text:
Former Och-Ziff Fund Manager Redl to Start Japanese Hedge Fund
Chris Redl, a former fund manager at Och-Ziff Capital Management Group LLC, plans to start a long-short hedge fund in April that will invest in Japan's most traded companies such as Toyota Motor Corp. and Canon Inc.
The Carnico Japan Fund will start with initial capital of about $20 million to $30 million on April 1, with New York-based Wolver Hill Advisors LLC as the anchor investor, said Redl, managing partner of Singapore-based Siena Capital. Redl is joined by Dean Kimpton, a former sales trader at Instinet Inc. in Tokyo, who will be the chief trader, he said.
New hedge-fund offerings globally outpaced closures for the first time since 2007 last year, and startup funds in Japan garnered $317 million in 2010, according to Hedge Fund Research Inc. and AsiaHedge New Funds Survey. He joins a breed of managers who are setting up their own shops in Asia after working at global financial firms.
"Hedge fund investors are looking for new funds, but still have a hard time pulling the trigger on very small startups, rightly or wrongly," said Kirby Daley, a Hong Kong-based senior strategist with Newedge Group's prime brokerage business. "Managers with experience at large hedge funds or in the prop trading groups being spun out of the banks are the only real exceptions right now, with many of them being given the benefit of the doubt with early stage investments."
Redl left Och-Ziff, the New York Stock Exchange-listed hedge fund run by Daniel Och, in 2009. Och-Ziff's assets under management rose to $28.4 billion as of Feb. 1, according to the firm's earnings statement last month.
In preparation for the fund's start, Redl ran the long-short equity strategy last year, betting on rising and falling stock prices. He had a 10 percent return from April 1 through Aug. 31, based on data audited by Ernst & Young, compared with an 18 percent drop during the same period by Japan's benchmark Topix index. In a short sale, a trader borrows stock and sells it in the hope it can be bought back later at a cheaper price.
A total of 935 hedge funds opened in 2010, topping each of the prior two years and the most since 2007 when almost 1,200 funds started, according to HFR, a Chicago-based industry researcher. Closures totaled 743 last year, the fewest since 2007 and almost half the record 1,471 in 2008, HFR said.
Morgan Sze, global head of Goldman Sachs Group Inc.'s principal strategies proprietary trading desk, and Charlie Chan, a former Credit Suisse Group AG proprietary trader, are among expected "high-profile" startups, according to the AsiaHedge New Funds Survey published last month.
'Horse's Mouth'
Japan-focused hedge funds have returned 3 percent so far this year through February, outperforming the 1.3 percent returned by the Eurekehedge Hedge Fund Index, which tracks more than 2,500 funds globally.
The Carnico fund, named after Redl's sons Carlo and Nico, focuses on stocks with trades amounting to $10 million a day on average over the past three months and on companies where Redl has met directly with company officials.
"I have to have the word from the horse's mouth in order to invest with conviction," Redl, 44, who also worked as an equity analyst in Japan at brokerages including Morgan Stanley and UBS AG, said in an interview in Tokyo yesterday. "Japan has its reputation of being a laggard in Asia, but we actually think it's a great market to invest in -- in terms of liquidity, long and short, this is the best market in Asia."
The fund will invest in 50 to 70 stocks, said Redl, who visits about 200 companies a year. The portfolio is built around the quarterly earnings results, while risk-management is overseen minute-to-minute, allowing the fund to be liquidated within a couple days if necessary, he said.
"Every quarter there is an exit strategy for the investments we have and every quarter there is a new story waiting to happen," Redl said. Still, "when there is a trend that happens, you don't fight it, you get out and be scared."
Hedge funds are mostly private pools of capital whose managers participate substantially in the profits from their speculation on whether the price of assets will rise or fall.


text:
So much of what we need every day we have to take with us wherever we go. This includes weapons, electronics, keys, etc. and we can't do without one of the items or else we feel uneasy and unprepared. So, what do you guys (and girls) carry in your pockets every day? Rick and I want to know!
Send us your EDC pictures and we'll share 'em with everyone! Just don't be stupid and take a picture of your credit card numbers or ID...that wouldn't be prudent.
Enjoy these EDC pictures from around the web, and let's compare. What do YOU need with you every day?
theBrigade wants YOU, to send in your photos! Do it HERE!

subset: commoncrawl


text:
The Manhattan Christian College volleyball team defeated Central Bible College in three sets on Saturday afternoon at the NCCAA Pre-Region Tournament.
This page and other exclusive local content require a subscription.
Terms of Service | Privacy Policy | The Manhattan Mercury, 318 North 5th Street, Manhattan, Kansas, 66502 | Copyright 2012
Reproduction of any kind is prohibited without written consent.


text:
The point at which chaos, The bizarre and an implicit legacy of devastation meet and merge: my little girl's front bottom.
"Mommy, mommy! n-n-NOONY!"
"What is it, honey?"
"Gosh! I just...NOONY BANOONY!!!"
"Oh, honey, -sob- I'm all agog."
"What is it, honey?"
"Gosh! I just...NOONY BANOONY!!!"
"Oh, honey, -sob- I'm all agog."
dodane przez Naom Chomsky sierpień 12, 2003
Directly following on from any banoony instance.
"inevitably the noony ensued."
dodane przez Jody Hoskins sierpień 16, 2003
macaroni and cheese, esp. store brand from a box.
man, im so baked, i could totally munch like six boxes of noonies right now. b
dodane przez liberate cannabis marzec 17, 2005
an unknown meta physical beast obscured by its own excretia, whose exertions cause vibrations detectable in the physical plane.
"whats that...feels kinda..."
"its just the Noony, get back to work"
"its just the Noony, get back to work"
dodane przez Timmy FeNimminidtz sierpień 12, 2003
something certain, doubtless.
"sweet ass."
dodane przez Breadless sierpień 16, 2003


text: To be classified as current assets, investments must be capable of being converted into cash quickly and management must intend to sell the investments as a source of cash to satisfy the needs of current operations. To be classified as long term, investments must not meet the requirements for short-term investments—not marketable and not intended to be converted into cash. Long-term investments also include funds earmarked for a special purpose, and other assets not used in company operations.


text:
Beyond: Two Souls cast photos show motion capture work
Beyond: Two Souls screenshots showing actors Ellen Page, Eric Winter and Kadeem Hardison donning mo-cap gear are posted below. There's also a few of Quantic Dream's David Cage looking on as the actors do their work, and some head shots. Beyond: Two Souls is a PS3 exclusive which is slated for 2013.
Sometimes we include links to online retail stores. If you click on one and make a purchase we may receive a small commission. For more information, go here.


text:
selection of Vespa Scooter designs @ ScooterBaby
100 USAF Aircraft Designs @ ZoomWear
Cooper designs @ ScooterBaby
Evolve Shop > United States Marine Corps > Vintage 1917 US Marines Travel Poster > US Marines WWI Posters
Vintage US Marine Corps WWI Recruit Poster. Marines History, great design for t-shirts, greeting cards, posters, prints, postcards, magnets, mugs and gifts.
Drag the square at the left to choose the part of your image you want to use. Tips: Click and drag any corner to resize; click and drag from the inside to move.
Click done if you're happy with the way it looks.
Selections of Classic and Vintage Designs on T-shirts, Posters, Framed
Prints, Postcards, Greeting Cards, Magnets, Stickers and Gifts.
This shop is powered by CafePress Inc.
Copyright © 1999-
Privacy Policy |
Trademark & Copyright Information
Non-US currency rates are updated daily and may fluctuate.


text:
Paintings Made by Me
DaVinci Social Art Club Membership: Includes 1 Studio Session Per Month & More
special delivery
shop unique gifts and deliver them with style
easy, flexible delivery
print it out, email it now, or schedule it for a later date--it's up to you
personalized email
Emailing your gift? Write a message, select a theme, and hit send. The price you paid will not be displayed in the email.
special printed voucher
Delivering the gift in person? Choose a theme, print it out, and pass it along to that special someone. It's that simple.


text:
Compact Instrumentation for Thermal Barrier Coating Integrity Monitoring
Award Information
Small Business Information
2572 White Road, Irvine, CA, 92614
Principal Investigator:
Peter DeBarber
Senior Scientist
(949) 553-0688
Senior Scientist
(949) 553-0688
Business Contact:
Cecil Hess
(949) 553-0688
(949) 553-0688
Research Institution:
AbstractIn this SBIR Phase II proposal, we outline a plan to develop a novel optical tool for quantitative Thermal Barrier Coating (TBC) integrity monitoring. Its operation uniquely combines three independent optical techniques based on measurement of fluorescence and thermal signals generated within the Thermally Grown Oxide (TGO) layer. These signals are used to quantify the compressive stress inside the TGO, the TGO layer thickness, and the fraction of delaminated interface areas. A technical advantage of this approach is that it provides inherent subsurface selectivity at the location where TBC structures are most prone to fail. During Phase I, we successfully demonstrated the feasibility of these techniques by performing a blind test evaluation. The thrust of Phase II is to develop these techniques into an imaging mode, with the additional advantage of more rapid mapping of complex surfaces such as turbine engine components. The design includes a compact optical probe for inspection of components in areas with difficult access.
* information listed above is at the time of submission.
An Official Website of the United States Government


text:
Big Daddy's Boxing Log - The making of a legend.
View Single Post
Big & Slow
ESB Addict
Join Date: Sep 2009
Location: Cincinnati, OH
Posts: 3,388
vCash: 75
Re: Big Daddy's Boxing Log - The making of a legend.
Worked out at Spears Amateur Boxing in Cincinnati.
My daughter and I went over to check the place out and had a good workout. Over the course of an hour we worked the Heavybag, showing her the 1+2. I practiced the 1+2 with her.
Tried showing her the Hook, but she wasn't getting it. Her 2 needs work. She's dropping the right hand and throwing an arm punch; no hip rotation. Her jab is coming along, but she chicken wings it sometimes, especially when she is tired.
We worked the DEB, same punches. I worked the speed bag. They had smaller, faster bags than what I have at home. I think I'm ready to step up to a faster bag. I was able to work it just fine on the rickety platform they have there.
Finally, I got into the ring and did some focus mitts with Coach Spears. He had me working on some awkward step-jab+2. It looked horrible. Darby taped it, and the video is here.
He said "I'm going to show you how to hit HARD." I guess those punches were hard, but they were telegraphed to hell and back. Also, the footwork gets you out of position and feels awful.
Everyone who has seen the video said he had no idea what he was doing. I checked him out but could find no pro record for him. Not sure where he got his experience, but he has a nice facility. Family atmosphere.
My daughter liked it.
View Public Profile
Visit Slacker's homepage!
Find More Posts by Slacker


text:
All Rise...
Judge David Johnson's wardrobe clashes with the Red Ranger.
The Charge
Join the Samurai Rangers in their fight to save mankind against time-jumping intruders.
The Case
The Samurai Rangers have enough on their plate. When they aren't grappling with typical teen life issues like low self-esteem and anger management, they're incessantly waging war against a batch of antique freaks from old-school Japan Hell-bent on flooding the Earth with evil ocean-water and running rampant.
But now a whole new set of headaches are set to ignite.
Following some funky pyrotechnics, the RPM Ranger Red, a Red Power Ranger from an alternate dimension drops out of a dimensional rift, hot on the heels of another dimension-hopping being, a malevolent super robot with aims of unloading a world of hurt on our fair planet. Thrown together by necessity, RPM RR and our Samurai Ranger heroes must set aside their swagger and work together to blow the living hell out of the bad guys.
First warning: Despite the disc claiming to be Clash of the Red Rangers: The Movie, this is no feature-length production. Any Rangers fans angling for an evening's worth of robust runtime and chopsocky entertainment are sure to be disappointed at the mere 45-minutes of clock the story burns through. So right off the bat, you should know the value-add is small. There aren't even any bonus episodes to inflate the runtime.
What does that leave us with? Essentially a glorified Power Rangers Samurai two-part episode about a douchebag Red Ranger who rides a motorcycle and makes fun of horses. See that's where the central tension comes from in the "film": the RPM Ranger Red is used to all manner of dope tech from his dope dimension and is positively aghast at the quaint conveyances the Samurai traipse about with. Though, to be fair, it is sort of odd that the warriors entrusted with guarding our world against the creeping totalitarianism of a demon horde choose to get from place to place on horseback, despite the fact they have access to lasers and humongous robots.
Eventually, our Ranger pals get along to defeat the bad guy and the moral life lessons are about as subtle as one of the zillions of big-ass explosions that litter the production, but, hey, that's how the Power Rangers roll.
The DVD: 1.78:1 anamorphic widescreen, 5.1 Dolby Digital, a selection of music videos, bloopers, audition footage and a lame fitness PSA.
The Verdict
Guilty of skimping on the content.
Give us your feedback!
Did we give Power Rangers: Clash of the Red Rangers a fair trial? yes / no
What's "fair"? Whether positive or negative, our reviews should be unbiased, informative, and critique the material on its own merits.
Other Reviews You Might Enjoy
• Spawn
DVD Reviews Quick Index
• DVD Releases
Scales of Justice
Perp Profile
Studio: Lionsgate
Distinguishing Marks
• Featurettes
• IMDb
DVD | Blu-ray | Upcoming DVD Releases | About | Staff | Jobs | Contact | Subscribe | Find us on Google+ | Privacy Policy
Review content copyright © 2013 David Johnson; Site design and review layout copyright © 2016 Verdict Partners LLC. All rights reserved.


text:
Stalin and His Hangmen: The Tyrant and Those Who Killed for Him (Paperback)
Stalin did not act alone. The mass executions, the mock trials, the betrayals and purges, the jailings and secret torture that ravaged the Soviet Union during the three decades of Stalin's dictatorship, were the result of a tight network of trusted henchmen (and women), spies, psychopaths, and thugs. At the top of this pyramid of terror sat five indispensable hangmen who presided over the various incarnations of Stalin's secret police. Now, in his harrowing new book, Donald Rayfield probes the lives, the minds, the twisted careers, and the unpunished crimes of Stalin's loyal assassins.
Founded by Feliks Dzierzynski, the Cheka the Extraordinary Commission came to life in the first years of the Russian Revolution. Spreading fear in a time of chaos, the Cheka proved a perfect instrument for Stalin's ruthless consolidation of power. But brutal as it was, the Cheka under Dzierzynski was amateurish compared to the well-oiled killing machines that succeeded it. Genrikh Iagoda's OGPU specialized in political assassination, propaganda, and the manipulation of foreign intellectuals. Later, the NKVD recruited a new generation of torturers. Starting in 1938, terror mastermind Lavrenti Beria brought violent repression to a new height of ingenuity and sadism.
As Rayfield shows, Stalin and his henchmen worked relentlessly to coerce and suborn leading Soviet intellectuals, artists, writers, lawyers, and scientists. Maxim Gorky, Aleksandr Fadeev, Alexei Tolstoi, Isaak Babel, and Osip Mandelstam were all caught in Stalin's web courted, toyed with, betrayed, and then ruthlessly destroyed. In bringing to light the careers, personalities, relationships, and accomplishments of Stalin's key henchmen and their most prominent victims, Rayfield creates a chilling drama of the intersection of political fanaticism, personal vulnerability, and blind lust for power spanning half a century.
Though Beria lost his power and his life after Stalin's death in 1953, the fundamental methods of the hangmen maintained their grip into the second half of the twentieth century. Indeed, Rayfield argues, the tradition of terror, far from disappearing, has emerged with renewed vitality under Vladimir Putin. Written with grace, passion, and a dazzling command of the intricacies of Soviet politics and society, "Stalin and the Hangmen" is a devastating indictment of the individuals and ideology that kept Stalin in power.
"From the Hardcover edition.
About the Author
Donald Rayfield is Emeritus Professor of Russian and Georgian at the University of London. In addition to his definitive biography of Chekhov (reissued in Faber Finds), his books include "The Dream of Lhasa: The Life of Nikolay Przhevalsky (1839-88), Explorer of Central Asia "and "Stalin and His Hangmen." His 'superb new translation' (William Boyd - "Guardian") of Gogol's "Dead Souls" was published in 2008.


text:
Form Timeline
Click here to view Form Timeline for runners
Fri, 4th Jan, 2013
View Using Active Card View all races on one page
Formscan By Gary Carson - SHAKE THE BUCKET has been raised 7lb since his win over course and distance and it looks a good move to claim off him now. He has run really well on his two subsequent starts and was just denied by a couple of necks on his last start over a longer trip. That showed he is still up to winning off this mark and with young Luke Dempsey taking 7lb off his back now he has to have a big shout. Alghanem also has a good record around here and ran well despite a 12lb rise for his course and distance win when chasing home Asian Wing last time. With another pound for that effort, however, the handicapper may have his measure. Shukhov bounced back to form here last time with a wind op given as the reason for his improvement. He still looks competitive off a 6lb higher mark. English import Hurricane In Dubai showed some decent form last summer and is an interesting contender on his first start for David Marnane.
Show Cards Help
An extended handicap for four yrs old and upwards (85 = 9st 10lb)
Weights - An extended handicap for four yrs old and upwards (85 = 9st 10lb)
Allowances - Top weight in the original handicap shall not be less than 9st 10lb.
Riders - (after calculation of the handicap) A winner shall carry 5lb extra for each race won Any horse rated above 85 shall initially be treated as having that rating and the highest weight allotted shall be 9st 10lb. Subsequently, the excess over 85 in any rating shall be added to the weight allotted to that horse. (For the purpose of this note, any four year old rated above 85 shall have the applicable weight for age allowance then prevailing deducted from the horse's rating prior to the original calculation of the handicap)
Probable SP 3/1 Alghanem, 7/2 Shake The Bucket, 5/1 Shukhov, 6/1 Salam Alaykum, 8/1 Prince Of Fashion, 10/1 Silverlord, 12/1 Denny Crane, 14/1 King's Trail, Hurricane In Dubai.
Previous Years
2012 Bramante 5 9-3 N G McCullagh 7/2 (Charles O'Brien) (Drawn 13)


text:
Pink eye and itis.o.o
(don't ask about the title and I broke it apart to make it easier to read)
I'm just the unhealthy girl down the block aren't I?
Lately my eyes have been itchy and I rub them constantly, then they water and get all red, my mom gave me drops but it don't help and I also have tonsillitis(How fun!)
So my mum took me to the doctors where they told me I have "conjuclivitis" "s...i...usitis"(I hates doctor handwriting..) and "tonsillitis"(you already knew that)
So this morning, I woke up and I couldn't see!>.>
My mom had to let me stay home.(Yes I'm super contagious and my school is forcing me again, but I can't go if I'm temporally blind~<3)
Has this ever happened to anyone? Any tips on getting better?
Sinusitis - meaning inflammation of the sinus membranes/cavities in your head. Those REALLY suck, I know that; all I can say is that if you get a headache, take a nap as with my personal experience, sinus headaches are a real pain to get rid of with medicines. If your nose is plugged up, get a cup of hot anything (coffee, chocolate, etc.) and just sit with your nose over it so the steam loosens the mucous in your nose so you can clear it out easier when you blow it. ^^
For tonsilitis, you may want to drink neutral temperature drinks (like tea) and things that are not spicy; if salty things help you when you have a sore throat, have something salty once or twice a day.
For pinkeye, I can't help you there, just keep using the drops. It should clear up in a few days; if not, see your doctor again, alright?
|All times are GMT -4. The time now is 06:06 PM.
© 2007 The Doll Palace


text:
Min 0.5 yard, incr. of 0.25 yard
Graceful geishas in formal kimonos perform a formal dance in a garden of stylized pines and waves of flowers. Gold metallic highlights add an extra touch of enchantment to this exquisite garden design. Taller Geishas are about 11 1/4", with gold metallic, from the 'Kabuki' collection by Chong-A Hwang for Timeless Treasures.


text:
Hi, I am Brenda Ginsberg, and I've been selling vintage and antique jewelry on the internet since 1998.
My passion is for beautiful, superbly made antique items.
I sell fine jewelry including vintage and antique earrings, rings, necklaces, pendants, lockets, bracelets, bangles and brooches. I also look for vintage and antique men's jewelry including cufflinks and dress sets. I sell some rare and special antique and vintage silver and objects of virtue, especially useful items that you can incorporate into your fine dining.
I look for quality, workmanship, and rarity and scour the globe for vintage and antique jewels that peak my curiosity and satisfy my regard for quality.
I see antiques as a link with the past! Think of the many generations of people who earned, looked after, and cherished these beautiful antique items. Who wore this pair of vintage earrings? I also think that besides being a luxury, and a privilege to own, it is our responsibility to ensure that they are passed down to future generations—whether in our family, or others.
We have a vast, and still growing, reference library that we use to research, catalog and describe the antique jewelry and antique silver we have for sale on our website www.brendaginsberg.com .
Each antique or designer named jewel on our website is carefully described and pictured from a variety of angles so that you may get a clear idea of what it would be like if you were holding it in your hands. We do our best to call any flaws. Our prices are more than fair.
Great service is an important part of what we offer to our customers. We have a professional packer and shipping staff to ensure that you will receive your valuable antique jewelry in the same fine condition that you saw it on-line.
Communication is the key to a successful transaction!
Enjoy your Shopping!
More About Our Web Site
Brenda Ginsberg Vintage Antiques & Jewelry
1200 S. Rogers Circle #16
Boca Raton, Florida 33487
Email: email@example.com
By Appointment


text:
It's a hot and sunny Saturday and we're on our way to Lynnville, a sleepy little town that you could live in Tennessee all your life without hearing of, but which today has drawn our attention because of an ad I saw somewhere for a blackberry festival. The whole trip, I'm reading to Tim from my latest library find, and right away, we're both so into the stories about food and parenting and the world of magazine editing that before we know it, we've driven the entire hour, past hilly pasture land and giant barns and no places to use a bathroom, anywhere, and then there's Lynnville, right before us, rewarding our travel with what turns out to be the very anti-climactic main street that today boasts one carnival booth, four craft tents and, off in the corner, a 85-year-old man selling tomatoes. No. Blackberries. None. So we talk with the tomato man, who tells us he's lived in Lynnville all his life, and we ask him about blackberries, and he says, no, there aren't any, but you … [Read more...]
You are here: Home / Archives for peas


text:
You Are About To Discover What Helps You Recognize And Stop Elder Care Abuse And Neglect - Before It's Too Late And The Damage Is Done!
The key is education and certification!
Top 5 Caregiver Education Programs
If you are smart enough to be looking for a good caregiver certification training program then you will probably do a Google search just for that. We hoped to save you time by doing the research for you and identifying the most popular and well regarded programs that come up on Google's search page.
The following rankings are based upon accessibility, variety of subject matter covered, price and overall value for both family caregivers and professional care aides who desire credentials for career growth. The results are ranked based on best overall.
1) CertifiedCare.org: This is the best overall value for standardized; comprehensive caregiver certification credentials and is the only program on our list that offers a Alzheimer's & Dementia Caregiving certification and a Special Needs Caregiving certification. This membership organization also supports community service programs and has received awards for innovation in geriatric caregiving and eLearning. You can only get the programs if you area member of the organization, but the programs are included in membership.
Pros: One complete online certification program for caregiver certification and Personal Care Aide certification. CertifiedCare offers the only caregiver – personal care aide certification program we reviewed that is comprehensive and accredited. The personal care aide certification program includes 4 modules (Family Caregiver Certification, Personal Care Aide Certification, Special Needs Certification which includes caring for chronic illnesses, and Alzheimer's & Dementia Certification). CertifiedCare also offers an advanced caregiver career certification, Senior Care Auditor, which is the first and to date the only comprehensive Senior Care Auditing certification program in the world. Along with the lowest overall price for certification programs, programs are refundable under certain conditions; graduates can receive both emailed and frame worthy certificates; students study at their own pace- there are no deadlines for completion; immediate test retakes are allowed; modules are well organized and build upon previous information covered in the prerequisite module; accredited curriculum; all tests are included in cost; no extra books to buy; payment plans available – one with no credit-zero interest terms. Also included (for free) is an eText about death and funeral planning. At around 80 hours, the entire program meets or exceeds most state and national education requirements for personal care aides; no quizzes or assignments; program is tax deductible. CertifiedCare maintains a free public registry for credential verification for their members for job placement assistance and higher wage floor. Students who complete the professional certification program are eligible to take RN clinic test so as to be able to apply for a medicare/medicaid payor number.
Cons: Only available online; only available in English at this time.
2) CactusWrenHomeCare.com: This is a great traditional classroom style caregiver training option and they also provide consulting for home care start ups.
Pros: Robust 62 hour training program, offers bundle program packages, reasonable prices for bricks and mortar classroom training, CPR/First Aid, fingerprinting and TB testing services and continuing education are offered. Live instruction format, so no need for tech support.
Cons: No distance learning training option- you must be able to get to Mesa or Phoenix Arizona for 2-3 days; course offerings are calendar controlled; programs are non-refundable; no option to receive frame worthy certificate and no Alzheimer's-Dementia or disability-special needs training and certification.
3) Ipced.com: Offers education for caregivers and administrators of assisted living facilities as well as a nice business success program.
Pros: Online format, Spanish and Chinese (Mandarin) language options, good 40 hour program for family or professional caregivers, quizzes control progress through different course topics, DVDs for certain topics, individual state training packages and continuing education opportunities.
Cons: Most expensive program on our list, uses third-party company for training materials (good luck with tech support questions), family and professional programs are combined so not much variety in the curriculum, must wait at least 24 hours to start programs and no option to receive frame worthy certificate. No disability/special needs caregiving program, textbooks not included and add to overall cost; strict 90 days to complete program deadline; technical support is only available Mon-Fri 8am -5pm and program requires a $50 set up fee plus costs of the program(s).
4) CaregiverList.com: This company has a very large website with a lot of resources. They offer a very affordable program, you can buy a background check and apply for a job from their website. They also offer resume writing assistance and a nice career center.
Pros: 10 hour online certification course, is among least expensive and the program meets some state minimum orientation requirements, they offer a practice Nurses Aide test, and test retakes are allowed.
Cons: Their minimum 10 hour orientation program is only introductory and does not include many important subjects; certification programs are not packaged or comprehensive; no refunds; test fees are extra; specialty education and certification programs are not offered.
5) CaringforMom.com: Offers small a la cart education courses reasonably priced and only suitable for part-time family caregivers, but no true testing and certification program for professionals.
Pros: Online courses that allow you to buy education snippets rather than complete programs and offers Washington state continuing education.
Cons: Lacks fully comprehensive curriculum, uses third party company for its training programs (good luck with tech support questions), must buy many courses to have somewhat complete training, no standardized educational material, can quickly become expensive (buying a la cart programs end up costing more than buying one fully comprehensive program), no test centered certification for verification of education achievement, and no frame worthy certificate offered (not best choice for professional care aides).


text:
Skip to main content
Search the history of over 498 billion pages on the Internet.
Search the Wayback Machine
All Texts
This Just In
Smithsonian Libraries
Lincoln Collection
Additional Collections
eBooks & Texts
American Libraries
Canadian Libraries
Universal Library
Shareware CD-ROMs
Community Texts
Project Gutenberg
Biodiversity Heritage Library
Open Library
Children's Library
Kimberly Kubus
All Video
This Just In
Prelinger Archives
Democracy Now!
Occupy Wall Street
TV NSA Clip Library
TV News
Animation & Cartoons
Arts & Music
Community Video
Computers & Technology
Cultural & Academic Films
Ephemeral Films
Understanding 9/11
News & Public Affairs
Spirituality & Religion
Sports Videos
Videogame Videos
Youth Media
All Audio
This Just In
Grateful Dead
Old Time Radio
78 RPMs and Cylinder Recordings
Live Music Archive
Audio Books & Poetry
Community Audio
Computers & Technology
Music, Arts & Culture
News & Public Affairs
Non-English Audio
Librivox Free Audiobook
Radio Programs
Spirituality & Religion
All Software
This Just In
Old School Emulation
MS-DOS Games
Historical Software
Classic PC Games
Software Library
Internet Arcade
Community Software
Software Sites
Tucows Software Library
Vintage Software
Console Living Room
Atari 2600
Magnavox Odyssey 2
Bally Astrocade
Sega Genesis
Sega Game Gear
Atari 7800
Sega Master System
All Image
This Just In
Flickr Commons
Occupy Wall Street Flickr
Cover Art
USGS Maps
Metropolitan Museum
NASA Images
Solar System Collection
Ames Research Center
Brooklyn Museum
Toggle navigation
6:00 am
morning maryland. >> he said i want to go home. i told him. >> the devastation caused by sandy is taking an emotional toll on a father. >> all right. so much coming up for you on this friday november 2nd good morning i am charley crowson. >> i am megan pringle. thanks for joining us. we have seen it sandy may be gone but she is having a huge impact not just here but other places. >> recovery is taking place and it's going to take quite a while in a number of areas. the scenes are all too familiar long lines and people waiting for gas and public transportation and still with no power or clean water in the northeast. >> let's go out to renee marsh live this morning in new york city. >> reporter: we are in midtown manhattan there's power but 25 blocks from here, people in lower manhattan, they are still in the dark. four days after super storm sandy tempers are high. >> we are going to die. you don't understand you got to
6:01 am
get your trucks here on this corner. now. >> reporter: new york senator chuck schumer met this woman while touring a water logged neighborhood. >> this is the worst i've seen and it's killing me it's killing me what the people have to go through. >> reporter: new yorkers are facing another day of crippled transportation and power outages. governor cuomo is warning there may be consequences for utility companies that did not properly prepare for sandy. con edison says the storm was worse than anyone expected. >> it was just off the charts and unfortunately we are where we are and we are like all the other utilities up and down the east coast right now trying to recover trying to get everybody back as quick as we can. >> reporter: in new jersey, lines for gas stretched for miles. some residents are returning home getting the first glimpse at the damage. >> and i am sure that the bay is here in my house. >> reporter: stories of tragedy are emerging. two young boys swept from their
6:02 am
mother's arms during the storm. a volunteer firefighter killed by a fallen tree. and mayor michael bloomberg says there's hard work ahead. >> what we have to do is in memory of those that we lost make sure that we build as quickly as we can and as safely as we can and have a future for those they left behind. >> reporter: all right. and we know that later on today, homeland security secretary janet napolitano and fema will be touring hard hit staten island. reporting live renee marsh back to you. sandy knocked out power to more than 340,000 people. this in just or area. most people have their lights back on. we checked bge's website and there are about 3500 customers still experiencing outage more than half of them are in baltimore county. crews do expect to restore service toy person by tonight.
6:03 am
>> they will need that power because the temperature keeps getting cooler and cooler. it's fall and it feels seasonal for us. but, the cold nights are tough. >> let's go over to lynette charles and see what we have in store. >> all right. temperatures are going to fall tonight actually the temperatures are well below average. these temperatures that we have been dealing with for the past several days are more like temperatures we get in late november. right now, we are on the chilly side this morning waking up in clarksville. 40 degrees, 42 in elkton and glen bernie and -- at 41. we will have the wind chill. maryland's most powerful radar is dry one lone shower around haganstown towards the west and snow across the area as well. especially if you heading into pennsylvania. but all in all, today will be mainly dry and maybe a popup shower here and there and drizzle but mainly dry conditions and also a few peeks of sunshine for today. we look at the planner and this is what it looks like.
6:04 am
still 40 by 80, and 50 by lunchtime and chilly and cool outside. the breezy conditions by 3 and you can see the clouds you can see the sunshine trying to peek out behind the clouds. let's check the abc2 timesaver traffic with lauren cook. >> reporter: good morning. a chilly start. but at least we get an extra hour sleep this sunday. looking forward to that. heading to route 295 no delays but that will very well change later tonight. the parkway is going to be shut down at 10:00 right at west nursery road. it won't reopen until 10 tomorrow morning. and west nursery road will be shut down at the same time but that won't reopen until 10 on sunday. so you want to stick with route 1 or 95. and as your alternate routes looking live here at 95, just north of 195 everything moving along no problems getting down to dc or if you are headed up north towards 695, speaking -- not speak of 695. 83 in hunt valley no problems
6:05 am
from shawan to the beltway. on the west side of 69511 minutes to travel the outer loop from 759 towards 95. that's your abc2 timesaver traffic megan and charlee over to you. five -- charley over to you. we are following breaking news in atlanta. police closed off streets around cnn's building because someone called 911 saying he was at the building with a chemical bomb. officers are sweeping the building looking for the caller and package. we will follow the story and any information that comes into the newsroom we will bring you the updates here on good morning maryland and also on abc2news.com. we told you this story dozens of times in the past several months and we will tell you this one more time. rainwater weather and cold weather and whatever, srchg holes. >> it happens and the aging infrastructure is cracking. sherrie johnson is live this morning in north baltimore. >> reporter: we are here in the 4600 block of york road in
6:06 am
north baltimore. this water main break is causing quite a few problems for people. you know, crews have been working around the clocks trying to fix this 16 inch water main. you can see here they are still a busy working and they were waiting for a part earlier this morning but now they are back at work trying to get this fixed and we called dpw crews and i spoke to a spokesperson about 40 homes and businesss are without water this morning. officials with the department of public works say the break happened around 1 yesterday afternoon and people from victoria's ministries international had to be evacuated. public works officials say crews are work on getting all the debris out of the way so they can get the break to start the repairs. water was rushing by so quickly that people parked nearby barely had a chance to react. >> i came out and the water was so high it was breaching into the car. so, it's to move the car
6:07 am
because i figured that it would be some kind of emergency to clear the blocks. >> reporter: the city has not talked about the cause of this water main break. but weather and the change of temperature and an aging infrastructure can cause the things and right now the northbound drivers they are traveling northbound in thesouthbound lane and southbound drivers are being redirected here on york road. reporting live, sherrie johnson, abc2 news. >> today is the last day you can vote early and if you plan to do it you better get ready to possibly wait in long lines. >> early voting was canceled for two days because of sandy and linda so is live in towson at one of the early voting centers and linda it's been pretty busy for the past several days hasn't it? >> reporter: it has. people waited in line for hours. we are here at the administrative building at towson university and you can tell by looking at this hill we are getting so close to election day. today is the last day for early
6:08 am
voting polls polls will open at 8 and stay open for 13 hours and close at 9 tonight. this is what it looked like last night at rammeddalstown community center. the line wrapped around the building. some -- randallstown community center. the line wrapped around the building. more than 267,000 voters have cast their ballot early since polling centers opened in maryland. hurricane sandy forced early voting to be canceled on monday and tuesday but it seems voters are now making up for lost time. >> it's a privilege. and maybe because of my age, but like i told you, being 94 i don't know when i will do this again for a president. so i did it today and my wife was with me. >> reporter: a lot of people making sure they are getting their votes in for this historic election. there are 46 early voting centers throughout the state of maryland. if you want to find the one in your county there are several. go to the website at abc2news.com. we have a list of all the early
6:09 am
voting polling centers again those polls will open at 8 this morning and close tonight at 9. we are live in towson linda so abc2 news. 8 minutes after 6. baltimore city police are looking for a man that sexually assaulted a 6-year-old girl. >> they got specifics on the guy who he very well may be. we will give outdescription and tell you the -- you the description and tell outsurprising place it happened. >> need a good night sleep? it may be the foods you eat. >> and remarkable video since sandy hit the east coast. trees down nothing new but this is incredible. we will tell you the story behind this video in a bit. >> so we are dealing with cold temperatures for today. i will tell you if and when we get out of this cold weather pattern coming up. >> reporter: everything is moving right along here on interstate 70 at columbia pike but we are dealing with a water main break that is disrupting traffic on york road. i will have the details coming up next. >> and a live look at times square in new york.
6:10 am
things trying to get back to normal. the marathon this weekend and giants are playing and let's go to this morning's tech bites. >> reporter: in today's tech bites no huge frenzy but the wait is over for apple fans. why folks in tokyo want to get their hands on the ipad many 7.9 inch tablet will go on sale for 229 dollars for wi-fi only version and a higher price. cell service is better for those in the hurricane zone. 20% of cell sites in the region are still knocked out. google introduced the nexus4 and technology editor found a lot to like including the photo sphere feature. >> you can take a 360 photo and capture the ceiling or the sky and you can capture wide angle so it's cool and on top of that they made it faster. there's no lag to the operating
6:11 am
system. >> reporter: and those are your tech bites, have a great day and i am rob nelson.
6:12 am
6:13 am
aying with us on good morning maryland. on this friday, news time 6:13. want to show you some really interesting images and some perspective shots as we are in the back hillside of sandy so we are getting an idea of just how bad this was. and how big it was. if you go to abc news.com, they have got a before and after slide show where you can manually go through this and this is chicago. on the south side lake michiganon a normal day. this is what happened as sandy made its way across the great lakes region. see things kicked up and churned up as a result of this storm. another shot we want to show you. we have seen this and normal
6:14 am
night in new york. this is on the lower manhattan side in brooklyn look around many we will talk about the darkin the big apple that's what they see. many buildings lit up. and then completely in the dark. also, one we wanted to show you a bridge in new jersey. this is one of those across the bay areas in the garden state. and after sandy rolls through, completely wiped out. and one more i want to show you quickly one of the more common shots the pier the amusement parkpier in seaside heights after sandy blew through earlier this week. completely wiped out and you see the northeast corner and it has been crushed. part of a roller coaster is in the atlantic ocean. a mess they had to clean up along new jersey and in new york, but if you want to soon an idea in the before and after format go to abc2 news and look on theb before and after shied show. you've been talking about the images and video we have seen. if you are at home and are away
6:15 am
from your tv, take a look at this. a family witnessed something -- look at this. trees in long island they toppled one after another before the fire starts. pretty dray madic video and audio -- dramatic video and audio. >> okay, my gosh. >> our trees. >> oh. >> our trees. >> your car oh, my god. oh, my god. >> it hit my car? >> it hit your car. >> there's fire dad. there's a fire. >> okay, my god. >> there's nothing i can do about that. >> oh, my god. >> oh, my god. >> certainly puts things in perspective like not only watching that video because it's incredible but hearing the family react and there's stuff -- they are stuck inside the house. >> and shows the helplessness against mother nature. >> exactly. unfortunately i am watching another system that is going to be tracking across the area. i will show it to you on the map.
6:16 am
doesn't look like it's going to do anything to us but new england i say maybe thursday wednesday thursday of next week, they could be seeing a coastal storm. and again you know about the track of things and it's way far out to sea if it comes closer inland or not. but that's what we are thinking right now. and i have to mention that. >> isn't the idea of rain in the area. >> yeah. >> and i wouldn't be doing my job if i didn't mention that. i know you don't want to hear it but this is what we are thinking. for us at home it will stay to the south and track up the coast. again, depending on how close it is i am going to show you that in a second. but let's show you what's going on with temperatures. it's cold. 40 in mount airy. jefferson at 39. baltimore 41 and more of the same in jess upand northeast coming in at 42 right now. and northville one of the spots there in the upper 30s. 40 in chestertown and 44 stevensville. so the winds are on the light to calm side. they will pick up as we go throughout the day. and we are going to be dealing with a wind chill so out of the
6:17 am
northwest at about 5 to 20 miles an hour, 15 miles an hour that's what we are working with. let's show you what's going on right now with sandy. and the remnants well up to the north as of now. still bringing chilly conditions in here and the reason why is we are getting the northwesterly flow. that's a cold flow. this will continue as we go through today and even into next week many we need sandy to pull out of here. so this is the storm this is one storm that's going to track mainly to the south of us as we go into monday, tuesday and then we will have a more significant storm that's going to take the same track and then head up the coast and this is what i am talking about affecting new england as we head into thursday, friday of next week. still it skirts us and we will have to keep our eyes peeled on that system and that's what i am going to do. for today, we are dealing with some clouds and sun and very cold temperatures once again with the high coming in around 53 degrees as we go toward the afternoon. let's check the amount bc2
6:18 am
timesaver traffic with lauren cook. >> reporter: i have to side with the facebook friends i want the sunshine to come out. >> working on it. >> reporter: thank you. we do have problems in north baltimore dealing with a water main break on york road at cold spring lane. and the southbound travel has-- is redirected northbound lane only one lane getting by. so, you want to stick with charles street this morning. or even 83. and as we check in and look live at 83, just north of 695, you will notice everything is moving along. no delays knot city. as far as belt the -- no delays into the city. as far as beltway 9 minutes on the outer loop from 795 towards interstate 70. and the beltway going to be a great shape from parkville up to towson and traveling on the northeast corridor of 95 there are no problems in white marsh. traveling from route 43 to 695 that will take you 4 minutes. that's a look at your abc2 timesaver traffic. megan and charleover to you.
6:19 am
don't forget to set your clock back. we will pick up an extra hour of sleep but if you like to get a couple more z's try changing your diet. >> food along with vitamins b # and b12 and folic acid can help you go to sleep so make sure to choose a diet you know full of complex carbohydrates and lean proteins. >> the doctor says bananas are packed with carbs and whole grain cereals with skim mill can be give you. [audio not understandable] they are considered a great lean source of protein and b-12 is in seafood it canly clams, oysters and -- particularly clams oysters and mussles nothing says bedtime like oysters. >> i don't know but if it works it works. good information. someone who has great information every friday is aileen gabbey from the maryland spca brought in a adorable kitten. >> this is picasso 4-month-old
6:20 am
kitten unwanted very sadly and we actually have a harder time placing the black cats and kittens. they just don't necessarily get adopted as quickly. there's no time limit. >> is it superstitions? >> i wonder if people just are looking for something bright and fare so we are having a reduced adoption fee for kittens 50 dollars it cost us between 3 and $500 to care for them. >> that's a big deal. >> it is. and you say you have a lot of black kittens right now. >> we do. and they make great pets up for adoption today. >> they are beautiful and so is this one. one thing i wanted to talk to you about while you are here, some people lost pets during the storm the noise and wind and rain and it scared a lot of pets off. what do you do if you are missing your best friend. >> it's upsetting not to know where they are. look around the immediate neighborhood as soon as you can. with cats you can go on the personality if you have a shy cat look closer to home. post posters in the neighborhood check with the local shelters and you can try
6:21 am
online things craigslist has been great with reuniting pets with openers and there's new services, too. there's something called dogs finding dogs. and you can google that on the web and they use dogs to find your pets and find toto.com is is available and they do phone calls in your neighborhood to let people know your pet is lost. >> good information. and always call shelters like aileen said especially in maryland asb -- spca and this kitten needs a home. >> very relaxed. >> you are open this weekend. >> we are. saturday and sunday. >> maryland aspc thanks for coming. >> thank you. >> charley. >> all right if you met someone from new jerso you know how -- new jersey you know how proud they are and when your hometown needs help the career can wait. the cleanup is getting a big helping hand. and we are used to the moves on the court how about off? what the william sisters are doing here.
6:22 am
good morning maryland continues in a moment.
6:23 am
6:24 am
well, inside the brewer, there's a giant staircase. and the room is filled with all these different kinds of coffee. actually, i just press this button. brew what you love, simply. keurig.
6:25 am
they have the moves on and off the court. venus and serena william show off their moves this time not on the tennis court check them out. dancing with kids this is in nigeria. they were there promote the girls power and they hung out at the school with the students and taught them traditional nigerian dance moves and look lake they did pretty good. >> she is out of breath serena out of breath. she and venus over there. that's great. lauren cook is here with a check of today's caption this. >> osay dorable sent in by sharon straw of her dog jack junior and her grand dog jays he is the one wearing the cones. >> i don't like this. >> sharon calls it the party hat. >> i like it. >> that's good. >> we posted this on facebook and it generated a lot of comments. the minute the door is open we
6:26 am
are out here and stop laughing at me. megan when you gois say we were geeing a tv dish it's no idea i would be the dish. and join saying -- jane saying where's the foil and valerie says wow, look at the legs on her she must be a german shepherd. so, thanks to sharon for sending this in and i need photos for next week. so e-mail them poo email@example.com -- them to email@example.com. john bon jovi is cancel the rest of his tour to help with the recovery efforts. he will get the charity restaurant back up and running soul kitchen feeds homeless and for those who can't afford a meal. right now it's closed because of a power outages. >> sandy will be the big story for a while and when you see the devastation it's hard to imagine losing everything especially a pet. >> the stories are a sad but the destruction and flood and
6:27 am
debris and sometimes the gleamer of hope is all you need. ♪ ♪ ♪ [ male announcer ] combine the pnc cashbuilder visa credit card with a qualifying pnc performance select checking account and earn 75% more than cards earning 1% cash back on almost everything.
6:28 am
6:29 am
you're watching the station that works for you, now, good morning maryland. she was tired of being ripped off
TV News
Search inside
Search only quotes
Search only political ads
Date - Most Recent
Date - Oldest
ABC2 News Good Morning Maryland 6am
ABC November 2, 2012 6:00am-6:30am EDT
News News/Business. New. (CC)
New York
Lauren Cook
North Baltimore
Renee Marsh
Sherrie Johnson
The City
New Jersey
Rob Nelson
Megan Pringle
Lynette Charles
Glen Bernie
Scanned in
Annapolis, MD, USA
Comcast Cable
Channel 78 (549 MHz)
Video Codec
Audio Cocec
Pixel width
Pixel height
Internet Archive
sound, color
Borrow a DVD of this show
Stream Only
In Collection
In Collection
Television Archive
In Collection
Television Archive News Search Service
Uploaded by
TV Archive
on 11/2/2012


text:
Fax: (215) 898-7392
Original Article
Prevalence of breast cancer treatment sequelae over 6 years of follow-up†‡§
The Pulling Through Study¶
Version of Record online: 6 APR 2012
DOI: 10.1002/cncr.27474
Copyright © 2012 American Cancer Society
Supplement: A Prospective Surveillance Model for Rehabilitation for Women With Breast Cancer
Volume 118, Issue Supplement 8, pages 2217–2225, 15 April 2012
Additional Information
How to Cite
Schmitz, K. H., Speck, R. M., Rye, S. A., DiSipio, T. and Hayes, S. C. (2012), Prevalence of breast cancer treatment sequelae over 6 years of follow-up. Cancer, 118: 2217–2225. doi: 10.1002/cncr.27474
- †
The articles in this supplement were commissioned based on presentations and deliberations at a Roundtable Meeting on a Prospective Model of Care for Breast Cancer Rehabilitation, held February 24-25, 2011, at the American Cancer Society National Home Office, in Atlanta, Georgia.
- ‡
The opinions or views expressed in this supplement are those of the authors, and do not necessarily reflect the opinions or recommendations of the editors or the American Cancer Society.
- §
Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://wileyonlinelibrary.com/onlineopen#OnlineOpen_Terms
- ¶
A Prospective Surveillance Model for Rehabilitation for Women with Breast Cancer, Supplement to Cancer
Publication History
- Issue online: 6 APR 2012
- Version of Record online: 6 APR 2012
- Manuscript Accepted: 7 NOV 2011
- Manuscript Received: 19 OCT 2011
- Manuscript Revised: 18 OCT 2011
- Abstract
- Article
- References
- Cited By
- breast neoplasms;
- side effects;
- survivors;
- surveillance;
- rehabilitation
There is a need to better describe and understand the prevalence of breast cancer treatment-related adverse effects amenable to physical therapy and rehabilitative exercise. Prior studies have been limited to single issues and lacked long-term follow-up. The Pulling Through Study provides data on prevalence of adverse effects in breast cancer survivors followed over 6 years.
A population-based sample of Australian women (n = 287) diagnosed with invasive, unilateral breast cancer was followed for a median of 6.6 years and prospectively assessed for treatment-related complications at 6, 12, and 18 months and 6 years after diagnosis. Assessments included postsurgical complications, skin or tissue reaction to radiation therapy, upper-body symptoms, lymphedema, 10% weight gain, fatigue, and upper-quadrant function. The proportion of women with positive indication for each complication and 1 or more complication was estimated using all available data at each time point. Women were only considered to have a specific complication if they reported the highest 2 levels of the Likert scale for self-reported issues.
At 6 years after diagnosis, more than 60% of women experienced 1 or more side effects amenable to rehabilitative intervention. The proportion of women experiencing 3 or more side effects decreased throughout follow-up, whereas the proportion experiencing no side effects remained stable around 40% from 12 months to 6 years. Weight gain was the only complication to increase in prevalence over time.
These data support the development of a multidisciplinary prospective surveillance approach for the purposes of managing and treating adverse effects in breast cancer survivors. Cancer 2012;118(8 suppl):. © 2012 American Cancer Society.
Advances in diagnostic and treatment approaches over the past few decades have resulted in a new reality in which survival after a diagnosis of breast cancer is favorable. It is estimated here are 2.5 million breast cancer survivors alive in the United States,1 and millions more worldwide.2 The curative care for breast cancer includes surgery, radiation treatment, chemotherapy, hormonal therapy, and other targeted therapies. The physical impairments associated with these treatments include those noted in the prospective surveillance model described elsewhere in this supplement.3 The incidence and prevalence of these persistent adverse effects and the extent to which women's lives remain affected by breast cancer treatment is poorly understood. Further, the question as to whether evidence that functional changes of arms and shoulders, or other breast cancer treatment complications, occur with high enough frequency to necessitate formal surveillance efforts has not been answered. For decades, formal prospective surveillance programs have demonstrated effectiveness at determining true incidence proportions and rates, ability to detect early and optimal intervention periods for a variety of illnesses,4-6 and health-related conditions or behaviors.7-9 These include surgical site infection,4 venous thrombosis,5 melanoma,6 and adverse drug reactions,7 as well as behaviors related to diabetes, exercise,8 and human immunodeficiency virus testing.9 It is reasoned that breast cancer treatment adverse effects would be amenable to prospective surveillance as well. Therefore, it is of interest to pursue the proposed prospective surveillance model, highlighted in this supplement, in order to determine how often breast cancer survivors experience any of the 9 issues reviewed in this supplement.
Thus far, most research on the incidence and prevalence of adverse effects of breast cancer treatment potentially amenable to rehabilitation have focused on the likelihood that any 1 of the myriad problems occurs. Estimates for incidence of chemotherapy-induced peripheral neuropathy vary widely according to timing, chemotherapy dosage, agent used, and severity, but it seems to occur in up to 83% of patients who are treated with taxanes, with reports that this adverse effect may or may not dissipate by itself over time.10 Bone health challenges are also common, in part due to hormonal therapies used to improve disease-free survival. Breast cancer survivors are 5-fold more likely than age-matched women with no cancer history to have vertebral fractures.11 Arthralgia and joint pain have been reported to occur in 36% of breast cancer survivors taking aromatase inhibitors.12 Lymphedema incidence ranges from 6% to 70%, according to length of follow-up, method of detection, and population studied.13 Fatigue occurs in up to 94% of breast cancer patients at some point after diagnosis.14 Upper-body problems are estimated to occur in 20% to 44% of patients, depending on method of assessment, severity, and length of follow-up.15 Evidence that women have functional limitations after breast cancer include the results from 3 large population-based studies,16-18 all of which indicate that self-reported functional status is likely to be worse in breast cancer survivors than in age-matched peers, with prevalence of functional limitations in cancer survivors ranging from 18% to 54% across the 3 studies. The variability in reported occurrence of these adverse treatment effects is likely due to differences across studies with regard to methods of diagnosis, length of follow-up, differences in the cohorts examined, and presentation of data.
Although we have the estimates reported above, defined and collected per individual impairments of interest, an area of research with limited evidence is the proportion of breast cancer survivors who avoid all of these problems, and what proportion of survivors still have these issues over multiple years of survival. Cancer treatment is aggregate in nature, and its impact on morbidity could be assumed to be likewise. It seems exceptionally unlikely that women who experience a single physical impairment would never develop additional impairments or functional limitations; in fact, it is most likely that physical impairments occur simultaneously.
Two prior cross-sectional studies have been identified that have examined the likelihood of experiencing any 1 of multiple possible impairments.19, 20 In 1 of these prior studies, 66% of 202 consecutively enrolled cancer patients who were undergoing outpatient cancer treatment reported 1 or more functional problems, with nearly 23% reporting a problem with ambulation.19 Review of electronic medical records revealed only 2 referrals for rehabilitation in the entire study population. The other study, also cross-sectional, assessed 163 community-dwelling women with metastatic cancer at a single time point during chemotherapy treatment. Of these, 92% reported 1 or more physical impairments.20 Although 88% of these women were determined to need rehabilitation upon examination, only 21% were sent to physical therapy services. Both studies involved patients actively undergoing treatment and conducted assessments at a single time point. To our knowledge, no study has followed breast cancer survivors over a period of years after the end of treatment and reported on the persistence of prevalent physical impairments related to cancer treatment.
Determining the proportion of breast cancer survivors who have 1 or more of the physical impairments noted in the proposed prospective surveillance model is important to establishing the need for multidisciplinary coordinated care that includes rehabilitation and exercise for breast cancer survivors. Data from the Pulling Through Study (PTS) can address this gap in the literature. This longitudinal observational cohort study originally recruited 287 breast cancer survivors 3 to 4 months after diagnosis, who were shown to be generally representative of the wider breast cancer population.20 Study participants were followed for more than 6 years, allowing for the estimation of the prevalence of specific treatment complications after breast cancer over time. The primary aim of this analysis was to examine the number of breast cancer survivors who experienced any 1 of the issues addressed in the surveillance model, to the extent that they were measured at multiple time points over 6 years of follow-up.
Patient Population
The PTS was a longitudinal investigation designed to assess the physical and psychosocial recovery of women after breast cancer treatment.21-24 Women diagnosed with unilateral breast cancer between January and December 2002, who were aged 75 years or younger, and residing within a 100-km radius of Brisbane, Queensland, Australia, were randomly selected from the Queensland Cancer Registry to participate (n = 511). Younger women (aged <50 years) were oversampled to ensure adequate numbers were available for specific age group analyses. A unilateral diagnosis allowed for the untreated side to serve as a control for certain outcomes, such as lymphedema, whereas the residence criterion facilitated the logistics of data collection for objective outcomes. Women 75 years and older were excluded to minimize the potential impact of age-related comorbidities.
The ethical approval process required doctor consent prior to contacting eligible participants and was obtained for 417 women (82%). Potential participants were mailed an invitation letter and study information package and were followed-up via the telephone to ascertain study interest. Informed consent was obtained for 69% (n = 287). Participation in the PTS involved a clinical assessment and/or completion of a self-administered questionnaire every 3 months from 6 to 18 months after diagnosis. Some participants consented to participate on a "questionnaire-only" basis (26%), restricting the data available on clinically assessed outcomes to 74% (n = 218). Following completion of the PTS, ethical approval was sought and granted to recontact participants at approximately 6 years after surgery (PTS-FU). Of the 287 original baseline participants, 11 withdrew from the original study and were therefore not recontacted. The records of the remaining 276 women were cross-referenced with the mortality database at the Queensland Cancer Registry in August 2008 and April 2009 to determine vital status, including date and cause of death. Residing address was confirmed through a search of the electronic White Pages, and a change of address search was carried out through Australia Post. Of the 276 potential participants, 22 (8.0%) were lost to follow-up, 36 (13.0%) refused to participate, 23 (8.3%) were deceased, and the remaining 195 (70.7%) women provided consent. Of these, 94% (n = 183) returned the questionnaires and 85% (n = 166) had clinical measures of lymphedema taken. Four women died (2 participants and 2 previously lost-to-follow-up) between time of the 6-year follow-up assessment and the final death search, yielding a total of 27 deaths from the original baseline cohort of 287. Metastatic breast cancer was the recorded cause of death for 23 of the women; 1 death was due to cancer at a site other than the breast, and 3 women died due to noncancer causes. Figure 1 presents recruitment and participant flow into the original PTS and follow-up (PTS-FU) study.
Data Collection
Tumor characteristics were abstracted from histopathology reports at the Queensland Cancer Registry. Personal characteristics including age and body mass index, and treatment characteristics (type of surgery, radiation, chemotherapy, hormone therapy, number of lymph nodes removed) were collected by participant-administered questionnaires. Also collected via the questionnaire were the following outcomes of interest: the self-report Functional Assessment of Cancer Therapy, Breast+4 (FACT-B+4) survey,25 self-report upper-body function (Disability of the Arm, Shoulder, and Hand [DASH] Scale),26, 27 weight and height, and posttreatment complications experienced. Lymphedema, height, and weight were assessed with objective measures. Individual items of the self-report FACT-B+4 survey and the self-report DASH scale were combined to create the following 3 unique variables: "upper-body symptoms," "upper-body function," and "fatigue." We describe below the specifics of how the aforementioned measurement elements were used to create an analytic data set that could address the question of prevalence of any 1 of multiple physical impairments at 6, 12, and 18 months and 6 years after diagnosis.
The variable "postsurgical adverse effects" was created using self-reported wound infection, other infection, seroma or hematoma, or axillary web syndrome. Women self-reported these concerns as yes/no/don't know (categorized as "no"). The 6-, 12-, and 18-month time points cover the occurrence of these symptoms in the previous 6 months, whereas the 6-year time point asks women to recall these concerns in the previous 12 months.
The variable "skin or tissue reaction to radiation therapy" was created using self-report of this concern in the same manner as described above for the "postsurgical adverse effects" variable.
The variable "upper body symptoms" was created using items in the FACT-B+4 and DASH questionnaires. From the FACT-B+4, items within the arm subscale ask women to rate the severity of pain, range of movement, numbness, stiffness, and swelling on the treated side during the past 7 days, by reporting how "true" on a 5-point Likert scale of "not at all" through to "very much," are statements regarding each symptom (eg, "one or both of my arms are swollen or tender," and "I have poor range of arm movement on this [treated] side"). Items from the DASH questionnaire were also used to capture the presence and severity of 2 symptoms: tingling and weakness. The DASH asks women to rate the presence and severity of these symptoms during the past 7 days using a 5-point Likert scale of "not at all" through to "extreme." Women were considered to have a positive indication for any of the above upper-body symptoms when reporting "quite a bit" to "very much" (4 or 5 on a 5-point Likert scale) for FACTB+4 items or "severe" to "extreme" (4 or 5 on a 5-point Likert scale) for DASH items. The proportion of women reporting at least 1 of these symptoms at each time point was then estimated.
The variable "lymphedema" was assessed using 2 possible measures: bioelectrical impedance (BIS) or circumferences. A woman was considered to have lymphedema if she met the threshold for either of the 2 objective measures used at a given measurement time point. Multifrequency BIS measurements were performed (SEAC SFB3; Impedimed), and the impedance of the extracellular fluid for each arm was estimated. The ratio of the impedance for the treated and untreated sides was then estimated, and values outside normal range (ie, more than 3 standard deviations from the normative mean, with side of dominance accounted for) were considered diagnostic for lymphedema.28 Circumferences were measured at the hand (at the 1st and 5th metacarpal), wrist (the distal edge of the styloid process), and then every 10 cm along each arm up to 40 cm. The sum of these 6 circumferences was estimated, and the difference between arms was assessed (treated minus untreated side). When the difference of sums was >5 cm, women were classified as having lymphedema. The definition for this technique was chosen as it is commonly used within clinical practice and research settings.29
The DASH questionnaire is a validated self-reported measure of "upper-body function." The questionnaire asks participants to rate how difficult certain daily and recreational tasks are to perform and the extent to which any upper-body problem interferes with normal activities, and also collects information regarding severity of arm symptoms. The final score of the 30-item instrument ranges from 0 to 100, whereby 0 reflects no disability (good function) and 100 represents extensive disability (poor function). Scores of >20 were deemed to reflect poor upper-body function, based on review of the literature on the use of DASH in the posttreatment breast cancer patient population.30-32 The median score in the present study population at 6 months after diagnosis was 11.33
Weight was assessed objectively at 6, 12, and 18 months and 6 years. Change in weight was determined by comparing self-reported weight 6 months prior to diagnosis (baseline) with follow-up objective weight measures. Increases of >10% of baseline values were considered gains.
The presence of fatigue was determined by responses to the FACT-B+4 item, "I have lack of energy." Those who reported "quite a bit" to "very much" (4 or 5 on a 5-point Likert scale) were classified as having fatigue.
The presence of "one or more" of the measured physical impairments was estimated, as was the total sum of impairments present. A participant was categorized as having 1 or more impairment(s) if she had a positive indication for any of the aforementioned treatment-related impairments. The number of impairments present was estimated by summing all positive indications. The maximum total number of impairments was 6.
Statistical Analysis
Baseline personal and treatment characteristics of the original PTS cohort and participants who consented for the 6-year follow-up period (PTS-FU) are described, using means and standard deviation for normally distributed continuous outcomes, medians and ranges for nonparametric continuous data, and proportions for categorical data. Proportions of women reporting the presence of breast cancer concerns including postsurgical complications, skin or tissue reaction to radiation therapy, upper-body symptoms, lymphedema, weight gain, fatigue, and upper-quadrant function at 6, 12, and 18 months and 6 years after diagnosis were estimated, using all available data at each time point.
As specified earlier, the original cohort was shown to be generally representative of the wider Queensland population of those with breast cancer. Also, demographic and treatment-related characteristics were similar for women in the original cohort and those in the target sample (Table 1). In brief, the average age of participants was 55 years (standard deviation = 10 years). At baseline, 44% were of healthy weight, 26% were overweight, and nearly 17% of study participants were obese. One-third had a partial or full mastectomy, whereas two-thirds had a lumpectomy. The majority had at least 1 lymph node excised (77%) with more than three-quarters having 5 or more nodes removed. Radiation was a common adjuvant therapy, received by approximately 75% of women, whereas just more than 40% received chemotherapy. Of note, women included in the 6-year follow-up did not differ significantly from participants in the first study assessment (eg, "baseline") with regard to any personal or treatment-related characteristics (data previously published33; data not shown).
|Target Sample
|Entire Cohort
|Follow-Up Cohort at 6 y
|n = 511
|n = 287
|n = 188
|Age, y, mean (SD)a
|54.8 (10.1)
|55.3 (10.0)
|55.1 (9.5)
|n (%)a
|n (%)a
|n (%)a
|Body mass index
|Underweight (<18.5 kg/m2)
|4 (1.2)
|2 (1.0)
|Healthy weight (18.5-24.9 kg/m2)
|129 (44.1)
|81 (42.2)
|Overweight (25-29.9 kg/m2)
|73 (25.7)
|52 (27.8)
|Obese (30+ kg/m2)
|48 (16.9)
|30 (16.1)
|33 (12.1)
|23 (12.8)
|247 (86.1)
|158 (86.3)
|40 (13.9)
|25 (13.7)
|Current smoker
|30 (10.2)
|18 (9.3)
|255 (89.1)
|164 (90.2)
|2 (0.6)
|1 (0.5)
|Education Level
|Year 10 or less
|126 (45.2)
|70 (39.8)
|High school
|32 (11.3)
|27 (14.9)
|67 (22.4)
|46 (24.0)
|Undergraduate or postgraduate degree
|60 (20.3)
|39 (20.7)
|2 (0.8)
|1 (0.6)
|Physical activityb
|49 (16.8)
|22 (11.9)
|<150 min/wk
|67 (23.3)
|35 (18.8)
|≥150 min/wk
|171 (59.8)
|142 (69.3)
|Cancer Stage
|Stage 1
|271 (53.8)
|160 (56.6)
|104 (56.7)
|Stage 2
|227 (43.6)
|117 (39.8)
|80 (41.2)
|Stage 3+
|10 (1.9)
|8 (2.8)
|3 (1.6)
|3 (0.6)
|2 (0.8)
|1 (0.6)
|Lymph node dissection
|No nodes removed
|70 (13.7)
|38 (13.1)
|24 (12.9)
|1-4 nodes removed
|43 (8.7)
|27 (9.7)
|14 (7.8)
|5+ nodes removed
|398 (77.6)
|222 (77.2)
|150 (79.3)
|Number of positive lymph nodes
|None removed
|70 (13.7)
|38 (13.1)
|24 (12.9)
|None positive
|266 (52.8)
|158 (55.9)
|108 (58.5)
|1-3 positive
|122 (23.3)
|59 (20.1)
|42 (21.7)
|4+ positive
|51 (9.7)
|29 (9.8)
|13 (6.4)
|2 (0.4)
|3 (1.1)
|1 (0.6)
|Surgery type
|Mastectomy (partial/full)
|195 (37.8)
|102 (35.1)
|65 (33.7)
|316 (62.2)
|185 (64.9)
|123 (66.3)
|Chemotherapyc (% yes)
|122 (41.0)
|80 (40.6)
|Radiationc (% yes)
|215 (75.0)
|138 (73.7)
|Hormonal therapyc (% yes)
|165 (57.9)
|109 (58.5)
The trends in the prevalence of symptoms over time are shown in Table 2. At 6 years after diagnosis, more than 60% of women were experiencing 1 or more adverse treatment effects. About 20% of women reported experiencing 2 or more physical impairments 6 years after diagnosis. The proportion of women experiencing 3 or more physical impairments decreased throughout follow-up, whereas the proportion experiencing none remained stable from 12 months to 6 years.
|6 mo
|12 mo
|18 mo
|6 y
|Postsurgical issuesa
|Skin/tissue reaction to radiotherapy
|Upper-body symptomsb
|Lymphedema (circumference)c
|Lymphedema (BIS)d
|Weight gain of 10% or moree
|Upper-body functiong
|One or more adverse treatment effectsh
|Number of above adverse treatment effectsh
The prevalence of most physical impairments decreased throughout the 6 years of follow-up, with the exception of lymphedema and weight gain. Lymphedema remained relatively stable, near 10% at each measurement time point, regardless of measurement technique. At baseline, 18% of participants had gained 10% body weight, which increased to 24% of participants at 6 years. Weight gain was also the most prevalent adverse treatment effect at the 18-month and 6-year time point. Without weight gain in Table 2, the prevalence of 1 or more adverse treatment effects becomes 87.4%, 61.9%, 56.5%, and 50.4% at the 4 time points, respectively.
When only data from the 80 women who had complete data at all 4 time points were included (data not shown), the results did not differ. More than 63% of women have 1 or more complications at 6 years after diagnosis. The proportion of women who experience no side effects after the 6-month measurement is just under 40% throughout follow-up.
The majority of breast cancer survivors who participated in the PTS report at least 1 of a myriad of adverse effects of breast cancer treatment over the course of 6 years of follow-up. As noted in the introduction, there is evidence of a sizeable gap between the need versus referral to rehabilitation services during active treatment.19, 20 In prior cross-sectional studies, the likelihood of referral to physical therapy was lower among minority and socioeconomically disadvantaged patients. Taken together, this evidence lends support for the hypothesis that the proposed prospective surveillance model may particularly benefit those with the fewest resources, and may address this potential health disparity among cancer survivors.
Additional data are needed to confirm whether the findings of the PTS can be replicated in other breast cancer populations. These data would be helpful to answering the question of whether there is a "mountain" of underserved issues among long-term breast cancer survivors or whether the issue of needing prospective surveillance and rehabilitation is a "molehill." There is a growing body of evidence to support the hypothesis that available rehabilitative and exercise interventions result in better outcomes when adverse treatment effects are identified and treated sooner.35-40 Yet, there is merit to conducting additional trials that address multiple treatment-related adverse events to provide a more definitive basis for the value of the prospective surveillance model proposed in another article within this issue.3 In addition, the cost/risk benefit of such programs will also need to be established.
The observed prevalence estimate of 60% of survivors who experience at least 1 adverse treatment effect may well be an underestimate, given that several common treatment sequelae were not measured in the current study (eg, cardiotoxicity, bone health, arthralgias, chemotherapy-induced peripheral neuropathy). In addition, relying on patients to recall subjective reports of physical impairments has limitations, with both under- and overestimation.41 On the other hand, for some adverse effects included in the prevalence estimates, it is not possible to discern whether the issue is truly the result of breast cancer treatment. Consideration must be given to the impact of other comorbid conditions as well as the natural course of aging, which may affect the overall health and functional status of women, regardless of breast cancer treatment. For example, upper-body functional impairments may arise among older women independent of cancer history. Furthermore, the causes of weight gain extend far beyond adverse cancer treatment effects; however, when weight gain was removed from the list of adverse treatment effects, the prevalence of 1 or more complication remained more than 50% at all time points. Regardless of the cause, if the impairments are observable and common in the population of breast cancer survivors, there is merit to surveillance if early treatment can be shown to reduce morbidity and be cost-effective compared to the current system of less frequent referral to rehabilitation and exercise.19, 20
Trends in the prevalence of adverse treatment effects reported in this study were limited to those effects with established and accepted clinical definitions,29, 42 and those that had an impact on the top of the Likert scale used (eg, a 4 or 5 on a scale of 1 to 5, where 5 was most severe). This approach was used to enhance a focus on clinically meaningful issues that affected function and were not likely to be self-limiting, in order to avoid overestimating adverse treatment effects. Creating the infrastructure for surveillance and rehabilitation of mild, self-limiting adverse treatment effects could lead to increased anxiety on the part of survivors and possibly contribute to the impression that there may be reason to avoid exercise for safety reasons. This is certainly a matter of concern, given the ample evidence of the safety of exercise training in this population.43 It is broadly agreed that any additional barriers to starting and maintaining an exercise program should be avoided.
The PTS allowed an initial examination of the longitudinal prevalence of persistent adverse treatment effects, given the length of follow-up and variety of measures and survey instruments used. However, these data were analyzed as a subset of a larger study, which was not specifically designed to examine aggregate impairments. Limitations of the measures used include the fatigue measure, which was based on a single question from the FACT-B+4 survey and lack of data on multiple adverse treatment effects included in the proposed prospective surveillance model.3 Additional measurement time points, inclusion of more objective measures, and a larger cohort would serve to improve our ability to draw conclusions regarding the trends in prevalence of persistent adverse effects of breast cancer treatment. Generalizability of the current findings is limited to caucasian women 75 years of age and younger and to those treated for breast cancer per the practices and policies common to Australia. The cohort was generally representative of the wider breast cancer population and was representative of the target sample (women diagnosed in urban Queensland) in terms of age and cancer history at baseline and at 6 years. However, 77% of the sample had 5 or more lymph nodes removed. The PTS recruitment occurred prior to when sentinel lymph node biopsy was widely used in Australia. This makes the current findings most applicable to women with more extensive axillary surgery than those who underwent a sentinel lymph node biopsy.
In conclusion, it is striking that the proportion of survivors who maintained 1 or more adverse treatment effects remains stable over 6 years of follow-up. Although additional research is needed to confirm these initial findings, the stability of the prevalence over 6 years lends merit to the proposal of prospective surveillance for adverse treatment effects in breast cancer survivors.
Support for this meeting and supplement were provided by the American Cancer Society through The Longaberger Company®, a direct selling company offering home products including handcrafted baskets made in Ohio, and the Longaberger Horizon of Hope® Campaign, which provided a grant to the American Cancer Society for breast cancer research and education.
The Pulling Through Study was funded by the National Breast Cancer Foundation, whereas the 6-year follow-up component was funded by the National Health and Medical Research Council and Cancer Australia. The National Breast Cancer Foundation also supports the research positions of S.A. Rye, T. DiSipio, and S.C. Hayes.
The authors made no disclosure.
- 1American Cancer Society. Breast Cancer. Atlanta, GA: American Cancer Society; 2010.
- 2
- 3
- 4Prospective surveillance effectively reduced rates of surgical site infection associated with elective colorectal surgery at a university hospital in Japan. Infect Control Hosp Epidemiol. 2006; 27: 526-528., , , et al.
- 5Prospective surveillance for perioperative venous thrombosis. Experience in 2643 patients. Arch Surg. 1996; 131: 472-480., , , , , .
- 6A high incidence of melanoma found in patients with multiple dysplastic naevi by photographic surveillance. Med J Aust. 1997; 167: 191-194., , , , .
- 7Comparative study of prospective surveillance and voluntary reporting in determining the incidence of adverse drug reactions. Am J Hosp Pharm. 1977; 34: 931-936., .
- 8A prospective study of exercise and incidence of diabetes among US male physicians. JAMA. 1992; 268: 63-67., , , , , .
- 9HIV incidence and HIV testing behavior in men who have sex with men: using three incidence sources, The Netherlands, 1984-2005. AIDS. 2007; 21: 491-499., , , et al.
- 10
- 11A high incidence of vertebral fracture in women with breast cancer. Br J Cancer. 1999; 79: 1179-1181., , , , , .
- 12Aromatase inhibitor-induced arthralgia in early breast cancer: what do we know and how can we find out more? Breast Cancer Res Treat. 2010; 120: 525-538., , , .
- 13Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med. 2009; 361: 664-673., , , et al.
- 14
- 15
- 16The persistent impact of breast carcinoma on functional health status: prospective evidence from the Nurses' Health Study. Cancer. 2000; 89: 2176-2186., , , , .
- 17Physical performance limitations and participation restrictions among cancer survivors: a population-based study. Ann Epidemiol. 2006; 16: 197-205., , , , .
- 18Functional limitations in elderly female cancer survivors. J Natl Cancer Inst. 2006; 98: 521-529., , , , , .
- 19The detection and treatment of cancer-related functional problems in an outpatient setting. Support Care Cancer. 2009; 17: 61-67., , , , .
- 20Prevalence and treatment patterns of physical impairments in patients with metastatic breast cancer. J Clin Oncol. 2008; 26: 2621-2629., , , .
- 21Level of physical activity and characteristics associated with change following breast cancer diagnosis and treatment. Psychooncology. 2009; 18: 387-394., , .
- 22Upper-body morbidity following breast cancer treatment is common, may persist longer-term and adversely influences quality of life. Health Qual Life Outcomes. 2010; 8: 92., , , , .
- 23Lymphoedema following breast cancer: incidence, risk factors and effect on upper body function. J Clin Oncol. 2008; 26: 3536-3542., , , , .
- 24Does quality of life among breast cancer survivors one year after diagnosis differ depending on urban and non-urban residence? A comparative study. Health Qual Life Outcomes. 2010; 8: 3., , , , .
- 25The validation of a quality of life scale to assess the impact of arm morbidity in breast cancer patients post-operatively. Breast Cancer Res Treat. 2001; 68: 273-282., , .
- 26Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996; 29: 602-608., , .
- 27
- 28Does the effect of weight lifting on lymphedema following breast cancer differ by diagnostic method: results from a randomized controlled trial. Breast Cancer Res Treat. 2011; 130: 227-234., , , , .
- 29Lymphedema secondary to breast cancer: how choice of measure influences diagnosis, prevalence, and identifiable risk factors. Lymphology. 2008; 41: 18-28., , , , .
- 30Upper extremity impairments in women with or without lymphedema following breast cancer treatment. J Cancer Surviv. 2010; 4: 167-178., , , et al.
- 31Causes of shoulder pain in women with breast cancer-related lymphedema: a pilot study. Yonsei Med J. 2011; 52: 661-667., , , .
- 32Shoulder function following autologous latissimus dorsi breast reconstruction. A prospective three year observational study comparing quilting and non-quilting donor site techniques. J Plast Reconstr Aesthet Surg. 2010; 63: 1505-1512., , , , .
- 33Objective and subjective upper body function six months following diagnosis of breast cancer. Breast Cancer Res Treat. 2005; 94: 1-10., , .
- 34Prevalence and prognostic significance of secondary lymphedema following breast cancer. Lymphat Res Biol. 2011; 9: 135-141., , , et al.
- 35Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial. BMJ. 2010; 340: b5396., , , et al.
- 36Pre-operative assessment enables early diagnosis and recovery of shoulder function in patients with breast cancer. Breast Cancer Res Treat. 2010; 120: 135-147., , , et al.
- 37Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial. JAMA. 2010; 304: 2699-2705., , , et al.
- 38Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer. 2008; 112: 2809-2819., , , , , .
- 39Factors predicting clinically significant fatigue in women following treatment for primary breast cancer. Support Care Cancer. 2011; 19: 1581-1591., , , et al.
- 40Physiotherapy after breast cancer surgery: results of a randomised controlled study to minimise lymphoedema. Breast Cancer Res Treat. 2002; 75: 51-64., , , .
- 41Validity of self-reported information on cancer: determinants of under- and over-reporting. Eur J Epidemiol. 2004; 19: 239-247., , .
- 42Weight gain after a breast cancer diagnosis and breast cancer outcomes. In:the American Association for Cancer Research 102nd Annual Meeting; April 2-6, 2011; Orlando, FL; 2011. Abstract 3722., , , et al.
- 43American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010; 42: 1409-1426., , , et al.


text:
Watch: UNLV Season Highlights Wisconsin Season Highlights
CHICAGO (AP)—Lon Kruger has changed zip codes a few times, adapted to climate and cultural changes and savored a coaching journey that has landed him on a select list.
He's one of only five Division I coaches to take four different programs to the NCAA tournament, joining Lefty Driesell, Jim Harrick, Rick Pitino and Eddie Sutton.
Kruger has taken Kansas State, Florida—which he took to the 1994 Final Four—Illinois and now UNLV to the NCAAs.
A victory over Georgia Tech on Friday was UNLV's first in the NCAA tournament since 1991, so Kruger's run of college success continues, despite the frequent change of addresses. The Runnin' Rebels meet Wisconsin on Sunday in the second round of the Midwest Region.
"We could have stayed in one place for 20 years and obviously some people do that. We chose a different route," Kruger said of his family that includes son Kevin, the Runnin' Rebels' starting point guard.
"Every stop along the way we've had great experiences, great relationships, great friendships. We realize you're giving some things up when you do that, but there's also a lot to be gained in making changes and meeting different people and being exposed to different parts of the country. It's worked out well and we have no regrets about it."
Kruger really made a change after his final season at Illinois in 2000 when he jumped to the NBA's Atlanta Hawks and found winning a much more difficult proposition, going 69-122 in two seasons plus before he was fired.
Like John Calipari and Tim Floyd—college coaches who had great success at that level but not so much when they ventured into the NBA—Kruger got back into the college game. And after two 17-win seasons and a trip to the NIT in his first two years, he has UNLV at 29-6 headed into the meeting with second-seeded Wisconsin.
Kruger credits good players for his ability to win in so many different programs during 21 years of college coaching. His record is 381-266.
"You just have to be yourself. I don't think you can be someone else for someone else, for the wrong reason," he said.
"My only concern throughout this whole career is the players, whatever I can do to help them mature and develop, whatever I can do to protect them while they're in a program, that's my focus. … There are a lot of different ways to do it. There's not one right away, one wrong way."
Kevin Kruger wasn't always crazy over leaving his friends and his home when dad said he was taking yet another job. Lon Kruger's first head coaching job came at Texas-Pan American in 1982, a year before his son was born.
"The move to Atlanta was tough. I was in high school," he said.
But looking back, it has worked out well—for all the Krugers.
"I'm glad I got to do that. I lived in Texas … I lived in the Midwest, South, North and Southwest for college," said Kevin Kruger, who transferred to UNLV from Arizona State. "I got friends I feel all over the country and not a whole lot of kids get to do that."
And not a whole lot of kids get to play for their dad. The father-son angle has been played heavily but neither seems to be weary of it. The physical resemblance is striking and the two Krugers even speak with the same inflections.
Wisconsin's Bo Ryan coached two of his sons, one at Wisconsin-Platteville and another at Wisconsin-Milwaukee, though neither played as big a role in the teams' success as Kevin Kruger.
"It was fun coaching them because I knew they were going to play hard, dive for loose balls and take charges," Ryan said.
"All the things you're asking your other players to do, your sons better be doing when they're playing."
What both Krugers hope Sunday is that Kevin shoots better than he has in the last two games. He was just 2-for-11 in the Runnin' Rebels 78-70 victory over BYU in the finals of the Mountain West Conference tournament and shot 0-of-8 from the field in the 67-63 win over Georgia Tech.
Kruger's shooting is just one worry. So are the sore ribs that leading scorer Wendell White got late in the victory over Georgia Tech.
Wisconsin (30-5) needed a big rally from an early 18-point deficit to beat Texas A&M-Corpus Christi 76-63 in the opening round Friday. The Badgers know they can't afford a similarly slow start against the Runnin' Rebels.
Kruger and Ryan are no strangers. They coached together during the 1995 World University games, helping the USA win a gold medal.
"Lon's a lot of fun. We've traveled together. He's a good guy. He understands what the world's all about and what he wants out of basketball and life," Ryan said.
"We never had him up on any stage in standup comedy or anything. .. But you know what? Inside he's having fun."
Team Comparison
- The Hunt: No. 23, Michigan
- NCAA rules Florida's Gak ineligible to play in 2016-17
- OSU officials: Coger died after 40-minute outdoor workout
- NCAA to survey potential host cities on discrimination laws
- George Washington investigating basketball coach Lonergan
- Alabama AD completes cancer treatment, cleared to go home


text:
Hi, is there a way to reinstall the previous version of Scrappy?
I just updated to V4 today and my page went crazy...
On iPad the menu bar only says "menu" and once clicked on all my main menu links drop down. It's as if it is showing the mobile version menu. I have disable my mobile plug-in, but no changes.
Also, all my custom sidebar widgets have defaulted to Scrappy defaults. NONE of the sidebar widgets display on iPad, but looked great on the previous version. They are all pushed to the bottom of the page below my main text.
I'm most concerned about the menu bar on iPad.
thanks for any help.


text:
U.S. Army War College >> Strategic Studies Institute >> Publications >> Details
Baghdad ER--Revisited
Authored by Colonel Erin P Edgar.
- Added September 16, 2009
- Type: Student (Carlisle) Papers
- 19 Pages
- Download Format:
PDF (Recommended)
ePub (Mobile Devices)
Kindle Reader
- Cost: Free
- Send this page to a colleague.
- Alert me when similar studies are published
- Share |
Brief Synopsis
The China Dragons of the 28th Combat Support Hospital deployed in support of Operation IRAQI FREEDOM from September 2006 until November 2007. This combat tour was historic in many regards, with the team challenged by unprecedented casualty numbers and indirect fire attacks. Not only did they save thousands of lives; they helped advanced trauma medicine, as leading hospitals worldwide have benefitted from military initiatives in the areas of bleeding control and hemostatic resuscitation. Their service epitomizes the strides that have been made in military combat medicine, and their challenges highlight the areas in which our medical system can improve further.
You may also be interested in the following titles:
Taking the Fight to the Enemy: Chinese Thinking about Long-Distance and Expeditionary Operations
NATO Cyberspace Capability: A Strategic and Operational Evolution
India's Evolving Nuclear Force and Implications for U.S. Strategy in the Asia-Pacific
Honduras: A Pariah State, or Innovative Solutions to Organized Crime Deserving U.S. Support?
Outplayed: Regaining Strategic Initiative in the Gray Zone, A Report Sponsored by the Army Capab...
Strategic Landpower and a Resurgent Russia: An Operational Approach to Deterrence, A U.S. Army W...
Starting Strong: Talent-Based Branching of Newly Commissioned U.S. Army Officers
View other pubs in the following categories:
Era of Persistent Conflict
Landpower Employment & Sustainment
Middle East and North Africa
Military Change and Transformation
Military Leadership
Military Strategy and Policy
War and Society
21st Century Warfare
Military Culture
Military Professionalism
Military Roles
Reserve Components
Strategic Planning Guidance
United States
Download it Now!
- Download Format:
PDF (Recommended)
ePub (Mobile Devices)
Kindle Reader
- PDF File Size: 0.62MB
- Download Format:
- Study is: Available via Download Only
- View Cart
- All hardcopies are free of charge, shipping inclusive.
- For out of stock or digital only publications, refer to the new GPO on-demand site. For a small fee, recieve many prior publications. Click here to visit.
- All materials on our website are available as a free download.