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Screening for Prostate Cancer
U.S. Preventive Services Task Force Recommendation Statement
Release Date: May 2012
The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific clinical preventive services for patients without related signs or symptoms.
It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.
The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.
This Recommendation Statement was first published in Annals of Internal Medicine (Ann Intern Med 2012;22 May). Select for copyright and source information.
ContentsSummary of Recommendation and Evidence
Clinical Considerations
Other Considerations
Response to Comments
Update of Previous Recommendation
Recommendations of Others
Members of the Task Force
|Task Force Ratings
Strength of Recommendations and Quality of Evidence
Summary of Recommendation and Evidence
The U.S. Preventive Services Task Force (USPSTF) recommends against prostate-specific antigen (PSA)-based screening for prostate cancer (D recommendation).
See Clinical Considerations section for a discussion about implementation of this recommendation.
Prostate cancer is the most commonly diagnosed non-skin cancer in men in the United States, with a lifetime risk for diagnosis currently estimated at 15.9%. Most cases of prostate cancer have a good prognosis, even without treatment, but some are aggressive; the lifetime risk of dying of prostate cancer is 2.8%. Prostate cancer is rare before age 50 years and very few men die of prostate cancer before age 60 years. Seventy percent of deaths due to prostate cancer occur after age 75 years (1).
Contemporary recommendations for prostate cancer screening all incorporate the measurement of serum PSA levels; other methods of detection, such as digital rectal examination or ultrasonography, may be included. There is convincing evidence that PSA-based screening programs result in the detection of many cases of asymptomatic prostate cancer. There is also convincing evidence that a substantial percentage of men who have asymptomatic cancer detected by PSA screening have a tumor that either will not progress or will progress so slowly that it would have remained asymptomatic for the man's lifetime. The terms "overdiagnosis" or "pseudo-disease" are used to describe both situations. The rate of overdiagnosis of prostate cancer increases as the number of men subjected to biopsy increases. The number of cancer cases that could be detected in a screened population is large; a single study in which men eligible for PSA screening had biopsy regardless of PSA level detected cancer in nearly 25% of men (2). The rate of overdiagnosis also depends on life expectancy at the time of diagnosis. A cancer diagnosis in men with shorter life expectancies because of chronic diseases or age is much more likely to be overdiagnosis. The precise magnitude of overdiagnosis associated with any screening and treatment program is difficult to determine, but estimates from the 2 largest trials suggest overdiagnosis rates of 17% to 50% for prostate cancer screening (3).
Benefits of Detection and Early Treatment
The primary goal of prostate cancer screening is to reduce deaths due to prostate cancer and, thus, increase length of life. An additional important outcome would be a reduction in the development of symptomatic metastatic disease. Reduction in prostate cancer mortality was the primary outcome used in available randomized, controlled trials of prostate cancer screening. Although 1 screening trial reported on the presence of metastatic disease at the time of prostate cancer diagnosis, no study reported on the effect of screening on the development of subsequent metastatic disease, making it difficult to assess the effect of lead-time bias on the reported rates.
Men with screen-detected cancer can potentially fall into 1 of 3 categories: those whose cancer will result in death despite early diagnosis and treatment, those who will have good outcomes in the absence of screening, and those for whom early diagnosis and treatment improves survival. Only randomized trials of screening allow an accurate estimate of the number of men who fall into the latter category. There is convincing evidence that the number of men who avoid dying of prostate cancer because of screening after 10 to 14 years is, at best, very small. Two major trials of PSA screening were considered by the USPSTF: the U.S. PLCO (Prostate, Lung, Colorectal, and Ovarian) Cancer Screening Trial and the ERSPC (European Randomized Study of Screening for Prostate Cancer). The U.S. trial did not demonstrate any prostate cancer mortality reduction. The European trial found a reduction in prostate cancer deaths of approximately 1 death per 1000 men screened in a subgroup of men aged 55 to 69 years. This result was heavily influenced by the results of 2 countries; 5 of the 7 countries reporting results did not find a statistically significant reduction. All-cause mortality in the European trial was nearly identical in the screened and nonscreened groups.
There is adequate evidence that the benefit of PSA screening and early treatment ranges from 0 to 1 prostate cancer deaths avoided per 1000 men screened.
Harms of Detection and Early Treatment
Harms Related to Screening and Diagnostic Procedures
Convincing evidence demonstrates that the PSA test often produces false-positive results (approximately 80% of positive PSA test results are false-positive when cutoffs between 2.5 and 4.0 μg/L are used) (4). There is adequate evidence that false-positive PSA test results are associated with negative psychological effects, including persistent worry about prostate cancer. Men who have a false-positive test result are more likely to have additional testing, including 1 or more biopsies, in the following year than those who have a negative test result (5). Over 10 years, approximately 15% to 20% of men will have a PSA test result that triggers a biopsy, depending on the PSA threshold and testing interval used (4). New evidence from a randomized trial of treatment of screen-detected cancer indicates that roughly one third of men who have prostate biopsy experience pain, fever, bleeding, infection, transient urinary difficulties, or other issues requiring clinician follow-up that the men consider a "moderate or major problem"; approximately 1% require hospitalization (6).
The USPSTF considered the magnitude of these harms associated with screening and diagnostic procedures to be at least small.
Harms Related to Treatment of Screen-Detected Cancer
Adequate evidence shows that nearly 90% of men with PSA-detected prostate cancer in the United States have early treatment with surgery, radiation, or androgen deprivation therapy (7, 8). Adequate evidence shows that up to 5 in 1000 men will die within 1 month of prostate cancer surgery and between 10 and 70 men will have serious complications but survive. Radiotherapy and surgery result in long-term adverse effects, including urinary incontinence and erectile dysfunction in at least 200 to 300 of 1000 men treated with these therapies. Radiotherapy is also associated with bowel dysfunction (9, 10).
Some clinicians have used androgen deprivation therapy as primary therapy for early-stage prostate cancer, particularly in older men, although this is not a U.S. Food and Drug Administration (FDA)–approved indication and it has not been shown to improve survival in localized prostate cancer. Adequate evidence shows that androgen deprivation therapy for localized prostate cancer is associated with erectile dysfunction (in approximately 400 of 1000 men treated), as well as gynecomastia and hot flashes (9, 10).
There is convincing evidence that PSA-based screening leads to substantial overdiagnosis of prostate tumors. The amount of overdiagnosis of prostate cancer is of important concern because a man with cancer that would remain asymptomatic for the remainder of his life cannot benefit from screening or treatment. There is a high propensity for physicians and patients to elect to treat most cases of screen-detected cancer, given our current inability to distinguish tumors that will remain indolent from those destined to be lethal (7, 11). Thus, many men are being subjected to the harms of treatment of prostate cancer that will never become symptomatic. Even for men whose screen-detected cancer would otherwise have been later identified without screening, most experience the same outcome and are, therefore, subjected to the harms of treatment for a much longer period of time (12, 13). There is convincing evidence that PSA-based screening for prostate cancer results in considerable overtreatment and its associated harms.
The USPSTF considered the magnitude of these treatment-associated harms to be at least moderate.
USPSTF Assessment
Although the precise, long-term effect of PSA screening on prostate cancer–specific mortality remains uncertain, existing studies adequately demonstrate that the reduction in prostate cancer mortality after 10 to 14 years is, at most, very small, even for men in what seems to be the optimal age range of 55 to 69 years. There is no apparent reduction in all-cause mortality. In contrast, the harms associated with the diagnosis and treatment of screen-detected cancer are common, occur early, often persist, and include a small but real risk for premature death. Many more men in a screened population will experience the harms of screening and treatment of screen-detected disease than will experience the benefit. The inevitability of overdiagnosis and overtreatment of prostate cancer as a result of screening means that many men will experience the adverse effects of diagnosis and treatment of a disease that would have remained asymptomatic throughout their lives. Assessing the balance of benefits and harms requires weighing a moderate to high probability of early and persistent harm from treatment against the very low probability of preventing a death from prostate cancer in the long term.
The USPSTF concludes that there is moderate certainty that the benefits of PSA-based screening for prostate cancer do not outweigh the harms.
Clinical Considerations
Although the USPSTF discourages the use of screening tests for which the benefits do not outweigh the harms in the target population, it recognizes the common use of PSA screening in practice today and understands that some men will continue to request screening and some physicians will continue to offer it. The decision to initiate or continue PSA screening should reflect an explicit understanding of the possible benefits and harms and respect patients' preferences. Physicians should not offer or order PSA screening unless they are prepared to engage in shared decision making that enables an informed choice by patients. Similarly, patients requesting PSA screening should be provided with the opportunity to make informed choices to be screened that reflect their values about specific benefits and harms. Community- and employer-based screening should be discontinued. The Table presents reasonable estimates of the likely outcomes of screening, given the current approach to screening and treatment of screen-detected prostate cancer in the United States.
The treatment of some cases of clinically localized prostate cancer can change the natural history of the disease and may reduce morbidity and mortality in a small percentage of men, although the prognosis for clinically localized cancer is generally good regardless of the method of detection, even in the absence of treatment. The primary goal of PSA-based screening is to find men for whom treatment would reduce morbidity and mortality. Studies demonstrate that the number of men who experience this benefit is, at most, very small, and PSA-based screening as currently implemented in the United States produces more harms than benefits in the screened population. It is not known whether an alternative approach to screening and management of screen-detected disease could achieve the same or greater benefits while reducing the harms. Focusing screening on men at increased risk for prostate cancer mortality may improve the balance of benefits and harms, but existing studies do not allow conclusions about a greater absolute or relative benefit from screening in these populations. Lengthening the interval between screening tests may reduce harms without affecting cancer mortality; the only screening trial that demonstrated a prostate cancer–specific mortality benefit generally used a 2- to 4-year screening interval (15). Other potential ways to reduce diagnostic- and treatment-related harms include increasing the PSA threshold used to trigger the decision for biopsy or need for treatment (12, 16), or reducing the number of men having active treatment at the time of diagnosis through watchful waiting or active surveillance (11). Periodic digital rectal examinations could also be an alternative strategy worthy of further study. In the only randomized trial demonstrating a mortality reduction from radical prostatectomy for clinically localized cancer, a high percentage of men had palpable cancer (17). All of these approaches require additional research to better elucidate their merits and pitfalls and more clearly define an approach to the diagnosis and management of prostate cancer that optimizes the benefits while minimizing the harms.
Patient Population Under Consideration
This recommendation applies to men in the general U.S. population. Older age is the strongest risk factor for the development of prostate cancer. However, neither screening nor treatment trials show benefit in men older than 70 years. Across age ranges, black men and men with a family history of prostate cancer have an increased risk of developing and dying of prostate cancer. Black men are approximately twice as likely to die of prostate cancer than other men in the United States (1), and the reason for this disparity is unknown. Black men represented a small minority of participants in the randomized clinical trials of screening (4% of enrolled men in the PLCO trial were non-Hispanic black; although the ERSPC and other trials did not report the specific racial demographic characteristics of participants, they likely were predominately white). Thus, no firm conclusions can be made about the balance of benefits and harms of PSA-based screening in this population. However, it is problematic to selectively recommend PSA-based screening for black men in the absence of data that support a more favorable balance of risks and benefits. A higher incidence of cancer will result in more diagnoses and treatments, but the increase may not be accompanied by a larger absolute reduction in mortality. Preliminary results from PIVOT (Prostate Cancer Intervention Versus Observation Trial), in which 30% of enrollees were black, have become available since the publication of the USPSTF's commissioned evidence reviews. Investigators found no difference in outcomes due to treatment of prostate cancer in black men compared with white men (12).
Exposure to Agent Orange (a defoliant used in the Vietnam War) is considered to be a risk factor for prostate cancer, although few data exist on the outcomes or effect of PSA testing and treatment in these persons. Prostate cancer in Vietnam veterans who were exposed to Agent Orange is considered a service-connected condition by the Veterans Health Administration. The USPSTF did not evaluate the use of the PSA test as part of a diagnostic strategy in men with symptoms potentially suggestive of prostate cancer. However, the presence of urinary symptoms was not an inclusion or exclusion criterion in screening or treatment trials, and approximately one quarter of men in screening trials had bothersome lower urinary tract symptoms (nocturia, urgency, frequency, and poor stream). The presence of benign prostatic hyperplasia is not an established risk factor for prostate cancer, and the risk for prostate cancer among men with elevated PSA levels is lower in men with urinary symptoms than in men without symptoms (18). This recommendation also does not include the use of the PSA test for surveillance after diagnosis or treatment of prostate cancer and does not consider PSA-based testing in men with known BRCA gene mutations who may be at increased risk for prostate cancer.
Screening Tests
Prostate-specific antigen–based screening in men aged 50 to 74 years has been evaluated in 5 unique randomized, controlled trials of single or interval PSA testing with various PSA cutoffs and screening intervals, along with other screening methods, such as digital rectal examination or transrectal ultrasonography (4, 19-22). Screening tests or programs that do not incorporate PSA testing, including digital rectal examination alone, have not been adequately evaluated in controlled studies.
The PLCO trial found a nonstatistically significant increase in prostate cancer mortality in the annual screening group at 11.5 and 13 years, with results consistently favoring the usual care group (19, 23).
A prespecified subgroup analysis of men aged 55 to 69 years in the ERSPC trial demonstrated a prostate cancer mortality rate ratio (RR) of 0.80 (95% CI, 0.65 to 0.98) in screened men after a median follow-up of 9 years, with similar findings at 11 years (RR, 0.79 [CI, 0.68 to 0.91]) (4, 15). Of the 7 centers included in the ERSPC analysis, only 2 countries (Sweden and the Netherlands) reported statistically significant reductions in prostate cancer mortality after 11 years (5 did not), and these results seem to drive the overall benefit found in this trial (Figure) (15). No study reported any factors, including patient age, adherence to site or study protocol, length of follow-up, PSA thresholds, or intervals between tests, that could clearly explain why mortality reductions were larger in Sweden or the Netherlands than in other European countries or the United States (PLCO trial). Combining the results through meta-analysis may be inappropriate due to clinical and methodological differences across trials.
No study found a difference in overall or all-cause mortality. This probably reflects the high rates of competing mortality in this age group, because these men are more likely to die of prostate cancer, as well as the limited power of prostate cancer screening trials to detect differences in all-cause mortality, should they exist. Even in the "core" age group of 55 to 69 years in the ERSPC trial, only 462 of 17,256 deaths were due to prostate cancer. The all-cause mortality RR was 1.00 (CI, 0.98 to 1.02) in all men randomly assigned to screening versus no screening. Results were similar in men aged 55 to 69 years (15). The absence of any trend toward a reduction in all-cause mortality is particularly important in the context of the difficulty of attributing death to a specific cause in this age group.
Primary management strategies for PSA-detected prostate cancer include watchful waiting (observation and physical examination, with palliative treatment of symptoms), active surveillance (periodic monitoring with PSA tests, physical examinations, and repeated prostate biopsy) with conversion to potentially curative treatment at the sign of disease progression or worsening prognosis, and surgery or radiation therapy (24). There is no consensus about the optimal treatment of localized disease. From 1986 through 2005, PSA-based screening likely resulted in approximately 1 million additional U.S. men being treated with surgery, radiation therapy, or both compared with the time before the test was introduced (7).
At the time of the USPSTF's commissioned evidence review, only 1 recent randomized, controlled trial of surgical treatment versus observation for clinically localized prostate cancer was available (13). In the Scandinavian Prostate Cancer Group Study 4 trial, surgical management of localized, primarily clinically-detected prostate cancer was associated with an approximate 6% absolute reduction in prostate cancer and all-cause mortality at 12 to 15 years of follow-up; benefit seemed to be limited to men younger than 65 years (13). Subsequently, preliminary results were reported from another randomized trial that compared external beam radiotherapy (EBRT) with watchful waiting in 214 men with localized prostate cancer detected before initiation of PSA screening. At 20 years, survival did not differ between men randomly assigned to watchful waiting or EBRT (31% vs. 35%; P = 0.26). Prostate cancer mortality at 15 years was high in each group but did not differ between groups (23% vs. 19%; P = 0.51). External beam radiotherapy did reduce distant progression and recurrence-free survival (25). In men with localized prostate cancer detected in the early PSA screening era, preliminary findings from PIVOT show that, after 12 years, intention to treat with radical prostatectomy did not reduce disease-specific or all-cause mortality compared with observation; absolute differences were less than 3% and not statistically different (12). An ongoing trial in the United Kingdom (ProtecT [Prostate Testing for Cancer and Treatment]) comparing radical prostatectomy with EBRT or active surveillance has enrolled nearly 2000 men with PSA-detected prostate cancer. Results are expected in 2015 (26).
Up to 0.5% of men will die within 30 days of having radical prostatectomy, and 3% to 7% will have serious surgical complications. Compared with men who choose watchful waiting, an additional 20% to 30% or more of men treated with radical prostatectomy will experience erectile dysfunction, urinary incontinence, or both after 1 to 10 years. Radiation therapy is also associated with increases in erectile, bowel, and bladder dysfunction (9, 10).
Other Considerations
Research Needs and Gaps
Because the balance of benefits and harms of prostate cancer screening is heavily influenced by overdiagnosis and overtreatment, research is needed to identify ways to reduce the occurrence of these events, including evaluating the effect of altering PSA thresholds for an abnormal test or biopsy result on false-positive rates and the detection of indolent disease.
Similarly, research is urgently needed to identify new screening methods that can distinguish nonprogressive or slowly progressive disease from disease that is likely to affect the quality or length of life, because this would reduce the number of men who require biopsy and subsequent treatment of disease that has a favorable prognosis without intervention. Additional research is also needed to evaluate the benefits and harms of modifications of the use of existing prostate cancer screening tools. Research is needed to assess the effect of using higher PSA thresholds to trigger a diagnostic prostate biopsy, extending intervals between testing, and the role of periodic digital rectal examinations by trained clinicians. Although not well-studied, these strategies may reduce overdiagnosis and overtreatment, and evidence suggests that they may be associated with decreased mortality. Research is also needed to compare the long-term benefits and harms of immediate treatment versus observation with delayed intervention or active surveillance in men with screen-detected prostate cancer. Two randomized, controlled trials, PIVOT (27) and the ProtecT trial (28), are studying this issue. Preliminary results from PIVOT potentially support increasing the PSA threshold for recommending a biopsy or curative treatments in men subsequently diagnosed with prostate cancer.
Additional research is needed to determine whether the balance of benefits and harms of prostate cancer screening differs in men at higher risk of developing or dying of prostate cancer, including black men and those with a family history of the disease.
Accurately ascertaining cause of death in older persons can be problematic; as such, basing clinical recommendations on disease-specific mortality in the absence of an effect on all-cause mortality may not completely capture the health effect and goals of a screening and treatment program. Additional research is required to better assess and improve the reliability of prostate cancer mortality as a valid outcome measure in clinical trials, as well as the best application of the concomitant use of all-cause mortality.
Two large randomized, controlled trials of 5α-reductase inhibitors (finasteride and dutasteride) have shown that these drugs reduce the risk for prostate cancer in men receiving regular PSA tests. However, the observed reduction resulted from a decreased incidence of low-grade prostate cancer alone (Gleason score ≤6).The FDA has not approved finasteride and dutasteride for the prevention of prostate cancer, concluding that the drugs do not possess a favorable risk–benefit profile for this indication. The FDA cited associated adverse effects, including loss of libido and erectile dysfunction, but most important, it noted that there was an absolute increase in the incidence of high-grade prostate cancer in men randomly assigned to finasteride or dutasteride compared with control participants in both trials (29). Additional research would be useful to better understand whether these drugs are associated with the development of high-grade prostatic lesions, determine the effect of 5α-reductase inhibitors (or other potential preventive agents) on prostate cancer mortality, and identify the population of men that may benefit most from prostate cancer prevention (with these or other chemoprevention strategies).
Research is needed to better understand patient and provider knowledge and values about the known risks and benefits of prostate cancer screening and treatment, as well as to develop and implement effective informed decision-making materials that accurately convey the best evidence and can be instituted in primary care settings across varied patient groups (for example, by race, age, or family history).
Response to Public Comments
A draft version of this recommendation statement was posted for public comment on the USPSTF Web site from 11 October to 13 December 2011. Commenters expressed concern that a grade D recommendation from the USPSTF would preclude the opportunity for discussion between men and their personal health care providers, interfere with the clinician–patient relationship, and prevent men from being able to make their own decisions about whether to be screened for prostate cancer. Some commenters asked that the USPSTF change its recommendation to a grade C to allow men to continue to make informed decisions about screening. Recommendations from the USPSTF are chosen on the basis of the risk–benefit ratio of the intervention: a grade D recommendation means that the USPSTF has concluded that there is at least moderate certainty that the harms of doing the intervention equal or outweigh the benefits in the target population, whereas a grade C recommendation means that the USPSTF has concluded that there is at least moderate certainty that the overall net benefit of the service is small. The USPSTF could not assign a grade C recommendation for PSA screening because it did not conclude that the benefits outweigh the harms. In the Clinical Considerations section, the USPSTF has clarified that a D recommendation does not preclude discussions between clinicians and patients to promote informed decision making that supports personal values and preferences.
Some commenters requested that the USPSTF provide more information about the consequences of avoiding PSA screening. A summary of the benefits and harms of screening can be found in the Table. In summary, the USPSTF concluded that choosing not to have PSA testing will result in a patient living a similar length of life, with little to no difference in prostate cancer–specific mortality, while avoiding harms associated with PSA testing and subsequent diagnostic procedures and treatments.
Commenters were concerned that the USPSTF did not adequately consider a separate recommendation for black men. Additional information about this population can be found in the Patient Population Under Consideration section.
Many commenters mistakenly believed that the USPSTF either relied solely on the PLCO trial or published meta-analyses or did its own meta-analysis to reach its conclusions about the efficacy of PSA-based screening. Although the commissioned systematic evidence review summarized the findings of 2 previously published meta-analyses, because they met the minimum inclusion requirements for the report, neither the authors of that review nor the USPSTF did a new meta-analysis. The USPSTF is aware of the heterogeneity in the available randomized trials of prostate cancer screening and the limitations of meta-analysis in this situation. Both the ERSPC and PLCO trials were heavily weighted by the USPSTF in its considerations, because they had the largest populations and were of the highest quality, although both had important—but different—methodological limitations. The screening intervals, PSA thresholds, use of digital rectal examinations, enrollee characteristics, and follow-up diagnostic and treatment strategies used in the PLCO trial are most applicable to current U.S. settings and practice patterns.
Commenters asked the USPSTF to consider evidence from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, showing that prostate cancer mortality decreased by 40% in the United States between 1992 and 2007 (30). Many suggested that the decline must be attributable to the effect of screening, because PSA-based screening was introduced in the United States in the early 1990s and became widespread by the mid-1990s to late 1990s. The challenge of ecologic data is that it is impossible to reliably separate out the relative effects of any changes in screening, diagnosis, or treatment practices (or fundamental changes in the underlying risk of developing or dying of the disease in the population due to a multiplicity of other causes) that may have been occurring simultaneously over a given time period. All of these, including screening, may have played some role in the decline seen in mortality; however, only a randomized trial can determine with confidence the magnitude of effect that can be attributable to a given intervention. According to the SEER database, in the 1970s and 1980s, before the introduction of widespread PSA screening, prostate cancer mortality rates started at 29.9 cases per 100,000 men and showed a slow but constant increase over time. The reason for this increase is unknown. Mortality from prostate cancer peaked between 1991 and 1993—roughly the same time when PSA tests became a common clinical practice—at 39.3 cases per 100,000 men, and began to decline by approximately 1 to 2 cases per 100,000 men per year after this point (2007 rate, 24.0 cases per 100,000 men). Information from randomized trials suggests that any potential mortality benefit from screening will not occur for 7 to 10 years. As such, it would be very unlikely that any decline in mortality rates from 1990 to 2000 would be related to screening.
Some commenters believed that the USPSTF should have considered a reduction in morbidity due to prostate cancer as an outcome, not just mortality. The rate of metastatic disease should roughly parallel the rate of deaths; if a large difference in metastatic disease was present between the intervention and control groups of the ERSPC and PLCO trials at 11 and 13 years of follow-up, a larger effect on the reduction in mortality would have been expected. Although the USPSTF agrees that a demonstrated effect of PSA-based screening on long-term quality of life or functional status would be an important outcome to consider, insufficient data are available from screening trials to draw such a conclusion. The ERSPC trial provides information about the incidence of metastatic disease only at the time of diagnosis, rather than longitudinal follow-up for the development of such disease in screened versus unscreened populations. Data on quality of life are available from randomized treatment trials of early-stage prostate cancer and suggest that treatment with observation or watchful waiting provides similar long-term quality of life as early intervention, with marked reduction in treatment-related adverse effects (31, 32).
Many commenters asked the USPSTF to review a publication reporting that the efficacy of PSA-based screening in the PLCO trial was affected by comorbidity status (33); they believed that this provided evidence that PSA-based screening could be recommended for very healthy men. In the article, Crawford and colleagues (33) reported that the hazard ratio for death in men without comorbid conditions in the annual screening versus the usual care group was 0.56 (CI, 0.33 to 0.95). However, the PLCO investigators later reported, as part of their extended follow-up of the trial, that this finding was sensitive to the definition of comorbidity used (23). Crawford and colleagues chose an expanded definition of comorbidity that included both "standard" Charlson comorbidity index conditions and hypertension (even if it was well-controlled), diverticulosis, gallbladder disease, and obesity. When the analysis was repeated by using only validated measures of comorbidity (that is, Charlson comorbidity index conditions only), an interaction was no longer seen. Several researchers (including PLCO investigators) have questioned the biological plausibility of this finding by Crawford and colleagues, noting, among other reasons, that the positive interaction seems to be largely driven by the inclusion of hypertension and obesity, conditions that seem to convey minimal excess treatment risks or differences in treatment options. These researchers also note that although Crawford and colleagues initially argue that comorbid conditions lessen the effectiveness of treatment (thus causing screening to be ineffective in less healthy men), participants in the usual care group with a greater degree of comorbidity actually had a statistically significant lower risk of dying of prostate cancer than healthier men (23, 34). Preliminary results from PIVOT also found that the effect of radical prostatectomy compared with observation did not vary by comorbidity or health status (12).
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Sheyna & Fashionhogger
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There are some spectacular designs, see for yourself here.
2 Comments | | in toronto | tagged Bead, Bluefly, Business and Economy, City Girl, Coupon, DIY jewelry, DIY necklaces, Fashion week, Florida, Handcrafted, India, Jewellery | Posted on Wednesday, September 21, 2011 at 5:32PM

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Human Resource Management
|John H. Jackson, Robert L. Mathis
|Publish Date:
|August 19, 2010
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Title: Human Resource Management
Book DescriptionTrust the authoritative resource for human resource management to offer the most current look at HR and its impact on today's organizations with both new and thoroughly updated cases and today's most recent examples--90 percent of which are from 2006 and beyond. Mathis/Jackson's HUMAN RESOURCE MANAGEMENT, Thirteenth Edition, is the most trusted resource and best-selling HR solution for preparing future or currently practicing HR professionals. Updated, strong academic coverage, including the latest 2009 HRCI outline, ensures this edition addresses all major topics for professional examinations (PHR, SPHR) given by the Human Resource Certification Institute (SHRM). The latest HR research and a wealth of new and proven learning features in every chapter demonstrate how HR impacts organizational strategy. Reorganized and streamlined topics examine emerging trends in technology, globalization, and HR Metrics, as well as other developments impacting the practice of HR today. A complete package of teaching and learning resources, including new CourseMate online learning tools, helps today's aspiring professionals prepare for career and future HR success.
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Book Details Summary: The title of this book is Human Resource Management and it was written by John H. Jackson, Robert L. Mathis. This particular 13th edition is in a Hardcover format. This books publish date is August 19, 2010 and it has a suggested retail price of $288.95. It was published by South-Western Pub and has a total of 634 pages in the book. The 10 digit ISBN is 053845315X and the 13 digit ISBN is 9780538453158. To buy this book at the lowest price, Click Here.


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Pequot Lakes community action group forms
Individuals and businesses in Pequot Lakes are recruiting members for a non-profit community action group with a primary goal of fundraising.
The group is modeled after the Brainerd community action group. The Pequot Lakes group was founded out of a desire to provide support, primarily financial support, to special events and projects in Pequot Lakes.
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Republicans are slamming President Obama's first post-election trip to the Bay Area — a fundraising swing around the political ATM that includes San Francisco — as a jaunt to "billionaire's row." The Republican response to Obama's trip comes as the President Wednesday begins a two day trip to the Bay Area, including San Francisco and […] [Read More]
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Obama allies are using Hurricane Sandy as a political weapon against Mitt Romney. The ad declares, "TELL MITT ROMNEY: CLIMATE CHANGE IS NOT A JOKE." [Read More]
LA Mayor Antonio Villaraigosa roams Tampa convention, says GOP Hispanic outreach "burns the enchiladas" (VIDEO)
Tampa, Florida — As a few Republicans milling around whispered about a "spy" in their midst, Democratic Los Angeles Mayor Antonio Villaraigosa was all smiles Tuesday, roaming the Tampa Bay Times Forum today to counter the GOP message as the Republican National Convention kicked off. Villaraigosa will have his own challenges next week, when he […] [Read More]


text:
Then you will be my wife?
When he and I are free.
Your father shall be saved!—I go to perfect all my plans.
[Kissing her hand.]
From this moment I am yours—body, mind and soul!
[Exit hurriedly.
When he has saved my father—death shall deliver me.
POTIN enters cautiously, with various things hidden under his clothes, giving him a grotesque appearance.
Now, O Fate, is your chance to protect a patriot! If I can only get away,—I shall escape perjury in Court, and tongue-lashing from my wife!—Now to run!—To run for Vendee! Better the awful thunder of masculine war than the piercing tenderness of a woman's tongue!
[Starting to run of, he begins to sing—to the tune of the Marseillaise chorus:]
To leave—to leave my wife!—
[Rushing in and stopping him.]
Hold, Citizen Potin!
Oh, Republic, I am lost!
Dodolphe—you're up to mischief! Speak out—what's up?
Patience, gentle lamb!
Don't lamb me, sir!
[Twisting him round.]
What's this mean?
[Tapping him.]
[Pulling breeches from under his coat.]
[Pulling cap from his breast.]
Ye gods, what's this?
[Pulling hose from his pockets.]
By heaven! A woman's hose!
[Shaking hose in his face.]
What does this mean?
Nothing, precious love! This is my uniform;—I
have recruited for
You—a soldier?
Yes: The safety of France demands it. I go to preserve the Republic! France beckons—while Victory extends her arms, panting to embrace my noble form!
Embrace ye?
[Putting his head under her arm.]
Let Victory try it if she dare!


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Forensic Data Collection in the GCC - Appendix A
GCC and neighboring countries - Data Compliance related laws and regulations
Please note that this is not an exhaustive list of laws and regulations relating to data compliance. With thanks to Takamasa Makita and Ben Smith of Clyde & Co, Dubai and Nick O'Connell of Al Tamimi, Dubai.
United Arab Emirates
Constitution of the United Arab Emirates
Federal Law No. 8 of 1980, Labor Law
Federal Law No. 3 of 1987, Penal Code
Federal Law No. 1 of 2006, Electronic Transactions & Commerce
Federal Law No. 5 of 2012, Cyber Crimes
Free Zones
TECOM Code of Guidance (2003)
DIFC Law No. 1 of 2007, Data Protection
DHCC Regulation No. 7 of 2008, Patient
Healthcare Information in the DHCC
Twofour54, Abu Dhabi Content Code (2011)
Telecommunication Regulator Authority, Privacy of Consumer Information Policy (2005)
Royal Decree No. 101 of 1996, Basic law of the Sultanate of Oman (Constitution)
Royal Decree No. 7 of 1974, Penal Code
Royal Decree No. 69 of 2008, Law of Electronic Transactions
Resolution No. 113 of 2009, Regulations on Protection of the Confidentiality and Privacy of Beneficiary Data
Constitution of Qatar (2004)
Law No. 11 of 2004, Penal Code
Law No. 14 of 2004, Labor Law
Law No. 5 of 2005, Protection of Trade Secrets
Law No. 34 of 2006, Telecommunications
Law No. 16 of 2010, Electronic Commerce and Transactions Law
Qatari Central Bank concerning the Instructions to Banks (November 2011)
QFC Regulations No. 6 of 2005 concerning the Data Protection Regulations
Constitution of Kuwait (1962)
Decree Law No. 32 of 1968, Central Bank of Kuwait Law
Decree Law No. 38 of 1980, Civil and Commercial Procedure
Decree Law No. 64 of 1999, Intellectual Property Rights Instruction 2/BS, BSI/278/2012 of Central Bank of Kuwait, Banking Confidentiality
Kingdom Saudi Arabia
Royal Decree No. A/90, dated 27.8.1412H (1 March 1992), Basic Law of Rule (Constitution)
Royal Decree No. M/12 dated 12.3.1422H (3 June 2001), Telecommunications Law
Royal Decree No. M/17 dated 8.3.1428H (26 March 2007), Anti-Cyber Crime Law
The Constitution of the Hashemite Kingdom of Jordan (1952)
Decree No. 15 of 1976, Penal Code
Decree No. 7 of 2003, Trade Secrets
Law No. 58 of 1937, Criminal Code
Law No. 131 of 1948, Civil Code
Law No. 88 of 2003, Banking Law (Central Bank, Banking Sector and Monetary System) Law No. 205 of 1990, Bank Secrecy
Constitution of Lebanon (1926)
Law No 349 of 1943, Criminal Code
Law of 3 September 1956, Banking Secrecy
Law No. 8 of 1970, Code Regulation the Legal Profession
Law No. 659 of 2005, Consumer Protection Code
Law No. 112 of 1959, Rules of Civil Servants
Code of Medical Ethics (1994)


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Win an Autographed Sick Puppies Guitar!
Fans of Sick Puppies already have plenty to celebrate with the band's new disc 'Connect' due out July 16, but now there's more to be excited about. Loudwire and Noisecreep have joined forces with Sick Puppies to offer up one lucky winner an autographed Epiphone Les Paul Special II guitar signed by band members Shimon Moore, Emma Anzai and Mark Goodwin.


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Download Pariah - Rift EP (2012)Pariah has made some intriguing singles with Blawan as part of Karenn, but there hasn't been a proper release from UK producer since 2010's Safehouses EP. On June 11, R&S will release the Rift EP, which features three new Pariah tracks. "Signal Loss" is a spare, minimal track driven by chopped up vocals and soft piano chords.
Download Vedomir - Vedomir (2012)
Dutch house and techno imprint Dekmantel have revealed details of a forthcoming artist album from mystery producer Vedomir.
The label, which is celebrating its fifth anniversary in 2012, today posted a stream of the album (along with the artwork and full tracklisting) on its Soundcloud page. Some of you may have noticed the label recently slip out a white label 12″ of Vedomir material, evidently as a teaser for the long player.
Entitled Vedomir, a quick listen to the tracks on offer reveals a musically rich take on downtempo deep house. In a move that will please vinyl fetishists, the LP will be released on gatefold double vinyl format, with design duties undertaken by Red Light Radio chief Orpheu de Jong.
Equally exciting is news of a second studio album from Juju & Jordash (aka Gal Aner and Jordan Czamanski), which the duo announced last week. Although details are still relatively sacre, Czamanski told Juno Plus the as yet untitled album would range musically "from nightmare techno to psychedelic folk, 80s industrial to free jazz".
Dekmantel will release Vedomir in the second week of April, 2012, on 2xLP vinyl format. There's no word on a release date for the Juju & Jordash album just yet but keep an eye on Juno Plus for more details as they emerge.
Those of you yet to be charmed by the output of Dekmantel should peruse our recent feature here, which comes replete with an exclusive mix from Juju & Jordash.
A1. Jump In The Past A2. Music Suprematism – (Keyboards And Co-Produced By Vasiliy Filatov) A3. Casserole 80th B1. Forks, Knives And Spoons B2. I Don't Aspire Perfection I Accept That I Have – (Keyboards And Co-Produced By Vasiliy Filatov) B3. Hello C1. Scream Of Kind Morning C2. Dreams D1. Lullably – (Keyboards And Co-Produced By Vasiliy Filatov) D2. Orud' Evo
Download Oliver Deutschmann - Darkroom Tales EP (2012)The first thing that must be pointed out about Deutschmann's Loganic collaboration, "Darkroom Tales," is that title. What a title. The music that bears it is every bit as hedonistic, decadent, and seedy as you'd hope: high-octane house that starts at a gallop — replete with deep, barely audible moans and sharp breaths — and never, ever slows down. It hungrily collects new elements to add to the dizzy conveyor-belt effect until it's a hurtling mass of moving bells and whistles. Shakers, mallets, a vaguely alienating vocal sample ("What it's gonna be? What's it gonna be?"), handclaps that slice up the bars into uneven, colliding chunks of broken rhythm — it's quite a ride. And if it weren't grandiose enough, an 'ardkore-worthy synth riff floats up from the abyss to dominate the track's midsection, a victory lap for a track that builds energy so masterfully it's hard not to get sucked into some kind of outrageous motion even if you're just listening on headphones. Label head, Tristen, provides an edit that's a little more Aim friendly, blurring the original's incisive slam into pleasant deep-house chord smears and turning the original's darkroom blackness into photo-negative white. The sexily swung groove is still there, but here it's weighed down by the lumbering kick and deconstructed melody, more like an added little bonus to an incredible track that didn't need reinterpreting in the first place. A label so well defined as Aim jumping off on a tangent can sometimes be a dealbreaker, but "Darkroom Tales" is easily one of the most infectious and impressive tracks of the young year so far. Tracklist: 01. Darkroom Tales (feat. Loganic) 02. Darkroom Tales (Tristen Edit)
Download Drexciya - Journey of the Deep Sea Dweller I (2012)
Forget James Cameron and his $200 million budget: Equipped only with outdated Japanese electronics, Drexciya were the true masters of the deep. From 1992 until 2002, the mysterious electro outfit created not only some of Detroit's most original and enduring electronic music; they created an entire imaginary world, one of the greatest myth systems in the history of techno.
A new compilation of the group's work, the first in a planned four-volume anthology put out by Rotterdam's Clone label, serves as a crucial introduction to Drexciya's worldview as well as, of course, their music. It's a good time for it: In the past two decades, the meaning of "electro" has repeatedly mutated and diluted though its association with electroclash, then Ed Banger's buzzy brand of dance music, and, lately, big-tent commercial rave like Deadmau5 and Wolfgang Gartner. The Drexciya reissue rightly returns the spotlight to the original electro's signature rhythms and analog palette.
From their first release, 1992's Deep Sea Dweller EP, Drexciya were obsessed with sub-aquatic realms. Their first tracks bore titles like "Sea Quake" and "Nautilus 12", and the following year's Bubble Metropolis EP, divided into "Fresh Water" and "Salt Water" sides and with center stickers depicting dolphins cavorting beneath craggy cliffs, poured it on thicker with "Aqua Worm Hole" and "Danger Bay". The music was appropriately liquid, with hi-hats like raindrops, bass like the belch of some fanged denizen of the fathomless dark, and blippy melodies bobbing like bioluminescent lures.
Adapting the lurching rhythmic template of 1980s electro-funk acts like Man Parrish, Cybotron, and Jonzun Crew, Drexciya emphasized the depth-charge qualities of a booming 808 kick, and the electric-eel jolt of a zapping filter sweep. But it went deeper than that. The music was punctuated by cryptic interludes and scraps of code, like an intercepted transmission from "Drexciyan Cruise Control Bubble 1 to Lardossan Cruiser 8 dash 203 X", a head-spinning array of names and numbers relating to something called the "Aquabahn".
Drexciya weren't just trafficking in metaphor and affect; they were telling a story, one worthy of its own blockbuster film. Their "Aquabahn" was, of course, a reference to Kraftwerk, whose robotic method act set an important precedent for Drexciya's own mythmaking. Played out across track titles and cover art, one sheets and liner notes, it went something like this: During the Middle Passage, many pregnant women, sick or dying or simply too much trouble for their captors, were thrown overboard. The fetuses in their wombs, still accustomed to a liquid environment, survived. They thrived, in fact, growing fins and gills, and made their home in the ruins of an underwater city, where they mounted their counter-offensive against human greed and stupidity.
The message fit with the militant stance of Detroit's Underground Resistance label collective, with which Drexciya were affiliated, and so did their anonymity. When James Stinson died, in 2002, I'm willing to bet that most fans didn't even know his name, nor that of his collaborator Gerald Donald. Drexciya were rumored to be related to other shadowy electro projects of the era, like Elecktroids and Dopplereffekt— a creepy, ostensibly antihumanist project featuring showroom dummies on its record covers and vocoded lyrics like "We have to sterilize the population"— but in the pre-Discogs era, this was all speculation. To immerse yourself in Drexciya's world was akin to following a particularly far-out comic book, where the misfits wrote the rules and justice always prevailed. It was punk as fuck, frankly— but from an Afrofuturist perspective.
But for all the talk of combat, Drexciya's was profoundly joyful music: impish, rippling, unpredictable, and never anything less than profoundly funky. This is the first takeaway from Journey of the Deep Sea Dweller I. This first volume focuses on the group's first five years, drawing from seven EPs released on labels like Underground Resistance, Submerge, and Warp. (Some tracks have been anthologized before, on 1997's landmark double CD The Quest, but that's long out of print.) Certain tropes predominate: whip-cracking 808 drum patterns, squelchy synthesizer arpeggios, dissonant bleeps and creepy chromatic chord progressions. But there's nothing formulaic about these tracks, which range from the pensive funk of "Aquarazorda" to the double-time frenzy of "Hydro Theory" and "Beyond the Abyss"; it's striking to realize how wildly Drexciya's tempos could vary, especially when compared to the deeply regimented BPMs of today's subgenres of electronic dance music. Indeed, Drexciya made few concessions to DJs: there are no 16-bar intros to facilitate mixing, and at least one point, you can hear a synthesizer pattern skip a beat, probably because one of the musicians leaned on his sequencer at the wrong time.
Lo-fi by today's standards, recorded straight to tape, in real time, with analog machines, Drexciya's sonics are unfailingly urgent and raw; there's more genuine menace in the roiling "Sea Quake" than in practically anything being made today. Clone's Alden Tyrell did a great job with the remastering, preserving the music's wide dynamic range and letting each frequency positively sizzle in space. As hair-raising as the songs can be, it's never an exhausting listen— unlike too much contemporary electronic music, mastered so uniformly loud that it leaves your ears gasping for air.
It's easy to remember Drexciya primarily for their shtick. Academics love them for their applicability to concepts like Afrofuturism and the Black Atlantic. (Kodwo Eshun was particularly brilliant writing about Drexciya; their slippery maneuvers served as the perfect foil for his own techno-theoretical poetics.) Detroit true-schoolers hold them up as examples of Motor City militancy and analog purism. These are all valid positions, but Journey of the Deep Sea Dweller I also reminds us of Drexciya's influence in other contexts, as well. The opening "Welcome to Drexciya" is a beatless burble that wouldn't sound out of place on a record from Emeralds or Oneohtrix Point Never, artists more commonly associated with the "cosmic" traditions of 1970s synthesizer music. Space is a place, sure. But to immerse yourself in Drexciya's underwater world is to be reminded that there are other dimensions just as worthy of exploration.
"Are Drexciyans water breathing, aquatically mutated descendants of those unfortunate victims of human greed?" wrote a figure identified as the Unknown Writer in the liner notes to 1997's The Quest. "Have they been spared by God to teach us or terrorize us? Did they migrate from the Gulf of Mexico to the Mississippi river basin and on to the great lakes of Michigan? Do they walk among us? Are they more advanced than us? How and why do they make their strange music? What is their Quest? These are many of the questions that you don't know and never will. The end of one thing… and the beginning of another. Out."
These questions had a different kind of resonance in the 1990s, before the answer to every question was just a click or two away, before every new "anonymous" artist felt like a walking, talking spoiler alert. To listen to Drexciya today is to wipe the slate clean. We may know James Stinson and Gerald Donald's names now, but their quest feels as cryptic as ever.
Download Lone - Galaxy Garden (2012)
The aptly titled Galaxy Garden marks a departure from Lone's previous two albums of blissed out, hip-hop infused electronica. His third LP retains the atmospheric touches of Lemurian and Ecstasy & Friends. It also shares their soundtrack qualities but this time it's the sonic backdrop to a psychedelic, schizophrenic journey through the cosmos.
Dreamy synths float all over this album giving it a lush but eery feel. There's beatless moments where pan pipes, whale noises, running water and acoustic guitar could take it into chill out territory but the frantic tribal percussion sees off any such thoughts. The songs shape shift rapidly and Lone glides through genres so smoothly it's barely worth mentioning them. It's the juxtaposition of sounds and ideas that makes this such an interesting listen. There's a clear 90s house/breakbeat influence but it's one of many. An old-skool rave track is topped with an 80s style noodling synth solo. Smooth melodies slide over low rumbling bass and insistent broken beats. It's like NASA broadcast a pirate radio station out of the milky way 15 years ago and it's somehow returned to earth covered in space dust.
Galaxy Garden is a giant leap for Lone taking his songs light years away from the earthy productions of previous albums. It's a tricky listen to get your ears around at first but your effort will be rewarded with an LP that doesn't tire easily.
Released May 7th on R&S Records.
Download Moodymann - Picture This (2012)
Moodymann is the nom de disc of Detroit native Kenny Dixon, Jr. An iconoclast with a funkdafied hairdo, Moodymann has built up a devoted listenership over the past two decades with his unique, mutant productions. Often pitched between high-fidelity and infidelity, Moodymann tracks are for those moments when hitting the dancefloor feels the same as rustling the sheets. Purveyor of the label Mahogani Music, Moodymann now connects with Scion A/V to deliver Picture This, eight exclusive tracks of Motor City magic.
Download Lone - Crystal Caverns 1991 (2012)
On his brilliant 2010 LP Emerald Fantasy Tracks, UK producer Matt Cutler combined breakbeat's hyper-speed rhythms with the winsome, glowing tones associated with Boards of Canada, resulting in a gorgeous flurry of emotional electronic music that transcended nostalgia-tripping. "Crystal Caverns 1991" is the first single from Cutler's follow-up to that LP under his Lone guise, Galaxy Garden; as the title suggests, he's looking to the past again, turning his ears to early 1990s rave— but, again, this isn't just about the past. The aggro-playful synth stabs and clipped vocal samples that are interspersed throughout provide visceral pleasure, but what's most impressive about "Crystal Caverns 1991" is Cutler's gift for unleashing beatific moments at just the right time, from the yo-yo bloops that hit midway throughout to those BoC-like tones layered under the tune's bubbly melody.
[from Galaxy Garden; out 05/07/12 via R&S]
Download Model 500 - Control / The Messenger (2012)
It's considered polite to relate a bit of biographical detail in these reviews—but quite frankly, is there much point here? Without Juan Atkins and R&S, the dance music map would have big holes in it. Back now on his lonesome for this release, with Mike Banks and Mark Taylor sitting on the subs bench, Atkins offers up two tracks of classic Detroit techno, which still manage to stand well apart from each other. "Control" thrashes along to a clanging, metallic Kraftwerk-style rhythm track, over which Atkins lays a twinkly, scurrying synth line and rising melodic pads. A host of robots add their voices to the tumult. "The Messenger" is an altogether more opulent offering of wobbly, haunting pads, steam-driven beats and cathedral-sized, verdant keyboard phrases. It's left, almost organically it seems, to fade out to a simple soundtrack of raw, crunching, metallic drums. A master at work, pure and simple. - Residentadvisor.net
Download Claro Intelecto - Second Blood EP (2012) Since emerging in 2003, UK man Claro Intelecto has pursued the deeper side of techno, and now makes his Delsin debut with a 3 track EP entitled Second Blood, which precedes the release of his full length album on the same label in march 2012. With a discography which includes a number of 12"s, EPs and full lengths on labels like Boomkat's own Modern Love as well as Ai Records and others, Manchester man Mark Stewart is known for dropping bomb after bomb, with these new efforts being no different. First up, the title track Second Blood is a lazy, scuffed and romantic sounding deep dub cut that lurches from one beat to the next with a lazy smile and soft eyes. Plenty of echo and reverb have it drifting off into the distance as warm pads and rising strings add subtle tension. Another lazy roller but this time with brighter melodic flashes, next effort 'Heart' is just as lateral, dubwise and soothing as the title track, melting your mind into a dreamy state of hypnosis before b2 'Voyeurism' lifts you out of your trance with a firmer kick drum, more cutting claps and groove that bounces a little more than it rolls. Some taught acid notes appear eventually, rounding off a cerebral, dead of night EP made as much for home listening as it is gentle Sunday afternoon comedowns. Essential stuff.
Download Boddika & Joy Orbison - Swims (2012) Two titans of the Bass/House scene unleash the mighty 'Swims' on heavy vinyl (only!) with sharp sleeve art via Swamp81. Over the latter half of last year it's become a staple in the sets of both Joy and Boddika plus their extended circle of affiliates, burning up floors with a succinct blend of warehouse 303s, booty-wallop bass and the kinkiest cowbells this side of Miami, all revolving around a vocal snatch from Tronco Traxx's 1995 single 'Walk 4 Me'. The original features on the A-side, sounding suitably chunkier than that youtube clip you've been caning, while the flipside sneakily offers a chords-driven bridge, sweetly heightening anticipation of a crowd-chewing acid line and cowbell attack. Undeniably BIG tracks.
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Home » News » Public Safety
Lost, found ... and billed for it: Effort renewed to pass the cost of rescues on to the rescued
The minimum rescue fee is one of three revenue raisers in House Bill 256 that sponsors believe will generate about $57,000 a year for a program that costs about $200,000. The fund routinely runs a deficit of about $100,000.
Hunters, fishermen, snowmobilers, boaters and all-terrain vehicle users currently pay the entire cost of rescues, while hikers account for about 60 percent of search and rescue operations.
Under the bill, those contributing to the rescue fund would not be charged for rescues, nor would someone who purchases an $18 hike safe card that the department would issue.
All others needing rescue would be charged on a sliding scale ranging from $350 to $1,000 based on the actual cost. The third source of funding would be a $10 surcharge on all fines for violating fish and game laws.
While lost and injured hikers often receive the most attention, Fish and Game search and rescues operations are for lost children, Alzheimer patients who wander away, drowning victims and fugitives hiding in the woods, said Fish and Game Executive Director Glenn Normandeau.
The prime sponsor of the bill, House Minority Leader Gene Chandler, R-Bartlett, told the House Fish and Game Committee, said it is not fair for sportsmen to be paying for the fund when they are not the prime users.
"This is a problem and we need to fix the problem." Chandler told the committee, but he ruled out using state general fund money, saying that is not an option.
Others agree the current system is not fair and something needs to be done to properly fund search and rescue operations, but believe the state's general fund should be used to pay for what they call an essential state service.
Former House Fish and Game Committee Chairman Dennis Abbott of Newmarket said what was being proposed would not solve the problem.
"This bill is like the little Dutch Boy who puts his finger in the dike," Abbott said. "This will not even come close to getting out of the deficit."
He said it was time for lawmakers to do something significant and fund search and rescue operations out of the state's general fund.
"It's time to fish or cut bait," Abbott said.
Susan Arnold, vice president for conservation of the Appalachian Mountain Club, said funding for the search and rescue program has been a problem for 25 years and she agrees the current funding mechanism is not fair.
"Search and rescue is about public safety, and is a public service critical to New Hampshire's $4.2 billion active outdoor recreation economy," Arnold said. "The fairest way to fund search and rescue is to allocate a miniscule portion - .002 percent - of revenues generated by the rooms and meals tax - a tax paid by the full range of potential users of search and rescue services, including hikers."
Arnold was concerned charging a fee for all rescues would make people reluctant to call for help, putting themselves and rescuers at more risk once the call is made later.
Volunteer groups who help with rescues in the mountains agree with Arnold and several volunteers said many may stop helping if the state charges for rescues.
John Scarniza, president of the Randolph Mountain Club that helps with rescues, and a former New Hampshire State Police troop commander, doubted the bill would raise $25,000. He said charging for rescue may cause many volunteers to decide not to help anymore letting the state run the entire operation.
"That's $25,000 in revenue for a tremendous loss of good will among volunteers and tourists," he said.
Scarniza said the hiking community makes a significant contribution to search and rescue efforts. Volunteers are often the first ones on the scene when a hiker calls for help, he noted, and said without their help the Fish and Game Department would have to pick more of the cost.
Fish and Game officials have seen the cost of rescue increase recently now that the National Guard charges $6,500 an hour for a Blackhawk helicopter. In the past, the use of the helicopters was viewed as training for guardsmen.
The average cost of a rescue is about $2,000 but can be as high as $50,000. Fish and Game can bill for the full cost of a rescue if a person is found negligent, but Normandeau said his department collects very little of the money.
"Collecting money is a nightmare for us," he said. "The person who simply writes the check is the exception not the rule."
The committee did not make an immediate decision on the bill.
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John Loturco
Two Arraigned In Fatal Labor Day Hit-And-Run On Long Island
According to prosecutors, Nicole Grammerstorf had her 5-month-old child in the Nissan SUV at the time of the crash. Prosecutors said she then tried to cover up the crash by taking the car to Mark Monserrat's auto body shop.
Woman Who Took Rap For Boyfriend In L.I. DWI Crash Sets Record Straight
Sophia Anderson, 21, was arraigned on charges of conspiracy and obstruction of governmental operation after prosecutors determined she wasn't the driver in the crash that displaced two elderly sisters from their house.
L.I. Woman Gets 25-To-Life For 1996 Killing Of Riverhead H.S. Homecoming Queen
Sixteen years after a murder that stunned Suffolk County, Thursday was sentencing day for the convicted killer. The victim was a 17-year-old homecoming queen. Prosecutors said she was stabbed dozens of times in a jealous rage.
L.I. Man Arraigned After Arrest For DWI Following Fatal Crash
Police say Leonard Hoppie, 20, and his 10-year-old brother were uninjured in the crash.


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$2,500 2013 Sym HD200 + accessories (included in the price)Sym · Los Angeles, CA2013 (October) SYM HD200 for sale! Still on Warranty (24 Months Limited Parts and Labor Warranty) Excellent condition! Very well taken c...Val V. · 15 hours ago
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$3,988 1998 Harley Davidson-Heritage-SoftailHarley-Davidson · Burbank, CACHROME: a.) Swingarm b.) Twisted Spokes c.) Brake Calipers d.) Highway Bars e.) Beach Cruiser Handle Bars f.) Exhaust New White Wall Tire...Harry O. · 2 days ago
$3,700 1980 Honda cb750 Custom Cafe Racer, All New BuildHonda · Huntington Beach, CAThis Awesome 1980/2013 Honda CB750 Custom Cafe Racer. This Is A Brand New Build With Only 39 Miles Since Completion. This Bike Was Built ...Bugaloo C. ·1 listing · 2 days ago
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Add to My ListAdd to FavoritesEdit Anime InformationBuy @ RightStuf Buy from Amazon Buy from Japan-Best
Alternative Titles
Japanese: STAR☆jewel スタージュエル
Type: OVA
Episodes: 1
Status: Finished Airing
Aired: Dec 8, 2011
Producers: Zyc
Genres: Yuri
Duration: 41 min. per episode
Rating: Rx - HentaiL represents licensing company
Score: 6.771 (scored by 517 users)
Ranked: #39002
Popularity: #4762
Members: 1,257
Favorites: 7
1 indicates a weighted score
2 based on the top anime page.
My Info
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text: We're pleased to announce the arrival of our annual Summer Clearance Sale. Act quick to pick up a bargain whilst we make way for new vintages. Stocks are extremely limited by definition and all wines will be sold on a first come, first served basis. So get your orders in now to avoid disappointment.


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Sign up for Yardbarker's daily Top 10 newsletter, the Morning Bark! Customize to get news on your favorite sports and teams.
Found October 31, 2012 on NESN.com:
PLAYERS: Joe Haden
TEAMS: Cleveland Browns, Notre Dame Fighting Irish
TEAMS: Cleveland Browns, Notre Dame Fighting Irish
Most wide receivers would have a hard time buying a catch against Cleveland Browns cornerback Joe Haden. But when it comes to his fans, Haden spares no expense. Haden met a Browns fan at a Cleveland-area sporting good store on Tuesday afternoon and after chatting with the fan, he even decided to buy him an official No. 23 Haden jersey. Bradley Morrison -- a student at Notre Dame College in Ohio, according to his Twitter profile -- was in a Finish Line store on Tuesday looking to buy a Haden jersey when the shutdown cornerback waltzed in for the surprise of a lifetime. After buying Morrison the jersey, Haden apparently also signed the jersey for the Browns diehard. It's always great to hear stories about athletes doing random acts of kindness, and even in a small act like this Haden epitomized the type of care and kindness fans hope for from their idols. Check out the photo of Morrison with Haden, and another of him donning his new jersey below. I was l...
Original Story: http://www.nesn.com/2012/10/joe-haden...
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Joe Haden: Browns have closed gap within AFC North
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The Browns won a game last week, don't get use to it. Week 9 preview.
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X's and O's with the Bros: On Brandon Weeden's Batted Passes
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Yes, this editorial has an unlikely title. If you have been following us, or the issues we work on, a little bit, the overwhelming impression is that things have been scaled back (emissions-trading aviation), postponed (the Fuel Quality Directive, possibly NOx from ship engines, truck CO2 emissions) and watered down (CO2 from cars, biofuels).
This briefing from BirdLife Europe, CEE Bankwatch, Friends of the Earth Europe, T&E and WWF explains how EU transport spending under the Trans-European Transport Networks (TEN-T) and Connecting Europe Facility (CEF) programmes could be made more effective, economically viable and sustainable.A full-length version of this analysis is also available.
The future of green road charging schemes in Europe has been hampered by a vote in the European Parliament's Transport Committee.
The European Commission adopted today a package entitled "Towards Greener Transport" which included a long-awaited strategy to allow transport to pay for the costs that they cause to environment and society. The package includes a legislative Proposal to revise the Eurovignette Directive that aims to remove a legal obstacle which prohibits trucks being charged for the costs that they cause in terms of congestion and pollution.


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Iowa > Logan Yellow Pages > Religion and Spirituality > Religious Services Logan
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The beach and resort centre of Costa Teguise are 1.5km away (courtesy bus to beach and resort centre operates three times a day); 200m from nearest bars and restaurants
This comfortable hotel offers spacious apartments located in the low, white buildings typical of Lanzarote. The Bluebay Lanzarote offers an excellent location with a variety of sports facilities, including tennis courts and a regular entertainment programme. The well-maintained grounds and spa make this an ideal choice for couples and families alike.
1 bedroom apartments (3 people or 2 adults and 2 children) have a separate twin bedroom plus double sofa bed in the living area and bathroom with shower (some rooms have baths).
2 bedroom apartments (4 adults and 2 children or 5 adults, min. occupancy 4 people) are as above with an additional twin bedroom.
All feature flat-screen satellite TV (UK channels payable locally), air conditioning, safety deposit box (payable locally), kitchenette with kettle, fridge, bathroom and balcony or terrace.
Single rooms are also availablet.
2 October 2014, East Midlands, 7 nights, All Inclusive
Last room availability check was at 09:00 am on 19/09/2014
Notice: This shows how many rooms are available for this holiday at this moment
You may be able to choose other room types from the accommodation page, but the cost of it might be higher. We may occasionally add more of the same room types on sale at a later date.
1 Room - 7 nights, All Inclusive 2 AdultsAmend accommodation
Spain, Costa TeguiseBased on 1529 reviews By Airtours


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PlantTherapy: Watering
Having just the right tool can motivate and make the job easier. I love finding a gift that can do the same: something simple and perfect. In the case of watering cans, I have used enough bad ones to know it's worth having the right one. Everyone hates to spend on something as simple as a watering can because it is so simple. But I treasure mine (a Haws) and get far less water on my carpet than I ever did before.
So I have a short list of good ones here. Good for the apartment or small container garden. I have no doubt that others have their favorites and we would love to hear about them!
The ones pictured above are available from Lee Valley and perfect for quick watering for smaller plants. - they screw onto the top of plastic water/soda bottles. Also makes great use of your bottles before recycling - and you can leave a bunch around your apartment as a ready reminder to water.
An atomizer is perfect if your apartment runs dry. Your ferns and orchids will love you for it. Because the water is atomized, it doesn't leave a mess. Also refreshing for your face. I have a glass one from the NYBG shop and it only cost about $12.00.
Dramm and Haws will easily match your new set of Crocs. Both companies have a great line of watering cans made across the pond but easily available here in the U.S. They are easy to fill, hard to spill, and beautifully balanced to make watering easy and more precise, even with the higher capacity cans.
And if you want to spend no more than $2-$6 on a can, Ikea's are really not that bad. I saw them hanging in Dmitri's on the UES the other week and they are very festive. Also better designed than most cheap plastic cans.
20 Comments
i love mine. it may not be chic, but it makes me smile. it's a pink elephant. the water comes out it's trunk & when you tilt it, the eyes move. it's goofy. i got it at urbn.com years ago.
How about the techie route?
Is there a backpack style of watering can? I have to refill and carry up to the roof my watering can like 4 times a day, would love to find a better solution (short of getting a plumber to install a water source on the roof).
These sure are alot fancier than the beer bottle I use. I do spill alot of water.
I have a Twist & Shout watering can. Just like the ones pictured above, you just screw it on a plastic bottle.
i don't have many plants, and they are a pretty small, lightweight, and hardy bunch, so i just put em under a low-running sink till the soil is wet..
it's very low maintenance, and it motivates me to keep dirty dishes to a minimum in my kitchen. though i guess it wouldn't work if i got a ficus tree.
AT readers are a clever bunch. The techie machine is amazing.
As for that backpack watering can - follow the link on my name to an eBay listing. You can always find sprayers there. You will look like the Rocket Boy going up to your roof to water your plants.
Also there is a great coil hose that you can get at Home Depot. It is very light and stretches faaaaaaaar. I prefer it to any other hose. It's not heavy, compact, and no need to wind it back up. I throw mine in a bucket when I take it indoors.
Watering in the sink is great and I do that for mine, too, if they fit. Gives me a chance to check the plant over for problems, too.
Twist and Spout - nice! I wonder if they sell them in stores...that is really a great design
I was looking at that coil hose last night when looking for something shorter than 50'. For some reason I decided to go for the 15' hose but I think I may get that coiled one after your endorsement.
I have a Haws too (the old fashioned kind - all metal), and I didn't think twice about the price. It's beautiful.
Possibly I am a garden freak for thinking a watering can is beautiful...
caitlin, surely the standards for freak are not so low? mine is the prettiest of all, old-fashioned and copper with a nice cylinder body and a long elegant spout, which sits on a stand in my bathroom to be admired when it is not in use. however i have been a total failure at find metal pots.
oooh. I HATE my Ikea watering can.
It is horribly designed--tippy, spill-y, blech. The handle is hollow, and the curve from the water-well to the handle allows water to spill over and run out of the handle unless you balance the f***er perfectly. (I'm crabby cuz I just watered yesterday and spilt water all over a beloved handmade wood bench.)
Who ever perfectly balances a tippy, heavy container of water? Argh.
and now I really want one of those copper ones. so pretty...
although not a pretty as a copper watering can here is a link to a portable sprayer
Amazing how many watering cans don't water! Dripping is THE WORST.
I finally bought one at Bo Concept that I love. Took it into the ladies room first to test it out!
I bought one of those bright yellow Dramm and Haws at Gracious Home several years ago. It is GREAT -- no drips, easy to aim, and the shower is the perfect intensity to clean the leaves without damaging them. Who knew a plastic watering can could be such a joy? (And, it doubles as a pail to fill the toilet tank when the water is running too slowly).
My Home Depot didn't know what I was talking about when I asked for a coiled hose you could use indoors. So I ordered one from Lee Valley Hardware: http://snipurl.com/s7tp I've had it about two months.
The coil is very tight (like a telephone receiver coil, presuming I'm not the only one who remembers those)...the 25' would not have been long enough for me, IMHO. Even the 50' has to be carefully "arranged" around the apartment as you move, lest it knock things over in it's wake!
I do love the convenience, though. I have MANY indoor plants (which you can see by clicking on my name), and watering takes about a quarter of the time it used to. I stopped trying to do a balcony garden b/c of the watering difficulties, but I am going to try again next year.
(Um, I should have said that those prices at the Lee Valley link are CAD.)
Matt - I got my Twist & Spout @ a gift store in Austin, Texas. If all else fails, you could always order online. :)
I just saw Twist and Shout at The Container Store today. I was wondering if it worked well. It was in the kitchen section was being marketed as an easy way to serve liter drinks.
That's "Twist and Spout," not "Shout." My error.


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Good morning, afternoon, evening to all you lovely human specimens.
Let's put this out there; I'm not stealing from anyone. This is true. And if you don't like it, then that's your problem. Let's pick on the girl in a wheelchair. Woo… did I make you feel guilty? No? Didn't think so. At least I tried.
Well, let's get started, now shall we? So I'm probably going to die early, maybe 50's; I hope not. But I can't stop the inevitable. I can fucking try though. So I have this disease called spinal muscular atrophy (SMA for you lazy people; I use it too). So (un)luckily, I have type II (that's a two if you can't read Roman numerals), which is better than type I and worse than type III. I is where the kid doesn't usually last past two years old. So I past that, so, that's good. III is when it sets in when you're like forty. So for all of you people reading this (if there are any) then YOU MIGHT GET WHAT I HAVE AT ANY SECOND. Or not. Probably not. So this disease is recessive and on one of my chromosomes, I'm missing a certain gene. This gene that I was supposed to have is supposed to make good muscles and stuff. That was today's lesson in biology, kids. (English lesson: I'm appealing to ethos because I'm telling you stuff and it sounds smart). So overtime, all the muscles in my body will get weaker and weaker. So that means like my biceps and calf muscles and you're probably going "oh that's not so bad; you'll just be a really scrawny weak kid." Well yeah, I am, but if you people forgot, the lungs, heart, and all that important stuff is muscle. So… I'll let you figure that out. I'm assuming you're smart enough to do that.
So, that's what I have. This probably won't be too successful because I'm not a worse case scenario and people just love to pity. I'm in fact quite well, thanks for asking. I'll tell you more stories if anyone feels like reading this. So this is a test, to see if anyone cares or if anyone searches for stuff. Maybe. Tumblr does wonders. Like spoiling certain season finales of a certain show. Ten points to Hufflepuff if you know what I'm talking about (no, I'm not a Hufflepuff).
So, see you in a bit, maybe.
Oh and feel free to tell me if you actually want more of this. Or else I just might keep posting and I'll just be talking to myself that then I'll look stupid.


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The Best 250-Calorie Dessert Recipes
Pages in this Story:
- Caramel Popcorn
- Big Fudgy Bittersweet Brownies
- Nutty Peanut Butter Cookies
- Fresh Raspberry-Mousse Almond Crumb Cake
- 6 Tips for Healthier Baking
Big Fudgy Bittersweet Brownies
Makes: 9 servings, 1 brownie each
Prep time: 25 minutes
Cook time: 25 minutes
- 1 large egg
- 1 egg white
- 3 tablespoons plain nonfat yogurt
- 1 1/2 teaspoons pure vanilla extract
- 1 1/2 cups sugar
- 1/3 cup canola oil
- 1/2 teaspoon sea salt
- 1/4 cup (3/4 ounce) unsweetened cocoa powder
- 3 ounces high-quality unsweetened baking chocolate, chopped (about 2/3 cup)
- 1/3 cup unbleached all-purpose flour
- 1/3 cup buckwheat or presifted whole wheat flour
- Preheat oven to 375 degrees F. Lightly coat an 8-inch-square nonstick baking pan with cooking spray. In a small bowl, whisk together egg, egg white, yogurt, and vanilla extract; set aside.
- In a small saucepan, combine sugar, oil, salt, and 3 tablespoons water, stirring constantly for 3 minutes on medium-high heat. Remove from heat; stir in cocoa and chocolate until chocolate melts, then add egg mixture. Add all flour, stirring until batter is smooth.
- Pour batter into baking pan. Bake 25 minutes, or until top is firm. Cool completely in pan on rack. Cut into squares.
Per serving: 250 calories, 4g protein, 35g carbohydrate, 14g fat (4g saturated), 3g fiber.
What do you think of this story? Leave a Comment.
The Raspberry Almond Crumb Cake is amazing! I made it for Easter and everyone loved it. I added extra raspberry jam to the mixture of jam and cream cheese though. The recipe calls for more cream cheese than jam, but I think my method was way tastier!4/5/2010 09:33:52 AM Report Abuse
What is the sodium content for these brownies. Please always add the sodium count for recipes. Thanks.3/28/2010 06:39:27 AM Report Abuse
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Study challenges popular perception of new 'hookup culture' on college campuses
A University of Portland study challenges the popular perception that there is a "new and pervasive hookup culture" among contemporary college students.
Relationship troubles? Some sad music might help you feel better
Consumers experiencing relationship problems are more likely to prefer aesthetic experiences that reflect their negative mood, according to a new study in the Journal of Consumer Research.
Working couples face greater odds of intimate partner violence
Intimate partner violence is two times more likely to occur in two income households, compared to those where only one partner works, a recent study at Sam Houston State University found.
Family and peer relationships essential to Mexican-American college students' success
Hispanics are enrolling in the higher education system at a greater rate than ever, yet they are less likely than their non-Hispanic peers to enter college or earn degrees, according to the Pew Hispanic Center. A new study ...
'Partner abuse is normal' say disadvantaged youth
The levels of violence girls and boys from disadvantaged backgrounds experience in their partner relationships is revealed in new University of Bristol research published today.
Study identifies protective factors that help women recover from childhood violence
Children who witness domestic violence are more likely to be in abusive intimate relationships and experience psychological problems such as post traumatic stress disorder (PTSD) in adulthood, according to the Centers for ...
A woman's blues bring a relationship down
Depression erodes intimate relationships. A depressed person can be withdrawn, needy, or hostileand give little back.
How has American identity changed?
First-generation West African immigrants from Nigeria and Ghana transition smoothly into major societal institutions, such as the workplace and the neighborhood, but have not built stable, mutually beneficial friendships ...
Australian study says people marrying less
Researchers from UQ's Institute for Social Science Research have found that marriage no longer enjoys the privileged status it once did.
New study explores role of sexual, social behaviors in seniors' well-being
Researchers and the general public have a new resource for information on the health and intimate relationships of older people, thanks to a new supplemental issue of The Journals of Gerontology Series B: Psychological an ...
Intimate abuse study finds clear links with poor health and calls for holistic primary care approach
Nearly a quarter of married and cohabiting women who took part in a survey said that they had been sexually, psychologically or physically abused by their partner, according to research published in the July issue of the ...


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Tax Law Questions
Online Tax Preparation Software
The availability of online software that to help calculate your federal and state income tax may make calculating and filing your taxes extremely convenient. You may be able to simply enter the amounts from your W-4 form and file your tax returns electronically in 15 or 20 minutes. However, you may need the help of a tax preparer, accountant or tax attorney if -
- You are married.
- You are divorced with dependant children.
- You are caring for an aged parent.
- You own a business.
- You receive income from investments.
- You worked outside of the United States for part or all of a tax year.
Filing An Extension
You may believe that filing and extension means that you will have a few extra months to pay your income tax. The opposite is true. Filing an extension gives you a few extra months to file your return. You are expected to pay your estimated tax by April 15, or apply to pay it in installments. The Internal Revenue Service has abundant information about income taxes and other federal taxes.
The Earned Income Tax Credit
The Earned Income Tax Credit can mean the difference between receiving a tax refund or paying taxes in April, but you may need to negotiate with your spouse or former spouse about which one of you is eligible to take the tax credit. This is just one issue that may arise after a divorce. Division of assets can result in an unexpected tax burden for one partner if not handled correctly. Income taxes are simply one area in which you may need the help of a professional. If you own property or conduct business, you may need help with -
- Property Taxes
- Payroll Taxes
- Customs and Tariffs
- Sales Taxes
- Estate Taxes
Tax lawyers are familiar with these issues. They can answer complex tax questions and can help you feel confident that you have made an informed decision.


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The written description of the audio segment begins, "Several Pennsylvania judges are suing the state over mandatory retirement. The judges argue forcing them to retire at age 70 is unconstitutional. Last week, the case moved up to federal court."
In news coverage of the lawsuit's removal to federal court, on December 28, 2012, The Patriot-News of Harrisburg, Pennsylvania posted online an article headlined "Fight over mandatory retirement for PA judges moves to federal court."
Posted at 10:28 PM by Howard Bashman
My earlier coverage appears at this link.
Posted at 02:44 PM by Howard Bashman


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The Vigo County Budget is tight just like every other budget.
Sometimes you have to spend money to keep from spending more later.
The Vigo County Commissioners asked and the County Council approved an estimated $100,000 appropriation to fix the roof of the courthouse dome.
There are some holes in the copper dome and that lets water leak through.
The leaking water can fill buckets depending on rain fall.
That water could ruin much of the work done over the past few years to renovate the building.
Hopefully the contractor can start soon before it gets too hot or the repairs will have to wait until the fall.