskawa America, Inc.
Motoman Robotics Division
Please visit: Yaskawa America, Inc.
Mailing Address:
100 Automation Way
Miamisburg, OH 45342 US
Motoman Inc. and Yaskawa Electric America, Inc. Combine to Form Yaskawa America, Inc.
Motoman Inc. and Yaskawa Electric America, Inc. Combine to Form Yaskawa America, Inc.
PerfectEdge™ is a complete, full robotic solution meets the challenges of tight tolerance chamfering, deburring and finishing processes, while offering a non-touch method of programming via menu-driven material removal software. Designed in collaboration with Arrow Gear, it includes a six-axis Motoman® DX1350D industrial robot and a precision indexer with hollow chuck controlled by a Yaskawa Sigma-5 servo motor for fixturing shafted gears.
The cell has an eight-slot protected tool holder and an Alfred Jaeger spindle. PerfectEdge has the capacity to process 20 inch diameter by 10 inch cylindrical parts. Designed on a common base with fork pockets, PerfectEdge can easily be deployed or relocated.
The PerfectEdge cell features a polycarbonate and aluminum full safety enclosure with electrically interlocked access doors. A particle and fume extraction system is included, making PerfectEdge easy to connect to an air handling system. Repetitive stress injuries and operator fatigue are eliminated, reducing scrap rates and improving safety.
Motoman's slim, dual-arm SDA-series robots are strong, quick and agile. They provide "human-like" flexibility with 15 axes of motion (7 axes per arm, plus a single axis for base rotation). Powerful actuator-based design and best-in-class wrist characteristics make the SDA-series robots suited for a variety of assembly, part transfer, machine tending, packaging and other handling tasks that formerly could only be done by people. Both robot arms can work together on one task to double the payload or handle heavy, unwieldy parts. The ability to use dual independent arms to process parts reduces the need for expensive custom fixturing and allows end-of-arm tooling to be simple and less costly. These models are controlled by the new, next-generation DX100 robot and system-level controller. Models: SDA5D, SDA10D, SDA20D
Motoman's SIA-series robots feature a revolutionary actuator-based 7-axis design that enables freedom of movement and the ability to maneuver in tight areas. These robots are ideal for assembly, injection molding, inspection, machine tending and a host of other operations. Models: SIA5D, SIA10D, SIA20D, SIA50D
Motoman Robotics provides robots and complete robotic automation for virtually every application and industry. Our extensive product line includes more than 175 general-purpose and application-specific robot models, with payloads from 2-800 kg (4-1,764 lbs). Motoman Robotics' more than 15 families of fully integrated, pre-engineered "World" solutions include robots, process equipment and safety equipment. Motoman Robotics' modular "World" solutions provide tremendous flexibility while reducing cost and risk. Experienced engineers evaluate your project and provide the best "World" solution or custom system to meet your automation needs. Motoman Robotics is committed to providing world-class quality, innovation and the highest level of customer satisfaction in the automation industry. Founded in 1989, Motoman Robotics Division of Yaskawa America, Inc. has grown to become the second largest robotics company in the Americas with an installed base of over 30,000 units.


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SOURCE SecurityMetrics
SecurityMetrics HIPAA Snippets provides healthcare guidance in digestible bits
OREM, Utah, June 24, 2014 /PRNewswire/ -- To more easily decipher complicated Health Information Portability and Accountability Act (HIPAA) security requirements, SecurityMetrics produced the HIPAA Snippets series, a sequence of 60-second videos outlining best practices for healthcare practices to comply with technical HIPAA requirements. Tackling topics such as social media compliance and remote access, HIPAA Snippets covers complex subjects in ways office managers nationwide can understand.
Many small to mid-size healthcare organizations find it difficult to keep up with HIPAA compliance requirements. Often, the responsibility of risk management and compliance falls to overburdened office managers or physicians who lack security training.
"The HIPAA Snippets series is designed to teach data security in a manner that is as enjoyable as it is instructive," said SecurityMetrics VP of Business Operations, Russell Stay. "Our goal is to painlessly deliver compliance and peace of mind. Devoting as little as 10 minutes each week to privacy and security rules can create demonstrable progress towards HIPAA compliance."
SecurityMetrics distinguishes itself from other HIPAA compliance vendors by liberating the administrator of complex data security responsibilities, explaining technical requirements in simple terms, and allowing them to spend more time on the important healthcare duties in which they were trained to excel.
To watch HIPAA Snippets, visit www.youtube.com/securitymetricsinc.
To learn more about SecurityMetrics Guided HIPAA Compliance, contact 801.995.6801, email firstname.lastname@example.com or visit www.securitymetrics.com/hipaa
About SecurityMetrics (www.securitymetrics.com)
SecurityMetrics is a global leader in data security that enables businesses of all sizes to comply with government, healthcare, and financial mandates. Since it's founding date, the company has helped over 1 million organizations worldwide protect their network infrastructure and data communications from compromise. Among other services, SecurityMetrics offers HIPAA compliance services, penetration testing, security consulting, mobile device vulnerability scanning, payment data discovery, and incident response. Founded in October 2000, SecurityMetrics is a privately held corporation headquartered in Orem, Utah. For more information visit www.securitymetrics.com.
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2nd Quarter US GDP Report (Revision)
According to the Bureau of Economic Analysis, US gross domestic product – the output of goods and services produced by labor and property located in the United States – accelerated at a pace almost double of what was previously reported. In the latest quarter, GDP stood at 3.3%, upwardly revised from a 1.9% annualized pace. The .. read more
FOMC Minutes
The Federal Reserve Board and the Federal Open Market Committee on Tuesday released the minutes of the Committee meeting held on August 5, 2008. Here is an excerpt: The information reviewed at the August meeting indicated that the economy expanded at a moderate pace in the second quarter, but recent financial market developments highlighted some of .. read more
The Worst Tax
Richard Rahn has an article posted at the Cato Institute about the corporate income tax: Rank the following taxes from best to worst: individual income taxes; payroll taxes, corporate income taxes, sales or consumption taxes, and residential property taxes. The vast majority of economists would rank the corporate income tax as being worst and the .. read more
The Root of the Housing Problem
Amity Shlaes has an article at Bloomberg that takes a different view of the housing problem: Aug. 20 (Bloomberg) — Everything will be all right if we just fix the housing problem. That was the hope investors clung to as they watched Fannie Mae and Freddie Mac crumble this week. The presidential campaigns reflect a .. read more
August Market Report – Commodity Bull Gore?
Is the commodity bull market over? After a recent decline of more than 23% in the Goldman Sachs Commodity Index, that question is on the minds of many investors, like us, who have benefited from higher commodity prices. Oil is down from $147 to about $114 in the last month, natural gas down 40%, corn .. read more
How to Kill a Recovery
Amity Shlaes, author of The Forgotten Man: A New History of the Great Depression, lays out the non monetary mistakes made that turned the Crash of '29 into the Great Depression. They sound a lot like Obama's economic platform: Giving in to protectionism – In Herbert Hoover's time, Sen. Reed Smoot and Rep. W.C. Hawley .. read more
A Strong Dollar will Reduce Oil Prices
I have a new article up at RealClearMarkets.com: In less than one month, oil prices have fallen nearly 22%. That drop happened during a period when our leaders in Washington accomplished exactly nothing of importance that could account for the fall. Sure, President Bush lifted the moratorium on offshore drilling, but that action will have .. read more
Retail Sales
Retail sales, which account for about one-third of gross domestic product, have weakened further in July, as most of the tax rebate checks have been distributed and used. Retail sales dropped 0.1% in July, slightly ahead of expectations. Excluding a 2.4% decline in automobile purchases, sales were up 0.4%, the slowest since February. Excluding gas .. read more


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Copyright Act of 1976
The Copyright Revision Act of 1976 (Public Law 94-553, revising the Copyright Law of the United States, Title 17, U.S. Code, effective January 1, 1978) significantly revised the copyright rules in effect in the U.S. since 1909. The provisions of this law became effective on January 1, 1978, and are codified as Title 17, U.S. Code. Hereinafter the law will be referred to as Title 17. The 1978 law was amended in 1980 to include computer software under the category of literary works (Title 17, Sect. 102) and permit certain modifications of computer software (Title 17, Sect. 117). In October 1998 Congress passed the Bono Copyright Extension Term Act to extend the term of protection for copyrighted works.
Particularly pertinent to libraries are Section 107: Limitations on exclusive rights: Fair use; Section 108: Limitations on exclusive rights: Reproduction by libraries and archives and Section 117: Scope of exclusive rights: Use in conjunction with computers and similar information systems, and the guidelines prepared by the National Commission on New Technological Uses of Copyright Work (CONTU) on permissible copying for interlibrary loan purposes. These portions of the law and the guidelines will hereinafter be referred to as Title 17, Sect. 107; Title 17, Sect. 108; Title 17, Sect. 117; and CONTU guidelines.
Two other agreements pertaining to the provisions of the copyright law are of interest to the UCLA community: the Agreement on Guidelines for Classroom Copying in Not-For-Profit Educational Institutions and Guidelines for the Educational Uses of Music.
Duration of Copyright
Published and unpublished works created on or after January 1, 1978:
- Single authorship: Starting with the moment of creation, lasts for author's life plus 70 years.
- Joint authorship: Last surviving author's life plus 70 years.
- Works for hire and anonymous and pseudonymous works: 95 years from publication or 120 years from creation, whichever is shorter.
Generally, works created before January 1, 1978, are protected for 95 years. For more information on when copyrights expire consult the chart prepared by Professor Laura N. Gassaway, University of North Carolina.
Materials in the public domain (not eligible for copyright):
- Works published before 1923
- Federal government publications
- Facts
- Other works may be in the public domain, refer to the chart prepared by Professor Laura N. Gassaway, University of North Carolina.
Editions with several dates in the copyright notice:
- The later material may be protected.
- The earlier material may be in the public domain.
- Unless original and revisions are clearly distinguishable, all should be treated as validly copyrighted work.
Foreign copyrights:
Title 17, Sect. 104 specifies that foreign works are subject to protection of the U.S. Copyright Law under the following conditions:
Special note: Foreign copyright regulations are very complex and the duration of copyright can vary significantly. Some authorities advise that it is not safe to assume that a foreign work copyrighted in the last 200 years is in the public domain. Following are some general guidelines which may be of assistance.
Unpublished works are subject to protection without regard to the nationality or domicile of the author.
Published works are subject to protection if:
- on the date of first publication, one or more of the authors is a national or domiciliary, or under sovereign authority of a foreign nation that is a party to a copyright treaty to which the U.S. is a party;
- the work is first published in the U.S. or in a foreign nation that, on the date of first publication, is a party to the Universal Copyright Convention; or
- the work is first published by the United Nations or any of its specialized agencies, or by the Organization of American States; or
- the work is a Berne Convention work; or
- the work comes within scope of a Presidential proclamation.
Ownership of Copyright
Initial ownership of copyright generally belongs to the author who in turn has exclusive rights to the reproduction, preparation of derivative works, public distribution, public performance, and public display [Title 17, Sect. 106].
The author may transfer ownership of copyright to others, or may license others to use the work.
Exceptions to the exclusive rights granted to the copyright owner are granted in Title 17, Sect. 107-118#, 202.
Fair Use Factors
Factors which must be considered in determining whether fair use applies include:
- the purpose and character of the use, including whether such use is of a commercial nature or is for nonprofit educational purposes;
- the nature of the copyrighted work;
- the amount and substantiality of the portion used in relation to the copyrighted work as a whole; and
- the effect of the use upon the potential market for or value of the copyrighted work.