text:
Bookmark this site
LAS VEGAS -- Former Speaker of the House of Representatives Newt Gingrich will deliver the keynote address at the National Automatic Merchandising Association's annual general session and membership meeting at the 2013 OneShow convention and trade show. The annual meeting is set for 8:30 a.m. to 10:30 a.m. on Thursday, April 25, at the Sands Expo Center here.
Famous as a leading proponent of the "Contract with America" that summarized the Republican position during the 1994 Congressional election, Gingrich was elected Speaker of the House in that same year. Under his leadership, Congress passed welfare reform, passed the first balanced budget in a generation, and enacted the first tax cut in 16 years. It also restored funding to bolster defense and intelligence capabilities.
Speaker Gingrich also has published 23 books including 13 fiction and nonfiction titles that have been ranked in The New York Times listing of best sellers. Gingrich and his wife, Callista, also host and produce documentaries, and are frequent guests on network and cable television news programs.
NAMA noted that Gingrich has become one of the nation's most sought-after public speakers, accepting engagements from some of the world's most prestigious organizations.
"We are delighted to welcome Speaker Gingrich, whose keynote address will anchor the NAMA Annual Meeting," said OneShow senior director LyNae Schleyer.
Other highlights of the general assembly and annual meeting will be the delivery of remarks by board chairman Mark B. Dieffenbach, Hershey Co., and the eagerly anticipated NAMA Industry Awards presentation.
NAMA senior vice-president of government affairs Eric Dell is facilitating the preparation for Gingrich's OneShow discussion by sharing some of the industry's key business and political issues and concerns that will serve as the foundation for the keynote speaker's remarks.
"We are certain NAMA members will find Speaker Gingrich's participation particularly valuable, given his unique and comprehensive view of the American landscape," Schleyer summarized. "From healthcare to business overall to the current administration, we're preparing for our members to learn something actionable and enjoy hearing his commentary."
NAMA's OneShow will be held from April 24 through 26 at the Venetian Hotel and its adjacent Sands Convention Center. This year's event is the 68th staging of the largest trade show for the vending and refreshment services industry. The show is expected to draw 200 exhibitors and more than 4,500 vending industry members.


text:
Fujifilm FinePix HS10 Review
Latest Camera Reviews
Lomo'Instant Automat Glass Review
3 day sale: Luminar is now on sale for the lowest price ever!
Mac users, Macphun's all-in-one photo editor Luminar is available for just $49£37 for new users, or $39£30 for existing Macphun users. We rated Luminar as "Highly Recommended". Visit the Luminar web site to try it for free.
Windows users, Macphun's all-in-one photo editor Luminar is now available in beta for free ahead of the full release late 2017.
We rated Luminar for Mac as "Highly Recommended". Visit the Luminar web site to try the beta for free.
Main Rivals
Listed below are some of the rivals of the Fujifilm FinePix HS10.
Canon PowerShot SX20 IS
World Exclusive! This is the first online review of the Canon PowerShot SX20 IS super-zoom camera. Featuring a 20x wide-angle zoom lens, 12 megapixels, 2.5 inch tilting LCD screen, electronic viewfinder, external flash hotshoe, HD video recording and full range of shooting modes, the compact Canon SX20 sounds like a thinking photographer's dream. Read our in-depth review of the Canon SX20 IS to find out if it lives up to expectations...
Nikon Coolpix P90
The Nikon Coolpix P90 is the latest entry in the competitive super-zoom camera market, offering a 24x optical lens with a 26-624mm focal length. Nikon's Vibration Reduction image stabilisation system helps to avoid the inevitable effects of camera-shake when using the longer focal lengths or in low-light, while the P90's new 3 inch tilting LCD screen makes image composition more versatile. Other key features include a 1cm macro mode, electronic viewfinder, PASM shooting modes, and an extensive ISO range of 64-6400. With an official price of £379.99 / €449.00 / $399.95, can the Nikon Coolpix P90 challenge the likes of the Panasonic DMC-FZ28, Olympus SP-590UZ, and Canon PowerShot SX1/10 IS?
Olympus SP-800UZ
Bored of your camera's hum-drum 3x zoom? Feel constricted by a mere 10x lens? Is 20x still not enough for you? Well, Olympus have the answer in the shape of the SP-800UZ, a brand new bridge-style compact camera that boasts a 30x zoom lens with an incredible focal range of 28-840mm. In addition, the 14 megapixel Olympus SP-800UZ also offers a 3 inch, 16:9 ratio LCD screen, 720p movie recording, 2Gb of internal storage and long-awaited support for SD memory cards. Zoltan ArvaToth gets up close and personal in the World's first Olympus SP-800UZ online review.
Panasonic Lumix DMC-FZ38
The Panasonic Lumix DMC-FZ38 (also known as the DMC-FZ35) is a new super-zoom camera that builds on the considerable success of the FZ28 and FZ18 models. Offering a high-definition video mode with stereo sound, faster autofocus and startup, new Power O.I.S anti-shake system and longer battery life, the Panasonic FZ38 concentrates on behind-the-scenes improvements whilst retaining the intuitive handling, Intelligent Auto mode, manual shooting modes and RAW support of the FZ28. Priced at £329.99 / $399.95, we bring you the World's first ever review of the Panasonic Lumix DMC-FZ38.
Pentax X70
The Pentax X70 is the latest super-zoom compact camera to land on our review desk, and the first entry from Pentax into this ever-competitive segment of the market. This 24x zoom model offers an amazingly versatile focal range of 26-624mm, covering everything from wide-angle landscapes to up-close-and-personal nature shots. If there still isn't enough telephoto range for you, the software-based Intelligent Zoom function boosts the X70's reach up to 3900mm. Also on offer are a 2.7-inch LCD monitor, 1280x720 pixel HD movies, 1cm macro and full range of manual shooting modes. Currently selling for around £370 / $399, Gavin Stoker finds out if the Pentax X70 can compete with the super zoom big boys in our latest expert review.
Sony Cyber-shot DSC-HX1
The Sony Cyber-shot DSC-HX1 is a super-zoom camera with some rather unique features up its proverbial sleeve. These include a 20x zoom lens and 9 megapixel CMOS sensor, both of which utilise Sony's DSLR technology, 3 inch tiltable LCD screen, and fast 10fps burst shooting mode. Going up against the likes of the Canon Powershot SX20 IS, Panasonic FZ38 and Olympus SP-590UZ, we find out if the £480 / $500 Sony HX1 hits the right spot...

subset: commoncrawl


text:
Mines technologies help companies secure funding
GOLDEN, Colo., Nov. 17, 2009 – Three bioscience companies licensed with Colorado School of Mines have been awarded funding by the Bioscience Discovery Evaluation Grant Program (BDEGP) through the Colorado Office of Economic Development and International Trade.
The BDEGP - Early Stage Bioscience Company Awards are a state-run competition open to Colorado companies that have an existing license with a Colorado research university.
The winners licensed with Mines captured three of the 12 awards announced.
- Microphage — Awarded $100,000, was started in 2002 and is based on technology from Dr. Kent Voorhees of the Chemistry and Geochemistry Department. The company is developing easy-to-use, rapid diagnostics that provide the information on bacterial infections, mainly MRSA.
- Oberon — Awarded $80,000, has a license with Mines to incorporate technology from the lab of Dr. John Spear, of the Environmental Science and Engineering Department. The company is researching and developing the production of single cell protein (SCP) from un-utilized food processing by-product streams. It plans to become the premier supplier of high-quality SCP meal destined for use in animal feed diets.
- PolyNew — Awarded $250,000 started in 1999 and is partially owned by Dr. John Dorgan, of the Chemical Engineering Department. PolyNew has an option to some Mines technology and is focused on developing environmentally friendly polymers/plastics.
Karen Gilbert, Public Relations Specialist / 303-273-3541 / firstname.lastname@example.com
Marsha Williams, Director of Integrated Marketing Communications / 303-273-3326 / firstname.lastname@example.com


text:
Gladys - from Singapore, Singapore
Here are a few ideas to help you avoid this problem. Make sure that your oven is properly heated to the correct temperature before placing the cake inside; allow the oven enough time to heat up to the appropriate baking temperature listed in your recipe. You may want to try using an oven thermometer to double-check the temperature of your oven. If the oven dial and the thermometer temperatures don't match, it may be that the oven is not heating properly.
Make sure to measure all of the recipe ingredients precisely. A cake won't rise correctly and may fall in the middle if the cake batter is too solid or runny. Following the correct baking time in the recipe is important, too. If you take a cake out of the oven before too early, it may not have had enough time to fully rise and set in the oven. If the baking time is up and the cake doesn't look finished, place it back in the oven for just a few minutes (make sure to keep a careful eye on the cake to avoid overcooking). To test if the cake is done, insert a toothpick or skewer into the middle of the cake and pull it out; the toothpick should come out pretty clean, with possibly a few crumbs stuck to it. If there is any wet batter on the toothpick, the cake still needs more time in the oven to bake.
Take care to not open the oven door while the cake is baking. Doing so allows heat to escape the inside of the oven, and causes the temperature to fall. Opening the door too much makes it difficult for the oven to stay as hot as it needs to in order to bake the cake. This can also cause the cake to not bake properly.
If a cake batter is over-mixed, too much air will mix into the batter. On that same note, under-mixing can cause uneven baking as well. For a successful cake, mix the batter only as much as the instructions state. I hope this helps!


text:
UT Tyler Department of Health and Kinesiology
Graduate Programs
The Department of Health and Kinesiology offers three programs leading to the master's degree. The programs offer advanced studies in health and/or kinesiology. The most common uses of these degrees are to enhance academic credentials related to career advancement and to prepare for doctoral studies.
Graduate Degree Programs:
- Master of Science (M.S.) in Health Sciences
- Master of Science (M.S.) in Kinesiology (with online option)
- Master of Education (M.Ed.) in Health and Kinesiology
Thesis Policies, Procedures, and Forms:


text:
Vanilla Ice on Miley Cyrus and Justin Bieber
Listen to Vanilla Ice on iHeartRadio | Listen to Miley Cyrus on iHeartRadio | Listen to Justin Bieber on iHeartRadio
Vanilla Ice is using some quotes from Miley Cyrus' recent "Rolling Stone" cover story to get back in the headlines.
On Monday, the rapper posted a picture of a supposed tattoo on the bottom on his feet, reading "Miley Cyru$," copying the one Miley debuted last week.
@mileycyrus #👅 WORD TO YOUR MOTHER ! LMAO! pic.twitter.com/ApDjMPkcfq— Vanilla Ice (@vanillaice) September 25, 2013
Miley spoke to the magazine about her friend Justin Bieber, saying that she is concerned because she doesn't want him to end up "a joke" and become another "Vanilla Ice."
But, according to the rapper born Rob Van Winkle, Miley should be taking some of her own advice.
In an interview with "TMZ," he says the two are having "a confusing moment" while through a transition, and that he hopes they do end up like him, because he's "very grateful" for where he is today.
He adds that he sees all kinds of similarities between him and Justin, and that though he wishes the star the best, he knows "there's something entertaining about watching people self-destruct."


text:
Staggered Chandelier - Small
- Overview
The art of arrangement. With strategically placed shades, the Staggered Chandelier is a modern take on a traditional design. This architectural piece draws eyes upward and has adjustable lengths to hang at just-the-right height in your dining room, kitchen or entryway.
• Antique bronze–painted frame; white linen shades.
• 27.5"diam. x 32.5"h.
• Six shades; takes six 60-watt candelabra bulbs (not included).
• Hardwired. Professional installation recommended.
• Adjustable length; includes two 12" hanging poles.
• Ceiling canopy and swivel joint for vaulted ceilings included.
• Assembly required.
• UL listed.
• Wipe clean.
• Imported.
- Details + Dimensions
• Overall product dimensions: 27.5"diam. x 32.5"h.
• Shade (6): 4.45"w x 5.5"d x 5.6"h.
• Extensions (2): 12" hanging poles.
• Overall length options (from ceiling to bottom of chandelier): 30.75", 42.75" or 54.75".
Assembly required. View assembly instructions.
Wipe clean with a damp cloth.
- Shipping + Return Info
These items ship from our Distribution Center by UPS and arrive in your home within 4-5 business days of order receipt.
Shipping Rates
The shipping rate varies depending on your order total and shipping options. View Shipping Rates and Options
Next Day Delivery
For an extra charge of $17.50 per address, we can arrange for rush delivery to most destinations.
We happily accept returns on stocked items within the time frames listed below. Products designated as special order (SPO) cannot be cancled or returned. All items on our website and in-store are considered 'stocked' unless expressly identified as 'special order' instead. Prior purchases are not eligible for price adjustments. Please familiarize yourself with our returns policy before placing your order.
Stocked Items: If you are dissatisfied with your purchase of a stocked item, you must exchange or return it within the following time frames for a full refund of the merchandise cost (delivery fees are non-refundable). Outside these time frames, we will replace or refund your purchase against manufacturer's defects ONLY. Please note that we cannot accept returns on gift cards or items damaged through normal wear and tear. We also cannot accept returns of final-sale items, which are identified by a price ending in .99 or .97.
- Quick Ship upholstery items must be returned within 7 days of the order receipt date.
- All other stocked products must be returned within 30 days of the order receipt date.
Special Order Items (SPO): Because they're custom made to your specifications, special order items may not be canceled or returned and are exchangeable against manufacturer's defects ONLY. SPO includes special order upholstery items, monogrammed/personalized items, special order rugs, one-of-a kind rugs and any products being shipped directly from a third-party vendor. Any special order items will be flagged as 'special order' in your shopping cart. NEW JERSEY CUSTOMERS: Special-order upholstered furniture returns are subject to applicable state law and are non-returnable after 24 hours of delivery.
For further assistance please call our customer service department at 1.888.922.4119 or send an email to email@example.com


text:
76% cotton, 15% yak and 9% nylon means Softyak DK has a stunning soft handle and is a perfect transeasonal yarn.
A wonderful cotton drape yarn which shows texture and cable detail. Softknit Cotton is also interchangeable with Handknit Cotton.
A versatile thread available in a variety of shimmering colours, Anchor Artiste Metallic is soft and easy to work with, perfect for adding a touch of shimmer to any garment.


text:
Benign prostatic hyperplasiaEnlarged prostate; BPH
An in-depth report on the causes, diagnosis, treatment, and prevention of benign prostatic hyperplasia (BPH).
Benign Prostatic Hyperplasia (BPH)
Benign prostatic hyperplasia (BPH) is a condition in which the prostate gland becomes enlarged. The size of the gland does not necessarily predict symptom severity. Some men with minimally enlarged prostate glands experience many symptoms while other men with much larger glands have few symptoms. BPH is very common among older men, affecting about 50% of men over age 60 and 85% of men over age 80.
BPH Symptoms
The symptoms associated with BPH are collectively called lower urinary tract symptoms (LUTS). These are generally classified as either voiding (obstructive) symptoms or storage (irritative) symptoms.
Common symptoms of BPH include:
- An urgent need to urinate and difficulty postponing urination
- A hesitation before urine flow starts despite the urgency to urinate
- Straining when urinating
- Weak or intermittent urinary stream
- A sense that the bladder has not emptied completely
- Dribbling at the end of urination or leakage afterward
Urinary retention (inability to void) is a serious symptom of severe BPH that requires immediate medical attention.
BPH is not a cancerous or precancerous condition. It rarely causes serious complications, and men usually have a choice whether to treat it immediately or delay treatment. Treatment options include medications and surgery. Alpha-blockers and 5-alpha-reductase inhibitors (5-ARIs) are the main types of drugs used for BPH treatment.
5-ARIs and Prostate Cancer
A controversial matter is whether 5-ARIs help protect against prostate cancer. Studies have suggested that 5-ARIs lower a man's overall risk for developing prostate cancer. However, the FDA has advised that these drugs may actually increase the risk of developing high-grade aggressive types of prostate cancer. A 2013 study in the British Medical Journal(BMJ) reported that 5-ARI therapy neither increases nor decreases the risk of death from prostate cancer.
Hyperplasia is a general medical term referring to an abnormal increase in cells. Benign prostatic hyperplasia (BPH) is noncancerous cell growth of the prostate gland. It is the most common noncancerous form of cell growth in men and usually begins with microscopic nodules in younger men. BPH is not a precancerous condition and does not lead to prostate cancer.
As BPH progresses, it can lead to enlargement of the prostate gland. The enlarged prostate can squeeze the urinary tube (urethra), causing urinary symptoms. These urinary difficulties are part of a group of symptoms called collectively lower urinary tract symptoms (LUTS).
Not all men with BPH have LUTS, and not all men with LUTS have BPH. Lower urinary tract symptoms can also be caused by many other conditions including overactive bladder, urinary tract infections, prostatitis (inflammation of the prostate), and nerve damage that weakens the bladder.
About a third of men with BPH have LUTS symptoms that interfere with their quality of life. The size of the prostate gland does not necessarily relate to the severity of a patient's symptoms.
The Prostate Gland
Description of the Prostate Gland. The prostate is a walnut-shaped gland located below the bladder and in front of the rectum. It wraps around the urethra (the tube that carries urine through the penis).
Functions of the Prostate Gland. The prostate gland provides the following functions:
- The glandular cells produce a milky fluid. During ejaculation, the smooth muscles contract and squeeze this fluid into the urethra. Here, it mixes with sperm and other fluids to make semen.
- The prostate gland also contains an enzyme called 5 alpha-reductase that converts testosterone to dihydrotestosterone, another male hormone with a major impact on the prostate.
Changes During the Lifespan. The prostate gland undergoes many changes during the course of a man's life. At birth, the prostate is about the size of a pea. It grows only slightly until puberty, when it begins to enlarge rapidly. It reaches normal adult size and shape, about that of a walnut, when a man is in his early 20s. The gland generally remains stable until about the mid-40s, when, in most men, the prostate begins to grow again through a process of cell multiplication (hyperplasia).
The Process of Urination
The process of urination is complicated:
- It begins when waste fluids flow out of the kidneys into two long tubes called ureters.
- The ureters empty into the bladder, which rests on top of the pelvic floor, a muscular structure similar to a sling running between the pubic bone and the base of the spine.
- The brain regulates muscles in the urinary tract through a pathway of nerves. As the bladder fills to its capacity of 8 - 16 oz of fluid, the nerves send signals from the bladder to the brain that indicate how full the bladder is.
- As the bladder fills, the outlet muscles contract to prevent urination.
- At the time of urination, the spinal cord initiates the voiding reflex. The detrusor muscle (which surrounds the bladder) contracts, while the internal sphincter (a strong muscle encircling the neck of the bladder) relaxes.
- When the internal sphincter is open, urine flows out of the bladder into the urethra (the tube that carries urine from the bladder out through the penis).
Doctors are not exactly sure what causes benign prostatic hyperplasia. The changes that occur with male sex hormone as part of the aging process appear to play a role in prostate gland enlargement.
Male Hormones. Androgens (male hormones) affect prostate growth. The most important androgen is testosterone, which is produced in the testes throughout a man's lifetime. The prostate converts testosterone toanother powerful androgen, dihydrotestosterone (DHT).
DHT stimulates cell growth in the tissue that lines the prostate gland (the glandular epithelium) and is the major cause of the rapid prostate enlargement that occurs between puberty and young adulthood. DHT is a prime suspect in prostate enlargement in later adulthood.
Female Hormones. The female hormone estrogen may also play a role in BPH. (Some estrogen is always present in men.) As men age, testosterone levels drop, and the proportion of estrogen increases, possibly triggering prostate growth.
Risk Factors
Age is the major risk factor for BPH.About half of men develop BPH by age 60 and about 85% of men have BPH by age 85. It is uncommon for BPH to cause symptoms before age 40.
Family History
A family history of BPH appears to increase a man's chance of developing the condition.
Heart Disease Risk Factors and BPH
Some evidence indicates that the same risk factors associated with heart disease may increase the risk of developing BPH. These risk factors include obesity, high blood pressure, low levels of HDL ("good") cholesterol, diabetes, and peripheral artery disease (PAD).
Lifestyle factors that are unhealthy for the heart (such as lack of physical activity, cigarette smoking, and poor diet) may also possibly increase BPH risk or worsen its symptoms.
Lower urinary tract symptoms (LUTS) are categorized either as voiding (formerly called obstructive) or storage (formerly called irritative) symptoms. BPH is often, but not always, the cause of LUTS, especially the voiding symptoms. Other medical conditions, such as bladder problems, can also cause these symptoms.
Some men with BPH may have few or no symptoms. The size of the prostate does not determine symptom severity. An enlarged prostate may be accompanied by few symptoms, while severe LUTS may be present with normal or even small prostates.
Voiding (Obstructive) Symptoms
Voiding symptoms can be caused by an obstruction in the urinary tract, which may be due to BPH. (Obstruction is the most serious complication of BPH and requires medical attention.) Voiding symptoms include:
- A hesitation before urine flow starts despite the urgency to urinate
- Straining when urinating
- Weak or intermittent urinary stream
- A sense that the bladder has not emptied completely
- Dribbling at the end of urination or leakage afterward
Storage (Irritative) Symptoms
Storage symptoms, also referred to as filling symptoms, include:
- An increased frequency of urination (every few hours)
- An urgent need to urinate and difficulty postponing urination
- Discomfort when urinating
- Frequent night-time urination, or nocturia, is one of the most well-publicized symptoms of BPH, but it's also one of the trickiest, since many if not most cases of nocturia are not caused by BPH but by other conditions.
Serious Complications
Acute urinary retention (inability to void) is a serious complication of severe BPH that requires immediate medical attention. Urinary retention can be a sign of obstruction in the bladder.
Bladder outlet obstruction (BOO) is a blockage at the base of the bladder that reduces or prevents the flow of urine into the urethra, the tube that carries urine out of the body. BPH is a common cause of this condition.
Even without complete obstruction, urinary retention can increase the risk for other complications including:
- Urinary tract infections (if urine does not empty completely from the bladder, bacteria can grow)
- Kidney damage (urinary tract infections can lead to kidney infections; bladder obstruction can lead to kidney failure)
- Bladder damage (the pressure exerted by retained urine can stretch and weaken the bladder walls; this can develop into urinary incontinence)
- Bladder stones (urine left in bladder can crystalize and form bladder stones)
A doctor makes a diagnosis of BPH based on description of symptoms, medical history, physical examination, and various blood and urine tests. If necessary, your doctor may refer you to a urologist for more complex test procedures.
Some diagnostic tests are used to rule out cancers of the prostate or bladder as the cause of symptoms. In some cases, symptoms of prostate cancer can be similar to those of BPH. Tests may also be performed to see if BPH has caused any kidney damage.
Medical History
The doctor will ask aboutyour personal and family medical history, including past and present medical conditions. The doctor will also ask about any medications you are taking that could cause urinary problems
Physical Examination
Digital Rectal Exam. The digital rectal exam is used to detect an enlarged prostate. The doctor inserts a gloved and lubricated finger into the patient's rectum and feels the prostate to estimate its size and to detect nodules or tenderness. The exam is quick and painless. The test helps rule out prostate cancer or problems with the muscles in the rectum that might be causing symptoms, but it can underestimate the prostate's size. It is never the sole diagnostic tool for either BPH or prostate cancer.
Other Physical Examinations. The doctor will press and manipulate (palpate) the abdomen and sides to detect signs of kidney or bladder abnormalities. The doctor may test reflexes, sensations, and motor response in the lower body to rule out possible nerve-related (neurologic) causes of bladder dysfunction.
Prostate Specific Antigen (PSA) Test
Your doctor may recommend a prostate specific antigen (PSA) test to check for prostate cancer. This test measures the level of prostate-specific antigen (PSA) in the blood. A PSA test measures the level of prostate-specific antigen (PSA) in the patient's blood.ThePSA testis a widely used but controversial screening test for prostate cancer. High PSA levels may indicate prostate cancer, but BPH itself usually raises PSA levels. And, some drugs used to treat BPH can decrease PSA levels.
A urinalysis can detect signs of bleeding or infection. A urinalysis involves a physical and chemical examination of a urine sample. A urinalysis also helps rule out bladder cancer.
To determine whether the bladder is obstructed, an electronic test called uroflowmetry measures the speed of urine flow. To perform this test, the patient urinates into a special toilet equipped with a measuring device. A reduced flow may indicate BPH. However, bladder obstruction can also be caused by other conditions including weak bladder muscles and problems in the urethra.
Cystoscopy, also called urethrocystoscopy, is a test performed by a urologist to check for problems in the lower urinary tract, including the urethra and bladder. The doctor can determine the presence of structural problems including enlargement of the prostate, obstruction of the urethra or neck of the bladder, anatomical abnormalities, or bladder stones. The test may also identify bladder cancer, and causes of blood in the urine and infection.
In this procedure, a thin tube with a light at the end (cytoscope) is inserted into the bladder through the urethra. The doctor may insert tiny instruments through the cytoscope to take small tissue samples (biopsies). Cytoscopy is typically performed as an outpatient procedure. The patient may be given local, spinal, or general anesthesia.
Ultrasound is a painless procedure that can give an accurate picture of the size and shape of the prostate gland. Ultrasound may also be used for detecting kidney damage, tumors, and bladder stones. Ultrasound tests of the prostate generally use one of two methods:
- Transrectal ultrasonography (TRUS) uses a rectal probe for assessing the prostate. TRUS is significantly more accurate for determining prostate volume.
- Transabdominal ultrasonography uses a device placed over the abdomen. It can give an accurate measure of postvoid residual urine and can be used to check for kidney damage caused by severe BPH.
Postvoid Residual Urine
The postvoid residual urine volume (PVR) test measures the amount of urine left after urination. Normally, about 50 mL or less of urine is left; more than 200 mL is a sign of abnormalities. Measurements in between require further tests. The most common method for measuring PVR is with a catheter, a soft tube that is inserted into the urethra within a few minutes of urination.
Ruling Out Other Causes of Symptoms
In addition to prostate cancer, other conditions and factors can cause lower urinary tract symptoms (LUTS)similar to those associated with BPH:
- Structural Abnormalities. Abnormalities in the urinary tract can cause BPH-like symptoms. These abnormalities include narrowing of the urethra, weakened bladder, and prostate muscle contractions. Such conditions can produce obstruction, impair or weaken the detrusor muscle surrounding the bladder, or cause other damage that impacts the urinary tract.
- Prostatitis. Prostatitis is an inflammation of the prostate gland that can be caused by bacterial or nonbacterial factors. (The most common form of prostatitis is nonbacterial, a condition also called prostatosis.) Symptoms include urgent need to urinate, frequent urination, and the need to urinate at night. Pain may occur in the lower back or rectum, or it may develop after ejaculation.
- Overactive Bladder. Overactive bladder (OAB), also known as urge incontinence, is marked by a need to urinate frequently. It most commonly affects women, but can affect men as well. It is possible for men to have both OAB and BPH.
- Nerve Damage. Neurological conditions such as multiple sclerosis and Parkinson's can cause nerve damage that affects the bladder's ability to function normally.
- Urinary Tract Infections. Untreated urinary tract infections (UTIs) can cause symptoms associated with LUTS.
- Medications. Many medications can cause lower urinary tract symptoms or urinary retention, and can worsen symptoms of BPH. These types of medications include antihistamines, decongestants, diuretics, opiates, and tricyclic antidepressants.
Treatment for BPH depends in part on the severity of symptoms. Men who have few or minimal symptoms may consider trying a period of "watchful waiting" before choosing drug (or surgical) treatment::
- Watchful Waiting. Watchful waiting (also known as active surveillance) involves lifestyle changes and an annual examination. (Even when choosing watchful waiting, it is important to have a doctor perform an initial examination to rule out other disorders.) Your doctor will monitor your condition to determine when it may be time to start treatment.
- Treatment. The primary goals of treatment for BPH are to improve urinary flow and to reduce symptoms. Many options are available. They include drug therapies to help shrink or relax the prostate, minimally invasive procedures that use lasers to reduce excess prostate tissue, and surgery to remove part of the prostate.
Deciding Between Treatment and Watchful Waiting
The choice between watchful waiting and treatment usually depends on symptom severity. The American Urological Association's BPH Symptom Score uses seven questions to evaluate a patient's urinary symptoms during the past month. (The International Prostate Symptoms Score is another index that is also used.) The questions are:
- How often have you had a sensation of not emptying your bladder completely after you finished urinating?
- How often have you had to urinate again less than2 hours after you finished urinating?
- How often have you stopped and started again several times when you urinated?
- How often have you found it difficult to urinate?
- How often have you had a weak urinary stream?
- How often had you had to push or strain to begin urination?
- How many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?
Responses for the first six questions are scaled from "not at all" to "almost always." (The last question uses answers ranging from "none" to "5 or more times.") Each response is assigned a number on a scale of 0 - 5 and totaled into a symptom score. The symptom score can fall anywhere between 0 and 35.
Patients with mild symptoms will have low scores and may decide to delay treatment. Higher scores indicate more severe symptoms. Treatment can reduce the score:
- A score reduction of 5 points indicates modest symptom relief
- A score reduction of 5 - 10 points indicates moderate symptom relief
- A score reduction of more than 10 points indicates large symptom relief
Your doctor can discuss with you the various treatment options and the likelihood of symptom relief they may provide. All treatments have various side effects, which need to be taken into consideration. Quality of life is as important as symptom severity.
Treatment Options
Medications. In general, there is no reason to treat BPH with medications unless symptoms become very bothersome. The size of the prostate, determined by exam or ultrasound, cannot indicate the need for medications. Evidence suggests that:
- Medications are the best choice for men with mild-to-moderate symptoms who want treatment. Choices include alpha-blockers, anti-androgens, or a combination of the two. Specific factors indicate the best choice, although most men take an alpha-blocker.
- Men with moderate-to-severe symptoms often respond to the same medications as men with mild symptoms. Recent developments in drug therapy have reduced or delayed the need for surgery.
Surgery. Surgery is an option for men with moderate-to-severe symptoms who have not been helped by medication. There are many types of surgical treatment for BPH. Transurethral resection of the prostate (TURP) is the standard procedure, but less invasive procedures, particularly those using heat or lasers to destroy prostate tissue, are becoming more common.
The most common reason for choosing surgery is obstruction of the bladder outlet, which causes urinary retention. Surgery may also be a reasonable option when BPH is clearly related to one or more of the following conditions:
- Recurrent urinary tract infection
- Blood in the urine (hematuria). The drug finasteride may help some men with this condition and should probably be tried before surgery.
- Bladder stones
- Kidney problems
- Moderate-to-severe symptoms that are not well controlled with medications
Increased urinary flow and reduced urine retention are the greatest improvements resulting from surgery. Often, however, the benefits of surgery are not permanent.
Lifestyle Changes
General Lifestyle Recommendations
Certain lifestyle changes may help relieve symptoms and are particularly important for men who choose to avoid surgery or drug therapy. They include:
- Limit daily fluid intake to less than 2,000 mL (about 2 quarts).
- Limit or avoid alcohol and caffeine.
- Limit beverages in the evening. Avoid drinking fluids after your evening meal.
- Try to urinate at least once every 3 hours.
- "Double-voiding" may be helpful -- after urinating, wait and try to urinate again.
- Stay active. Cold weather and immobility may increase the risk for urine retention. Keeping warm and exercising may help.
- Try to achieve and maintain a healthy weight. Obesity and lack of physical activity increase the risk for lower urinary tract symptoms.
Avoiding Medications that Aggravate Symptoms
Decongestants and Antihistamines. Men with BPH should avoid, if possible, the many medications for colds and allergies that contain decongestants, such as pseudoephedrine (Sudafed, generic). Such drugs, known as adrenergics, canworsen urinary symptoms by preventing muscles in the prostate and bladder neck from relaxing to allow urine to flow freely. Antihistamines, such as diphenhydramine (Benadryl, generic), can also slow urine flow in some men with BPH.
Diuretics. Diuretics are drugs that increase urination. They are often used to treat high blood pressure. If you take a diuretic, you may want to talk to your doctor about reducing the dosage or switching to another type of drug. No one should stop taking a diuretic without medical supervision.
Other Drugs. Other drugs that may worsen symptoms are certain antidepressants and drugs used to treat spasticity.
Pelvic Floor Muscle Training
Pelvic floor muscle exercises, first developed to help women with childbirth, may also help men prevent urine leakage, particularly after surgical procedures. These exercises strengthen the pelvic floor muscles that both support the bladder and close the sphincter.
Performing the Exercises. Since the muscle is internal and sometimes hard to isolate, doctors often recommend practicing while urinating:
- Contract the muscle until the flow of urine is slowed or stopped. Attempt to hold each contraction for 20 seconds.
- Release the contraction.
- In general, patients should perform 5 - 15 contractions, three to five times daily.
Dietary Factors
A heart-healthy diet rich in vegetables and fruit may help reduce BPH risk. Some evidence indicates that fruits and vegetables rich in beta-carotene and vitamin C may help protect against BPH. Dietary choices should also focus on increasing intake of healthy fats, such as omega-3 fatty acids, and limiting intake of unhealthy saturated fats and trans-fatty acids.
Herbs and Supplements
Generally, manufacturers of herbal remedies and dietary supplements do not need approval from the FDA to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been several reported cases of serious and even lethal side effects from herbal products. Patients should check with their doctor before using any herbal remedies or dietary supplements.
Popular herbal and dietary supplement treatments for BPH include:
- Saw palmetto is one of the most popular herbal remedies for BPH. It comes from the berry of the plant Serenoa repens. Most clinical trials have shown a very small effect or no benefit at all. A large, high-quality study found that saw palmetto did not help men with moderate-to-severe BPH even if the herb was taken for 1 year. Another high-quality study found that saw palmetto had no benefit even when the dose was tripled.
- Other popular herbs include extracts from African plum tree (Pygeum africanum), rye grass pollen (Secale cerale), stinging nettle root (Urtica dioica), South African star grass (Hypoxis rooperi), and pumpkin seed oil (Cucurbita peponis). Beta-sitosterol is a plant sterol found in some dietary supplements marketed for prostate health. There is no scientific evidence that any of these remedies help treat BPH.
- Patients should be aware that high doses of zinc supplements may increase the risk and progression of BPH.
The twomain drug classes used for BPH are:
- Alpha-blockers. These drugs relax smooth muscles, especially in the bladder neck and prostate. They include terazosin (Hytrin, generic), doxazosin (Cardura, generic), tamsulosin (Flomax, generic), alfuzosin (Uroxatral), and silodosin (Rapaflo). Alpha-blockers help relieve BPH symptoms, but they do not reduce the size of the prostate. They can help improve urine flow and reduce risk of bladder obstruction. Alpha-blockers are often the first medication choice, especially for men with smaller prostates.
- 5-alpha-reductase inhibitors (5-ARIs). Finasteride (Proscar, generic) and dutasteride (Avodart, Jalyn) block the conversion of testosterone to dihydrotestosterone, the male hormone that stimulates the prostate. These drugs are helpful for men with significantly enlarged prostates. In addition to relieving symptoms, they increase urinary flow and may even help shrink the prostate. However, patients may have to take these drugs for up to 6 - 12 months to achieve full benefits.
Because alpha-blockers and 5-ARIs work in different ways, some patients find that a combination of the two controls symptoms better than a single drug alone. Other men find that a single drug is adequate for symptom control. .
Alpha-adrenergic antagonists, commonly called alpha-blockers, relax smooth muscles in the prostate and make it easier for urine to flow. They quickly improve symptoms, usually within days. Because these drugs are short-acting, symptoms return once a man stops taking the medication. Alpha-blockers do not shrink the size of the prostate or change PSA levels.
Alpha-blockers are generally referred to as either nonselective or selective:
- Terzosin (Hytrin, generic) and doxazosin (Cardura, generic) are the nonselective alpha-blockers used for BPH treatment. Nonselective alpha-blockers relax all smooth muscles in the body that surround blood vessels. Because of this, they can lower blood pressure, sometimes causing side effects such as light-headedness or even fainting.
- Tamsulosin (Flomax, Jalyn, generic), alfusozin (Uroxatral), and silodosin (Rapaflo) are the selective alpha-blockers used for BPH. Selective alpha-blockers target more specifically the smooth muscles of the prostate, but they can also affect other areas of the body, such as the eyes. They have fewer side effects than non-selective alpha blockers and are now prescribed much more often than the older drugs.
Side Effects. Alpha-blockers can cause headache, and stuffy or runny nose. Alpha-blockers can reduce blood pressure, which may cause dizziness, lightheadedness, and fainting. Orthostatic hypotension, a sudden drop in blood pressure when standing, can occur and increases the risk of falling. Taking the medication close to bedtime can help reduce these side effects.
Because of the reduced blood pressure side effect, do not take non-selective alpha blockers with the phosphodiesterase (PDE5) inhibitors used for erectile dysfunction [sildenafil (Viagra), tadalafil (Cialis),vardenafil (Levitra), or avanafil (Stendra)]. Men who take selective alpha blockers may be able to use erectile dysfunction pills with guidance from a doctor. (Men may experience a decreased ejaculate while taking these drugs.However, erectile dysfunction is not a usual side effect of alpha-blockers, as it is with finasteride and dutasteride.)
A special concern for tamsulosin, and other selective alpha-blockers, is that they are associated with a condition called intraoperative floppy iris syndrome (IFIS). IFIS is a loss of muscle tone in the iris that can cause complications during cataract surgery. Patients who are planning cataract or other eye surgery should be sure to inform their doctors prior to the surgery. IFIS appears more likely to occur with selective alpha-blockers than non-selective alpha blockers.
5-Alpha-Reductase Inhibitors (5-ARIs)
The prostate gland contains an enzyme called 5 alpha-reductase that converts testosterone to another androgen called dihydrotestosterone. Drugs known as 5-alpha-reductase inhibitors (5-ARIs), block this enzyme and thus reduce dihydrotestosterone in the prostate thereby preventing prostate growth.
The 5-ARIs used for treating BPH are:
- Finasteride (Proscar, generic)
- Dutasteride (Avodart, Jalyn). Jalyn is a 2-in-1 pill that combines dutasteride with the alpha-blocker tamsulosin.
Because 5-ARIs help shrink enlarged prostates, they are most effective in reducing symptoms in men with very large prostates. These drugs take several months before they have an effect so men may not notice any signs of improvement for 3 - 6 months.
Side Effects. Finasteride and dutasteride can cause erectile dysfunction, lowered sexual drive (libido), and ejaculation and orgasm disorders. These drugs can reduce the volume and quality of semen released during ejaculation. These sexual side effects may sometimes persist even after the drug is discontinued. (A positive side effect of finasteride is possible reduction of hair loss related to male hormones and, in some cases, hair growth in men with mild-to-moderate male pattern baldness.)
These drugs decrease prostate-specific antigen (PSA) levels, which may mask the presence of prostate cancer. To resolve this problem, doctors calculate PSA levels in men taking these drugs by doubling the PSA values. This doubling equation helps provide an accurate measurement. The FDA advises doctors that an increase in PSA (even if it's in a normal range) while taking this drug may indicate the presence of prostate cancer.
A controversial matter is whether 5-ARIs help protect against prostate cancer. Studies have suggested that 5-ARIs lower a man's overall risk for developing prostate cancer. However, based on these studies, the FDA advises that these drugs may actually increase the risk of developing high-grade aggressive types of prostate cancer. A 2013 study reported that 5-ARI therapy neither increases nor decreases the risk of death from prostate cancer. The 5-ARIs are not approved for prostate cancer prevention. Men who take these drugs for BPH should discuss this issue with their doctors. The FDA recommends that doctors rule out other urologic conditions, including prostate cancer, that may mimic BPH before prescribing 5-ARIs for BPH treatment.
Other Drugs
Anticholinergic drugs, also called antimuscarinics, such as tolterodine (Detrol) may be helpful for some patients. For treatment of BPH, they may be prescribed either alone or in combination with an alpha-blocker drug.
Tadalafil (Cialis) is approved for treating BPH either alone or when it occurs along with erectile dysfunction. Tadalafil should not be used in combination with alpha-blockers without careful consideration and monitoring for excessive blood pressure lowering. Like all PDE5 inhibitor drugs used for erectile dysfunction, men who take nitrate drugs should not take tadalafil.
Several surgical approaches are used to treat BPH. Reasons for performing prostate surgery include:
- Persistent or recurrent episodes of urinary retention (inability to urinate)
- Persistent blood in the urine
- Bladder stones
- Moderate or severe lower urinary tract symptoms that do not improve with medication
Surgical options include invasive and minimally invasive procedures. The choice of which surgical procedure to use depends on various factors, including a man's age and general health.
The most effective surgical procedure, transurethral resection of the prostate (TURP), is also the most invasive and has the highest risk for serious complications. However, because it is more effective than less invasive procedures, TURP remains the procedure of choice for many doctors.
Minimally invasive procedures use laser or some other form of heat to destroy excess prostate tissue. Although minimally invasive procedures may be an appropriate choice for some patients, including younger men, none to date have proven superior to TURP.
Transurethral Resection of the Prostate (TURP)
Transurethral resection of the prostate (TURP) involves surgical removal of the inner portion of the prostate, where BPH develops. It is the most common surgical procedure for BPH, although the number of procedures has dropped significantly over the past decades because of the increased use of effective medications and the increasing use of laser procedures.
Procedure. The surgeon inserts a thin fiber-optic tube called a resectoscope into the urethra. No incision or stitches are needed. The resectoscope is a type of endoscope. It has a telescope lens to help the surgeon see the prostate gland. The surgeon uses a wire cutting loop inserted into the resectoscope to cut away excess prostatic tissue, and water solutions are used to flush away the excised matter. TURP usually requires a 1 - 2 day hospital stay.
A Foley catheter generally remains in place for 1 - 3 days after surgery to allow urination. This device is a tube inserted through the opening of the penis to drain the urine into a bag. The catheter can cause temporary bladder spasms that can be painful. The catheter may be removed while the patient is in the hospital or after he is sent home.
Recuperation. Urine flow is stronger almost immediately after most TURP procedures. After the catheter is removed, patients often feel some pain or sense of urgency as the urine passes over the surgical wound. These sensations generally last for about a week and then gradually subside. Complete healing takes about 2 months. The following are some tips for speeding recovery and avoiding complications:
- During recuperation avoid driving, operating heavy equipment, lifting, sudden movements, and straining the muscles in the lower tracts, such as during a bowel movement.
- Drinking 8 glasses of water a day after surgery is important to flush the bladder and help healing.
- Foods that help prevent constipation, such as fruits and vegetables, are important. A laxative may be needed if constipation occurs.
- Pelvic floor (Kegel) exercises can help reduce incontinence. Performing three to four sets of 30 contractions daily is recommended.
- Don't resume sexual activity until your doctor says it's safe to do so.
- Check with your doctor about any drugs or herbal supplements that you take to make sure that they will not thin blood and increase bleeding.
Complications. The TURP procedure is generally safe but there are some risks for short- and long-term complications.
Immediate short-term complications after surgery may include:
- Bleeding. Some blood in the urine is normal after TURP surgery but persistent heavy bleeding or clotting is a sign of a more serious complication. In rare cases, if the bleeding is very heavy, patients require blood transfusions.
- Infection. Urinary tract infections are more likely to occur the longer the catheter is in place
- Urination problems. Temporary urinary leaking or dribbling (urinary incontinence) is common after surgery and usually resolves within a month. Temporary inability to urinate (urinary retention) may occur for a few days following surgery, which is why a catheter is used to help remove urine.
- TURP syndrome. If the fluids used during TURP build up, water intoxication can develop, which can be serious. TURP syndrome occurs in a very small percentage of patients and can be treated with diuretics to remove excess fluid.
Long-term complications after surgery may include:
- Retrograde Ejaculation. Retrograde ejaculation, also called dry orgasm is very common. With this condition, the semen is ejaculated into the bladder rather than out through the urethra. Retrograde ejaculation does not affect sexual pleasure but it does impair fertility.
- Erectile Dysfunction. Erectile dysfunction, the inability to maintain an erection, is not common but can occur.
- Urinary Incontinence. Temporary urinary incontinence is common after TURP but in rare cases some men become completely unable to hold back their urine.
- Repeat Surgery. Up to 10% of patients who undergo TURP need a repeat operation within 5 years. Sometimes, scarring in the bladder severe enough to cause obstruction occurs within a year of the procedure and may require transurethral incision (TUIP). More often, the urethra is scarred and narrows, but usually this condition can be corrected by a simple stretching procedure performed in the doctor's office.
Other Invasive Surgical Procedures
Transurethral Incision of the Prostate (TUIP). In TUIP, the surgeon makes only one or two incisions in the prostate, causing the bladder neck and the prostate to spring open and reduce pressure on the urethra. TUIP is generally reserved for men with minimally enlarged prostates who have obstruction of the neck of the bladder.
TUIP is less invasive than TURP, has a lower rate of the same complications (particularly retrograde ejaculation), and usually does not require a hospital stay. More studies are still needed, however, to determine whether they are comparative in long-term effectiveness.
Open Prostatectomy. In open prostatectomy, the enlarged prostate is removed through an open incision in the abdomen using standard surgical techniques. This is major surgery and requires a hospital stay of several days. Open prostatectomy is used only for severe cases of BPH, when the prostate is severely enlarged, the bladder is damaged, or other serious problems exist. Some patients need a second operation because of scarring. Side effects of open prostatectomy can include erectile dysfunction and urinary incontinence.
Laser Surgery
Procedures. Laser technology is used for removal of prostate tissue. Laser procedures can usually be done on an outpatient basis, and there is little risk for bleeding. The procedure involves passing a small tube with a tiny camera and the laser fiber through the urethra of the penis. The procedure is performed under spinal, epidural, or general anesthesia.
Laser procedures have a faster recovery time and less risk of incontinence than invasive surgical procedures, but their long-term effectiveness is less clear. Laser surgery may not be appropriate for men with larger prostates. The procedures use various forms of heat to destroy cells with mechanisms that range from coagulation to complete vaporization:
- Transurethral holmium laser ablation of the prostate (HoLAP) uses laser energy to target and vaporize obstructing prostate tissue. The removal of the tissue helps to restore urine flow.
- Transurethral holmium laser enucleation of the prostate (HoLEP) is similar to HoLAP except a portion of the prostate is cut into smaller pieces and then flushed out from the bladder.
- Holmium laser resection of the prostate (HoLRP) is similar to HoLEP except the prostate fragments are removed througha resectoscope instrument.
- Photoselective vaporization of the prostate (PVP) uses a potassium-titanyl-phosphate (KTP) laser ("green-light" laser) to vaporize prostate tissue. The procedure is virtually bloodless and may be a better option for men taking anticoagulant ("blood thinner") medication. Improvement lasts for up to 1 year after the procedure. More studies are needed to confirm long-term efficacy.
Other Less Invasive Procedures
These minimally invasive procedures carry fewer risks for incontinence or problems with sexual function than invasive procedures, but it is unclear how effective they are in the long term.
Transurethral Microwave Thermotherapy (TUMT). Transurethral microwave thermotherapy delivers heat using microwave pulses to destroy prostate tissue. A microwave antenna is inserted through the urethra with ultrasound used to position it accurately. The antenna is enclosed in a cooling tube to protect the lining of the urethra. Computer-generated microwaves pulse through the antenna to heat and destroy prostate tissue. When the temperature becomes too high, the computer shuts down the heat and resumes treatment when a safe level has been reached. The procedure takes 30 minutes to 2 hours, and the patient can go home immediately afterward.
Transurethral Needle Ablation (TUNA). Transurethral needle ablation is a relatively simple and safe procedure, using needles to deliver high-frequency radio waves to heat and destroy prostate tissue.
Transurethral Electrovaporization (TUVP). Transurethral electrovaporization uses high voltage electrical current delivered through a resectoscope to combine vaporization of prostate tissue and coagulation that seals the blood and lymph vessels around the area. Deprived of blood, the excess tissue dies and is sloughed off over time.
Prostatic Stents
Prostatic stents used for BPH are flexible mesh tubes that are inserted into the urethra. Typically, the insertion procedure takes only 15 minutes. Patients need only regional anesthetic and mild sedation. There is minimal recuperation and no overnight hospital stay. Unfortunately, stents often need to be removed later because of poor placement or complications, including irritation when urinating, urinary tract infections, and treatment failure. At this point, stents seem best suited for high-risk surgical patients or those with a limited life expectancy.
- www2.niddk.nih.gov -- National Institute of Diabetes and Digestive and Kidney Diseases
- www.auanet.org -- American Urological Association
Abrams P, Chapple C, Khoury S, Roehrborn C, de la Rosette J; International Consultation on New Developments in Prostate Cancer and Prostate Diseases. Evaluation and treatment of lower urinary tract symptoms in older men. J Urol. 2013 Jan;189(1 Suppl):S93-S101..
Barry MJ, Meleth S, Lee JY, Kreder KJ, Avins AL, Nickel JC, et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA. 2011 Sep 28;306(12):1344-51.
Bell CM, Hatch WV, Fischer HD, Cernat G, Paterson JM, Gruneir A, et al. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA. 2009 May 20;301(19):1991-6.
Burke N, Whelan JP, Goeree L, Hopkins RB, Campbell K, Goeree R, et al. Systematic review and meta-analysis of transurethral resection of the prostate versus minimally invasive procedures for the treatment of benign prostatic obstruction. Urology. 2010 May;75(5):1015-22. Epub 2009 Oct 24.
Davidson JH, Chutka DS. Benign prostatic hyperplasia: treat or wait? J Fam Pract. 2008 Jul;57(7):454-63.
Donnell RF. Minimally invasive therapy of lower urinary tract symptoms. Urol Clin North Am. 2009 Nov;36(4):497-509, vi-vii.
Kramer BS, Hagerty KL, Justman S, Somerfield MR, Albertsen PC, Blot WJ,et al. Use of 5-alpha-reductase inhibitors for prostate cancer chemoprevention: American Society of Clinical Oncology/American Urological Association 2008 Clinical Practice Guideline. J Clin Oncol. 2009 Mar 20;27(9):1502-16. Epub 2009 Feb 24.
Lourenco T, Pickard R, Vale L, Grant A, Fraser C, MacLennan G, et al. Minimally invasive treatments for benign prostatic enlargement: systematic review of randomised controlled trials. BMJ. 2008 Oct 9;337:a1662. doi: 10.1136/bmj.a1662.
McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011 May;185(5):1793-803. Epub 2011 Mar 21.
Moyad MA, Lowe FC. Educating patients about lifestyle modifications for prostate health. Am J Med. 2008 Aug;121(8 Suppl 2):S34-42.
Parsons JK, Sarma AV, McVary K, Wei JT. Obesity and benign prostatic hyperplasia: clinical connections, emerging etiological paradigms and future directions. J Urol. 2013 Jan;189(1 Suppl):S102-6.
Penson DF, Munro HM, Signorello LB, Blot WJ, Fowke JH; Urologic Diseases in America Project. Obesity, physical activity and lower urinary tract symptoms: results from the Southern Community Cohort Study. J Urol. 2011 Dec;186(6):2316-22. Epub 2011 Oct 20.
Robinson D, Garmo H, Bill-Axelson A, Mucci L, Holmberg L, Stattin P. Use of 5a-reductase inhibitors for lower urinary tract symptoms and risk of prostate cancer in Swedish men: nationwide, population based case-control study. BMJ. 2013 Jun 18;346:f3406.
Roehrborn CG. Male lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Med Clin North Am. 2011 Jan;95(1):87-100.
Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Morrill B, et al. The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. J Urol. 2008 Feb;179(2):616-21; discussion 621. Epub 2007 Dec 21.
Sarma AV, Wei JT. Clinical practice. Benign prostatic hyperplasia and lower urinary tract symptoms. N Engl J Med. 2012 Jul 19;367(3):248-57.
Schroeck FR, Hollingsworth JM, Kaufman SR, Hollenbeck BK, Wei JT. Population based trends in the surgical treatment of benign prostatic hyperplasia. J Urol. 2012 Nov;188(5):1837-41. Epub 2012 Sep 19.
Tacklind J, Fink HA, Macdonald R, Rutks I, Wilt TJ. Finasteride for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2010 Oct 6;(10):CD006015.
Theoret MR, Ning YM, Zhang JJ, Justice R, Keegan P, Pazdur R. The risks and benefits of 5a-reductase inhibitors for prostate-cancer prevention. N Engl J Med. 2011 Jun 15. [Epub ahead of print].
Advanced Studyec
Related Informationec
Review Date: 9/20/2013�
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


text:
Bringing astronomy down to earth
1 November 2011
Analysing starlight seems about as far removed from solving problems here on earth as it's possible to get. 'Astronomical spectroscopy is a long way ahead of applicability,' admits UCL's Professor Jonathan Tennyson. 'I'm a blue-sky physicist. And yet my work has more subtle applications than you might imagine.'
focus is on what Tennyson calls 'very hot water' – very hot indeed. The fusion
process that powers stars leads either to a carbon- or an oxygen-rich solar
environment. Water vapour arises in the latter case when oxygen combines with
the star's hydrogen. Researchers at UCL have identified water not only in these
oxygen-rich stars and in comets, but also in planets beyond our solar system,
unknown when they began the research. To their surprise, they also found it
around carbon stars, a finding which overturned previous assumptions about the
relative abundance of the two elements.
Grounded theory
The research turns out to have relevance to terrestrial problems as well. The water spectra can be used for the early detection of forest fires, for example. Connections like these underline the value of theoretical physics. 'Our latest list has 500 million water spectral lines. You couldn't hope to measure them all. So I'd argue the only way forward is to build a really robust theoretical model,' says Tennyson.
Although his own work involves the fundamental quantum mechanics that govern molecular interactions, Tennyson tries to pick problems where his contribution might have practical use. One application where it is especially important to know about these collisions is in the plasma etching processes used to make integrated circuits. 'The etching industry is based on empiricism – it's like cooking.' Manufacturing tends to rely on chef-like skill as much as science. Yet it is hugely expensive. 'So it's clear that if you can gain an insight into where to go on theoretical grounds, you can make real progress.'
Computer modelling
Tennyson now leads a project, which aims, using a computer program, to model what happens in processes involving electron collisions with gas phase molecules. It is available as freeware on his website, but with Dan Brown, 'entrepreneur in residence' at UCL's Computer Science Department, he has also set up a company, Quantemol. With funding from NESTA, Quantemol has developed an expert system to run the code for commercial clients.
One company that recognized the superiority of Tennyson's modelling is Surface Technology Systems (now SPTS), which used the program in its own manufacturing and has worked with Tennyson on subsequent versions, which are being developed with help from UCL Business. Leslie Lea, formerly chief scientist at STS, found Tennyson 'the stereotypical professor in that he was very excited about the work' but also 'good at recognizing where an idea can be used in a different field.'
IMAGE: Water vapour in the atmosphere of a star. Credits: NASA, ESA, RAS, UCL, G. Bacon (STScI), Dan Durda, Andy McLatchie & Sylvain Girard


text:
AUDIO: Tom Hamilton credits Francona for Indians success
(Cleveland) - "This season's been much better than any of us envisioned."
That's Indians play-by-play man Tom Hamilton's take on the 2013 Indians and their run to the post season.
Hamilton was on with Mike Snyder and Bob Frantz Monday morning to recap the four-game sweep of the Houston Astros that's left the Indians with a 1.5 game lead for the second wild card slot.
Hamilton says it all begins with Manager Terry Francona who keeps the team loose. "Now you see the value of a guy who's been there/done that," says Hamilton.
Hamilton also credits the veteran players like Jason Giambi for also keep the mood light and the younger players loose. Hamilton says he doesn't think the team will tighten up with six games left.
As for the Indians pitching, Hamilton says they're #2 in the American League since the All-Star break. The Indians will also be getting Justin Masterson back, and may use him out of the bullpen for a few games to get some innings in.
Listen to Tom's conversation with Frantz and Snyder....
Get breaking news sent to your mobile phone. Text "news" to 21095.
(Copyright © 2013 by Clear Channel, all rights reserved. Photo by WTAM 1100)


text:
The climate 'tis changing. Good thing it's not global warming!
By Barbara Kessler
Green Right Now
You say climate change, I say global warming. These two terms don't seem all that far apart. Both refer to the massive shifts in climate, around the globe.
But an analysis by Yale and George Mason universities has found that the term "global warming" sounds waaay more alarming and worrisome. Especially to liberals, Gen Xers and men, according to the study.
Whereas the term climate change, produces a much more subdued and less emotional reaction from people, rather as if Prince Charles had mentioned the phenomenon over tea before nodding off.
So, let's review: Global warming, woooo, scary! Think Norman Bates approaching the shower curtain as the orchestra shrieks, louder and louder.
Climate change, meh. It's not normal. But no Norman.
This pretty much tracks with what the Dark Lord of Political Terminology decided way back in 2001, when according to the study he advised George W. Bush to not get burned by "global warming."
"Prior to the 2002 mid-term elections, Frank Luntz, a Republican pollster and strategist, gave the George W. Bush administration the following advice in a secret memo about how to win the "environmental communications battle", including global warming. [Editor note: See how they're mainly focused on winning the war of words and not so much the actual problem? Take heed voters.]
Luntz's recommendation to Republicans was to use the term climate change instead of global warming: "It's time for us to start talking about 'climate change' instead of global warming…'climate change' is less frightening than 'global warming'. As one focus group participant noted, climate change 'sounds like you're going from Pittsburgh to Fort Lauderdale.' While global warming has catastrophic connotations attached to it, climate change suggests a more controllable and less emotional challenge."
Luntz, the wordmeister, nailed it.
GWB took that advice and switched right over to climate change, according to later analysis.
Interestingly, today, conservatives and liberals, for whatever reason, have since switched their positions on the terminology of climate change.
Research now shows that conservative think tanks are more likely to use the term "global warming" than climate change, while liberals are the other way around.
To deconstruct that, you'd probably have to read the study. I'll take a guess that liberals, as they're wont to do, may be placating and wooing conservatives by adopting the more palatable climate change term. Or perhaps they're simply trying to downplay their own inaction on this global crisis.
Conservatives, for different reasons, may have seized "global warming" because it seems to put the lie to climate change during cold and snowy winters. See, there's no global warming, you can build an igloo in Pittsburgh! (In fact, an Oklahoma Senator and compatriots famously did denounce climate change as not real by constructing an igloo in DC a few years back.) I say this because conservatives, speaking now of those in Congress and leadership roles, still tend to "not believe" the scientific phenomenon of global warming and have been known to point to snow and ice as evidence on their side.
Liberals sometimes do the same, singling out certain weather events as proof of the onslaught of climate change. Hurricane Katrina is a good example. This massive hurricane may have fit into the pattern of warming oceans creating mega storms, or she may have done more damage because industrialists paved her way when they ruined the shoreline ecology that could have mitigated her assault on New Orleans.
And so we remain politically paralyzed. Debating whether climate change, or global warming, even exists, as this multi-headed Godzilla stomps toward Manhattan. (Get ready for Godzilla references this summer; can't be helped.)
In the end, we really probably need a scarier phrase than even Global Warming – Global Boiling? Climate Crash? (clearly I don't know that better word) – to convey the disaster ahead. I think those of us who "believe in" climate change could find comfort in a more frightening term, and not one so pansy as Tom Friedman's Global Weirding, which granted, captures the erratic nature of climate change, but totally fails on the fearsomeness scale.
Oh look, Miami's disappearing. Isn't that weird? Well yes, but it's also #$(&@#)$(&@ arghhhhhhhhh, frightening as heck.
Global warming was more associated with glaciers melting, coastal flooding and:
- Greater certainty that the phenomenon is happening, especially among men, Generation X (31-48), and liberals;
- Greater understanding that human activities are the primary cause among Independent
- Greater understanding that there is a scientific consensus about the reality of the phenomenon among Independents and liberals
- More intense worry about the issue, especially among men, Generation Y (18-30), Generation X, Democrats, liberals and moderates
- A greater sense of personal threat, especially among women, the Greatest Generation (68+), African-Americans, Hispanics, Democrats, Independents, Republicans, liberals and moderates
- Higher issue priority ratings for action by the president and Congress, especially among women, Democrats, liberals and moderates
- Greater willingness to join a campaign to convince elected officials to take action, especially among men, Generation X, liberals and moderates.
(See more at: http://environment.yale.edu/climate-communication/article/global-warming-vs-climate-change/#sthash.PR2LgxnH.dpuf)
Copyright © 2014 Green Right Now | Distributed by Noofangle Media
More Green Right Now
More Stories
ERIE, Pa - Lake Erie Cyclefest is just weeks away, and…
The community will gather tonight, to remember a man who was shot and…
Police are investigating, after bullets are fired in to Erie homes.
Don't Miss
Latest News
- Copyright 2017 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
- Copyright 2017 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
- Copyright 2017 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.


text:
Proposition 35 would crack down on those convicted of sex trafficking in California, with increased prison terms, fines and registration requirements.
But critics, including some who work to protect victims of forced prostitution, say the measure is too vague and that defense attorneys could argue with its definition of human trafficking, tying cases up in courts and ultimately hurting victims. Some also say the proposition could intrude on privacy rights.
Supporters point to cases where those convicted of sexual exploitation crimes got off with light sentences.
For example, in a case just last month in Los Angeles, Brian Smith of L.A. and Lashanay Cohill of Indio were convicted of pimping and pandering, assault and human trafficking of a minor.
The two victims -- girls under 18 from South Los Angeles and Mojave -- were kidnapped, transported to someone else's home, then forced into prostitution.
If the girls refused to have sex with strangers, one of the kidnappers used a device made of wire hangers he called the "Green Monster" to beat them until they submitted.
One of the victims refused to testify.
Cohill, a woman in her 20s whose defense attorney said also was coerced by Smith, received a year of probation. Smith, meanwhile, received 12 years.
If Prop. 35 -- the Californians Against Sexual Exploitation Act -- passes, someone like Smith could receive 15 years to life, proponents say.
"By making this a severe crime, we can deter opportunists," said Daphne Phung, founder of California Against Slavery and co-author of Prop. 35.
Phung said she created the proposition after seeing a documentary last year on human trafficking.
Prop. 35 increases prison terms for human traffickers, requires convicted sex traffickers to register as sex offenders, makes them disclose their Internet accounts and demands that they pay for services to help organizations that serve victims.
Phung said the cost to taxpayers might be a few million dollars each year.
"The higher the fines that are collected, the more will all go toward helping victims," Phung said. "These girls are not criminals."
Chris Kelly, a 2010 candidate for California attorney general and former chief privacy officer for Facebook, helped draft Proposition 35 and has contributedmore than $2 million to fund the effort, according to Voter's Edge, which tracks contributions.
Those opposed to Prop. 35 vary about why the law would be ineffective and even unconstitutional. A federal law already prosecutes human traffickers. Proposition 35 would align with the federal law, but some argue the definition of "trafficking" could be broadened and misused.
The American Civil Liberties Union has an issue with perpetrators being required to disclose all Internet accounts, saying it infringes on free speech.
"The measure requires that registrants provide online screen names and information about their Internet service providers to law enforcement -- even if their convictions are very old and have nothing to do with the Internet or children," according to an ACLU statement.
"This provision essentially eliminates the ability of registrants to engage in anonymous online speech and imposes a substantial burden whenever a registrant wants to use a new online platform to speech, infringing on registrants' First Amendment right to free speech."
The nonprofit Exotic Service Providers Legal Education and Research Project -- which provides legal advice to those in various erotic industries, including prostitution and pornography and works to protect sexual privacy -- opposes the measure as well, saying: "If implemented, it will prove harmful to the victims of trafficking rather than helping them. Moreover, it expands the definition of trafficking to ensnare innocent people."
An organization that works with victims of child prostitution also opposes the measure, saying it will be ineffective.
Dr. Lois Lee, founder of Children of the Night, a Van Nuys-based organization that helps child prostitutes and led legislators into creating mandatory sentencing laws that guaranteed harsher penalties for pimps, said the bill leaves out one important factor: Pimps tend to hide their assets pretty well.
California law allows victims of prostitution to sue their pimps, Lee said.
"In California, there is a civil code that allows the victim of prostitution to sue her pimp," Lee said.
"A few years ago, we looked for assets for pimps that were arrested," Lee said. "We could not find pimps with assets in their names. We brought in the IRS and Treasury Department and they found the money in the mother's name."
She called Prop. 35 do-gooder legislation that may do more harm than expected.
"The state law is good enough," Lee said. "Proposition 35 looks good on the surface, but anyone supporting this proposition does not understand and does not work with children of sex trafficking."
Proposition 35YES means: Longer prison sentences and larger fines for committing human trafficking crimes.
NO means: Existing criminal penalties for human trafficking would stay in effect.


text:
I want God; not my idea of God. C.S. Lewis
My god doesn't …
I don't believe in a god who …
How many times have we heard this?
I ask you, if God is God; if He made everything, everywhere, including us, then what does it matter what we think of Him? All these quippy little assertions are at base the expression of an underlying belief that God is the clay and we are the potter. They lead directly to what George Barna jokingly described as a nation of "310 million people with 310 million religious expressions."
I believe this is the root of the "I don't believe in religion; I believe in Jesus" phenomenon. If you can subtract Jesus from 2,000 years of Christian teaching, why then, you can create a Jesus who fits you and your prejudices, your wannabes, and your wannados right down to the ground. You can create a phony, basically useless Jesus who doesn't demand conversion, never asks for repentance and would not think of chiding you for your "understandable" little sins.
You can create your own personal feel-good Jesus, who inevitably will be a Jesus without the cross. The only problem with that, of course, is that this jesus is not god. He is not Christ. Jesus without the cross is not Christ. Jesus without the cross was a First Century itinerate preacher and miracle worker who died 2,000 years ago. He's the shorn and nonsensical little nothing that the film-flammers who attack Christianity try to make Him out to be.
Dietrich Bonnhoefner had a phrase for this. He called it "cheap grace." Here's what he said:
"Cheap grace is the grace we bestow on ourselves. Cheap grace is the preaching of forgiveness without requiring repentance, baptism without church discipline, Communion without confession…. Cheap grace is grace without discipleship, grace without the cross, grace without Jesus Christ, living and incarnate."
The Christian culture in which so many of us live is a sham and a flam, a product of cheap grace gone wild that is drummed into our minds by the steady beat of media promotion. Today, we not only have cheap grace, we have competing cheap graces whose followers are focused on defeating one another in the culture wars rather than following Christ.
We have the cheap grace purveyors of the right who tell us that all that stuff Jesus said in the Sermon on the Mount, and indeed, throughout the Gospels, doesn't mean what it so plainly says. They create a morality-free zone surrounding anything to do with business and commerce, exempting the most egregious assaults on the common good from any application of 2,000 years of Christian teaching.
Then, on the other side of the cultural divide, we have the cheap gracers who proclaim that any standards of personal morality are in fact violations of personal freedom and assaults on tolerance and love. They carry this to the point that simple disagreement with such actions as abortion, serial marriage, same-sex marriage, and the commodification and sexualization of women and children is attacked and labeled "hate," "homophobia," and, bizarre as this sounds, sexism.
These competing versions of cheap-grace, god-made-in-my-image faux christianity have become the public face of Christian teaching. Their followers attack one another with a ruthlessness worthy of Caiaphas, and a pragmatic amorality that would be the pride of Machiavelli. Their total lack of respect for Jesus Christ and the Gospels is only equaled by their pretentious self-righteousness.
These are mean people. They are mean with the meanness that any thinking person would expect of someone who has turned their back on Christ in order to twist His message into a club to beat their political opponents with.
Why they do it is obvious: To gain power, fame and money.
How they manage to succeed at it is more subtle. Anyone who honestly read the New Testament would pick up on the fact that what these people are giving us is the stone, not the bread; a snake rather than a fish. Yet millions upon millions of "Bible believing" Christians not only fall for this crass twisting of the Gospels in the name of self-justification, they abandon the real Gospels to follow and teach it themselves.
Are they that stupid? Can't they read the Bible for themselves and see that these are lies?
I think the answer rests in the fact that they can read the Bible; they just don't like what it says.
The story of the Gospels is not built around some "follow me and I'll make you into little Ceasars" sort of promise. It is in fact quite the opposite. When Satan tempted Jesus, he offered Him all the kingdoms of this world and Jesus turned him down. What Jesus did instead was set Himself on the path that led to the cross.
These sham teachers of phony gospels of their own devising are offering us the same deal that Satan offered Jesus. The difference being that many of us are taking the deal. Follow them, and you can have any kind of sex you want with whomever you chose. Follow them and you can kill your own children, reduce other human beings to things to be destroyed for your pleasure and feel holier than thou for doing it.
Set your foot on the broad and smooth path of the phony jesus these liars give us and you can lie, steal, cheat, hoard, destroy whole economies for your personal gain. You can push most of the world into death-dealing poverty and back it up with armies you supply from your factories and go to church on Sunday and be honored as great people of a phony god.
Wide is the way that leads to perdition, and it seems that in today's world it is most often paved by the self-righteous hypocrisy of following false gods of our own creation that we have cast in our own image.
This is cheap grace, and it always seems to end up giving those who choose it a license to kill.
Bonnhoefner also talked about another kind of grace. He called it "costly grace." I tend to call it "real grace," but that's just me and my simple-minded way of looking at things.
Here is part of what he said:
Costly grace is the gospel which must be sought again and again and again, the gift which must be asked for, the door at which a man must knock. Such grace is costly because it calls us to follow, and it is grace because it calls us to follow Jesus Christ. It is costly because it costs a man his life, and it is grace because it gives a man the only true life. It is costly because it condemns sin, and grace because it justifies the sinner. Above all, it is costly because it cost God the life of his Son: "ye were bought at a price," and what has cost God much cannot be cheap for us. Above all, it is grace because God did not reckon his Son too dear a price to pay for our life, but delivered him up for us. Costly grace is the Incarnation of God.
Cheap grace is a sham and a phony. It is a lie we tell ourselves. Costly grace, the grace that comes from following Jesus even if it's unpopular, even if it means picking up your cross and following after Him, is what can and will heal our culture and save our world.
According to a survey conducted by the Barna Institute, America is drifting more and more toward the cheap grace of God Made in Our Image; the ultra personal god who follows our teachings instead of asking us to follow his.
God made in our image will never ask us to do anything costly. He will always understand our transparent justifications, even of the most heinous crimes. What he can never do is cleanse us, re-orient us and change us into what we were meant to be when God first made us. What we will never see by following him is eternal life. There is no redemption in making an idol out of yourself, in worshipping a self-made, all-agreeing comfortable little kitchen god that you create out of your longing to never be wrong, never sacrifice, never make a tough choice.
Only God, the real God, can redeem us, make us new and lead us into life everlasting. The price of following Him is the same now as it has always been. It is the costly grace of the cross.


text:
Subpoenaes for some Cleveland Police officers
(Cleveland) - Some Cleveland Police officers involved in the deadly November chase that ended in the deaths of two suspects have been subpoenaed to appear before a grand jury.
The officers are expected to appear today and Thursday in connection with the chase which started near the Justice Center downtown and wound its' way into E. Cleveland where suspect Timothy Russell and passenger Malissa Williams were shot Nov. 29, 2012 in a hail of gunfire.
Officers say Russell tried to mow them down with his car following the chase. 13 Officers fired 137 shots into the vehicle.
Cleveland Police Chief Mike McGrath, last month, announced the suspensions of 63 officers for speeding and failing to get approval to join the chase.
Get breaking news sent to your mobile phone. Text "news" to 21095.
(Copyright 2013 Clear Channel, all rights reserved.)


text:
50 Cent says he tried to give Chief Keef advice
Listen to 50 Cent on iHeartRadio | Listen to Chief Keef on iHeartRadio
50 Cent says he tried to give career advice to Chief Keef, but the embattled emcee "didn't listen." In a radio interview, the G-Unit leader explains that he thought he could help Chief Keef because he saw similarities to the beginning of his own career.
50 says the 17-year old up-and-coming rapper is "completely influenced" by his environment. While that may cause Chief Keef to get "bumped around" at first, 50 says Keef can change things if he catches on and realizes his potential. Once he becomes aware of his actions, Fif says Chief Keef will be able to "evolve into something significant."
Chief Keef has been arrested numerous times this year. He was recently picked up on a misdemeanor trespassing charge, shortly after leaving a Skokie, Illinois courtroom to plead guilty to a speeding charge. In May he was arrested in Georgia for allegedly smoking marijuana in a hotel room.
Photo Credit Getty Images


text:
PARIS: Defending champion and world number one Serena Williams has been knocked out of the French Open by Spain's Garbine Muguruza as the women's tournament was thrown wide open.
The top seed lost 6-2 6-2 in the second round to the world number 35 with her defeat coming just an hour after sister Venus also went out 2-6 6-3 6-4 to Slovak teenager Anna Schmiedlova.
It was the earliest exit for a defending champion at Roland Garros since 2005 when Anastasia Myskina of Russia went out in the first round.
Wednesday's defeat was Serena's worst at a Grand Slam in terms of games won and was only the second time in her career she had been beaten at a major in the round of 64.
The last time that happened was on her debut at the 1998 Australian Open.
It was also just the fourth time the Williams sisters had lost on the same day at a major.
"Nothing worked today," said 17-time major winner Serena, who hit just eight winners and a huge 29 unforced errors with five double faults.
"I just couldn't serve. But you can't be on form every day. I hate to be off at a Grand Slam but it happens, it's not the end of the world." Muguruza immediately won praise for her performance.
"Shocker at the French - Serena loses to Garbine Muguruza. Garbine is here to stay, that's for sure, quite a talent," tweeted Martina Navratilova.
The young Spaniard was over-joyed by her performance.
"Today's a great day," she said.
Serena'a defeat was good news for Maria Sharapova who is now the overwhelming title favourite with second seed Li Na having been knocked out in the first round on Tuesday.
The Williams sisters had been scheduled to meet in the third round.
Instead the tournament will get Muguruza against Schmiedlova, the 19-year-old Slovak who ended 32-year-old Venus's 17th French Open.
"It's the biggest win of my career," said world number 56 Schmiedlova who had lost to Venus in straight sets in Miami this season.
"I have big respect for her. She's a great player and I still cannot believe I won."
Defeat for Venus, the 29th seed, meant she has now failed to get beyond the second round in Paris on her last three visits.
She was undone by 47 unforced errors on a half-full Philippe Chatrier court and despite saving two match points it was all too much for mother Oracene who was caught on TV napping as Venus slipped to defeat.
"I think she's very good already, and she's going to be even better as she continues to play. I see wonderful things for her," said Venus of her opponent.
Later Wednesday, Maria Sharapova, the seventh seeded 2012 champion, faces Bulgaria's Tsvetana Pironkova, a Wimbledon semi-finalist in 2010.


text:
Hey! Don't forget to visit the online store for t-shirts, plush Sparkys and all-new dry-erase boards! NEW: if you missed the Kickstarter for 25 YEARS OF TOMORROW, there's a limited quantity of remaining stock available here!
ALSO: please consider joining SPARKY'S LIST!
READ THE LATEST CARTOON Mondays at Daily Kos and Tuesdays at The Nation!


text:
Pharmacy Single Vanity Base
$1495 Regular
$1121 Member
We've brought the clean lines of 19th-century pharmacy fixtures into the bath, pairing ample storage with impeccably polished marble for a timeless aesthetic. Hand-welded steel frames have a durable, moisture-resistant black enamel finish with nickel bin pulls and exposed hinges.
Show Details +
- 37½"W x 23"D x 32½"H
Shown in Black.
Pharmacy Single Vanity Base - 37½"W x 23"D x 32½"H
$1495 Regular
$1121 Member


text:
Texas A&M's Johnny Manziel Presented With 2012-13 Manning Award
Thursday, May 2, 2013
Johnny Manziel, the captivating star from Texas A&M University, visited New Orleans on Thursday to officially accept the 2012-13 Manning Award, presented by the Allstate Sugar Bowl. In addition to being the first freshman to win the honor, he is also the first unanimous selection for the award, which recognizes the top quarterback in the nation. The Manning Award, now in its ninth year, was created by the Allstate Sugar Bowl to honor the college football accomplishments of Archie, Peyton and Eli Manning. It is the only quarterback award that takes into consideration the candidates' bowl performances in its balloting. The award is voted on by a panel of local and national media, as well as each of the Mannings.


text:
Child neglect and psychological abuse
Child neglect (also called psychological abuse) is a form of child abuse that occurs when someone intentionally does not provide a child with food, water, shelter, clothing, medical care, or other necessities.
Other forms of child neglect include:
- Allowing the child to witness violence or severe abuse between parents or adults
- Ignoring, insulting, or threatening the child with violence
- Not providing the child with a safe environment and adult emotional support
- Showing reckless disregard for the child's well being
See also:
The rate at which children are physically and emotionally neglected is difficult to define.
Risk factors may include:
- Mental illness
- Poverty
- Stresses in the family
- Substance abuse by parents or caregivers
Abused children are at risk of becoming abusers themselves as adults.
Symptoms of psychological abuse may include:
- Difficulties in school
- Eating disorders, leading to weight loss or poor weight gain
- Emotional issues such as low self-esteem, depression, and anxiety
- Rebellious behavior
- Sleep disorders
- Vague physical complaints
See also: Failure to thrive
Exams and Tests
Children with suspected emotional abuse should be examined by a trained mental health professional. All neglected or psychologically abused children should be examined for other forms of physical abuse.
If you think a child is in immediate danger because of abuse or neglect, you should call 911.
If you suspect that a child is being abused, report it right away. Most states have a child abuse hotline. You may also use the Childhelp National Child Abuse Hotline (1-800-4-A-CHILD).
The law requires health care workers, school employees, and child care professionals to report suspected abuse.
Treatment of the abused child may include nutritional and mental health therapy.
It may be necessary to remove the child from the home to prevent further abuse.
Treatment for abusers may involve parenting classes and treatment for mental illness, alcohol, or drug abuse.
Support Groups
There are many support groups available, including:
Prevent Child Abuse America - www.preventchildabuse.org
Outlook (Prognosis)
With treatment, many children and parents can be reunited as a family. The long-term outcome depends on:
- How severe the abuse was
- For how long the child was abused
- The success of therapy and parenting classes
Possible Complications
As in all forms of child abuse, severe injury or death is possible.
Other long-term problems may include:
- Becoming an abuser in adulthood
- Depression
- Lack of self confidence
- Rebellious behavior
When to Contact a Medical Professional
Call your health care provider if a child has:
- Physical changes, such as unexplained injuries, weight loss, or severe tiredness
- Unexplained behavior changes
Suspected child abuse of any form must be reported to the authorities.
Community programs, such as home visits by nurses and social workers, can help families change behaviors or prevent the start of abuse in high-risk families.
School-based programs to improve parenting, communication, and self-image can help prevent future abuse and may help to identify abused children.
Parenting classes are very helpful. Newlywed adults without children should be encouraged to take these classes before they have each child. The dynamics in the home change when each new child is born.
Johnson CF. Abuse and neglect of children. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 36.
Review Date: 1/24/2011
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


text:
CMMC offers cover-to-cover ("core") indexing and abstracts for more than 620 journals (over 500 in full text), and selected ("priority") coverage of nearly 200 more,
Combines two databases, CommSearch (formerly produced by the National Communication Association (NCA)), and Mass Media Articles Index. Over 400 journals are indexed with full text access to over 200 titles. Covers communication, mass media, and related areas.
Library service desk: 828-262-2820 or Ask a Librarian [1]
Access is restricted to ASU students, faculty, and staff.
Number of simultaneous users: unlimited; Terms of Use [2]


text:
Members Login
New Members Sign-Up
Top Boards
Israel hails US call...
Egypt admits wounded...
Obama´s opportu...
Palestinians fire ro...
Israel, Palestinians...
Israel not honoring ...
Gaza Smugglers Ready...
Saudi Asks Israel to...
Israels Political S...
Mideast peace takes ...
Historical Perspectives
U.S. approves 1.3 billion dollars in military aid to Egypt (HA´ARETZ NEWS) By Natasha Mozgovaya and DPA 03/25/12)
Source: http://www.haaretz.com/news/diplomacy-defense/u-s-approves-1-3-billion-dollars-in-military-aid-to-egypt-1.420447
HA'ARETZ} NEWS SERVICE Articles-Index-Top
U.S. Secretary of State Hillary Rodham Clinton gave the green light Friday for U.S. military aid to Egypt despite concerns that Cairo was not meeting goals in its democratic transition.
Clinton waived conditions placed by Congress on the 1.3 billion dollars of aid - requiring Egypt to meet certain democratic reforms before being granted the funds - saying the move was in the United States´ national interest.
"These decisions reflect America´s over-arching goal: to maintain our strategic partnership with an Egypt made stronger and more stable by a successful transition to democracy," State Department spokeswoman Victoria Nuland said.
Nuland pointed to progress made in elections but said the U.S. remained concerned about protection for non-governmental organizations and other issues.
"Egypt´s transition to democracy is not yet complete, and more work remains to protect universal rights and freedoms. The Egyptian people themselves have made this clear to their own leaders," she said.
Congress passed a law late last year that required Egypt´s military rulers to support a transition to civilian rule, hold elections and protect religious freedom in order to get the longstanding U.S. aid.
Clinton cleared Egypt for 200 million dollars in economic aid and said it was meeting the conditions of its peace treaty with Israel.
Senator Patrick Leahy, who had been among the policy´s strongest proponents after U.S. non-governmental organizations and their workers in Egypt were harassed by authorities, expressed disappointment in the State Department decision.
"Waiving the new conditions on democracy and human rights is regrettable, and handing over the entire 1.3 billion dollars at once to the Egyptian military compounds the mistake by dissipating our future leverage," he said.
"Using this waiver authority, at this time, sends a contradictory message. The Egyptian military should be defending fundamental freedoms and the rule of law, not harassing and arresting those who are working for democracy."
Congress had acted to step up pressure on Cairo after the offices of the U.S. NGOs and other international groups were raided and workers were temporarily kept from leaving the country. A trial in the case is set to resume next month. (© Copyright 2012 Ha´aretz 03/25/12)
Return to Top