This image provided by NASA-TV shows the SpaceX Dragon commercial cargo craft as it is backed away from the International Space Station early Tuesday March 26, 2013 by the International Space Station's Canadarm2 robotic arm. The Dragon is expected to splash down in the eastern Pacific ocean approximately 246 miles off the coast of Baja Calif., later this morning. (AP Photo/NASA)
This image provided by NASA-TV shows the SpaceX Dragon commercial cargo craft as it is backed away from the International Space Station early Tuesday March 26, 2013 by the International Space Station's Canadarm2 robotic arm. The Dragon is expected to splash down in the eastern Pacific ocean approximately 246 miles off the coast of Baja Calif., later this morning. (AP Photo/NASA)
This image provided by NASA-TV shows the SpaceX Dragon commercial cargo craft after it was detached from the International Space Station early Tuesday March 26, 2013 by the International Space Station's Canadarm2 robotic arm. The two spacecraft were traveling Canada at the time. The rising sun and the curvature of the earth can be seen behind the spacecraft. The Dragon is expected to splash down in the eastern Pacific ocean approximately 246 miles off the coast of Baja Calif., later this morning. (AP Photo/NASA)
This image provided by NASA-TV shows the SpaceX Dragon commercial cargo craft as it is backed away from the International Space Station's Canadarm2 robotic arm early Tuesday March 26, 2013 on it's return to earth. The Dragon is expected to splash down in the eastern Pacific ocean approximately 246 miles off the coast of Baja Calif., later this morning. (AP Photo/NASA)
This image provided by NASA-TV shows the SpaceX Dragon commercial cargo craft after it was detached from the International Space Station at 4:10 a.m. EDT Tuesday March 26, 2013 by the International Space Station's Canadarm2 robotic arm. The two spacecraft were traveling over the western edge of California at the time. The Dragon is expected to splash down in the eastern Pacific ocean approximatel 246 miles off the coast of Baja Calif. later this morning.
CAPE CANAVERAL, Fla. (AP) ? The Dragon cargo ship has left the International Space Station and is on its way back to Earth.
Astronauts released the unmanned cargo ship from the end of the space station's giant robot arm Tuesday morning.
The parting occurred about 250 miles over the South Pacific. The privately owned spacecraft will splash down in the Pacific early in the afternoon. It's returning science samples and old space station equipment.
The California-based SpaceX company launched the Dragon from Cape Canaveral, Fla., at the beginning of March. NASA is paying SpaceX to periodically supply the space station.
Mechanical trouble caused a one-day delay in Dragon's arrival to the space station.
Three people are aboard the space station right now. They'll be joined by three more following this week's Soyuz launch from Kazakhstan.
In the second installment of his "Being Biden" audio series, Vice President Joe Biden recaps a moment he shared with two nuns, whom he described as "lovely women," outside of St. Peter's Basilica in Vatican City earlier this week when he attended the Inauguration Mass of Pope Francis.
"What you see is, I had just walked out the side door of St. Peter's Basilica after meeting and getting the opportunity to shake hands and a great conversation with Pope Francis, and the first people I saw were a group of nuns who to me epitomize everything Pope Francis talked about in his homily and what he stands for about generosity to other people, about reaching out, about making it a point to understand that we are our brother's keeper," Biden said in the installment called "A Good Omen."
Biden, the nation's highest-ranking Roman Catholic, led the presidential delegation to Pope Francis' investiture earlier this week and was accompanied by House Minority Leader Nancy Pelosi and Gov. Susana Martinez, R-N.M.
"In his homily, the pope said being human means respecting each of God's creatures, responding and respecting the environment in which we live," Biden said. "He said it means protecting people, showing love and concern for each other, every person, every child, elderly, those in need were often the last we think of and that's what in my experience being raised as a Catholic and educated by the nuns, that's what those, those lovely women I'm talking to symbolize to me. So I thought it was a good omen.
"We are our brother's keeper. We have an obligation and I think that's the way, the only way we're going to make the world better and safer.
"It translates at home with the simple things like making sure we fix the broken immigration system, making sure we make our neighborhoods safer by having rationale gun safety and international relations, reaching out and have war as the last option to protect our interests and so it was an exciting time. It gave me a lot of hope and, again, I'll close where I began. Just look at the expression in the faces of those two nuns. You can tell they share my view," he said.
Biden launched his "Being Biden" series last week and described the importance of the Second Amendment to him and the hunters to whom he served rolls at a wild-game dinner earlier this month.
Mar. 12, 2013 ? An analysis of data from the Framingham Offspring Study -- a long-term study that follows children of participants in the original Framingham Heart Study -- may have answered a question that has troubled individuals considering stopping smoking: do the health effects of any weight gained after quitting outweigh the known cardiovascular benefits of smoking cessation? The report in the March 13 issue of JAMA concludes that the benefits of stopping smoking far exceed any weight-gain associated risk.
"Among people without diabetes, those who stopped smoking had a 50 percent reduction in the risk for heart attack, stroke or cardiovascular death, and accounting for any weight increase didn't change that risk reduction," says James Meigs, MD, MPH, of the General Medicine Unit at Massachusetts General Hospital (MGH) senior author of the JAMA report. "In patients with diabetes -- among whom weight gain is a particular concern -- we saw the same pattern of a large risk reduction regardless of weight gained."
No study has previously investigated whether smoking-cessation-associated weight gain increases the risk of cardiovascular disease. One did look at the effects on risk factors such as blood pressure and lipid levels, but none have analyzed the actual occurence of cardiovascular events. Participants in the Framingham Offspring Study, which began in 1971, have a comprehensive medical exam and history taken every four to six years. The current investigation analyzed data from participant visits conducted from the mid 1980s into the mid-2000s, which covering the third to eighth visits for the overall study. The number of participants at each exam cycle ranged from almost 2,400 to about 3,250, totalling 11,148 individual person-exams.
Based on information gathered at each exam, participants were categorized as never smokers, current smokers, recent quitters -- who had stopped smoking since their last exam -- and long-term quitters. At the third study visit, 31 percent of participants were current smokers, and by the eighth visit only 13 percent continued to smoke. A general trend toward weight gain was seen across all study participants. Smokers, never smokers, and long-term quitters gained an average of 1 to 2 pounds between study visits, while recent quitters had gained an average of 5 to 10 pounds since their previous visit. But no matter how much weight they gained, the risk of cardiovascular events in the six years after quitting dropped in half for participants without diabetes. A similar drop in the incidence of cardiovascular events was seen in participants with diabetes, but it did not reach statistical significance, probably because less than 15 percent of the overall group was know to have diabetes.
"We now can say without question that stopping smoking has a very positive effect on cardiovascular risk for patients with and without diabetes, even if they experience the moderate weight gain seen in this study, which matches post-cessation weight increase reported in other studies," says Meigs, an associate professor of Medicine at Harvard Medical School.
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The above story is reprinted from materials provided by Massachusetts General Hospital.
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Journal References:
Carole Clair et al. Association of Smoking Cessation and Weight Change With Cardiovascular Disease Among Adults With and Without Diabetes. JAMA, 2013 DOI: 10.1001/jama.2013.1644
Clair C, Rigotti NA, Porneala B, et al. Association of Smoking Cessation and Weight Change With Cardiovascular Disease Among Adults With and Without Diabetes. JAMA, 2013; 309 (10): 1014-1021 DOI: 10.1001/jama.2013.1644
Fiore MC, Baker TB. Should Clinicians Encourage Smoking Cessation for Every Patient Who Smokes?JAMA, 2013; 309 (10): 1032-1033 DOI: 10.1001/jama.2013.1793
Note: If no author is given, the source is cited instead.
Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.
In today?s age of technology, electricity is something we cannot do without. Unfortunately, most of the electricity we use is generated from fossil fuels which emit pollutants and greenhouse gases. Sulfur dioxide, carbon monoxide, particulate matter and other pollutants contribute greatly to the formation of acid rain and the further degradation of the ozone layer. This is the only habitual planet known so far and naturally, we would want to preserve it for future generations.
One option for sustainable living is the use of natural gas as a source of energy in the home. Though sourced from fossil fuels, natural gas is cleanest of all fossil fuels and thus decreases harmful pollution levels. Moreover, natural gas costs over 50% less than electricity. Natural gas appliances have also become more efficient which translates to greater savings and lesser carbon footprint. Though more expensive when purchased, these appliances are very efficient and cost effective. Natural gas can be used not only for heating and cooking but also for cooling homes through natural gas powered air conditioning.
Not all residential appliances can run on natural gas though. Television, microwave ovens, blenders and other such appliances require electricity. What you can do is ask your local energy provider if Green Power is available in your area. This is electricity generated by renewable energy generators from sources that produce no greenhouse emissions. These sources include wind power, solar, biogas and mini hydro.
To maximize savings, a combination of both power sources would be ideal. You may opt to use Green Power for electrical appliances and use natural gas for your cooking needs as well as indoor heating or cooling. Whichever source you choose or is available in your area, what?s most important is that you make green living your family?s lifestyle.
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TROY ? Lori Jo Vest of LJV?Consulting LLC and Marilyn Suttle, Michigan-based authors of the book ?Who?s Your Gladys? How to Turn Even the Most Difficult Customer into Your Biggest Fan,? have built an extensive bank of free customer service and business podcasts for use by businesses, associations and other service-minded organizations.
The series resides at http://www.whosyourgladys.com/podcast.html. The podcasts feature best-selling authors, customer service experts and thought leaders in a variety of business categories.?
?We?ve been fortunate that so many celebrated business experts have been willing to share their wisdom so freely,? noted Vest. ?The podcasts are filled with valuable tips and strategies that business can put into place immediately. They provide an excellent way to keep everyone?s attention on what it takes to increase profits ? exceptional service which brings repeat business.?
Added in February, the newest podcast features Jon DiJulius, best-selling author and successful entrepreneur. DiJulius?owns two businesses, John Robert?s Spa, a chain of upscale Cleveland locations named one of the top 20 salons in America and The DiJulius Group, a consulting firm focused on changing the world by creating a customer service revolution.
Vest and Suttle?partner to offer a variety of success-building keynotes, customer service model development, custom workshops and one-on-one coaching to companies in a variety of industries. Their book, ?Who?s Your Gladys? How to Turn Even the Most Difficult Customer into Your Biggest Fan,? was published by the American Management Association?s publishing division, AMACOM/New York and is sold around the world. You can visit the website and blog for their customer service work at www.whosyourgladys.com.
TORONTO (Reuters) - AT&T Inc will start selling the highly anticipated BlackBerry Z10 touchscreen smartphone in the United States on March 22, the company said on Monday, sending BlackBerry shares more than 10 percent higher.
BlackBerry , formerly known as Research In Motion, is hoping the new devices, already on sale in Canada, Britain and more than 20 other countries, will help it win back market share in the United States, which was once a stronghold for the smartphone industry pioneer.
The U.S. launch of the new devices has been delayed due to a longer carrier-testing phase in the country. AT&T said pre-sales of the devices will begin on Tuesday, March 12.
BlackBerry says sales of its new smartphone have been outpacing its expectations so far, but investors are keen to see how it fares in the United States. The company has lost U.S. market share rapidly to Apple Inc's iPhone and a slew of devices powered by Google's Android operating system.
As expected, AT&T said it would sell the devices for $199.99 with a two-year contract. T-Mobile USA said on Friday it planned to start selling the BlackBerry Z10 to its business customers in the United States on Monday.
Verizon Inc , the biggest U.S. wireless carrier, has yet to say when it will start selling the Z10. The Z10 and the soon to be launched Q10, which will come with BlackBerry's traditional physical keyboard, are powered by the new BlackBerry 10, or BB10 operating system.
"We believe the Street is pricing in such a weak fiscal 2014 that BB10 does not need to be an outstanding success to surprise," Scotiabank analyst Gus Papageorgiou said in a note to clients on Monday.
Papageorgiou, who has a "sector outperform" rating on the stock, said he expects the company sold about 1 million BlackBerry 10 devices in the quarter ended March 2.
"Gross margins should begin to move higher as more Z10s enter the mix," he said. "Next quarter will be the true test as BB10 launches in the U.S."
BlackBerry shares were up more than 10 percent at $14.37 in mid-morning Nasdaq trading on Monday, while its Toronto-listed stock rose by a similar margin to C$14.78.
(Reporting by Euan Rocha; Editing by Lisa Von Ahn; and Peter Galloway)
Mar. 11, 2013 ? Good news for the ozone layer above the Arctic. The Montreal Protocol is showing effects: according to recent measurements, the ozone layer over the North Pole should recover by the end of the century. This is one of the main findings of the EU project RECONCILE, which was completed in February 2013. Scientists from J?lich and their colleagues from 35 research institutions and universities in 14 countries spent four years investigating the chemical process of ozone depletion. Their findings verified once again that chlorine compounds are indeed responsible for this. The scientists used the new insights to improve existing climate models. These models facilitate more reliable predictions on how the ozone layer will develop in future and on the possible consequences of climate change for the stratosphere.
"Even if the ozone layer recovers, climate change could alter the underlying conditions. This is yet another reason to reduce greenhouse gas emissions and stop climate change," emphasizes environmental chemist Dr. Marc von Hobe from Forschungszentrum J?lich, which coordinated RECONCILE. Climate change could alter the temperature, circulation patterns and chemical composition in the stratosphere. This also influences the ozone layer, which in turn has a bearing on temperature. Furthermore, possible ventures to mitigate climate change could have a negative impact on the ozone layer. One example is the so-called Geoengineering. The term describes the use of technological means to intervene in the geochemical or biogeochemical processes of Earth.
In the Montreal Protocol, signed in 1987, more than 190 countries vowed to reduce the emission of chlorine containing chemicals such as chlorofluorocarbons (CFCs). A study published around six years ago indirectly called into question the role of CFCs and the Protocol. "In the project, we successfully answered some of the open questions regarding ozone loss, and we demonstrated that besides the destruction caused by chlorine, no additional chemical mechanisms play a decisive role," says Marc von Hobe. Analyses of air samples at the University of East Anglia and the University of Frankfurt as part of the project showed a clear decrease in stratospheric chlorine. Although these compounds remain in the atmosphere longer than previously thought, the scientists expect the ozone layer to recover by the end of the century.
This forecast remains unaffected by incidents such as at the beginning of 2011 when the scientists observed the most severe ozone depletion above the North Pole yet. The decisive factor two years ago was an unusually long Arctic winter. Ozone is only depleted under very cold conditions. During the polar night, the polar vortex develops -- a sort of closed system with very cold air, which warmer air masses from the south cannot penetrate. Polar stratospheric clouds (PSCs) form in this vortex at temperatures below -80 ?C. On their surfaces, a series of chlorine reactions is initiated that ultimately lead to ozone depletion. The longer the very cold conditions last, the more ozone is destroyed. Only when the polar vortex breaks down in spring can the ozone layer recover.
When they investigated these processes in more detail, the RECONCILE researchers unearthed a number of surprises. For example, scientists from J?lich showed that surface reactions also occur very efficiently on liquid aerosols in the air. "For chlorine chemistry, the formation of PSCs is not as important as the temperature. Theoretically, the reactions can occur anywhere where it is cold enough and sufficient chlorine is present," explains Tobias Wegner, who wrote a PhD thesis on aerosol particles and chlorine activation at Forschungszentrum J?lich. However, PSCs still play an important role in ozone depletion. Nitrogen compounds, which react with chlorine compounds to stop the ozone depletion process at the end of the winter, are bound in PSC particles and fall downwards due to gravity. Therefore, chlorine reactions can continue right into spring. "The findings of the project have completely altered our understanding of these clouds. We learned that PSCs can form much more rapidly and at higher temperatures than we thought," says Prof. Tom Peter from ETH Zurich.
Scientists from the Max-Planck-Institute for Chemistry, Johannes Gutenberg University Mainz and TU Darmstadt discovered an unexpectedly wide range of particles in their samples. These particles presumably descend from higher stratospheric layers into the polar vortex and contain metals, silicates, black carbon, etc. The origin of these particles is currently being investigated by a group at Mainz as part of the project entitled "In situ experiments on the chemical composition of high-altitude aerosols and clouds in the tropical upper troposphere and lower stratosphere" (EXCATRO), which was awarded an ERC Advanced Grant by the EU.
With regard to another point, the scientists were able to put some of our worries to rest: after the record Arctic winter, there were fears of a dramatic increase in UV radiation in the northern hemisphere. "Although we did find elevated values, they were not nearly as high as would be required to considerably increase the risk of skin cancer," says Marc von Hobe.
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In copywriting 101 we learn to avoid jargon, but that doesn?t mean that we apply the knowledge. If you will not listen to your English teacher, maybe you will listen to Google?
Here is proof that jargon can greatly damage your website?s profitability and effectiveness.
What is Jargon?
Jargon is language that ?dresses up? a message with a sense of importance, but has vague meaning. Experts use jargon all the time, until it becomes second nature. To you, your own jargon is crystal clear. But listen to someone else?s jargon to understand what your jargon sounds like to others.
The natural response to jargon is ?huh??
The Jargon Police, A.K.A copywriters
I?ll borrow the command of master copywriter, Robert W. Bly:
Don?t use insider jargon when writing to non-specialists.
Even when writing to specialists in my MBA program, I found that avoiding jargon whenever possible helped my essays stand out from my classmates? jargon-riddled papers, and earned me higher grades.
My professors can understand MBA jargon perfectly well, except that it takes extra effort even for them. Jargon is difficult to understand even to someone who knows it.
Is jargon always bad?
Bly?s article provides some great examples of when to use jargon (if you are a used car salesman or as a kind of secret handshake among industry insiders).
As a rule of thumb, you should use jargon in your copy less often than swear words, i.e. pretty much never.
Here is another well-written article from professional copywriter, Sid Smith: How Too Much Jargon Will Ruin Your Message. Smith points out that your users cannot understand what to you seems so clear, so you should get out of your head, listen to how your ideal clients describe what you do, and borrow your user?s language to describe your solution.
The takeaway? Avoid unnecessary jargon.
Maybe you are thinking, ?yeah, yeah, I get it. No jargon, yada yada yada. Now leave me alone, word nerds.?
That is what my client thought too, but no longer.
A one-word change = 100x result
Often a little tweak, something we normally overlook, makes the biggest impact.
After some keyword research for a client, I recommended that they use the phrase ?sales tax refund? to describe their services. They opted to use the phrase they always used, sales tax recovery, figuring it was close enough, and more technically proper.
How much difference could it make? Besides, most competitors also call it sales tax recovery. They can?t all be wrong?
Well, maybe they can be.
Here are the number of monthly searches for each of the two terms: 170 for ?sales tax recovery? and 5400 for ?sales tax refund.? Whoa.
[You can do this kind of research right now for free. Search for keyword tool in Google, it will be the first result, and use your free Google account to log in. Check the box for "phrase match" to replicate these results].
Let?s do the math. The simple term?with a mere one-word change?is searched for 31 times more often than the jargon term.
Also, if you notice, the competition for the more popular term is actually lower. More competitors use the ?proper? jargon term too, leaving empty space for competition that uses the term people are actually searching for.
This research suggests that using ?sales tax recovery? instead of ?sales tax refund? will get roughly 100x the results with the same work.
I asked my client the difference between the terms. Is a sales tax refund actually different than recovery? They said the only difference was that ?sales tax recovery? was the proper term. Then I showed them my simple chart.
Although we already sent them a comprehensive keyword report with this data included, sometimes it takes a simple comparison with the simplest possible research to change behavior.
It looks like your English teacher was right. People don?t search for jargon, unless they are experts, in which case they don?t need expert help.
This also illustrates another principle: people don?t care what you do (tax recovery services), they care what is in it for them (tax refunds).
How Jargon Hurts Profits
The refund vs recovery debate concerns one of my client?s high-value, flagship services. A slight edge here means a lot of extra profit in the long-term.
Once a website can convert traffic into revenue, doubling traffic will double revenue. Almost always, doubling revenue more than doubles profit (because your fixed costs remain the same). Jargon not only decreases traffic, but it also decreases conversions, a double whammy.
Okay, so what? Big deal, right? This is just one case and one keyword tweak. Besides, every page will have dozens, even hundreds of keywords.
The point is that applying a few basic copywriting fundamentals to your website?s articles and pages can make a massive difference over time, even if you never do any keyword research at all.
Additionally, ?avoid jargon,? is just one of many advanced copywriting techniques that you can employ to everything you write or speak.
Simple Guidelines for Jargon-free Copy
Learning the principle ?avoid jargon? will not actually prevent you from using jargon, as this case study shows. That is because you need to develop a process for what to do instead, or you will go back to old habits.
Yes, you should use clear and simple language, but the problem is that what is clear and simple to you is not clear and simple to newbies. How do you get around that?
Three things that get in the way of jargon-free copy:
A desire to appear intelligent and professional.
A fear that being different than competitors/peers will make you seem weird in a bad way.
The extreme difficulty of seeing a problem from a beginner?s perspective as an expert (the curse of knowledge).
Now that you understand the problems, you can begin to apply the solutions. I?ll present some simple antidotes.
Apply the George W. Bush communication strategy: use simple language, repeat a clear and simple message, and don?t be afraid to stumble over your words occasionally. Simple, common language inexpertly delivered helps people trust you more than they otherwise would. In other words, highly effective language conceals its own skill, just as great makeup makes you look like you aren?t wearing any.
Listen to your users struggle to explain their problems. Capture their exact words. Use their exact language when describing your solution. Hint: the internet saves verbatim records of the struggle to understand your field on help forums and Q&A sites.
Apply keyword research to uncover the most common terms people use to describe the core problems that you solve with your business.
Use concrete analogies when your subject is complex, abstract or vague. Concrete means you can visualize it. See this article on vivid analogies?for more depth.
Test your messages on newbies and watch for confusion. This is the hardest part, but also the biggest opportunity to stand out. You will be surprised how little actually gets across, but most likely your competitors have no idea how little of their message gets across.
It is natural to drag your feet. Jargon busting requires effort and practice. Yet its difficulty is what makes jargon busting such a great way to stand out online.
I totally understand that you are busy. That is why we are working on article-writing templates that walk you through a proven article-writing process. That is why we focus on simple principles that you can apply any time, even while watching TV. And that is why we offer copywriting services.
Okay, so try these simple jargon-busting techniques for at least a week and see if your awareness of jargon and geek-speak is not enhanced. Do you have any additional jargon-busting techniques you find useful? I would love to hear them in the comment section.
Canada's Jay Johnson, top left, and Mexico's Eduardo Arredondo fight during the ninth inning of a World Baseball Classic game, Saturday, March 9, 2013, in Phoenix. (AP Photo/Matt York)
Canada's Jay Johnson, top left, and Mexico's Eduardo Arredondo fight during the ninth inning of a World Baseball Classic game, Saturday, March 9, 2013, in Phoenix. (AP Photo/Matt York)
Canada's Tyson Gillies, right and Mexico's Alfredo Aceves fight during the ninth inning of a World Baseball Classic game, Saturday, March 9, 2013, in Phoenix. (AP Photo/Matt York)
Canada's Jay Johnson, right, and Mexico's Eduardo Arredondo fight during the ninth inning of a World Baseball Classic game, Saturday, March 9, 2013, in Phoenix. (AP Photo/Matt York)
Canada's Jay Johnson, bottom right, and Mexico's Eduardo Arredondo fight during the ninth inning of a World Baseball Classic game as teammates try to break them up, Saturday, March 9, 2013, in Phoenix. (AP Photo/Matt York)
Canada manager Ernie Whitt (12) and Mexico manager Rick Renteria greet each other before a World Baseball Classic game on Saturday, March 9, 2013, in Phoenix. (AP Photo/Matt York)
PHOENIX (AP) ? A little bunt single turned this WBC matchup into a World Boxing Classic.
Alfredo Aceves and several players threw nasty punches when a fierce, full-scale brawl broke out in the ninth inning Saturday of Canada's 10-3 romp over Mexico in the World Baseball Classic, a melee that also involved fans and set off skirmishes in the seats.
"Whoever says that we're just here as an extra spring training game or we're just here to say we represented our country and then go home obviously didn't see how intense that game was and what it means to everybody that was involved," Canadian slugger Justin Morneau said.
Multiple fights erupted after Canada's Rene Tosoni was hit in the back by a pitch from Arnold Leon with the score 9-3 at Chase Field, home of the Arizona Diamondbacks. It quickly turned into a wild scene, as chaotic as any on a major league field in recent years.
Even when the fisticuffs ended, Canadian pitching coach Denis Boucher was hit in the face by a full water bottle thrown from the crowd. Canada shortstop Cale Iorg angrily threw the bottle back into the crowd.
Several police officers came onto the field trying to restore order, and there were a few skirmishes in the decidedly pro-Mexico crowd of 19,581. Seven players were ejected after umpires huddled, trying to sort out the frenzy.
Canadian first base coach Larry Walker, a former NL MVP, said he held back Mexico star Adrian Gonzalez during the altercation. The solidly built Walker also tried to restrain Aceves.
"I had a hold of him and I thought I saw Satan in his eyes," Walker said.
There had already been several borderline plays on the bases when things got out of hand. A bunt hit by Chris Robinson heightened the tension ? a WBC tiebreaker relies heavily on runs and the Canadians wanted to score again in the ninth. Third baseman Luis Cruz fielded Robinson's bunt and seemed to tell Leon to hit the next batter.
Managers from both teams blamed the tiebreaking rule that uses run differential to determine what team moves on to the next round.
"It was just simply a misunderstanding," Mexico manager Rick Renteria said. "In a normal setting, a normal professional setting I should say, a 9-3 bunt in that particular fashion would be kind of out of the ordinary."
Right as the game resumed, someone in the crowd hurled a baseball that almost hit Walker in the head.
"That's when I went out to the umpire and I said, 'Another thing comes out, we're going to pull our team off the field," Canadian manager Ernie Whitt said.
The collision of WBC rules and the unwritten rules of the game led to the blowup, Renteria said.
"I think in just in the heat of the moment you lose sight of it," he said, "and maybe that's how it occurred."
Whitt said WBC officials need to look at the tiebreaking rule.
"There's got to be another method other than the scoring runs, running up the score on the opposing team," he said. "No one likes that. That's not the way baseball's supposed to be played. There's professionalism that we're all accustomed to here in North America. And unfortunately teams are knocked out of the tournament because other teams run up the score on them. Unfortunately that's what you have to deal with when you have that type of format."
Morneau, Gonzalez and Joey Votto were among the big-name, high-priced stars playing in the game. The fight was exactly the kind of thing that must have made major league managers and general managers cringe at the thought of one of their players getting hurt in such a fracas.
"There's a point you got to stand up for yourself," said Morneau, a former MVP with the Minnesota Twins. "We got hit for playing the game, and that happens, but at the same time you got to stand up for yourself. You can't just get pushed around."
"Obviously everyone wishes it didn't happen, but it happens in the game sometimes," he said. " I think we have all learned from being in the minor leagues that, especially in low-A ball, high-A ball, those things get real crazy. There's not as much security. It starts to get out of control pretty bad, and I think you learn from that, you learn to keep your head on a swivel."
Aceves was among four Mexican players thrown out ? the angry Boston reliever was tossed to the ground by Philadelphia minor league outfielder Tyson Gillies during the height of the fury, then rushed to rejoin the fray.
"I did it see it on video. I saw it afterward. I saw the altercation, yes," Red Sox manager John Farrell said after Saturday night's exhibition game against Baltimore in Fort Myers, Fla. "I think we all hope our players don't get injured when they go off to a tournament , especially in that type of melee."
As for Aceves, "it looks like he came out of it OK, with the exception of a couple of welts on his head," Farrell said. "We had a message from their trainer that he came out of it OK despite taking a couple of left hooks to the head."
Also ejected were Leon, Oliver Perez and Eduardo Arredondo of Mexico and Tosoni, Pete Orr and Jay Johnson of Canada. A statement from organizers said tape of the incident would be reviewed for possible disciplinary action.
All in all, it was far from the worldwide goodwill that is supposed to accompany this competition, where players exchange team hats with opponents before the start of each game as a sign of sportsmanship.
A day earlier on the same field, Mexico posted an emotional 5-2 over the United States in a game without incident. Canada, meanwhile, absorbed an embarrassing 14-4 loss to Italy.
Mexico finished its Pool D play at 1-2. Canada is 1-1 going into a game Sunday against the United States.
Whitt said he hoped any decision on suspensions would take into account that Mexico has finished its pool play, while Canada has a big game remaining.
Canada scored four times in the first inning, and Mexico cut the lead to 4-3 with two runs in the fourth.
Karim Garcia, Edgar Gonzalez and pinch hitter Sebastian Valle started the inning with singles. Garcia tried to score from second on Valle's single and was thrown out from center field by Gillies.
Robinson, the catcher, held on to the ball in a collision with Garcia down the third-base line. Garcia never did touch the plate.
Gil Velazquez followed with an RBI double and Arrendondo's sacrifice fly cut Canada's lead to one.
Robinson's hard slide into second broke up a potential double play and allowed a run to score in a two-run seventh inning that put the Canadians ahead 7-3.
Morneau, who had four hits and drove in three runs, doubled in a run, then Michael Saunders walked and Robinson was hit in the foot by a pitch. With one out, pinch hitter Jimmy Van Ostrand grounded to second.
But Robinson took the legs out from Velazquez at shortstop to prevent the relay throw and a run scored.
"'We want to play the game hard. We want to play it properly. You get an opportunity to help a team, help your teammates, by breaking up a double play or something, that's something we do," Robinson said.
All that led up to the ninth, with Mexico trailing badly and facing possible elimination despite the big win over the United States.
Robinson bunted because Canada wanted to widen the margin.
Two pitches came close to Tosoni and the next one hit him in the back. He dropped the bat and walked toward the mound.
When the players all rushed onto the field. Some just shoved, other threw wild haymakers. And just when it seemed things would calm down, more skirmishes ensued.
When the bottle was thrown from behind the Canadian dugout, one Canada player had to be restrained from going into the stands.
No player seemed to be hurt.
"I know the bodies kept moving everywhere but there was a lot more people holding people back than there was real action going on," Renteria said, "as is always the case."
As for his team, Whitt said, "You can't hurt Canadians."
John Ascher, research scientist, invertebrate zoology, American Museum of Natural History, New York, N.Y.
Julie Mustard, assistant research professor, School of Life Sciences, Arizona State University, Tempe, Az.
Gregory Sutton, postdoctoral research assistant, School of Biological Sciences, University of Bristol, Bristol, England
With warmer weather (hopefully) just around the corner, what can we expect this spring from some of nature's most important pollinators? Plus, new research on the electric fields in flowers and the effect of caffeine on honeybees offers fascinating glimpses into bee behavior.
Mar. 6, 2013 ? Neutron stars, the ultra-dense cores left behind after massive stars collapse, contain the densest matter known in the Universe outside of a black hole. New results from Chandra and other X-ray telescopes have provided one of the most reliable determinations yet of the relation between the radius of a neutron star and its mass. These results constrain how nuclear matter -- protons and neutrons, and their constituent quarks -- interact under the extreme conditions found in neutron stars.
Three telescopes -- Chandra, ESA's XMM-Newton, and NASA's Rossi X-ray Timing Explorer (RXTE) -- were used to observe 8 different neutron stars, including one in 47 Tucanae, a globular cluster located about 15,000 light years away in the outskirts of the Milky Way. The image shown here was constructed from a long Chandra observation of 47 Tucanae. Lower-energy X-rays are red, X-rays with intermediate energies are green, and the highest-energy X-rays are shown in blue.
In the image, the double, or binary, star system labeled as X7 contains a neutron star slowly pulling gas away from a companion star with a mass much lower than the Sun. In 2006, researchers used observations of the amount of X-rays from X7 at different energies together with theoretical models to determine a relationship between the mass and the radius of the neutron star. A similar procedure was used for Chandra observations of a neutron star in another globular cluster, NGC 6397, and for two other neutron stars in clusters observed by ESA's XMM-Newton.
Four other neutron stars were observed with RXTE to undergo bursts of X-rays that cause the atmosphere of the neutron star to expand. By following the cooling of the star, its surface area can be calculated. Then, by folding in independent estimates of the distance to the neutron star, scientists were able to gather more information on the relationships between the masses and radii of these neutron stars.
Because the mass and radius of a neutron is directly related to interactions between the particles in the interior of the star, the latest results give scientists new information about the inner workings of neutron stars.
The researchers used a wide range of different models for the structure of these collapsed objects and determined that the radius of a neutron star with a mass that is 1.4 times the mass of the Sun is between 10.4 and 12.9 km (6.5 to 8.0 miles). They also estimated the density at the center of a neutron star was about 8 times that of nuclear matter found in Earth-like conditions. This translates into a pressure that is over ten trillion trillion times the pressure required for diamonds to form inside Earth.
The results apply whether the entire set of bursting sources, or the most extreme of the other sources, are removed from the sample. Previous studies have used smaller samples of neutron stars or have not accounted for as many uncertainties in using the models.
The new values for the neutron star's structure should hold true even if matter composed of free quarks exists in the core of the star. Quarks are fundamental particles that combine to form protons and neutrons and are not usually found in isolation. It has been postulated that free quarks may exist inside the centers of neutron stars, but no firm evidence for this has ever been found.
The researchers also made an estimate of the distances between neutrons and protons in atomic nuclei here on earth. A larger neutron star radius naturally implies that, on average, neutrons and protons in a heavy nucleus are farther apart. Their estimate is being compared with values from terrestrial experiments.
The neutron star observations also provided new information about the so-called "symmetry energy" for nuclear matter, which is the energy cost required to create a system with a different number of protons than neutrons. The symmetry energy is important for neutron stars because they contain almost ten times as many neutrons as protons. It is also important for heavy atoms on Earth, like Uranium, because they often have more neutrons than protons. The results show that the symmetry energy does not change much with density.
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The above story is reprinted from materials provided by Chandra X-ray Observatory.
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Journal Reference:
Andrew W. Steiner, James M. Lattimer, Edward F. Brown. The Neutron Star Mass-Radius Relation and the Equation of State of Dense Matter. The Astrophysical Journal, 2013; 765 (1): L5 DOI: 10.1088/2041-8205/765/1/L5
Note: If no author is given, the source is cited instead.
Disclaimer: Views expressed in this article do not necessarily reflect those of ScienceDaily or its staff.
Source: www.ibtimes.com --- Wednesday, March 06, 2013 Apple reinvented the touch screen manipulation of mobile devices. Now a new patent application pointed to upcoming iPhone versions that will read users’ commands via squeeze gestures. ...
CORAL GABLES, Fla. (AP) ? One of the investigators who worked the NCAA's inquiry of Miami athletics wrote a letter on former booster and convicted felon Nevin Shapiro's behalf just days before he was sentenced two years ago.
In the same letter, dated June 3, 2011, Ameen Najjar even suggested that the NCAA could eventually hire Shapiro.
Najjar, who is no longer with the NCAA, told U.S. District Judge Susan Wigenton that college sports' governing body could have utilized Shapiro "in the future as a consultant and/or speaker to educate our membership."
Najjar also said that Shapiro assisted the NCAA with investigations involving a number of schools. Najjar did not specify the schools ? not even Miami, where Shapiro is the central figure in the scandal that has dogged the Hurricanes' athletic department for at least two years.
"Throughout the course of our interactions, it is my belief that Mr. Shapiro possesses a unique depth of knowledge and experience concerning representatives athletics interest ('Boosters'), agents and the provision of extra-benefits to student-athletes," Najjar wrote in the letter, a copy of which was obtained Wednesday by The Associated Press.
Najjar left the NCAA last year and attempts by the AP to reach him in recent weeks have been unsuccessful. The NCAA did not immediately respond Wednesday to a request for comment.
Najjar's was just one of a number of letters written to the court on Shapiro's behalf before sentencing, none of which appeared to sway Wigenton. Four days after the date of Najjar's letter, the judge gave Shapiro a longer sentence than prosecutors asked for on the securities fraud and money laundering counts he admitted to in a plea agreement in September 2010.
She also ordered him to pay more than $82 million in restitution to his victims.
Najjar wrote to Wigenton using NCAA letterhead, and did so when he had the title of director of enforcement. His role in missteps that the NCAA made during the investigation was detailed last month, when a probe that NCAA President Mark Emmert ordered found, among other things, that Najjar appeared to manipulate the investigation by hiring Shapiro's attorney, Maria Elena Perez, and having her use subpoena power to interview people related to the Miami case.
The NCAA does not have subpoena power. Two people were subpoenaed and deposed as part of Shapiro's bankruptcy case, though some of the information gleaned in those interviews was being used in the NCAA's case against Miami.
The NCAA said it was removing that ill-gotten information from the notice of allegations, which Miami was presented with last month and included the charge that the Hurricanes had a "lack of institutional control" when it came to monitoring Shapiro's access to the athletic department.
Perez, in a letter to the Florida Bar dated Feb. 21, said she "is not and has never acted, in the capacity of an attorney for the NCAA." She billed the NCAA for about $57,000 for work she performed related to the investigation, and records show she received about one-third that amount.
Perez told the AP last month that "had I realized I was dealing with, what is in my opinion ... such an incompetent regulatory institution, I would have never allowed Mr. Shapiro to have had any type of contact with the NCAA ? period."
What's the matter with a little arbitrage between friends? ConcertIn.com is an interesting music discovery system that uses your Facebook social graph to find bands you and your friends like and, if you can't make the concert, it lets you resell your tickets to your personal circle of buddies. It's obviously a bit shady - some would call this a scalping site - but creator Jan Horna says that his service "brings a clear and transparent user identity to the marketplace," reducing the chance of shady dealings.
John Brennan moved one step closer to being the next CIA director today.
The Senate Intelligence Committee voted 12-3 to move Brennan's nomination out of the committee this afternoon. Brennan, the current chief counterterrorism adviser to President Obama, must now face a full Senate vote for his nomination to be confirmed for his new job as head of the CIA.
Senate Majority Leader Harry Reid, D-Nev., has indicated that he'd like the full Senate to vote on Brennan at some point this week.
Prompting the move in the Senate Intelligence Committee, where the Brennan nomination had been held up for numerous days, was an agreement with the White House to provide the committee access to all Office of Legal Counsel opinions related to the targeted killing of Americans by drones.
"I am pleased the administration has made this information available," Committee Chairwoman Sen. Dianne Feinstein, D-Calif., said in a statement on the release of the White House information on drones to the committee. "It is important for the committee to do its work and will pave the way for the confirmation of John Brennan to be CIA director."
Brennan still faces an uphill climb in the full Senate where some Senate Republicans, like Sens. John McCain, R-Ariz., Lindsey Graham, R-S.C., and Kelly Ayotte R-N.H., have vowed to hold up his nomination until the administration answers questions on the attack on the U.S. consulate in Benghazi, Libya, on Sept. 11 of last year.
"John and I are hell-bent on making sure the American people understand this debacle called Benghazi," Graham said this weekend on CBS "Face the Nation."
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GOMA, Congo (AP) ? Congolese government troops gave control of two key eastern towns back to the M23 rebel group to avoid jeopardizing the ongoing peace process, a spokesman for the military said Sunday.
Kiwanja and Rutshuru had been M23 strongholds since the group had taken control of them in July 2012. But following a split within the rebellion last week, the armed group had left the towns to reinforce positions against the new splinter, and another rebel group moved in. The military then secured the towns on Friday.
"We couldn't leave the population alone, and we had to secure the area to make sure there were no crimes committed," said Col. Olivier Hamuli, the military spokesman. He said they've since given control back to M23.
"Our troops left Rutshuru and Kiwanja to avoid taking a step back regarding the evolution of the negotiations in Kampala," he said, adding that they are now only one kilometer (mile) from Kiwanja.
Government forces cannot take back M23 territory as negotiations as mediations are ongoing, according to an agreement reached in November at the International Conference for the Great Lakes Region (ICGLR) in Uganda.
"The M23 signed an agreement with the ICGLR and the Congolese government after we took Goma in November. The government troops had to leave our territory because Rutshuru and Kiwanja are in our territory,"said Col. Vianney Kazarama, the spokesman for one of the M23 factions led by Gen. Sultani Makenga.
M23 is a rebellion allegedly backed by Rwanda and Uganda. In November, after eight months of sporadic fighting against the national army, the rebels took the strategic city of Goma, but withdrew two weeks later under international pressure.
Since then, negotiations between the M23 and the government have been held in Kampala, but no serious outcome has yet been announced.
The group split on Wednesday following a dispute over leadership. The president of the movement, Jean-Marie Runiga, was dismissed by Gen. Makenga, the military leader of the movement. Runiga left with the second strongman of the M23, Gen. Baudoin Ngaruye and Bosco Ntaganda, who is wanted by the International Criminal Court.
Both factions have been fighting each other since, creating a power vacuum in the M23 stronghold. Following the Congolese army handover of Rutshuru and Kiwanja to Makenga's faction, Runiga's faction issued a statement saying that the army should have given them the territory.
Runiga, in the statement, accused Makenga of being an ally of Congo's military.
The faction led by Ntaganda and Runiga, positioned on the road to Goma near Kibumba, had apparently attempted to take Goma on Sunday, but were pushed back by the U.N. peacekeeping forces, the U.N. mission in Congo said.
"We fired on Bosco Ntaganda's positions because they moved towards Goma. We told them to stop their movements but they resisted. We sent helicopters that fired on their positions. It was near Kibati," said Alexandre Essome, a spokesman for MONUSCO, the U.N. mission in Congo.
Runiga's faction could not be reached for comment on the attempt.
Colon cancer screening doubles with new e-health record use Public release date: 4-Mar-2013 [ | E-mail | Share ]
Contact: Rebecca Hughes hughes.r@ghc.org 206-287-2055 Group Health Research Institute
Group Health randomized trial in Annals of Internal Medicine shows cost saving
SEATTLEResearchers used electronic health records to identify Group Health patients who weren't screened regularly for cancer of the colon and rectumand to encourage them to be screened. This centralized, automated approach doubled these patients' rates of on-time screeningand saved health costsover two years. The March 5 Annals of Internal Medicine published the randomized controlled trial.
"Screening for colorectal cancer can save lives, by finding cancer earlyand even by detecting polyps before cancer starts," said study leader Beverly B. Green, MD, MPH. "But screening can't help if you don't do itand do it regularly," added Dr. Green, a family physician at Group Health and an affiliate investigator at Group Health Research Institute.
More than one in 20 Americans will develop colorectal cancer, which is second only to lung cancer in causing deaths from cancer, Dr. Green said. Screening for colorectal cancer is strongly recommended for everyone age 50 to 75 years, but almost half of Americans do not get screened regularlyfar below the screening rates for cervical and breast cancer.
"It's important to find ways to ensure that more people are screened for colorectal cancerand keep being screened regularly," Dr. Green said. "I've seen patients die from this cancer. So I was thrilled to find that our intervention doubled screening rates and kept them up to date regularly over two years in people who hadn't been getting regular screening."
The SOS (Systems of Support to Increase Colorectal Cancer Screening) trial started by identifying 4,675 Group Health patients, age 50 to 73, who weren't up to date for colorectal cancer screening. Then they were randomly assigned to one of four stepped groups:
The first group received "usual care," which includes both patient and clinic reminders for those overdue.
The second group received this plus "automated" care, which included a letter telling them they were due for colorectal cancer screening and a pamphlet about screening choices and the pros and cons of three screening options recommended by Group Health and the U.S. Preventive Services Task Force: fecal occult blood testing (FOBT) yearly; flexible sigmoidoscopy every five years (with one FOBT in between); or colonoscopy every decade. Those patients who didn't call to schedule a colonoscopy or sigmoidoscopy received a FOBT kit in the mail with illustrated instructions and a postage-paid return envelope and a reminder letter three weeks later if the kit was not completed.
The third group received usual care, automated interventions, and an additional step called "assisted" care if they still had not completed screening. Assisted care included a medical assistant calling patients to ask which screening option they preferred and provided simple assistance to get this done, such as sending a request for a colonoscopy to their physician, or reviewing the FOBT instructions.
The fourth group received usual care, automated, the assisted intervention, and an additional step called "navigated" care if they were still overdue for screening or requested a colonoscopy or sigmoidoscopy during the automated or assisted steps. Navigated care included a nurse calling to advise patients and facilitate their screening, for those who wanted help in making their choice or didn't get screened after the medical assistant's call. Patients who chose colonoscopy or sigmoidoscopy were helped with making an appointment and preparing for the procedure and followed until the test was completed.
Each step of the SOS intervention raised the percentage of patients who were current for colorectal screening for both years: 26 percent for usual, 51 percent for automated, 57 percent for assisted, and 65 percent for navigated care.
The two-year costs of the automated intervention plus the screening were actually $89 lower than if the patients had received only usual care. The reason: compared with patients who received usual care, more of those in the automated care group happened to choose FOBT instead of sigmoidoscopy or colonoscopy. And the kit costs much less than the procedures do.
"Traditionally, the onus has been on each primary-care doctor to encourage their patients to get health screening tests on schedule," Dr. Green said. Group Health pioneered using a centralized registry to remind women to be screened regularly for breast cancer. "We borrowed that approach and applied it to colorectal cancer," she added. "We empowered patients to do testing on time, by giving them options, or sending them a FOBT kit by default if no choice was made."
What's next? "We plan to test whether improved adherence persists for more than two years," she said. This is particularly important for patients who choose FOBT, because it should be repeated every year. "We are also testing this intervention in 'safety-net' clinics, which serve low-income people," Dr. Green added. More of those clinics now have electronic health records and can now leverage these to provide population-based care, similar to Group Health and Kaiser Permanente.
###
The SOS trial was supported by grant R01CA121125 from the National Cancer Institute of the National Institutes of Health.
Dr. Green's co-authors at Group Health Research Institute were Assistant Investigator Jessica Chubak, PhD, MBHL, Senior Biostatistician Melissa L. Anderson, MS, and Analyst Programmer Sharon Fuller. Dr. Green has a joint appointment as an assistant clinical professor at the University of Washington School of Medicine, and Dr. Chubak is also at the University of Washington School of Public Health. Their other co-authors were Ching-Yun Wang, PhD, of the Fred Hutchinson Cancer Research Center, in Seattle; Richard T. Meenan, PhD, of the Kaiser Permanente Center for Health Research, in Portland, OR; and Sally W. Vernon, PhD, of The University of Texas Health Science Center at Houston.
Second study in same issue
Other Group Health researchers published a different study of colorectal screening in the same issue of the Annals of Internal Medicine: Diana S.M. Buist, PhD, and Carolyn M. Rutter, PhD, senior investigators; Jessica Chubak, PhD, an assistant investigator; Aruna Kamineni, PhD, a research associate; Eric Johnson, MS, a biostatistician; and Joseph Webster, a programmer/analyst.
In people of average risk at four HMO Research Network sites, including Group Health, they found that screening colonoscopy was associated with reduced risk of newly diagnosed late-stage cancers for both left- and right-sided colorectal cancers. Screening sigmoidoscopy was associated with a reduced risk of left-sided, but not right-sided, late-stage colorectal cancers. (Cancers differ depending on whether they are on the left or right side of the bowel.)
They published with colleagues at the University of Pennsylvania Perelman School of Medicine, in Philadelphia; the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute, in Boston; the University of Massachusetts Medical School, in Worcester; the University of Washington School of Public Health, in Seattle; the National Cancer Institute, in Bethesda, MD; Meyers Primary Care Institute/Reliant Medical Group, in Worcester; HealthPartners Health System, in MN; Marshfield Clinic Research Foundation, in WI; Kaiser Permanente Northwest, in Portland, OR; Kaiser Permanente Division of Research, Oakland, CA; and Kaiser Permanente Hawaii, in Honolulu.
Annals of Internal Medicine
Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine's mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.
HMO Research Network
The HMO Research Network includes 19 research centers, each associated with a health care delivery system. Researchers at the centers collaborate on multi-site studies in real-world health care settings across the United States and in Israel. With access to information on more than 16 million ethnically and geographically diverse patients, these researchers are finding solutions for common and rare health problems. Since 1994, the Network has been answering pressing questions about keeping people healthy and delivering effective care.
Group Health Research Institute
Group Health Research Institute does practical research that helps people like you and your family stay healthy. The Institute is the research arm of Seattle-based Group Health Cooperative, a consumer-governed, nonprofit health care system. Founded in 1947, Group Health Cooperative coordinates health care and coverage. Group Health Research Institute changed its name from Group Health Center for Health Studies in 2009. Since 1983, the Institute has conducted nonproprietary public-interest research on preventing, diagnosing, and treating major health problems. Government and private research grants provide its main funding.
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Colon cancer screening doubles with new e-health record use Public release date: 4-Mar-2013 [ | E-mail | Share ]
Contact: Rebecca Hughes hughes.r@ghc.org 206-287-2055 Group Health Research Institute
Group Health randomized trial in Annals of Internal Medicine shows cost saving
SEATTLEResearchers used electronic health records to identify Group Health patients who weren't screened regularly for cancer of the colon and rectumand to encourage them to be screened. This centralized, automated approach doubled these patients' rates of on-time screeningand saved health costsover two years. The March 5 Annals of Internal Medicine published the randomized controlled trial.
"Screening for colorectal cancer can save lives, by finding cancer earlyand even by detecting polyps before cancer starts," said study leader Beverly B. Green, MD, MPH. "But screening can't help if you don't do itand do it regularly," added Dr. Green, a family physician at Group Health and an affiliate investigator at Group Health Research Institute.
More than one in 20 Americans will develop colorectal cancer, which is second only to lung cancer in causing deaths from cancer, Dr. Green said. Screening for colorectal cancer is strongly recommended for everyone age 50 to 75 years, but almost half of Americans do not get screened regularlyfar below the screening rates for cervical and breast cancer.
"It's important to find ways to ensure that more people are screened for colorectal cancerand keep being screened regularly," Dr. Green said. "I've seen patients die from this cancer. So I was thrilled to find that our intervention doubled screening rates and kept them up to date regularly over two years in people who hadn't been getting regular screening."
The SOS (Systems of Support to Increase Colorectal Cancer Screening) trial started by identifying 4,675 Group Health patients, age 50 to 73, who weren't up to date for colorectal cancer screening. Then they were randomly assigned to one of four stepped groups:
The first group received "usual care," which includes both patient and clinic reminders for those overdue.
The second group received this plus "automated" care, which included a letter telling them they were due for colorectal cancer screening and a pamphlet about screening choices and the pros and cons of three screening options recommended by Group Health and the U.S. Preventive Services Task Force: fecal occult blood testing (FOBT) yearly; flexible sigmoidoscopy every five years (with one FOBT in between); or colonoscopy every decade. Those patients who didn't call to schedule a colonoscopy or sigmoidoscopy received a FOBT kit in the mail with illustrated instructions and a postage-paid return envelope and a reminder letter three weeks later if the kit was not completed.
The third group received usual care, automated interventions, and an additional step called "assisted" care if they still had not completed screening. Assisted care included a medical assistant calling patients to ask which screening option they preferred and provided simple assistance to get this done, such as sending a request for a colonoscopy to their physician, or reviewing the FOBT instructions.
The fourth group received usual care, automated, the assisted intervention, and an additional step called "navigated" care if they were still overdue for screening or requested a colonoscopy or sigmoidoscopy during the automated or assisted steps. Navigated care included a nurse calling to advise patients and facilitate their screening, for those who wanted help in making their choice or didn't get screened after the medical assistant's call. Patients who chose colonoscopy or sigmoidoscopy were helped with making an appointment and preparing for the procedure and followed until the test was completed.
Each step of the SOS intervention raised the percentage of patients who were current for colorectal screening for both years: 26 percent for usual, 51 percent for automated, 57 percent for assisted, and 65 percent for navigated care.
The two-year costs of the automated intervention plus the screening were actually $89 lower than if the patients had received only usual care. The reason: compared with patients who received usual care, more of those in the automated care group happened to choose FOBT instead of sigmoidoscopy or colonoscopy. And the kit costs much less than the procedures do.
"Traditionally, the onus has been on each primary-care doctor to encourage their patients to get health screening tests on schedule," Dr. Green said. Group Health pioneered using a centralized registry to remind women to be screened regularly for breast cancer. "We borrowed that approach and applied it to colorectal cancer," she added. "We empowered patients to do testing on time, by giving them options, or sending them a FOBT kit by default if no choice was made."
What's next? "We plan to test whether improved adherence persists for more than two years," she said. This is particularly important for patients who choose FOBT, because it should be repeated every year. "We are also testing this intervention in 'safety-net' clinics, which serve low-income people," Dr. Green added. More of those clinics now have electronic health records and can now leverage these to provide population-based care, similar to Group Health and Kaiser Permanente.
###
The SOS trial was supported by grant R01CA121125 from the National Cancer Institute of the National Institutes of Health.
Dr. Green's co-authors at Group Health Research Institute were Assistant Investigator Jessica Chubak, PhD, MBHL, Senior Biostatistician Melissa L. Anderson, MS, and Analyst Programmer Sharon Fuller. Dr. Green has a joint appointment as an assistant clinical professor at the University of Washington School of Medicine, and Dr. Chubak is also at the University of Washington School of Public Health. Their other co-authors were Ching-Yun Wang, PhD, of the Fred Hutchinson Cancer Research Center, in Seattle; Richard T. Meenan, PhD, of the Kaiser Permanente Center for Health Research, in Portland, OR; and Sally W. Vernon, PhD, of The University of Texas Health Science Center at Houston.
Second study in same issue
Other Group Health researchers published a different study of colorectal screening in the same issue of the Annals of Internal Medicine: Diana S.M. Buist, PhD, and Carolyn M. Rutter, PhD, senior investigators; Jessica Chubak, PhD, an assistant investigator; Aruna Kamineni, PhD, a research associate; Eric Johnson, MS, a biostatistician; and Joseph Webster, a programmer/analyst.
In people of average risk at four HMO Research Network sites, including Group Health, they found that screening colonoscopy was associated with reduced risk of newly diagnosed late-stage cancers for both left- and right-sided colorectal cancers. Screening sigmoidoscopy was associated with a reduced risk of left-sided, but not right-sided, late-stage colorectal cancers. (Cancers differ depending on whether they are on the left or right side of the bowel.)
They published with colleagues at the University of Pennsylvania Perelman School of Medicine, in Philadelphia; the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute, in Boston; the University of Massachusetts Medical School, in Worcester; the University of Washington School of Public Health, in Seattle; the National Cancer Institute, in Bethesda, MD; Meyers Primary Care Institute/Reliant Medical Group, in Worcester; HealthPartners Health System, in MN; Marshfield Clinic Research Foundation, in WI; Kaiser Permanente Northwest, in Portland, OR; Kaiser Permanente Division of Research, Oakland, CA; and Kaiser Permanente Hawaii, in Honolulu.
Annals of Internal Medicine
Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine's mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.
HMO Research Network
The HMO Research Network includes 19 research centers, each associated with a health care delivery system. Researchers at the centers collaborate on multi-site studies in real-world health care settings across the United States and in Israel. With access to information on more than 16 million ethnically and geographically diverse patients, these researchers are finding solutions for common and rare health problems. Since 1994, the Network has been answering pressing questions about keeping people healthy and delivering effective care.
Group Health Research Institute
Group Health Research Institute does practical research that helps people like you and your family stay healthy. The Institute is the research arm of Seattle-based Group Health Cooperative, a consumer-governed, nonprofit health care system. Founded in 1947, Group Health Cooperative coordinates health care and coverage. Group Health Research Institute changed its name from Group Health Center for Health Studies in 2009. Since 1983, the Institute has conducted nonproprietary public-interest research on preventing, diagnosing, and treating major health problems. Government and private research grants provide its main funding.
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Public release date: 4-Mar-2013
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