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Drs. Lapane, Trivedi, and Mor: Brown University, Box G-ST, 121 South Main Street, Providence, RI 02903.
Dr. Weinstock: Dermatoepidemiology Unit, Veterans Affairs Medical Center, 111D, 830 Chalkstone Avenue, Providence, RI 02908.
Current author addresses and author contributions are available at www.annals.org.
Recent evidence suggests that statins may prevent cancer.
To quantify the association between statin use and the occurrence of keratinocyte carcinoma in high-risk veterans.
Cohort study.
6 Veterans Affairs medical centers.
1037 participants of the Veterans Affairs Topical Tretinoin Chemoprevention Trial, a randomized, multicenter, double-blind, vehicle-controlled trial of topical tretinoin, 0.1%, for prevention of keratinocyte carcinoma conducted from November 1998 to November 2004.
Time to first occurrence of keratinocyte carcinoma on the face or ears. Participants using a statin at randomization, according to the Veterans Affairs Pharmacy Benefits Management database, were considered exposed. Study dermatologists conducted physical examinations at baseline and every 6 months during follow-up. The association between statin use at randomization and the outcome was evaluated by using propensity score matching (n = 608) and Cox proportional hazards regression (n = 1037).
Among the 1037 participants, 37% used a statin at randomization (n = 397) for a median duration of at least 900 days over a median follow-up of 3.5 years. In the propensity score-matched analysis, statin use at randomization was not associated with keratinocyte carcinoma (rate ratio, 0.92 [95% CI, 0.73 to 1.16]), a finding that was consistent with the estimates derived from the Cox proportional hazards regression (rate ratio, 0.84 [CI, 0.70 to 1.02]).
The extent of residual confounding is unknown, and the confidence bounds around the measures of association were wide. These data may not be generalizable to lower-risk populations.
These data show no conclusive or consistent relationship between long-term statin use and risk for keratinocyte carcinoma.
Department of Veterans Affairs, Agency for Healthcare Research and Quality, American Cancer Society, and National Institutes of Health.
Keratinocyte carcinoma consists of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) and is the most common cancer in the United States, with more than 1 million cases occurring in 2006 (1). Basal cell carcinoma causes substantial illness, including local tissue destruction and disfigurement (2, 3). Squamous cell carcinoma metastasizes more frequently than BCC, leading to an elevated mortality risk, particularly in elderly persons (4, 5). Few effective strategies exist for preventing keratinocyte carcinoma. The most important preventive measure is regular sunscreen use (6).
Statins reduce cardiovascular morbidity and mortality (7–11) but are pharmacologically pleiotropic, with preliminary evidence showing beneficial effects in other diseases, including dementia (12, 13), fractures (14, 15), and multiple sclerosis (16, 17). Statins may also prevent cancer by inhibiting the mevalonate pathway (18, 19). This pathway promotes synthesis of downstream nonsterol isoprenoid derivatives that may block apoptosis and promote tumor growth, angiogenesis, and tumor metastasis (20–23). Data on whether statins prevent cancer have been inconclusive, with some studies showing no effect (24) and others suggesting that they are beneficial (25). These conflicting findings may be due in part to varying effects of statins on cancer in different tissue types or locations (26).
We aimed to estimate the association between statin use and new lesions of keratinocyte carcinoma in the Veterans Affairs (VA) Topical Tretinoin Chemoprevention (VATTC) trial sample. The trial followed participants closely and provided standardized and complete assessments of outcomes and potential confounders.
We conducted a cohort study by linking data from the VATTC trial and the VA Pharmacy Benefits Management database. Details of the VATTC trial have been published elsewhere (27, 28). The VATTC was a randomized, multi-center, double-blind, vehicle-controlled trial of topical tretinoin, 0.1%, applied to the face and ears for prevention of keratinocyte carcinoma in high-risk veterans conducted from November 1998 to November 2004 at 6 VA medical centers. The study centers were chosen for participation on the basis of factors related to their suitability for serving as centers in the overall randomized trial but were geograph ically distributed throughout the United States. The 6 locations were Chicago, Illinois; Durham, North Carolina; Miami, Florida; Long Beach, California; Phoenix, Arizona; and Oklahoma City, Oklahoma. Table 1 lists the trial's exclusion criteria.
Eligible veterans were at least 18 years of age, received care at 1 of the 6 participating VA centers, and had 2 or more keratinocyte carcinomas in the 5 years before enrollment (n = 1131). Study personnel received signed informed consent from all participants before enrollment. The 8 relevant institutional review boards approved the study protocol and procedures. We excluded 52 participants without pharmacy claims in the Pharmacy Benefits Management database. We also excluded 42 participants who initiated statin therapy during follow-up, leading to a final sample of 1037 veterans (Figure 1).
The primary outcome was the first occurrence of keratinocyte carcinoma (BCC or invasive SCC) on the face or ears. We did not count recurrent lesions. We chose to combine BCC and SCC, despite certain etiologic differences (such as lag time after ultraviolet exposure, association with genetic mutations, and relation to immunosuppression and human papillomavirus exposure), because they are both skin cancers derived from epidermal cells, the primary cause of both is ultraviolet sun exposure, and their therapies (both pharmacologic and surgical) are nearly identical. Because of the similarities of BCC and SCC, we hypothesized that the statins would penetrate each type of cancer equally, leading to similar pharmacologic activity across tumor types and a similar reduction in the rate of BCC and SCC that would be only minimally affected by their etiologic differences.
Study dermatologists conducted physical examinations at baseline and every 6 months during follow-up. One of 2 central reference dermatopathologists read each biopsy specimen of the face and ears. Both central dermatopathologists read 10% of all biopsy specimens for a VATTC reliability substudy (27), which showed high reliability for diagnosis of BCC (κ = 0.88) and substantial agreement for diagnosis of invasive SCC (κ = 0.62) (Appendix Table, available at www.annals.org).
We derived medication use information from the VA Pharmacy Benefit Management database for VATTC participants who used an outpatient VA pharmacy from 29 September 1998 to 15 November 2004. The Pharmacy Benefits Management database contains claims for all prescription transactions from every VA site (29). More than 99% of prescriptions in the Veterans Health Information Systems and Technology Architecture—the VA gold standard—are recorded in the Pharmacy Benefits Management database (4). We matched the Pharmacy Benefits Management data to VATTC data.
We categorized participants according to their use of statins at their randomization date. We considered participants exposed if they had used any statin (simvastatin, atorvastatin, fluvastatin, lovastatin, or pravastatin) at the date of randomization, although under the VA system at the time, simvastatin and lovastatin were the primary agents used. Because participant accrual occurred throughout the first 4 years of the trial, we had a varying amount of pharmacy claims available before each person was randomly assigned, but had no data before 1998. We hypothesized that statin use at randomization represented long-term use, an assumption supported by an analysis of duration of use on the basis of the available data. Forty-two participants initiated statin therapy during VATTC follow- up. We excluded initiators because we considered the duration of statin use to be too short to have an effect on the outcome and because there were too few initiators to estimate an effect of short-term use reliably.
We estimated the average daily dose of statins by dividing the product of the dose per tablet and the dispensed quantity by the total days of supply dispensed for each prescription claim. We assumed that simvastatin, atorvastatin, fluvastatin, and pravastatin are equipotent.
We considered factors that may affect risk for keratinocyte carcinoma to be potential confounders, including age; sex; race or ethnicity; education; smoking history; sun exposure history; psoriasis; eczema; inflammatory acne; rhinophyma; the number of actinic keratoses at baseline; the number of previous keratinocyte carcinomas; sunscreen use; sun avoidance behaviors; and measures of sun sensitivity, which included variables on hair color, skin color, freckling, reaction to first summer sun exposure without sunscreen, skin oiliness, the year-round presence of tan lines, and the Charlson Comorbidity Index score (30–34). We also considered use of tanning beds, chemical peels, 5-fluorouracil, immunosuppressants, nonsteroidal anti-inflammatory agents, other cholesterol-lowering medications, or angiotensin-converting enzyme inhibitors as potential confounders (35, 36). The primary VATTC intervention, topical tretinoin, did not confound our estimates; hence, it is not included in our final Cox regression and propensity score models.
The VATTC personnel ascertained measures of potential confounders at baseline and at follow-up visits, including measures of sun sensitivity and exposure. The study investigators' questions about these exposures related to various points in the participants' lives, including early childhood, adolescence, and intervals throughout adulthood (for example, age ≥18 years, age 40 to 60 years, or in the 5 years before enrollment). This allowed for adjustment of potential confounders that may have exerted a causal effect at different relevant etiologic periods. Baseline clinical examinations included standardized scales of photo-damage, counts and relative intensity of precancerous and other clinically relevant lesions, and questions about the average number of hours spent in the sun at different points in the participants' lives. Other questions ascertained the proportion of time spent in the sun that participants used sun-avoiding techniques (for example, wearing a hat), the annual frequency of sunburns at different life stages, and the presence of previous diagnoses (for example, eczema). During follow-up, study investigators measured what proportion of time participants used their study sunscreen, had sunburns, or were exposed to other potential keratinocyte carcinoma causes (such as tanning beds). The degree of missing data was low (approximately 2% on variables used) and varied with little omitted information in variables on demographic characteristics, smoking, previous sun exposure, and previous diagnoses, but with relatively more omitted information about family history and follow-up sun exposures.
We calculated person-time as the number of days from randomization to the first occurrence of an outcome, the date of the last study visit for those who were lost to follow-up, the date of death, or the date of study termination. The relation between statins and keratinocyte carcinoma was conceptualized a priori; however, because the primary trial evaluated another intervention, there were no formal sample size considerations for our study.
We estimated the association between statin use and keratinocyte carcinoma incidence by using Cox proportional hazards regression models. To evaluate and rule out departures from the proportional hazards assumption, we plotted log–log survival functions and tested the exposure variable for an interaction with time. To evaluate confounding, we first forced age, sex, a measure of intrinsic sun sensitivity, measures of past sun exposure, variables reflecting the study centers, and cigarette smoking into the model. We then used a manual forward selection process, adding the remaining potential confounders one by one. We retained variables in the model that changed the estimated effect of statins on the occurrence of keratinocyte carcinoma by approximately 5% or more. We evaluated categorized measures of sun exposure and sun avoidance behavior at different points in the participants' lives and tested different categorizations of these measures on the basis of empirical distributions. We further adjusted for comorbid conditions by using the Charlson Comorbidity Index (33), which we estimated by using the algorithm described by Romano and colleagues (34). We adjusted for a summary score of sun sensitivity, which was taken as the numerical average of the answers to 7 questions, each of which ranged from 0 to 1 (least to most sun-sensitive). We modeled covariates by using dummy variables for intrinsically categorical variables. Continuous variables were categorized by using clinically and empirically derived criteria and were modeled in a similar manner. By using Cox regression models, we derived crude and adjusted rate ratios and 95% CIs to estimate whether statin use was associated with a reduction in the rate of keratinocyte carcinoma.
We also estimated the association between statin use and the occurrence of keratinocyte carcinoma by using propensity score matching (37). We used logistic regression to estimate the probability of statin use at randomization as a function of the potential confounders. We used a non- parsimonious modeling approach and tested for interactions to maximize the discrimination of the predictive model. To maximize efficiency, we included potential con-founders that may be related to the risk for keratinocyte carcinoma, regardless of whether they were associated with statin use (38). This included all variables used in the Cox regression plus additional variables that fit this criterion. The c-statistic for the predictive models was 0.71, suggesting a moderate overlap between the predicted probability distributions of statin use between users and nonusers. Successful use of propensity score matching is conditional on sufficient overlap of the propensity score distribution among the exposed and unexposed. To maximize matching within the area propensity score distribution overlap, we matched exposed and unexposed participants on the propensity score by using the greedy matching algorithm (39). The greedy algorithm uses an iterative process to identify the closest matches first and then widens the caliper for matching with each subsequent iteration. We assessed for covariate balance before and after propensity score matching by examining frequency distributions by exposure status. We compared these distributions by using chi-square tests for categorical variables and 2-sample t tests for continuous measures. Suitable matches were not available for 98 statin users, resulting in a propensity-matched sample of 608 veterans after 1-to-1 matching. Using this matched cohort, we estimated adjusted rate ratios and 95% CIs.
To evaluate the effect of statin discontinuation during follow-up, we tested the influence of treating the exposure indicator as a time-varying covariate in the Cox regression model, which attributed statin user person-time as un-exposed after discontinuation. This approach is informative about whether our definition of statin use misclassifies actual use. Differences in the estimates between the fixed-time and time-varying models may also reflect a true biological effect of statin discontinuation; however, we hypothesized that there would be no difference between the models. We conducted analyses to evaluate the extent and effect of competing risks and loss to follow-up on the findings. We also tested the assumption of noninformative censoring by evaluating the withdrawal rate and competing risks by statin use. We conducted these analyses to evaluate the potential for bias from differential loss to follow-up.
The Cooperative Studies Program of the Department of Veterans Affairs, Office of Research and Development, supported the main trial and portions of this work. Veterans Affairs Cooperative Studies Program personnel participated closely in the design, data collection, and analysis of the main trial. These same personnel reviewed the manuscript. The authors conducted the design, analysis, and interpretation of the study. The Agency for Healthcare Research and Quality, the American Cancer Society, and the National Institutes of Health provided additional support. These funding sources played no role in the design, conduct, or reporting of this study.
Among the participants, 37% used a statin at randomization. The median follow-up time was 3.5 years for statin users and 3.6 years for nonusers. The median time to first keratinocyte carcinoma or censoring was 2.1 years for statin users and 2.0 years for nonusers. Table 2 shows the characteristics of the full and propensity score–matched study populations. Nearly all study participants were non-Hispanic white men. On average, statin users were older than nonusers. Statin users scored higher on the Charlson Comorbidity Index and were more likely to use other cholesterol-lowering medications and angiotensin-converting enzyme inhibitors. Unexposed participants had higher in- trinsic sun sensitivity and were more likely to have a history of eczema and use of immunosuppressant drugs. On average, the exposed and unexposed propensity score–matched groups had similar distributions of the measured covariates, including assignment to tretinoin treatment. The characteristics of participants excluded by propensity score matching were slightly different from those of the retained patients. Excluded statin users were more likely to use angiotensin-converting enzyme inhibitors and other cholesterol-lowering medications and were less likely to have a family history of keratinocyte carcinoma. Excluded nonusers were more likely to have rhinophyma, psoriasis, eczema, and a family history of BCC or SCC.
The average duration of statin use during the study was at least 900 days (Table 3). At least 80% of patients exposed used a statin for at least 6 months before their date of ran- domization. The daily dose of statins increased from an average of 18.8 mg per user for their first prescription on record to 34.0 mg for the last. More veterans took high doses of statins later in the study, with 15.4% of participants taking 60 to 80 mg/d at the end of follow-up compared with only 3.8% at randomization. A greater proportion of veterans used high-potency statins (atorvastatin and simvastatin) at the end of the study, whereas use of lovastatin decreased (Table 3).
Table 4 shows the crude and adjusted rate ratios from the Cox proportional hazards model (n = 1037). Fifty-two percent of participants had keratinocyte carcinoma during follow-up, with 42% of veterans receiving a diagnosis at least 1 BCC and 24% of at least 1 SCC. The crude incidence rate of any keratinocyte carcinoma was 234.8 per 1000 person-years. The crude incidence rates of BCC and SCC were 168.0 and 80.8 per 1000 person-years, respectively. In the unadjusted analysis, use of a statin at randomization was associated with a 17% lower rate of keratinocyte carcinoma. Adjustment by Cox regression for clinical, demographic, and medication use characteristics, including the primary trial intervention, had little effect on this finding. This reduction was evident after approximately 1 year and persisted throughout follow-up (Figure 2). The estimated rate ratios were similar to the primary estimates when evaluated for simvastatin and lovastatin separately. The use of other cholesterol-lowering medications was associated with an inconclusive decrease in the rate of keratinocyte carcinoma (rate ratio, 0.86 [95% CI, 0.66 to 1.13]). We found no evidence of an interaction between statin use at randomization and randomization to topical tretinoin in the primary trial.
In the propensity score–matched cohort (n = 608), use of a statin at randomization was not associated with the rate of keratinocyte carcinoma (rate ratio, 0.92 [CI, 0.73 to 1.16]) (Table 4). An analysis that treated statin exposure as a time-varying covariate to account for drug discontinuation yielded similar estimates as the fixed-time model (rate ratio, 0.83 [CI, 0.69 to 0.99]). Withdrawal rates were low and not differential by statin use (2.3% among statin users and 3.4% among nonusers). Deaths occurred in 10.6% of statin users and 11.3% of nonusers. These formal sensitivity analyses are available from the authors on request.
In our crude model, we found that statin use at randomization was associated with a 17% lower rate of new lesions of keratinocyte carcinoma among high-risk veterans. Adjustment for individual material confounders by Cox regression did not alter this estimate. After approximately 1 year, the difference in risk remained approximately constant and was consistent for BCC and SCC separately. Results of our propensity score–matched analysis, however, suggests that statin use is not associated with the rate of keratinocyte carcinoma. Because of the width of the CIs, these data are inconclusive, but they do not refute the hypothesis that statins may prevent cancer.
Our Cox regression results are consistent with findings from a pooled analysis of clinical trials that found that use of fluvastatin was associated with a 24% reduction in the occurrence of nonmelanoma skin cancer (40). To our knowledge, no other studies have specifically shown an effect of statins on risk for keratinocyte carcinoma. Most research evaluating the effect of statins on skin cancer has focused on melanoma. A recent systematic review of randomized clinical trials showed no statistically significant reduction of melanoma incidence among users of statins and fibrates (41). Late-acting etiologic actions are more important for SCC than for BCC (30, 31), and we hypothesized that statin exposure in this study occurred late in the keratinocyte carcinoma etiologic process. The point estimate for SCC was more protective than for BCC (although not statistically separable), which is consistent with this previous knowledge.
Because our study was inconclusive, it does not refute the hypothesis that statin use is associated with a lower risk for some cancers. Indeed, recent data suggest that statins lower risk for prostate cancer (42), especially with long-term use (43) or in advanced disease (22, 44, 45), but seem to have no benefit in colorectal cancer (46, 47). However, an epidemiology study by Farwell and colleagues (48) found an approximate 25% reduction in total cancer among statin users in the Veterans Affairs New England Healthcare System data (48). Others found associations between statins and lower risk for renal cell carcinoma (49) but no association with lung and breast cancer (50).
Data on cancer incidence from large randomized trials of statins have been similarly inconclusive. A recent meta- analysis of randomized trials showed no effect of statins on cancer incidence and death (51). It is likely, however, that the studies in the meta-analysis were affected by exposure (52) and outcome (53) misclassification and insufficient follow-up time (54). The relative lipophilicity of statins may influence their cancer prevention efficacy by affecting their target-cell penetration (52). Hydrophilic agents, such as pravastatin, may not penetrate certain tumor cells, which might render them ineffective or even harmful (52). The importance of statin lipophilicity may also vary by tumor site. This argues against the notion that statin chemoprevention is a class effect. Moreover, differences in tumor site and characteristics may affect a cancer's sensitivity to statins (53). Each of these issues may have biased the results of the meta-analysis toward the null and may similarly affect individual randomized trials and epidemiology studies.
Many previous studies did not have power to assess cancer outcomes, especially at specific sites; did not rigorously measure cancer outcomes; and were not conducted in participants at high risk for cancer (7–11). The VATTC investigators ascertained cases of keratinocyte carcinoma consistently and validly, especially for BCC and the full spectrum of SCC (27). This rigorous measurement has been unavailable in previous studies (40). Our approach decreases the possibility of outcome misclassification. However, the reliability estimates from an internal VATTC validation study suggest that, despite these efforts, there is still some error in the outcome measurement, with κ values for interrater agreement of SCC as low as 0.62 for our outcome of invasive SCC (27). Any residual misclassification is unlikely to be related to receipt of a statin or error in other variables and would therefore attenuate our estimates. In addition, BCC, which was measured with less error, accounted for most outcomes.
Statin users may be more likely than nonusers to seek the services of health professionals. This could lead to increased probability of diagnosing keratinocyte carcinoma in this group that could bias the estimate of the statin–keratinocyte carcinoma relation toward no effect. However, the VATTC investigators examined participants every 6 months and ascertained other keratinocyte carcinoma events through usual care pathology reports. This method makes this bias unlikely in our study. Assuming a true protective effect of statins, long-term users of these drugs may have been less likely to enroll in the VATTC because 1 inclusion criterion was a history of 2 or more keratinocyte carcinomas. However, because these data suggested that statin use was of long duration in the VATTC participants, selection bias by this mechanism is unlikely.
Because we used claims data to ascertain exposure, we cannot be sure that participants who received statins actually took their medication. However, recent work has shown that VA pharmacy claims accurately assess medication use (4). Our study is an improvement over previous work assessing the effect of statin use on various cancers, which may have been affected by exposure misclassification (24). However, in our study, veterans may have filled prescriptions outside of the VA pharmacy system, which could have led to underascertainment of medication use. To address the possibility that veterans could have filled prescriptions elsewhere, we included only participants who used the VA pharmacy system. This approach ensured similar completeness of drug data among the statin users and non-users. Moreover, veterans have a financial incentive to fill their prescriptions within the VA system, and evidence suggests that VA pharmacy claims are valid and reliable for ascertaining chronic disease burden (55). Any exposure misclassification by this mechanism would probably dilute our results.
Our drug use data started in September 1998. Because of this left-censoring, we could not ascertain the date of statin treatment initiation or estimate the actual duration of statin use. However, the available data suggested that statin therapy was of long duration. Results of the time-varying Cox regression model suggest that keratinocyte carcinoma is not immediately sensitive to discontinuation of a statin, which is consistent with the notion that keratinocyte carcinoma has at least a moderate-length empirical induction period and that short-term therapy may be insufficient. In the case of a true biological discontinuation effect or exposure misclassification, an attenuation of the primary estimate in the fixed-time model compared with the time-varying model would be expected. We found no evidence of this, but our study was underpowered to test the effect of statin discontinuation. However, the consistent small decrease in keratinocyte carcinoma risk associated with statin use in these models may reflect residual confounding, which is better controlled in the propensity score–matched analysis.
The VATTC study participants were at high risk for keratinocyte carcinoma. The incidence of keratinocyte carcinoma varies by sex and geographic region (56). The rates among the unexposed participants in this study were 50 to 100 times greater than those observed in the general population (56). Whether our findings are generalizable to populations at low or moderate risk is unknown. We found the expected association between well-known risk factors and the occurrence of keratinocyte carcinoma, including male sex, older age, and sun sensitivity (data not shown) (30, 32).
Confounding by indication is an unlikely noncausal explanation of our estimates because risk factors for kera-tinocyte carcinoma are unlikely to influence the decision to prescribe statins, but we cannot rule out the possibility of unmeasured confounding. However, the VATTC investigators collected measurements on many potential con-founders. This ascertainment of potential confounding factors is a strength of the study. Conducting the study in this setting was preferable to using data from cardiovascular disease prevention studies. There was little material confounding in our study, including among variables that we considered plausibly associated with statin use (for example, health behaviors, such as sunscreen use). This provides further evidence that unmeasured confounding is not at play. The estimated association between the use of other cholesterol-lowering drugs and keratinocyte carcinoma was compatible with chance despite a point estimate that suggests a protective effect. The implication of this finding is unclear, but it does not refute the hypothesis that statins may prevent cancer independently of cholesterol synthesis (20, 21). Previous work has shown that statin users are generally healthier than similarly aged nonusers (57). The rate ratios for other preventive therapies (for example, antihypertensives and other cholesterol-lowering agents) and keratinocyte carcinoma were close to 1.0, which suggests that the "healthy-user" effect does not explain our Cox regression findings.
Statins are prevalent, are well tolerated, and have been shown to improve outcomes for persons with cardiovascular disease. Preclinical research has elucidated potential mechanisms of a chemopreventive effect of statins, including beneficial effects on apoptosis and angiogenesis (20, 21). This study provides inconclusive evidence on the potential protective effect of statin use on the occurrence of cancer. Future studies must test the effect of individual statins on other types of cancer and assess whether this association varies by type of statin, dose, and duration of use.
Statins are pharmacologically pleiotropic. Some studies suggest that these agents may prevent keratinocyte carcinoma.
In this analysis of data from a Veterans Affairs trial of topical tretinoin for prevention of skin cancer, 37% of 1037 participants at high risk for keratinocyte carcinoma were taking statins. During a median follow-up of 3.5 years, half of the participants had keratinocyte carcinoma. Analyses showed no statistically significant associations between statin use and risk for keratinocyte carcinoma.
Confidence bounds around the measures of associations were wide.
Evidence that statins prevent keratinocyte carcinoma is inconclusive.
The authors thank Kimberly Marcolivio, MEd; Robert Dyer, MD, MPH; and Margaret M. Boyle for their thoughtful assistance. They also acknowledge members of the VATTC trial group: study chairman Martin A. Weinstock, MD, PhD; Executive Committee members Martin A. Weinstock, MD, PhD, Russell P. Hall, MD, Mark F. Naylor, MD, Julia E. Vertrees, PharmD, John J. DiGiovanna, MD, and Stephen F. Bingham, PhD; study dermatopathologists Clifford R. White, Jr., MD, and Michael Piepkorn, MD; site investigators Russell P. Hall, MD, Mark F. Naylor, MD, David Eilers, MD, Jonette E. Keri, MD, James Kalivas, MD, Gary W. Cole, MD, Catherine Yanna, PA-C, and Robert S. Kirsner, MD; and study coordinator Kimberly Marcolivio, MEd.
Grant Support: Dr. Weinstock was supported by the Department of Veterans Affairs Office of Research and Development (CSP 402), and Dr. Dore was supported by the Agency for Healthcare Research and Quality (grant 5T32HS000011-21). Additional support was received from the American Cancer Society. Dr. Weinstock also received support from the National Institutes of Health (grants R01CA106592, R01CA106807, R25CA087972, and R01AR49342).
|Dermatopathologist 2
|Keratinocyte carcinoma n (%)
|Dermatopathologist 1
|167 (47.0)
|43 (12.1)
|17 (4.8)
|128 (36.1)
|Basal cell carcinoma n (%)
|Dermatopathologist 1
|116 (32.7)
|3 (0.8)
|17 (4.8)
|219 (61.7)
|Invasive squamous cell carcinoma n (%)
|Dermatopathologist 1
|51 (14.4)
|40 (11.3)
|0 (0)
|264 (74.4)
Potential Financial Conflicts of Interest:Consultancies: D.D. Dore (Pfizer). Grants received: K.L. Lapane (Pfizer).
Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Dore (ude.nworb@erod_divad). Data set: Not available.
Author Contributions: Conception and design: D.D. Dore, K.L.
Lapane, V. Mor, M.A. Weinstock.
Analysis and interpretation of the data: D.D. Dore, K.L. Lapane, A.N. Trivedi, M.A. Weinstock.
Drafting of the article: D.D. Dore.
Critical revision of the article for important intellectual content: D.D. Dore, K.L. Lapane, A.N. Trivedi, V. Mor, M.A. Weinstock.
Final approval of the article: D.D. Dore, K.L. Lapane, A.N. Trivedi, V. Mor, M.A. Weinstock.
Provision of study materials or patients: M.A. Weinstock.
Statistical expertise: D.D. Dore, K.L. Lapane.
Obtaining of funding: M.A. Weinstock.
Administrative, technical, or logistic support: D.D. Dore, K.L. Lapane, V. Mor, M.A. Weinstock.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's Canada Institute for Scientific and Technical Information in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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End Of A Century is a compilation of art by the late great graphic artist, drawn from the NME archives.
The silly spot has everything you'd associate with a mid-80s sunglasses ad from waterskis to someone getting thrown in a pool, layered with retro tape distortion.
Intel and Dell's What Lives Inside has the same director as Maleficent and top-notch visual effects by MPC – but is spoiled by terrible product placement.
Fujitsu has developed smartglasses that project imagery directly onto the user's retina with a laser, instead of using small LCD screens like other wearables.
Why bother with trackpads and keyboards when you could control your PC with fruit and Play-Doh instead? That's the central question behind Makey Makey Go.
Photographers are often stymied by their own reflection or that of their camera when shooting through glass, but researchers at MIT and Google Research have developed a method to remove them automatically.
Anatomy and chocolate aren't normally found together in art – but here they represent a big choice in Asma Javeri's life.
This lovely spot includes stop-motion, illustration, special effects and a lot of carpentry. Discover how it was made.


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Super 8 Meadow Wood Courtyard
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Woke to beautiful peaceful sunny morning in the Reno "guesthouse" at James' house. Struggled making numerous calls to try to get insurance for the Boomer. Not an easy task. Finally success with Thumm, so we can now plan our onward trip and not have to think of Plan B, that ...
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Superhero Crawl, Zombie Crawl- organized bar hopping dressed in costume
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Palmer – Alaska's Best kept Secret
The Palmer Historical Society is dedicated to our hometown of Palmer, Alaska, a quaint little town, nestled in the beautiful Matanuska Valley and surrounded by the Talkeetna and Chugach Mountains. We are truly a hometown kind of community.
The first people to live in the Matanuska Valley, where Palmer is located, were the Dena'ina and Ahtna Athabaskans.
In the 1880's Alaska pioneer George Palmer established a trading post next to the Matanuska River. Mr Palmer was a rugged entrepreneur with a history of doing business around the Matanuska valley which included growing the first vegetables, the first privately owned stores, and the first appointed U.S. postmaster in Knik. Mr Palmer also brought the first hay reaper into the area, started selling farm equipment, and established trading posts to trade and supply the people of the area with food, goods, mail, fur, etc.
The town site of Palmer served as a gateway to the Alaska interior for fur traders, trappers, gold miners and those wanting to live life on the frontier.
Palmer also served as a homesteading area for miners who had returned from the Nelchina gold stampede in 1913 to lead an agricultural lifestyle. Development of the coal mines north of Palmer, Eska and Chickaloon, and the influx of gold miners heading to Independence Mine in Hatcher Pass contributed to the increase in population.
In 1914, John Bugge was the first homesteader in the Palmer area. Mr Bugge started a farm where the Palmer-Wasilla Highway and Glenn Highway intersect.
In the late 19th century, the U.S. government began to take interest in the Matanuska coal fields located north of Palmer. This interest sparked financiers to consider constructing the Alaska Central Railroad in 1904. The advent of World War I created a need for high quality coal to fuel U.S. battleships, and by 1917 the US Navy had constructed rail from the port of Seward to the Chickaloon coal deposits. At the end of WWI, the U.S. Navy distributed land in the coal fields to war veterans and additional land was opened to homesteading. Farmers, miners and homesteaders began to populate the area.
The Palmer Post Office was opened July 6, 1917 under the name of Warton. With railroad accessibility, new markets for agriculture began to open up for farmers in the Matanuska Valley.
Although the Federal Department of Agriculture broke ground on the experiment station in 1917, Palmer didn't become a bustling community until the Colonist families arrived in 1935. In one year, Palmer transformed from a mere whistle stop rail siding to a planned community with modern utilities and community services.
Our town site was designed in 1935 during the Great Depression as one of the 100 planned FDR New Deal "resettlement communities". In May of that year, 204 families from Michigan, Minnesota, and Wisconsin (including one family from Oklahoma) were relocated to the Matanuska Valley in order to develop an agricultural community in what was then a Territory. Many of the structures built are now in a nationally recognized historic district.
Palmer incorporated as a City in April 1951 and has been an Alaskan leader in community infrastructure development through the years, with many dedicated citizens giving caring thought to community needs and lifestyle amenities.
We invite your participation and efforts to promote, preserve and protect our town's unique history!
Keep a watchful eye – you may be able to save a historical treasure for us!
Palmer Historical Society
Box 1935
Palmer, AK 99645
(907) 745-1935


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Cover Girl Covergirl and Olay Tone Rehab 2 in 1 Foundation
153 reviews
64% would repurchase
Package Quality: 4.3
Price: $$$
Package Quality: 4.3
Price: $$$
INGREDIENTSIngredients Cyclopentasiloxane, Water, Glycerin, Dimethicone Crosspolymer, Sodium Chloride, Acetyl Glucosamine, Diethylhexyl Carbonate, Niacinamide, Ethylhexyl Methoxycinnamate, Talc, PEG/PPG 18/18 Dimethicone, Panthenol, Palmitoyl Pentapeptide 4, Tocopheryl Acetate, Allantoin, Methicone, Aluminum Hydroxide, Benzyl Alcohol, Camellia Sinensis Leaf Extract, PEG 10 Dimethicone Crosspolymer, Methylparaben, Ethylparaben, Propylparaben, Disodium EDTA, Fragrance, PEG 100 Stearate, May Contain:, Titanium Dioxide, Iron Oxides.
on 9/21/2012 8:27:00 PM
Age: 44-55
Skin: Combination, Fair, Warm
Hair: Brown, Straight, Fine
Eyes: Grey
I finally gave in and bought this--I kept looking at it with curiosity, but was kept away by the price. Seemed crazy for a Cover Girl product. But with a coupon and a sale, it was a bit better.
I like it in some respects. I would call it medium coverage. It evened out my skin tone well and covered some things, but not everything. Which is ok. It is not dewy, but not matte. It's a nice finish. I applied it with my fingers and then blended with a sponge, which seemed to work well. I didn't have any problem with it settling into fine lines or emphasizing my pores. I bought it when the weather was still hot and humid, and at that time, it got too oily too quickly. Now with fall and cooler temps, I am getting dryer, so I'm not getting as much shine. Thus, I guess it would be better for skins that are not too oily.
My biggest problem with this is breakouts. I start getting a lot of pimples a few days after I start using this. Put it away, get my face to clear up, and then when I take it out and start using this again, here they come again. So I guess I have to give up on it. The other negative would be that it doesn't hold up well to a long day. It sort of fades away.
I do love the packaging. The pump is great for dispensing just the amount you want--no waste.
I don't think this is a horrible foundation. But if you are breakout prone, approach with caution.
on 9/18/2012 10:54:00 PM
Age: 36-43
Skin: Combination, Fair-Medium, Not Sure
Hair: Brown, Other, Other
Eyes: Blue
I just bought and tried this tonight as a test on one side of my face, and the other I put another one I just bought. (L'oreal Lumi True match) on other side. They looked almost identical. After about an hour the Lumi one go more shiney around nose and chin. I put a very light dusting of Covergirl translucent loose powder with big brush and it now looks fantastic! I get like this kind of matte but not that chalky ugly dry look. I see slight dewey sheen trying to come through. The makeup did NOT settle into my fine lines under eyes and crows feet, which is awesome! The makeup felt so light, it didn't even feel like I was wearing any. Just a fyi- I also own Revlon CS in both the regular bottle and the newer cream one in jar and they both feel heavy and masky to me. I thought I loved those until I tried this Cover girl and the L'oreal one. Now I know what the one girl at Sephora, and a Estee Lauder rep at Macys meant when they both told me I did not need a full coverage foundation, they said I had beautiful skin and need only tinted moisturizer or very light wearing foundation. But of course I was determined to get full coverage one, (like what do they know..lol) and I keep getting nasty results of cakey, chalky, settling in lines making me look old!. --duh ..should listen to the pro's!
The true test is to take a mirror OUTSIDE and look at yourself! YOU WILL BE AMAZED at what you see! I was horrified today when I took one look in that mirror at my face with the Revlon. When I wear Revlon CS, especially with powder, I look too made up with a mask, powder settling in lines making me look 10yrs older! It's really weird because I put makeup on in one of those lighted magnified mirror and I thought it looked good until today. I am just horrified with myself I never realized it looked this bad. My lines are not even that bad, but they somehow look way worse when makeup settles in them.
Now when I put this Covergirl one and look in mirror my skin looks evened out, flawless, younger, no matter what lighting, mirror etc! just Amazing! The L'oreal Lumi one is great too. I bought both based on reviews here, thinking I will take one back. But nope, I am keeping both and the Revlon CS cream and powder is going back to the store asap!
on 9/16/2012 12:37:00 PM
Age: 36-43
Skin: Combination, Fair-Medium, Neutral
Hair: Brunette, Straight, Fine
Eyes: Brown
I received this foundation and the Cover Girl & Olay Pressed Powder as part of a recent BzzAgent trial. I've read some of the reviews and hope people will first sort by their skin type and/or tone, otherwise products can be so subjective based on your skin type.
I have dry/combo skin--very dry under-eyes and cheeks, normal to oily in the t-zone. I find it's best for me to wear something that suits my dryer skin and then use powder or blot papers on my t-zone to tamp down any shine, as needed.
This foundation really surprised me with a lot of positive qualities to recommend it, especially as I don't typically wear drugstore foundations. Following are my thoughts broken down by Pros/Cons.
Packaging: Love! This comes in a cylindrical, light-weight plastic bottle with an easy-to-control pump...perfect for travel, won't spill, truly hygienic and dispenses as much or as little product as you want. I wish all my foundations came in similar packaging!
Colour: While the colour Buff Beige was a hair too light for me, [I'm about NC 20-25, Armani LSF in #5] I think it's a somewhat forgiving, flexible base that could probably work for a variety of skin tones in the lighter warm/neutral range. It stayed nicely in believable skin tone territory--didn't pull too pink or too yellow like many drugstore foundations can.
Texture: Easily blendable and smooth with fingers and/or a variety of brushes. My favourite being a slightly damp BeautyBlender sponge. I didn't experience any separation or oxidizing with this. The colour went on smoothly and stayed true.
Finish: Probably both a pro and a con for me. Although my dryer/combo skin liked the not-too-matte, not-too-greasy finish, I prefer an undetectable foundation that's sheerer than medium in coverage. I expected this to have more of a tinted moisturizer look to it based on the inclusion of serum, but it was more medium/full-coverage on me. I could tell I had foundation on--something I'm not used to or fond of. The finish has a slight sheen to it, hard to describe but almost a low-wattage metallic glow that on my pretty good skin read more obvious than luminous.
Wear: I never use long-lasting foundations as they don't work with my dryer skin type. For me this had average wear, it faded evenly to a more natural finish as the day wore on.
Scent: I'd rather any face product be fragrance-free. The scent isn't unpleasant and doesn't linger after application but it's there and noticeable when you open the bottle and apply this.
Lack of Sunscreen: Although I own several foundations that don't include sunscreen and I'd never rely on the sunscreen in foundation alone, ideally any anti-aging base should have some sun protection. This one doesn't.
Overall I think this is strong contender for a drugstore foundation, probably best suited to someone with normal/dry or normal/dry/combo skin looking for a solid medium coverage and slight sheen.
on 9/15/2012 8:44:00 AM
Age: 36-43
Skin: Oily, Fair, Neutral
Hair: Blond, Straight, Fine
Eyes: Hazel
I received this product as a BzzAgent to review. The color I chose was buff beige. I wear Kevyn Acouin SX05, Ocean Mist Cosmetics Shell, & Revlon Photoready Nude for comparison. This color matched my skin tone very well.
Application with my fingers was streaky and a lot of product was needed to get good coverage since I have very pink cheeks. I also applied with my stippling brush. This way worked MUCH better. Only one pump was used for nice, medium coverage. It blended well.
As the day progressed, The foundation began to wear off and pool into the larger pores on my cheeks, leaving my with a slightly spotted look. Not pretty. I have oily skin which probably does not help. By the end of the day, my cheeks had no makeup (from constant blotting) and there was little left anywhere else on my face. People with normal or dry skin may not have this issue.
Since I was doing a review in this foundation, I wore it daily for 2 weeks. I use a primer, which may have helped lasting power only slightly. I also ended up taking the foundation and corresponding powder to work for touch ups. After two weeks, I had to stop. I rarely have issues with acne since I have a good skin care routine, but this product has really caused me to break out badly. I will not purchase in the future.
on 9/4/2012 5:49:00 PM
Age: 19-24
Skin: Combination, Medium Brown, Cool
Hair: Brown, Kinky, Coarse
Eyes: Brown
I like it, but I wouldn't repurchase it.
It has a nice shade selection, and I picked "tawny"; I have to admit I'm impressed by how well it blends with my skin tone (I can be jaded about drugstore shades and how hard it is to match to my skin tone). It's a light/light-medium coverage, and since I have combo/oily skin and this has a serum in it I don't need a moisturizer underneath.
My main thing, which is what a lot of people have already stated, is the oily factor in this. I can't complain because it doesn't say anything about combating oil as a purpose, but it really is a dealbreaker for me since halfway through the day my face gets way more shiny looking than I prefer (even when I put on oil absorbing powder as a finish afterwards). If I wear a moisturizer underneath it makes my face look dirty as well. Since I wear sunscreen everyday and this makes it hard for me to do that, it's a dealbreaker. However, winter is coming, so this may work for the months where the air is drier. Still though, I'd rather not rebuy this.
on 9/1/2012 6:10:00 PM
Age: 44-55
Skin: Combination, Other, Not Sure
Hair: Blond, Other, Other
Eyes: Green
This is a wonderful foundation! Provides great coverage that doesn't settle into the fine lines around my 53 year old eyes! Pair it up with the Covergirl/Olay pressed powder and you're good to go for the day!
I spent a lot on department store brands in the past, but this is soooo much better and less of a drain on my pocketbook!
on 9/1/2012 3:40:00 PM
Age: 56 & Over
Skin: Dry, Fair-Medium, Not Sure
Hair: Brown, Other, Other
Eyes: Blue
Have spent a fortune in the effort to find my HG foundation. First purchased a shade that was a little too light, but the texture and coverage was so wonderful that I went one shade darker (#132 Nude Beige), and gave the light shade to a fairer friend. Now I'm about to spend a lot of money buying quite a lot of the Nude Beige for fear it will be discontinued by the company without warning. I am over 60. This is the only -- repeat, the ONLY -- foundation that does not emphasize fine lines on my cheeks, below my eyes, etc., and leaves no chalky residue, etc., etc. Well, we all know the flaws in most foundations. For me, this has none. It goes on smoothly, a tiny bit goes a very long way, and it has very, very good staying power. Hope it works for you, too.
Update: This is still my HG, and I switch from Nude Beige and Medium Beige.
on 9/1/2012 12:02:00 AM
Age: 30-35
Skin: Acne-prone, Other, Not Sure
Hair: Blond, Other, Other
Eyes: Blue
I had the opportunity to try this product as a BzzAgent. I normally prefer to use powder foundation, specifically MAC Studio Fix, mainly because I can apply it easily in my usual morning rush. However, I was actually quite impressed with this product. I like the pump packaging, makes it very easy to not use too much and it is hygenic. I also find this foundation gives me natural coverage, not too heavy, which is just what I like. The foundation matches my skin tone perfectly as well. The one downside for me is that this does not work well to control shine, as I have combo/oily skin, though shine control is not something this product claims as a benefit. The price is quite reasonable, considering I feel it performs at the same level as much higher priced liquid foundations. I also feel this lasts through the day just as well as any other expensive foundation I have used. Overall, this foundation performed considerably better than I expected. I would repurchase, though I see myself using this more for special occasion when I want a bit more polished look rather than day to day work/running errands.
on 8/20/2012 1:08:00 AM
Age: 19-24
Skin: Sensitive, Other, Not Sure
Hair: Other, Other, Other
Eyes: Other
Smells wonderful, i get pretty good coverage, then again my skin is not horrible. i have oily skin. and this did add to it. Not heavy, looks natural. I would purchase this product again.
on 8/18/2012 3:04:00 PM
Age: 44-55
Skin: Combination, Fair-Medium, Not Sure
Hair: Red, Other, Other
Eyes: Brown
It's pretty expensive, but I wanted to try it. I loved it enough to keep buying it, even if it's $20!
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text:
So don't blame we if you tryin' to do drugs
Lyric Meaning
Don't blame the Zombie's music for you wanting to do drugs.
Meechy Darko says there not trying to promote drugs.
"I live by D.R.U.G.S., which stands for 'death and reincarnation under god's supervision.' I fully believe we've been here before. I died when I was 16—that was the first time I did shrooms. I got hit in the face with reality. After all the years of brainwashing and bullshit, that trip really woke me up. That's when I became a zombie."
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text:
On-TV iPod menu navigation revisited
Ask iLounge offers readers the opportunity to get answers to their iPod-, iPhone-, iPad-, iTunes-, or Apple TV-related questions from a member of the iLounge editorial team. We'll answer several questions here each week, and of course, you can always get help with more immediate concerns from the iLounge Discussion Forums. Submit your questions for consideration using our Ask iLounge Submit Form. We reserve the right to edit questions for grammar, spelling, and length.
Q: I have a 5G iPod and an Apple Universal Dock. Is there any way to view the iPod's screen itself (song title, album art, etc.) on my TV?
- Jim
A: The current version of Apple's iPod software doesn't support this feature. Until it does, Apple's Universal Dock will be of no use for on-screen navigation. However, other companies have been developing hardware solutions to the problem.
We addressed this question back in January after having seen two such devices at Macworld Expo, but we'll revisit it today with an important update:
DLO has announced that their HomeDock Deluxe, a dock-and-remote solution featuring on-screen navigation, is now available and shipping for $149. See iLounge's full review of the product here.
The second such device we've seen, and one we're even more excited about, is Griffin Technology's TuneCenter and, now, their TuneCenter Pro. At $100 and $130, both are cheaper than DLO's option, and have the additional feature of wired or wireless networking for internet radio. These will be available in May and June.
We'll reserve our final judgements on the TuneCenter for our full review, but be aware that more solutions are on the way.
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text:
Mövenpick regains Yonge St. Marché
Mövenpick Marché will reopen the popular concept restaurant at its one-time flagship location – the corner of Yonge and Wellington Sts. – in the next six to eight months.
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We can call it Marché once again.
Richtree Market restaurant, the eatery that has sat in the heart of Brookfield Place for six years, shut its doors on Sunday to make way for the return of the Swiss company that brought the concept of a market-style restaurant to Canada.
Mövenpick Marché will reopen the popular concept restaurant at its one-time flagship location – the corner of Yonge and Wellington Sts. – in the next six to eight months.
The return of Mövenpick to downtown Toronto and this particular location is an ironic twist in a bitter relationship between the restaurant and Richtree, which years ago forced Mövenpick out of the Canadian marketplace.
All this week, customers who once flocked to the tourist-friendly, iconic Richtree were greeted by an empty foyer, while the large windows on Yonge and Wellington were covered.
Richtree's closure comes days before the lease for the space was to expire, said Melissa Coley, spokeswoman for landlord Brookfield Properties.
Coley said Mövenpick Marché would be the new tenant of both the concourse and street-level spaces.
"If you recall, they were the ones who were originally here," said Coley. "It's coming full circle."
Swiss restaurant and hotel operators Jorg and Marian Reichert opened Toronto's first Mövenpick Marché in 1992. The Reicherts founded Richtree Markets Inc. in 1996, and held the North American franchise rights to the Mövenpick name.
Following a flurry of lawsuits and corporate infighting, Mövenpick and the Reicherts ended their relationship in 2003.
Richtree gave up its right to the franchise and the remaining Mövenpick restaurants in North American were renamed Richtree Markets.
The Reicherts later left Richtree.
Mövenpick announced last fall it would reopen 10 restaurants in Toronto, taking on Richtree directly, which plans to keep its six remaining eateries open.
"We are totally convinced that we will quickly be successful in winning over new customers in Toronto with our market-fresh cuisine and our traditional methods of baking breads and pastries," said Mövenpick CEO Oliver Altherr in a press release.
A Richtree employee, who didn't want to be named, said all the employees at the Yonge and Wellington location, estimated at 200 people, were given layoff notices or fired in the days before the closure.
She said that employees had been aware of the closure, although there had been no public announcement. She said it was unclear whether Mövenpick Marché would rehire staff who lost their jobs at Richtree.
Richtree did not respond to requests for comment.
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text:
1. A man aboard a New Zealand-bound Qantas Airlines flight was asked to remove his "Princess Bride" t-shirt after other passengers reported that they found it intimidating.
Wynand Mullins wearing the shirt in question.
2. The shirt quoted one of the most famous lines from the beloved 1987 movie:
Wynand Mullins told Stuff that he received a few strange looks from other passengers while waiting to board his flight from Sydney to Auckland and was approached by a flight attendant soon after he took his seat:
"The flight attendant said to me: 'Are you able to remove it because some of the passengers are quite intimidated by it'. I thought it was all a bit silly. The person next to me was laughing, because they knew the movie."
Mr Mullins said he didn't have another shirt to wear and hoped he would get to wear a pilot's shirt - but wondered how the other passengers would then react to that.
The flight attendant left in search of another T-shirt but never returned - and didn't make eye contact with Mr Mullins again.
4. "Intimidating?"
- At least three people have died in South Carolina due to severe rainfall. More than 11 inches of rain fell on the city in 48 hours. ›
- President Obama says the U.S. has launched a full investigation into the airstrikes that killed 22 people at a hospital in Afghanistan on Saturday. ›
- The World Bank announced that for the first time it is forecasting the rate of extreme global poverty to drop below 10% in 2015 . ›


text:
The Process
BY: variousauthors
I think of myself as diamond,
perhaps pure gold.
Maybe my life is an antique vase,
unique, precious, and rare.
Consider the point it which they all began.
Think of the process each went through.
Each test of life has shaped me.
Failure has polished the diamond I am.
The tragedy purified my golden finish.
Another love lost has moulded me like clay,
and shaped me into this lovely vase.
You have given me strength
to overcome stress and change,
only to make my faith stronger in the end.
Prayables Features
Prayables Blog
posted by PrayablesSpiritually Health Get rid of what enslaves you. Find spiritual health and well-being by discovering personal freedom. Don't be defeated by your life circumstances. Here's how to change your life for good. Inspired by Rabbi Karyn Kedar's new book, "Omer: A Counting" Written by Susan Diamond, ...
Previous Posts: You Can Have A Better Marriage | Living Life Outside the Box
Today's Spiritual Quote
Today's Spiritual Quote
When Sidda heard the clamor, her head tilted to one side. Those eagles, like angels, don't distinguish between work and play. To them, it is one and the same.
-Rebecca Wells,more quotes
"Divine Secrets of the Ya-Ya Sisterhood"
"Divine Secrets of the Ya-Ya Sisterhood"


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Thornton, Matthew (1714?–1803), an American patriot and a signer of the Declaration of Independence. Thornton was born in Ireland and was brought to America as a child. He became a doctor and settled in New Hampshire about 1740. Soon active in state politics, he became a leading figure in the patriot cause. Thornton was elected to the Continental Congress after the Declaration of Independence had been drafted in 1776, and was thus one of the last delegates to sign the document. He served in the Congress for about a year and then returned to New Hampshire, where he was a supreme court judge until 1782.
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Patrick Henry
Henry, Patrick (1736-1799), a United States orator and statesman. He was one of the first American patriots to speak out against taxation by Britain.
How the Boston Tea Party Worked
In the dark of night on Dec. 16, 1773, residents of Boston poured more than 90,000 pounds of tea into the harbor. But they weren't trying to set a world record for the most cups of tea made at one time. They were protesting the British government.


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Handsome Gunther is a young man with only one possession…a walking and talking cat! This crazy Puss is the cleverest creature in the Kingdom and he's determined to make Gunther into a Prince. Antonio Banderas is pretty neat in this. Little tots might get scared but this is a really good kid movie.
Puss In Boots (1999)
CategoriesCartoons Free Classic Movies USA ONLY


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March 26, 2014 - Products
Buyers Products has introduced a rectangular LED flood light with an adjustable stainless steel stud mount to east mounting on trucks and trailers.
The water-resistant flood light is rated at IP67 and features six clear LEDs that produce 1350 lumens. The LEDs are encased in a black, powder-coated cast-aluminum housing. It measures 5.75 inches wide and 2 inches tall.
The new LED flood comes with a five-year warranty.
Tags: LED, Lighting, Buyers Products
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Set of Tools Cleans Male Pins on Terminals
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Paccar Announces MX-11 Diesel for North America


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Systemated Business ProductsRead MoreElevate your work product by taking advantage of the office supplies at Systemated Business Products in Altadena. Find furniture that's perfect for your workspace when you mix and match items or streamline your taste. For a style that suits your backyard, browse the selection of patio furniture before the sun goes down. Make sure everything in your bathroom matches and browse the furniture selection for all the best designs. Be your own interior designer and revamp your living room with some new furniture from here, such as living room furniture. Your new and trendy bedroom furniture set is waiting for you. Come browse a variety of options, such as bedroom furniture, and go home with a new bedroom set. If your walls are looking a little bare, spruce them up with items like curtains and mirrors. Sharpen your artistic eye with a little help from this store — even the most impressive artists are dazzled by the stunning pieces on display. Items like rugs, throw pillows, and vases will provide your home with that much-needed flair, so get to decorating. Forget circling the block; Systemated Business Products has plenty of nearby parking options. Systemated Business Products has everything you need to make the perfect home office or desk come to life, so get to Altadena and start shopping today.2770 Winrock AveAltadena, CA US
Emma Sue's Used FurnitureRead MoreToss your clunky furniture and replace your old furniture with some smaller, modern pieces from Emma Sue's Used Furniture in Altadena. Make sure everything in your bathroom matches and browse the furniture selection for all the best designs. You'll love the look of your brand new office when you outfit its furniture with the selection at store. For a style that suits your backyard, browse the selection of patio furniture before the sun goes down. Splurge on a new bedroom set from here, such as bedroom furniture, and enjoy the benefits of a beautifully designed and well-furnished bedroom. Whether you need living room furniture or other furniture items, you can find all of your needs here. If you're in need of some design tips, head on over to this store and peruse the exquisite pieces on display. Nobody likes looking at a blank slate, so consider hanging a little something on your wall. Pieces like curtains and mirrors are just a few suggestions from here you're sure to love. For the homiest of homes, add some warmth with goodies like rugs, throw pillows, and vases. A great selection of parking spots are nearby. Emma Sue's Used Furniture in Altadena offers the best deals on furniture so stop by today and find a new piece for your home.2142 Fair Oaks AveAltadena, CA US
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Ten Thousand Villages PasadenaRead MoreYou'll definitely love coming to Ten Thousand Villages Pasadena's one-of-a-kind furniture store in Pasadena, where you can browse their different wares. Try an item from Ten Thousand Villages Pasadena; it's been known to make its wearers look amazing. Hats, gloves, and scarves galore are available at Ten Thousand Villages Pasadena. Ten Thousand Villages Pasadena boasts an impressive selection of souvenirs and memorabilia that is definitely worth your visit when you're looking for commemorative gifts. Time to update your look? This store has everything a woman wants from cute summer dresses to basic tees. Dog-owners can bring their pups with them to this canine-friendly establishment. Say goodbye to dirt and dust with a new and easy-to-maneuver vacuum cleaner. Drivers should plan to park on the street when dining at Ten Thousand Villages Pasadena's S Lake Ave residence. Buying new furniture doesn't have to be difficult and at Ten Thousand Villages Pasadena in Pasadena it isn't. Stop by today and find your perfect fit.567 S Lake AvePasadena, CA US
The Sewing Studio LARead MoreReady to rev up your style? Head to The Sewing Studio in Pasadena, where you can shop all the latest fashion trends and hottest looks of the season. Holiday decorations like holiday decorations will keep your home looking good year-round. This store features stunning works of handcrafted art that are easy on any eye. Your eyes will light up at the selection of accessories including handbags and false. Looking for a great baby shower gift? Browse the selection of baby accessories here and find the perfect present. A new computer makes all the difference in the world. Stop in at this store to see all that it has to offer including printer_copier_scanner_string and computers. There is ample parking located within the area, making your parking spot hunting quick and stress-free.107 S Fair Oaks Ave, Ste 107Pasadena, CA US


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Fits 3,5,6 & 6.5 Gallon glass carboys and 500ml flasks. A breathable Silicone stopper that acts as both a stopper and an airlock. Unique design allows CO2 pressure to escape but keeps Oxygen and airborne contamination out. Quickly became our stopper of choice for wine. Used by numerous commercial wineries. Also has great application for beer ferments: Will create a vacuum if fermenting wort cools (as opposed to pulling water in from your traditional airlock.) Air tight seal is great for extended fermented lager when CO2 production is still present but very slight. The top measures 1 1/2" wide and the bottom is 1 1/8" wide.
While the FE479 carboy stopper is a great, economical choice, you may also want to check out our premium, breathable, silicone carboy hood FE496 as well.
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Latex free balloons Non latex balloons
We stock a full line of latex free and non latex balloons. Excellent substitute if your allergic to latex balloons. Balloons shapes include, round, heart, square, star, teardrop. Non latex balloons sold plain or with printing. Bulk discounts. Fast shipping. Open 7 days. Call toll free (866) 512-5666. (310) 628-6127 Pacific Time Zone.More info Email a friend
Giant Weather Balloons
Weather balloons in sizes ranging from 3 ft up to 50 ft. Great for weddings, concerts, events, outdoor advertising, science experiments, video projection, visual surveys, aerial photography, flying advertising, crafts, projects and hobbies. We also stock reusable vinyl inflatables which are great for trade shows and repeated events. Fast shipping. (310) 628-6127 or toll free (866) 512-5666. PacificMore info Email a friend
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Like to decorate your home with beautiful flowers, but hate to see them withered? Need silk flowers for crafts? Our silk flowers will be your best choice. Come visit our website: http://www.4seasonfloral.com/ You will be surprised, just a little money can change your home that much!!! To save 50% off for all of items Please enter Coupon Code: "Happy50off" when you check outMore info Email a friend


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Ultra durable bags and cases for the iPhone, iPad, and iPad Mini made from discarded rubber tire inner tubes Read more
Funding Canceled
Funding for this project was canceled by the project creator on June 21, 2013.
Ultra durable bags and cases for the iPhone, iPad, and iPad Mini made from discarded rubber tire inner tubes
About this project
Why Tires?
Discarded rubber tires and inner tubes are among the largest and most problematic sources of waste worldwide. Tires are made to be incredibly strong and long lasting, which is great for the operation of a vehicle but a nightmare when it comes to recycling. Mechanically breaking down a tire to be recycled is difficult, costly, and requires the burning of fossil fuels. Tires placed in landfills or stockpiles create a great health risk by polluting the nearby air and water. This is a huge problem when you consider that tires are one of the most frequently replaced parts of any vehicle.
Luckily every yin has a yang. The same strength and durability that makes these items difficult to recycle, makes them ideal for repurposing into something new.
The Process
We've built relationships with recycling centers and scrap dealers that can provide used rubber tire inner-tubes before they are melted or shredded. Despite the fact that this material is sold in very large and costly bulk orders, we were able to obtain a small sample to create our prototypes.
The process begins with the rubber tire inner-tube (after a thorough cleaning) being cut to our patterns and prepped for sewing. We've partnered with a small family run workshop that specializes in making small bags and cases to assist with production. They have helped in stitching our prototypes and are poised to handle large production runs.
Our very early prototypes were made with no inner lining which left the interior drab and not incredibly protective.
We added a colorful inside lining to all the items and a thin foam padding to the device cases. Lastly, we added a custom made tag with our name renewpurpose.
The Results
Risks and challenges
The rubber material we're working with has a rather large and costly mandatory minimum order size. With the small sample amount that we have received, we've been able to produce a handful of prototypes of each of the items seen here. We need your help to raise funds so we can bulk purchase the necessary material (diverting it from a melting tank or landfill), and produce the items in large numbers.
The primary challenge we face is acquiring the rubber tire inner tubes before they have been processed or shredded for scrap. With the relationships we've built so far we don't foresee this being a problem. With the incredibly large amount of tires that are discarded everyday, and the ever-increasing number of cars on the road, we don't anticipate any shortage of material being created.
The small workshop we've partnered with to assist in producing our prototypes is absolutely capable of producing larger amounts in a reasonable amount of time. Upon our project being funded, we will acquire all the necessary rubber and fabric materials and work closely with the workshop to have all the items produced quickly.Learn about accountability on Kickstarter
No. The current pledge amounts include international shipping.
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About $10 USD
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Enjoy the good feeling that you are supporting an environmentally friendly product. Have your name listed on our website as a contributor. We greatly appreciate all contributions.LessEstimated delivery:Manage your pledge
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5 backers
Rubber Tire iPhone Sleeve Case - Fits all versions of the iPhone and most smartphones of similar sizes.Less
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About $45 USD
1 backer
Rubber Tire iPad Mini Case - Fits most other tablets of similar sizesLess
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About $45 USD
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Rubber Tire HandbagLess
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2 backers
Rubber Tire iPad Case - Fits all versions if the iPad and other tablets of similar sizesLess
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About $90 USD
2 backers
Any two item combo - iPhone Sleeve Case or iPad Mini Case or iPad Case or HandbagLess
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About $155 USD
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iPhone Sleeve Case + iPad Mini Case + iPad Case + HandbagLess
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About $250 USD
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iPhone Sleeve Case + iPad Mini Case + iPad Case + Handbag + Personal handwritten letter of thanksLess
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About $500 USD
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iPhone Sleeve Case + iPad Mini Case + iPad Case + Handbag + Personal handwritten letter of thanks + be listed on our website as one of our close friends and supporters.Less
Funding period
- (30 days)


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Sep 14
Open mic night
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Open mic
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Open mic night
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Open mic night
Bio: Sonically versitile, having played in nearly all styles and genres of bands, starting out as a bass player for rock and southern gospel bands as a teenager in the mountains of Virginia, then moved to Florida to attend Full Sail where he aquired his recording arts degree. He returned to Virginia t...See Full Bio


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|Open daily 10am to 6pm!
|Peaches: We grow many different varieties
|A peach is a peach, right? Lucky for you, there are many different varieties that ripen at various times so you can enjoy a fresh peach all summer long!
Big Dan grows all of these peaches...
|Home U-Pick'em Hayrides Produce Farm Life Favorites Location Contact Us
|Revised: July 26, 2015
|Big Dan's Farm Market
|(c) BigDans.com 2015


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Additional file 4.
Results from simple linear regression analyses on the 'extended dataset' using phylogenetic generalized least squares (PGLS) model and phylogenetic independent contrasts (PIC). PIC analyses are conducted at both all-anuran and family levels; outliers, which deviated from the majority of the data points by more than three interquartile ranges from the quartiles, were excluded. All species with relevant data are included in each pairwise correlation analysis. Only correlations with degrees of freedom ≥ 3 are presented. P < 0.10 are in bold. * Dicro = Dicroglossidae; the family has 'mean' data only.
Format: DOCX Size: 136KB Download file
Han and Fu BMC Evolutionary Biology 2013 13:27 doi:10.1186/1471-2148-13-27