No suplemento da edição de novembro do American Journal of transplantation foi publicado os Guidelines de transplante renal do KDIGO (Kidey Disease Improving Global Outcomes), abordando as práticas clínicas baseadas em evidencia em transplante renal, incluindo imunosupressão de indução e de manutenção e sua monitorização, tratamento da rejeição aguda, tratamento da injuria crônica do exenrto, monitorização da função do enxerto, infecção, diabetes, hipertensão, dislipidemia, obesidade, doença cardiovascular, anemia, doença óssea e cancer no transplante.

Guidelines (texto completo)

So you google a name of a movie you really want to see. What happens? You get loads of links saying things like “Watch this movie free!” before it has even been released. This got me thinking. How can you tell whats illegal, whats a scam and whats truly legit.
There isnt really any clear guidelines for teenagers, or any internet user for that matter, on how you can tell what site are illegal, scams, carry viruses or anything like that.
Now everyone has been told that free downloads are illegal, but then you have certain people releasing free downloads that are genuine and totally legal. How do you tell the difference? Lot’s of people may think that its pretty easy to tell the difference – if its on a legit site thats well known such as iTunes, then its going to be legal – there would be uproar if it wasn’t. But what about the not so well known sites? How do you know if its legal? You dont. In my opinion this is all highly unfair – you can’t tell if something is illegal or not, then it turns out it is and you get caught out using an illegal site. You get in trouble with the police, and those posting their sites on google, arent.
Same with watching movies. How are you supposed to know if watching it online is legal or not? I mean obviously if the movie hasnt even been released in the cinema yet its going to be illegal, or at least some kind of fraudulent scam. But what about after its been released and is now on DVD or not in the cinema any more? Is it illegal to watch these films online for free or otherwise? It is high time that there are clear guidelines about whats legal and whats not online. And I dont mean some kind of boring 10,000 word manifesto written by the governemt. That’s crap and not very easy to read. We need something that makes it very clear as to what is legal and whats not and whats a scam and whats legit. But it needs to appeal to those who need to know, especially teenagers. And no that does not mean writing it all in text speak or putting it into some kind of rap. That wont appeal to all teenagers.

To be honest with you all, I dont understand why there arent any real guidelines on this sort of thing. I mean yeah ok theres the media saying dont do this its bad but then they say ooo this well known company are doing this but in a totally legal way. It doesnt make any sense. We need clear guidelines and we need them about 10 years ago.

Upon consulting the God that is of course Google, I discovered that it depends on if the copywrite holder has allowed the movie or what ever it is you want to watch, to be showed online. How are we supposed to know? Is there some kind of declaration?
And of course, there are loads of sites that claim to be legit. But are they really? How do we know?
If anyone knows how you can tell, let me know

xoxo Charley L

Guidelines for Men’s Shoes

Each and every man must have at least 6 pairs of shoes. “NO!”, you exclaim, “I can get by with one pair!” But when it comes right down to it, more than one pair of shoes is necessary ~ for both your feet and your relationship status.

Following are my guidelines for the shoes every man should own and why.


1. Slippers

Let’s start with a new day and you’re getting out of bed. The floor is cold! You need a pair of well-made slippers, moccasins, or house shoes to keep those tootsies warm and toasty while you’re making coffee, don’t you? Also, on the weekends when you climb back in for a little snuggling, your feet will be nice and warm for your bed-mate. Ahhh, I can hear sighing in appreciation all over the world!
~or~
If it’s warm where you are, flip-flops are okay. (See #6)

2. Sneakers

I know what you’re thinking – “this is the only pair of shoes I need, go no further!” But, I’m here to tell you sneakers (gym shoes, cross-trainers, etc.) are for the gym, or for running, playing basketball, football – whatever sport floats your boat. Do not wear these every day! Think of the poor, poor sneakers – they’re overused and stinky. Think of your poor, poor feet – they need a break – they want, no, they need something different to wear. It’s proven – ask the shoe experts!

3. Casual Shoes

Now here’s where many a man makes his mistake – the casual shoe is essential to every man – “Why?”, you ask. Because you do, that’s why! You have casual Friday at work maybe, or you go out to dinner and a movie – two instances where you will need a casual shoe!

Preferably you should have an oxford or loafer in two colors, one brown pair and one black pair. But if you have to choose one, choose black – it goes with everything. And don’t skimp – get a good pair that will last a few years. Your feet and significant other will thank you. (A side note on this – your shoe should match your belt – always!)

4. Dress Shoes

Each and every one of you has family, right? What two things happen in every family? Folks get married and they die. You will need dress shoes for both of these occasions. I suggest a black shoe, perhaps patent leather. It’s important that you keep these shined and ready at a moment’s notice. You never know what life is going to deal you, be prepared.

5. Work Boots

At some point in your life someone is going to ask you to dig a hole, mow the lawn, fix the fence, or any number of things that require work boots. Choose a sturdy steel-toe boot with good support and you’ll do just fine with the “honeydo” list, honey.

6. Sandals

I’ve spoken with many a gent who will not let their feet anywhere near a pair of sandals, but I’m here to tell you that you can do it! Before you wear sandals, though, you must make sure your feet are presentable. If your feet have never seen the light of day, get yourself a Ped-Egg and get to scrubbing! Remove those hideous callouses and trim your funky nails, man! Okay, now that we can bear to see your feet without gagging, there are a number of options in the sandal department. PLEASE – keep in mind quality footwear and what your feet really look like – get a second opinion! So, if after getting that much needed pedicure, your feet are still fugly I suggest a closed-toe sandal with a weave that allows the foot to breathe. If you have some sexy man feet – put ‘em in anything that shows ‘em off! Flip-flops are always good to keep around, but these must be bought new every year. One season is all you’re going to get out of a flip-flop, sorry.

In closure, I know not all of you are in a relationship, but these guidelines apply to all men ~ married, single, straight, gay, any man with feet really. So, if you’re not in a relationship and want to be, ask yourself this – would these guidelines hurt? No. Would they help? A big, hearty YES! For both your feet AND your relationship status!

Now boys, get to DSW and shop! Make those hearts and feet happy!

http://www.dsw.com/dsw_shoes/catalog/landing_index.jsp?catName=Mens_shoes

Notice of Overbidding Guidelines for FHA Financing

FHA guidelines will limit the underwriter to insuring the loan for the lower of two values; the offer price or the appraised value (displayed as the As-Is Value). If your offer price is higher than the appraised value, the FHA underwriter will require that your buyer(s) cover the overbid amount with a cash deposit. The buyer(s) will not be allowed to build the overbid amount into an FHA loan.

HUD’s mortgagee letter 2000-27 will require that the FHA UW use the appraisal obtained by PEMCO. This mortgagee letter instructs the FHA UW NOT to obtain a new appraisal; nor can the FHA UW request that new comps be pulled and the PEMCO appraisal updated.

If your offer price is higher than the appraised value and tentative acceptance is extended to you, the options available to you are:

1.       Proceed with contract execution. PEMCO will require that the selling broker verify that the cash reserves are available to cover the overbid amount before we execute the contract.

2.       Use cash or conventional financing. All of the guidelines outlined above apply to FHA financing only. A conventional lender will have their own set of guidelines not governed by HUD.

3.       Cancel prior to contract execution. If there is an acceptable backup, we will award tentative acceptance to the backup offer. If there are no acceptable backup offers, the property will be relisted.

 All of this information can be found at www.hudpemco.com.

To purchase a HUD owned FHA insured home contact Rick Duda, HUDREGOV Certified Agent and Specialist

American Girl is a bimonthly, four-color magazine for girls ages 8 and up.  American Girl readers are girls in the formative years, girls who dream big dreams.  We hope to encourage that dreaming and to reinforce each reader’s self-confidence, curiosity, and self-esteem as she
prepares to navigate adolescence in the years ahead.  Our lead time is approximately six to nine months.

Fiction
We’re looking for contemporary fiction up to 2,300 words. The protagonist should be a girl between 8 and 12 who captures the hopes,  thoughts, and emotions unique to that precarious age between childhood and teenager.  We look for top quality writing and thoughtfully
developed characters and plots.  Stories should engage readers quickly and have a satisfying conclusion.  We are always looking for humor and seasonal stories. We don’t publish science fiction, romance, or horror stories.

Nonfiction
We’re looking for individual girls or groups who are doing something other girls would love to read and learn about.  Find a topic about which girls are passionate.  Past pieces have featured synchronized swimmers, rhythmic gymnasts, ballerinas, and girl bands.  Some of our most successful pieces are sports-related, but that doesn’t mean we won’t consider other contemporary topics or profiles.  Look for new twists on familiar topics.  Please send queries rather than finished manuscripts.

Girls Express
This section offers the most opportunities for freelance writers.  We’re looking for short profiles of girls who are into sports, the arts, interesting hobbies, cultural activities, and other areas. We are also looking for true stories about girls who have had unusual experiences.  The girl must be the “star” and the story must be from her point of view. Be sure to include the age of the girls you’re pitching to us.  Let us know if you have any photo leads.  We also welcome how-to
stories: how to send away for free things, hot ideas for a cold day, or how to write the President and get a response.  Stories should be no more than 150 words. In addition, we’re looking for easy crafts and recipes that can be explained in a few simple steps, ideas for contests, and current products and trends for girls to review.

Craft and Cooking
We welcome original craft and cooking ideas that are new and exciting to our readers. Projects should require limited parental involvement and supplies should be inexpensive and readily available.  Keep in mind the skill level of our readers.  Safety is a priority. Query with a short
explanation of the project and an example, photograph, or sketch.

Brain Waves
We’re looking for visual puzzles, mazes, math puzzles, word games, simple crosswords, cartoons, and other ideas. Seasonal ideas are especially welcome.

Sample Issues
American Girl costs $4.95 per issue at the newsstand and is available in many children’s bookstores. To get a sample copy, send a check for $5.95 made out to American Girl. Please include your mailing address.

Payment: $500 minimum for stories; $300 minimum for articles

Rights:  FNASR (first North American serial rights)

How to Submit
All queries and requests for sample magazines should be addressed to:
Magazine Department Assistant
American Girl
8400 Fairway Place
Middleton, WI  53562-2554

Please Note
American Girl cannot reply or return a manuscript unless you enclose a self-addressed stamped envelope. Please allow 12 weeks for a reply.

For more information go to Writers Guidelines.

Click here to add Advice from a Caterpillar to your RSS reader.

As if the recent release of changes in recommendations regarding breast cancer early detection were not enough, we now have hot on it’s heels a major change in recommendations for cervical cancer screening.  The irony of these two recommendations, though from differing groups and based on review of extensive data (which certainly in the case of breast cancer is open to debate) is that they suggest changes in long standing policy regarding early detection, which have clearly had an effect on reducing the incidence and mortality from these two cancers.  The cervical cancer recommendations have some thoughtful commentary regarding using these tests too early in a young woman’s life.  These concerns are valid.  However, it is also true, that among many populations and peer groups early sexual activity is a fact of life.  Having said that, the rate of HPV is rampant  and it seems, from a public health perspective a bit perplexing, that when we have initiatives to use a new vaccine to prevent HPV, we would at that same time be suggesting taking measures that makes diagnosing HPV less likely.   Not sure ACOG has thought that angle through enough. Proper testing is important and excessive testing is not helpful.  However, the individualization of recommendations we applaud from a medical perspective, but we know that this will lead to coverage issues for patients and doctors as health insurers will adjust their payment policies to reflect these new recommendations.  Below is potpourri of comments from ACOG and various news leads on this most public story . . . ben kazie md

Women should have their first cervical cancer screening at age 21 and can be rescreened less frequently than previously recommended, according to newly revised evidence-based guidelines issued today by The American College of Obstetricians and Gynecologists (ACOG) and published in the December issue of Obstetrics & Gynecology. Most women younger than 30 should undergo cervical screening once every two years instead of annually, and those age 30 and older can be rescreened once every three years.  Cervical cancer rates have fallen more than 50% in the past 30 years in the US due to the widespread use of the Pap test. The incidence of cervical cancer fell from 14.8 per 100,000 women in 1975 to 6.5 per 100,000 women in 2006. The American Cancer Society estimates that there will be 11,270 new cases of cervical cancer and 4,070 deaths from it in the US in 2009. The majority of deaths from cervical cancer in the US are among women who are screened infrequently or not at all. Cervical cancer is a slow growing cancer caused by certain strains of the human papillomavirus (HPV), an extremely common sexually transmitted disease among women and men. HPV also causes genital and anal warts, as well as oral and anal cancer…..

First Cervical Cancer Screening Delayed Until Age 21 Less Frequent Pap Tests Recommended – http://www.acog.org/from_home/publications/press_releases/nr11-20-09.cfm

New guidelines for cervical cancer screening say women should delay their first Pap test until age 21, and be screened less often than recommended in the past. The advice, from the American College of Obstetricians and Gynecologists, is meant to decrease unnecessary testing and potentially harmful treatment, particularly in teenagers and young women. The group’s previous guidelines had recommended yearly testing for young women, starting within three years of their first sexual intercourse, but no later than age 21. Arriving on the heels of hotly disputed guidelines calling for less use of mammography, the new recommendations might seem like part of a larger plan to slash cancer screening for women. But the timing was coincidental, said Dr. Cheryl B. Iglesia, the chairwoman of a panel in the obstetricians’ group that developed the Pap smear guidelines. The group updates its advice regularly based on new medical information, and Dr. Iglesia said the latest recommendations had been in the works for several years, “long before the Obama health plan came into existence.”  She called the timing crazy, uncanny and “an unfortunate perfect storm,” adding, “There’s no political agenda with regard to these recommendations.”…..

Guidelines Push Back Age for Cervical Cancer Tests – http://www.nytimes.com/2009/11/20/health/20pap.html?_r=4

The cervical cancer screening advice follows another panel’s controversial mammogram report, but experts say it’s a much different situation. Still, Paps are the only reason some women see a doctor. Only days after a federal panel scaled back on breast cancer screening recommendations for many women, another organization — the American College of Obstetricians and Gynecologists — has done the same for a screening credited with drastically reducing the rates of cervical cancer in the U.S. Women of all ages should undergo Pap smears less frequently than they do now, those new guidelines say. And young women are advised not to bother until age 21. The pullback follows the U.S. Preventive Services Task Force’s dismissal of routine breast cancer screenings for women younger than 50. That move triggered a storm of protest from medical groups and individual women, with some breast cancer specialists and Republicans accusing health officials of moving toward a rationing of care and services. On Wednesday, U.S. Health and Human Services Secretary Kathleen Sebelius emphasized that the task force guidelines amounted to advice, not policy, and that women should continue to consult with their physicians about mammograms based on their own histories and needs…..

Group recommends less-frequent Pap tests – http://www.latimes.com/news/nationworld/nation/la-sci-pap-smears20-2009nov20,0,5747799.story

Women can delay having their first Pap test for cervical cancer until they turn 21 and many can wait longer to go back for follow-up screenings, according to new guidelines released Friday by a major medical group. The American College of Obstetrics and Gynecologists (ACOG) recommended the change after concluding that more frequent testing did not catch significantly more cancers and often resulted in girls and young women experiencing unnecessary stress, anxiety and sometimes harmful treatments because of suspicious growths that would not cause problems. “We really felt that the downsides of more frequent screening outweighed any benefits,” said Alan G. Waxman, a professor of obstetrics and gynecology at the University of New Mexico who led the revision of the guidelines. “More testing is not always more intelligent testing.” The change comes amid sharp controversy over new recommendations from a federal task force that women wait until age 50 before they begin having routine mammograms and that women age 50 to 74 scale back to getting the exams routinely every two years…..

Cervical cancer screening can wait till 21, group says – http://www.washingtonpost.com/wp-dyn/content/article/2009/11/19/AR2009111904743.html

Women in the United States should start cervical cancer screening at age 21 and most do not need an annual Pap smear, according to new guidelines issued on Friday that aim to reduce the risk of unnecessary treatment. The guidelines from the American College of Obstetricians and Gynecologists or ACOG now say women younger than 30 should undergo cervical cancer screening once every two years instead of an annual exam. And those aged 30 and older can be screened once every three years. The recommendations are based on scientific evidence that suggests more frequent testing leads to overtreatment, which can harm a young woman’s chances of carrying a child full term. “Overtreatment of minor abnormal pap tests in young women and adolescents can lead to consequences such as preterm labor in some cases. It increases the risk,” said Dr. Thomas Herzog of Columbia University in New York, who is chairman of an ACOG subcommittee on gynecologic cancers. “Preterm delivery has become a huge problem in the United States that has potential serious consequences for the unborn fetus,” said Dr. Jennifer Milosavijevic, a specialist in obstetrics and gynecology at Henry Ford Health System in Detroit, who supports the guideline changes…..

New guidelines: Pap smears should start at age 21 – http://in.reuters.com/article/worldNews/idINIndia-44108820091120

The revised guidelines released today by the American College of Obstetricians and Gynecologists also recommend that women 30 and older get screened with a so-called Pap test once every three years, instead of every two to three years. The American Cancer Society’s gynecologic cancer director said the society agreed with the advice of the doctors’ organization that additional screenings may lead to unnecessary treatment. The ob-gyn organization is the second medical group this week to recommend less-frequent cancer screenings, citing scientific data. A U.S.-backed panel said Nov. 16 that most women in their 40s shouldn’t get annual mammograms to prevent breast cancer, setting off protests from women, physicians and health advocacy groups such as the cancer society. “The data is very good that a Pap test every two years is as good as a Pap test every year,” said Alan Waxman, the lead author of the new guidelines and a professor of obstetrics and gynecology at the University of New Mexico in Albuquerque, in a telephone interview. The additional tests are inconvenient and costly, and research shows “it doesn’t make a difference in terms of lives saved,” he said…..

Screening for Cervical Cancer Should Start at 21 – http://www.bloomberg.com/apps/news?pid=newsarchive&sid=aLDLltBDBErU

For the second time this week, a major U.S. medical panel has revised recommendations for a key test that millions of American women use to detect cancer. On Monday, it was mammograms. Today, it’s Pap tests. The American College of Obstetricians and Gynecologists says that women no longer need annual cervical cancer screenings. It also says women can now wait until they’re 21 to get their first Pap test, instead of getting one after they’ve become sexually active. “The tradition of doing a Pap test every year has not been supported by recent scientific evidence,” said Dr. Alan G. Waxman of the University of New Mexico, who headed the American College’s guideline revision…..

Annual Pap tests no longer needed, panel says – http://www.tampabay.com/news/health/annual-pap-tests-no-longer-needed-panel-says/1052944

Most women in their 20s can have a Pap smear every two years instead of annually, say new guidelines that conclude that’s enough to catch slow-growing cervical cancer. The change by the American College of Obstetricians and Gynecologists comes amid a completely separate debate over when regular mammograms to detect breast cancer should begin. The timing of the Pap guidelines is coincidence, said ACOG, which began reviewing its recommendations in late 2007 and published the update Friday in the journal Obstetrics & Gynecology.  The guidelines also say: -Routine Paps should start at age 21. Previously, ACOG had urged a first Pap either within three years of first sexual intercourse or at age 21. -Women 30 and older should wait three years between Paps once they’ve had three consecutive clear tests. Other national guidelines have long recommended the three-year interval; ACOG had previously backed a two- to three-year wait. -Women with HIV, other immune-weakening conditions or previous cervical abnormalities may need more frequent screening…..

Report: 20-somethings can go 2 years between Paps – http://www.washingtonpost.com/wp-dyn/content/article/2009/11/20/AR2009112000089.html

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]]> http://kashifkhawaja.wordpress.com/2009/11/23/worshipping-sinning/ Mon, 23 Nov 2009 05:01:44 +0000 kkashifkhawaja http://kashifkhawaja.wordpress.com/2009/11/23/worshipping-sinning/ http://joveeno.wordpress.com/2009/11/21/how-to-survive-long-distance-relationship/ Sat, 21 Nov 2009 09:44:23 +0000 joveeno http://joveeno.wordpress.com/2009/11/21/how-to-survive-long-distance-relationship/ http://ugpp.wordpress.com/2009/11/20/a-quick-introduction/ Fri, 20 Nov 2009 21:51:44 +0000 espendyrland http://ugpp.wordpress.com/2009/11/20/a-quick-introduction/

We are starting up again, with a new blog and a new theme. We thought
it was nessisary to include an introduction to the new blog, where we will be dividing between who is to cover the different types of stories.
We will also include, a different view on different kinds of cases, deviating from the former blog. because this is currently a two-man operation, I would also like to say that it is only going to be me (Espen Dyrland), and Ole Henrik Berg ie. the former administratiors from the old site.

to enlighten this; here’s a quick recap on how things will be done:
- We aim to have a greater dept and understanding for a post, and maybe prevent posts being childish and not of the quality we would like to present.
- Diversity in writing is also something we have to take into account, because if we traverse on the same path for quite some time, people will lose interest.
- Thus if you feel like you have something that you would be interesting for this blog; feel free to contact us through the contact E-mail you find on our site.
PS: We promise that we are not going to have any unfinished blogposts without tags and/or categories, terrible image, but we will follow a uniformal writing structure.

Sincerely
Espen & Ole

Well, it’s that time again. I usually blog with news that you can use in the industry, guideline updates and general knowledge updates, however today I have some bad news coming down the pipe.

We at Plaza Loans are catching wind that many banks are going to be raising the minimum credit score for FHA loans from 620 to 640. I know I know…I’m sorry!

Plaza Loans has one where house lender that has already made the change however we still have the 620 score available, though if you have clients that have lower credit scores…NOW IS THE TIME TO RAISE THEIR SCORES TO BE SAFE!! Remember, banks fall in line with each other for protection…once the large banks make this change (B of A, Wells, etc) the others will follow suit.

So now the question is…how do I raise my scores? It’s very easy!

1. First rule of thumb…NEVER allow your balance to available credit ratio to go over 50%. Example: Credit limit is $1300, make your maximum balance $650 and below.
2. Plan for the credit you want to obtain. Make sure that when you are going to obtain credit, it is for a reason…the time for frivolity is over. Just because you CAN save 10% at Nordstrom’s by applying for a card DOESN’T mean you should!
3. Never close credit cards, you don’t have to use them…just don’t close them! 
4. Have a good mix of credit; cars, credit cards, installment debts (furniture, jewelry etc) 
5. PAY YOUR BILLS ON TIME! I know; in these hard times…things happen. Remember…just because the payment is late DOES NOT MEAN it will show up on your credit. It must be 30 days late before it will report to the bureaus! So, if you must be late make sure that you get that payment to them WITH the late payment fee BEFORE it is 30 days later than the due date. Example: Due date is December 1^st…it MUST be paid no later than the 30^th of December! (I do not advocate this method however I am not naïve I understand things happen) 

If you would like a consultation on your specific credit situation and further tips on how to raise your scores, please feel free to contact me!

Cory Polk
Loan Officer
Plaza Loans
408-754-3847 Direct
209-518-9462 Cell
408-978-2069 Fax
cory@plazaloans.com

Click on the following links to see my pages:
Web Site   Facebook   Blog

Everyone is up in arms regarding the government’s new guidelines regarding mammograms for women. The U.S. Preventative Services Task Force is recommending that women should have their first mammogram done at the age of 50, and then repeat it once every two years.

The American Cancer Society says that women should get their first mammogram when they are 40 and then continue yearly until the age of 75.

Apparently there are many women up-in-arms over these new guidelines. The question is why? Why are we so alarmed about a new idea on this matter? Every month research and science are coming up with new levels or statistics or “facts” about one medical condition or another.

A recent European study has now deemed that men should only have prostate exams once every four years along with a PSA test. The American Cancer Society recommends men get yearly testing once they are over 50 years old.

There is no reason women have to be alarmed by the new standard being offered for mammograms. If they want a yearly test they can get one. If they have cancer concerns before they reach 50, the test is still available. Yes, women have been saved by mammograms. They have also been scared by false positive readings or misreadings. Some women have also undergone cancer treatment because they have been diagnosed as having breast cancer when they do not.

In my own family my great-aunt had her yearly mammogram, which was negative. A month later she felt a lump in her breast. It was diagnosed as cancerous. She had treatment and it was caught in time, but no thanks to the mammogram.

Every woman has a different idea about what is right for them. If you believe in mammograms you will continue to have them because you deem it necessary. If you don’t believe in them, you may listen to the new guidelines  and evaluate if you think this is a good measure of action for you.

Either way, we have to decide what is best for us individually, new guidelines or not.

by sunsets_for_you/via Flickr

By Jacob Molyneux, senior editor/blog editor

Diana Mason, AJN’s emeritus editor-in-chief, posted here on the new U.S. Preventive Services Task Force mammography recommendations earlier this week, noting some troubling questions AJN had raised years ago about how much evidence actually supports the wholesale acceptance of yearly screening for women age 40 and older.

But we know that the bottom line for many American women remains this: “Are you really telling me that it’s better not to know as early as possible that I might have cancer? You must be kidding!” After all, we’ve all heard of someone whose life may have been saved by the early detection provided by a mammogram or a breast self-exam.

What about the other side of the experiential coin? Forget the evidence for a minute. Let’s not talk about the fact that, as Maryann Napoli pointed out in AJN in 2004, the “technology leads to the unnecessary treatment of some cancers that might have remained latent, and it also detects invasive breast cancers so slow-growing that women will have long lives regardless of when tumors are found.” That’s what the science may be telling us. That’s for the number crunchers.

What we want to know is more basic: have you or your patients ever experienced real suffering and anxiety from a false positive result, or negative consequences from treatments that you may now believe to have been unnecessary? Is there really anything to this concern—and will it ever be enough to convince women without significant risk factors for breast cancer that it might actually be better to wait for that mammogram?

(For some illuminating historical perspective on the topic, see the Op-Ed piece in today’s NY Times, Addicted to Mammograms.)

How to use a public computer wisely

If you are anything like me, you will have wondered on numerous occasions – how safe it is really to use computers in a public library, Internet café, or other public places?

Especially when connecting your external hard drive to these type mediums. Will I lose all my information and important documents? Will my private data become public domain, accessible and seen by all?

It is very important to keep your personal information and financial information safe at all times, especially when using a public computer.

So, experts recommend that you do not surf the net, or access any computer with a device which contains any personal and confidential material, as this will only put your data at risk of being stolen and compromised.

The most important thing you should do is ensure that your passwords are secured.
Some people like to use simple passwords, some people even use “password” as their password. You should try to make your password a combination of numbers and letters and at least eight characters long, don’t forget to remember it. If you make it easy to guess your password then it’s your fault if your account gets hacked.

Basically, one should always bear in mind that as informative and useful as the internet is, it is also a haven for predators, looking for ways to coerce and embezzle money from unsuspecting individuals!

Don’t be a statistic and fall victim to these ploys! Instead – be weary and wise, and do not trust that a public computer will be safe for your data.

Advisable is to rather to what you need to do on these public computers, but do not store any valuable data on that computer, or even your flash drive, as the possibilities of your data being placed at risk this way, is highly likely!

At the beginning of the week, the United States Preventative Task Force issued a set of new guidelines for use of mammography. And the storm hit — OMG, the government will be rationing health care; OMG! the gubmint wants women to die!

“I do believe that women will die” if they’re followed, she said.

Not once in the ensuing storm of criticism, did anyone bother to look at the statement that these new guidelines are NOT for ALL women, and will actually promote doctors to spend some time with their patients and give them some individualized time deciding on the most effective course of prevention for the individual patient. Furthermore, not a single one of the idiots trotted out to oppose the new guidelines (Kathleen Sebelius, Debbie Wasserman, for example) have bothered to recognize that even low doses of radiation from yearly mammography can lead to breast cancer — yes, radiation (which remains in the body) is one of the KNOWN causes of breast cancer. And finally, not once have I heard anyone in the media note that these new guidelines put the US in line with European nations that also use a screening process and which have no higher incidence of breast cancer with less screening.

Today, another group, American College of Obstetricians and Gynecologists, has issued new guidelines for Pap Smears. Again, the guidelines call for less screenings.

The new guidelines say women 30 and older who have three consecutive Pap tests that were normal, and who have no history of seriously abnormal findings, can stretch the interval between screenings to three years.

In addition, women who have a total hysterectomy (which removes the uterus and cervix) for a noncancerous condition, and who had no severe abnormalities on previous Pap tests, can quit having the tests entirely.

The guidelines also say that women can stop having Pap tests between 65 and 70 if they have three or more negative tests in a row and no abnormal test results in the last 10 years.

The changes do not apply to women with certain health problems that could make them more prone to aggressive cervical cancer, including H.I.V. infection or having an organ transplant or other condition that would lead to a suppressed immune system.

These are some pretty specific ifs contained in the new guidelines, just as there were specific ifs in the new guidelines for mammography.

Nevertheless, the idiots with serious reading comprehension problems and a basic understanding of cervical cancer are coming out of the woodwork, including for this NY Times article.

On the other hand, Ms. Jemison said that now that she is over 21, “I would still go every year” for the Pap test.

“One of my cousins had cervical cancer, so that’s in my head too,” she said. “I’d rather get it checked out regularly than have to worry about that.”

There is no evidence that cervical cancer is inherited. However, there can be a familial connection of a suppressed immune system, which, under the new guidelines, means you should continue to get yearly pap smears.

I’m left wondering why the media insists on promoting stupid, which will not further discussion of the cause and effect of over-testing, for both mammograms and pap smears.

If you ever had the feeling of failure, corruption, loss of hope, absence of happiness, impure, weak, hatred, selfishness, dishonourable, no faith, pain, betrayal, mocked & despair, well take it in, because this is the only way you’ll settle, of course there are other ways to deal with this so I’ll try and write as many way as possible. Before that I’ll tell you what depression is.

 Major depression is one of the most debilitating illnesses affecting Americans today. It can affect your ability to function, think, and feel. More specifically, it is a mood problem noted by pervasive sadness, disappointment, and hopelessness. The depressed person usually has difficulty finding pleasure in life, has feelings of intense loneliness, and has limited energy to engage in life activities. Most people have periods when they feel discouraged about their circumstances. However, true depression goes deeper by lasting longer and impacting one’s whole existence.

People dealing with depression often wish for a better day, but have lost hope that it will come. They do not know how to ‘feel’ better. Those suffering from depression may experience extreme mood fluctuations or a desire to withdraw from interactions with others. Frustrated with the inability to snap out of it, they become more discouraged. In some cases, depression can last for extended periods of time – months or even years. One way to deal with depression is to determine the severity of the experience, understand the influences that prompted its onset, and securing treatment options. I’ll also tell you what causes depression.

Depression can be prompted by a variety of factors. Some episodes of depression are situation-induced. For example, the death of a loved one, the loss of one’s job, or the disappointment of failed efforts to get into graduate school can all initiate an episode of depression. When someone can discern the source of depression, the outlook is more favourable. Specific measures can be incorporated to deal with the pain. However, when no source is clear, the depression may worsen due to lack of treatment.

In addition to situational factors, there are other stressors that prompt depression. Chemical imbalances, personality factors, drug and alcohol use, physical illness, and inadequate dietary practices can influence the onset of depression. Given that so many influences can impact one’s mental health, it is important to monitor one’s lifestyle and health practices.

• Study
• Eat vegetables
• Exercising
• Changing your routine in your aspect of life
• Talk to a trustworthy friend
• Play games, watch videos

This is for if you fail and feel very bad.

By Anthony Chen

Well it sure didn’t take long for another expected flip flop to occur on this White House Administration’s watch. This time it is on the issue of mammograms age guidelines as per the United States Preventive Services Task Force a tentacle of the United States Department of Health and Human Services. Oh the irony!

I wonder when the illustrious 21 member panel of the U.S Preventive Services Task Force met in it’s entirety (1), what were the winning results of research to hatchet, the long standing recommendations, that have not completed 3 generations of observations to validate such rapid change, and when is the next scheduled meeting of the panel (2)?

Now really, who made this call?

(1) Directly from http://edocket.access.gpo.gov/2009/E9-24306.htm

[Federal Register: October 9, 2009 (Volume 74, Number 195)]
[Notices]
[Page 52249-52250]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr09oc09-84]

———————————————————————–

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality

National Advisory Council for Healthcare Research and Quality:
Request for Nominations for Public Members

AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS.

ACTION: Request for nominations for public members.

———————————————————————–

SUMMARY: Section 931 of the Public Health Service Act (PHS Act), 42
U.S.C. 299c, established a National Advisory Council for Healthcare
Research and Quality (the Council). The Council is to advise the
Secretary of HHS (Secretary) and the Director of the Agency for
Healthcare Research and Quality (AHRQ) on matters related to activities
of the Agency to improve the quality, safety, efficiency, and
effectiveness of health care for all Americans.
Seven current members’ terms will expire in November 2009. To fill
these positions in accordance with the legislative mandate establishing
the Council, we are seeking individuals who are distinguished: (1) In
the conduct of research, demonstration projects, and evaluations with
respect to health care; (2) in the fields of health care quality
research or health care improvement; (3) in the practice of medicine;
(4) in other health professions; (5) in representing the private health
care sector (including health plans, providers, and purchasers) or
administrators of health care delivery systems; (6) in the fields of
health care economics, information systems, law, ethics, business, or
public policy; and (7) in representing the interests of patients and
consumers of health care. Individuals are particularly sought with
experience and success in activities specified in the summary above.

DATES: Nominations should be received on or before Friday, November 20,
2009.

ADDRESSES: Nominations should be sent to Ms. Deborah Queenan, AHRQ, 540
Gaither Road, Room 3238, Rockville, Maryland 20850. Nominations also
may be faxed to (301) 427-1341.

[[Page 52250]]

FOR FURTHER INFORMATION CONTACT: Ms. Deborah Queenan, AHRQ, at (301)
427-1330.

SUPPLEMENTARY INFORMATION: Section 931 of the PHS Act, 42 U.S.C. 299c,
provides that the Secretary shall appoint to the National Advisory
Council for Healthcare Research and Quality twenty-one appropriately
qualified individuals. At least seventeen members shall be
representatives of the public and at least one member shall be a
specialist in the rural aspects of one or more of the professions or
fields listed in the above summary. In addition, the Secretary
designates, as ex officio members, representatives from other Federal
agencies specified in the authorizing legislation, principally agencies
that conduct or support health care research, as well as Federal
officials the Secretary may consider appropriate. The Council meets in
the Washington, DC metropolitan area, generally in Rockville, Maryland,
approximately three times a year to provide broad guidance to the
Secretary and AHRQ’s Director on the direction of and programs
undertaken by AHRQ.
Seven individuals will be selected presently by the Secretary to
serve on the Council beginning with the meeting in the spring of 2010.
Members generally serve 3-year terms. Appointments are staggered to
permit an orderly rotation of membership.
Interested persons may nominate one or more qualified persons for
membership on the Council. Self-nominations are accepted. Nominations
shall include: (1) A copy of the nominee’s r[eacute]sum[eacute] or
curriculum vitae; and (2) a statement that the nominee is willing to
serve as a member of the Council. Selected candidates will be asked to
provide detailed information concerning their financial interests,
consultant positions and research grants and contracts, to permit
evaluation of possible sources of conflict of interest.
The Department seeks a broad geographic representation. In
addition, AHRQ conducts and supports research concerning priority
populations, which include: Low-income groups; minority groups; women;
children; the elderly; and individuals with special health care needs,
including individuals with disabilities and individuals who need
chronic care or end-of-life health care. See 42 U.S.C. 299(c).
Nominations of candidates with expertise in health care for these
priority populations are encouraged.

Dated: October 2, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E9-24306 Filed 10-8-09; 8:45 am]

BILLING CODE 4160-90-M
(2) Is the bold quote from the above – Request for Nominations for Public Members. “…Seven individuals will be selected presently by the Secretary to serve on the Council beginning with the meeting in the spring of 2010…”

There’s more to be written about the United States Preventive Services Task Force… to be continued.

***Also forwarded to The 912 Project Fan Site for use.

I am not a breast cancer survivor nor have I been particularly close to someone going through the life changing process this experience requires. But I do consider myself a somewhat informed person who cares about the lives of those around me as well as my own life, making breast cancer awareness something I feel is needful to be educated about.

Just a few days ago it was announced that the official guidelines for breast cancer screening have been changed. Previously women were encouraged to get mammograms done every year to help diagnose breast cancer, hopefully early enough to save a life.

Although – Mammogram technology is still a rudimentary technology and does not always give a correctly identified  cancer nor does it always find cancer that is present.

This means in some instances when a blip was found, and a women went in and had it removed, it was found to be a false positive and simple scar tissue from breast feeding or another type of anomaly the machine detected incorrectly. The women went home relieved to find out she truly did not have breast cancer, but she and her family did go through the stress and anguish of the ordeal. And assumingly there was an expense the insurance company also incurred for it.

Because of this possible “anguish”, I quote a spokesperson having said, they are no longer encouraging women to get yearly mammograms.

Simplified – Although mammograms do detect many instances of breast cancer and save many lives, sometimes it is wrong and upsets people needlessly. So at the cost of precious lives, rather than upset people, let’s give fewer mammograms.

Of course there are many people upset and angry and left feeling like their life that was saved by a yearly mammogram is worthless, and in the future, predictably others, as they are dying from undetected breast cancer, that will feel they were a simple casualty to keep others from feeling anguish.

And sadly there are those who have already happily announced cancelling their surgery to remove lumps found on recent mammograms since it may not really be breast cancer after all.

Truly a better screening method does need to be developed, and it is up to the individual and their selected doctor to decide if yearly mammograms are necessary. And it is also highly possible I am missing a large part of the story or overlooking a more likely out come from the change in recommendation.

But are losing human lives worth avoiding the sufferance of possible anguish? Would the loss of a mother, daughter, sister, wife, friend or even acquaintance be better than seeing them go through the distress of a false positive? Is living your life for many more years worth it to you to get a yearly mammogram even though you may have to go through a period of possibly torment?

This story from the Wall Street Journal is near and dear to my heart, not only figuratively but quite literally. The news broke yesterday that a government task force has announced new federal guidelines for breast cancer screening. The U.S. Preventative Services Task Force decided to not continue with their recommendation for yearly mammograms for women 40 and older. They threw those guidelines right out the window. What did they do? Well make sure your jaw won’t hit a sharp object when it drops and keep reading.

Instead of recommending that more women get yearly mammograms, they want less. The new guidelines say that ONLY women age 50 or older and younger than 75 without special risk factors need to get yearly mammograms. Apparently your grandma isn’t worth screening, she’s going to be dead soon anyway, why prolong it? If you’re head isn’t spinning yet, just wait.

Their reasoning behind it? Oh this is a classic case of cost/benefit analysis but only if you live in Bizarro World.

The task force concedes that the benefits of early detection are the same for all women. But according to its review, because there are fewer cases of breast cancer in younger women, it takes 1,904 screenings of women in their 40s to save one life and only 1,339 screenings to do the same among women in their 50s. It therefore concludes that the tests for the first group aren’t valuable, while also noting that screening younger women results in more false positives that lead to unnecessary (but only in retrospect) follow-up tests or biopsies.

WHAT?? ONE LIFE? Well guess what, ONE LIFE could be my mother or your sister, or wife or daughter. Two years ago, my mother, who at the time was 47, had her yearly mammogram. The test results came back and the oncologist said, “There’s a cell cluster, it could be cancer, but we need to do a biopsy to be sure.” The lump was too small for my mom to detect on her own and the only way it would have been spotted was during a mammogram. My mother was terrified! When the test results came back, my dad and I went with her to hear what the doctor had to say. Thankfully, it wasn’t cancer, but it was a cluster of cells that often times indicate that a person has a higher likelihood to developing breast cancer (DCIS). They had removed all the cells in the biopsy and then gave my mother a prescription for tamoxifen, a drug which cuts the risk of breast cancer in half for high risk patients. I understand that now my mother falls into the “at-risk” group. But she didn’t before that day.

Well, what about Grandma? Well, listen, according to this super awesome panel of non-experts in the area of breast cancer notes that the benefits of screening:

“occur only several years after the actual screening test, whereas the percentage of women who survive long enough to benefit decreases with age.” It adds that “women of this age are at much greater risk for dying of other conditions that would not be affected by breast cancer screening.”

Um. Let me compose myself. ARE YOU FREAKING KIDDING ME??? They actually say that since granny lived long enough without breast cancer, that they’re going to worry about other conditions. Who gets to pick and choose? My grandma is a very vivacious 73, and you mean to tell me that in two years she’s not worth the yearly screening? That giving her a yearly mammogram just skews the cost/benefit analysis so far off that frankly, her life isn’t worth it? A mother of 8, grandmother of 25 and great-grandmother of 5, isn’t worth the cost of yearly screening. Get used to it folks. This is just the beginning.

Fact of the matter is this, the government is already over stepping their role and now they’re taking even more liberty to tell us, “Meh…you’re just not worth the money, sorry, here’s some pain killers. Good luck.” I know its extreme, but its just a sign of things to come. And if you think THIS is scary, you just wait to see what happens if they pass that preposterous health care bill. How much is your life worth? Well according to the government, its roughly $125, the cost of yearly screening.