WASHINGTON (AP) ? The U.S. and its allies have made only spotty and incremental progress in the Afghan war, with overall violence declining just slightly in the past year and widespread corruption continuing to hamper the shaky government, according to a new Pentagon report.
It also noted that the ongoing insider attacks, in which Afghan forces or people dressed in Afghan uniforms turn their weapons on coalition troops, "have the potential to significantly disrupt the Coalition mission in Afghanistan."
The report comes as the U.S. Army is updating its handbook for soldiers on how to detect and prevent such attacks. A draft of the 70-page handbook includes a pullout tip card that details indicators of a possible insider attack, such as reclusive behavior, desire for control, increased focus on violence and abrupt behavioral changes.
It also reminds soldiers to be aware of cultural differences, including the need to avoid doing things in front of Afghans that are considered offensive. Troops, the handbook says, should not blow their noses, put their feet up on desks, wink, spit, point fingers at Afghans or use the "ok" hand signal, which some Afghans interpret as an obscene gesture,
The handbook, titled "Insider Threats-Afghanistan, Observations, insights and Lessons Learned," also details the more than 320 casualties caused by insider attacks between May 2007 and Oct. 1, 2012. A recent review of the data by The Associated Press revealed that the Haqqani insurgent network, based in Pakistan and with ties to al-Qaida, is suspected of being a driving force behind a significant number of the insider attacks.
Military leaders have worked to reduce the insider threat, noting that it is driving a wedge between coalition and Afghan troops, rattling the trust between them and raising questions about how effectively the allied forces can train the Afghans to take over security of their own country in 2014 and beyond.
The senior U.S. official acknowledged Monday that the U.S. continues to be very concerned about the attacks, even though there have been fewer in recent months. The coalition forces are trying to identify high-risk groups and Afghans, and the handbook is aimed at helping them do that.
At least 63 coalition troops ? mostly Americans ? have been killed, by the AP's count, and more than 85 wounded in at least 46 insider attacks so far this year. That's an average of nearly one attack a week. In 2011, 21 insider attacks killed 35.
At the same time, Taliban leaders are calling on insurgents to battle on through the coming winter season to try and take back ground they've lost, but a senior defense official said Monday that the U.S. has seen no increased effort on the part of the fighters as a result.
The semiannual report released Monday shows that the number of enemy attacks for the first nine months of the year dipped by about 3 percent compared to the same time frame in 2011, but the level of violence was actually higher this year than it was in 2009.
The report also blamed this year's shortened poppy harvest for a brief uptick in enemy attacks over the spring. The report said that lower-level insurgents often work during the harvest, lowering the attack levels for roughly six weeks. But weather shortened the harvest to 2-3 weeks this year, allowing militants to return to the battlefield more quickly.
The senior defense official, who was not authorized to talk publicly about the report so requested anonymity, said that while violence levels have remained relatively constant, the violence has been pushed out of heavily populated areas.
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NEW YORK (Reuters) - Stocks advanced slightly on Monday, helped by gains in McDonald's after the fast-food giant posted strong sales results, and a move up in technology shares.
Technology stocks were the S&P 500's best-performing sector as Hewlett-Packard Co climbed 2.5 percent to $14.14 on rumors that activist investor Carl Icahn is building a stake in the PC maker. The stock is down 44.5 percent for the year and ranks as the Dow's worst performer.
Tech was also supported by Cisco Systems , which gained 2.2 percent to $19.75 after the company presented its midterm growth strategy on Friday. Monday's rally put the stock on track for its fifth advance in the past six sessions.
U.S. President Barack Obama met with Republican House Speaker John Boehner on Sunday to negotiate a budget deal. A Boehner aide said Monday that talks are continuing. Obama is expected to make remarks at 2 p.m. from Michigan where he is touring an auto plant.
Persistent worries about the negotiations over the "fiscal cliff," a series of automatic tax hikes and spending cuts that could hurt economic growth next year, have kept market moves small of late.
"The funnel is starting to get narrower and narrower at the end of the year. We're waiting for political resolutions, waiting for headlines," said Brian Battle, director of trading at Performance Trust Capital Partners, in Chicago.
The benchmark S&P 500 index has yet to see a move greater than 0.5 percent in either direction for December, and hasn't moved more than 1 percent either way since November 23. However, the market has regained most of the losses incurred post-election as investors refocused on the fiscal cliff.
McDonald's Corp gave the Dow a jolt, gaining 1.3 percent to $89.66, as its November sales were stronger than expected and showed a bounce back from a decline in October.
The Dow Jones industrial average rose 22.11 points, or 0.17 percent, to 13,177.24. The Standard & Poor's 500 Index gained just 0.75 of a point, or 0.05 percent, at 1,418.82. The Nasdaq Composite Index was up 5.38 points, or 0.18 percent, at 2,983.42.
News out of Italy kept sentiment in check as Prime Minister Mario Monti said he would resign after the approval of the 2013 budget. The move added to uncertainty about progress being made to tackle the euro zone's debt problem and drove Italy's borrowing costs higher.
(Editing by Jan Paschal)
Source: http://news.yahoo.com/stock-index-futures-signal-lower-wall-street-open-092937004--finance.html
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Getty ImagesAndrew Luck has led the Colts to a 9-4 record this season.
TRASH TALK
By Michael Ventre
NBCSports.com contributor
updated 11:49 p.m. ET Dec. 10, 2012
And who has been more valuable this year than Luck?
Certainly people like Peyton Manning of the Denver Broncos and Adrian Peterson of the Minnesota Vikings are worthy of serious consideration. They?re extremely valuable to their teams, and they?re having terrific seasons.
But none of those men is on a team that was projected to be as awful as the Indianapolis Colts were expected to be this season. They were the worst team in the league last year. They were expected to win between three to six games in 2012, and that was if everything went well. The roster was in rebuilding mode.
Chuck Pagano was in his first year as head coach when he got the news that he had leukemia and needed to take a leave to get treatment, which created the possibility of a team adrift without leadership.
Instead, Luck stepped up in a major way. The Colts are 9-4, and much of their success is due to their first-year QB. He has engineered six fourth-quarter comebacks in 2012. That?s absolutely astonishing.
Rookie quarterbacks are supposed to learn on the job. They?re not supposed to take a team from the basement to a likely postseason berth in their first season.
There have been plenty of valuable players in the NFL this year. But when you ponder the magnitude of what Luck has done with the Colts, he is the most valuable player in the league. Like Johnny Manziel, he should have hardware to hoist at the end of this season.
Larry Fitz a waste?
Rarely will you hear someone called ?the biggest waste of money in football? and have it be considered a huge compliment. But that?s what we have in Larry Fitzgerald.
The Arizona Cardinals? star is one of the league's top five receivers, maybe even top three, and maybe even No. 1 if he had someone like Aaron Rodgers or Peyton Manning throwing him the football. But of course he doesn?t.
Fitzgerald is coming off a game Sunday in which he had one reception for two yards in a 58-0 embarrassment against the Seahawks in Seattle. He has 57 catches this year. With three games left ? starting with Sunday?s outing against the visiting Detroit Lions ? he is projected to finish the 2012 season with 70, which would be his worst output since he grabbed 69 in 2006.
And when you consider the level of quarterbacking Arizona is getting, right now the focus should be on getting Fitzgerald two more catches over these next three games, so he can be assured it won?t be his worst year ever (that would be 58 catches in his rookie season of 2004).He also only has four touchdowns; his worst output has been six, achieved twice in his career. That dubious mark is within reach. His streak of 1,000-yard seasons looks almost certain to end at five, especially with guys like John Skelton and Ryan Lindley throwing the football.
Fitzgerald is as great a guy as he is a football player. But when you consider that he signed an eight-year, $120 million contract in 2011 and you take a look at his production this season, the only conclusion is this:
What a waste of money.
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More newsCSN: The Texans entered Monday night's game against the Patriots with an NFL-best 11-1 record. Then New England whooped them, 42-14.
Source: http://nbcsports.msnbc.com/id/50154220/ns/sports-nfl/
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Orlando, FL (PRWEB) June 20, 2012
Big Italy, a new Italian restaurant located at the corner of International Drive and South Kirkman Road, opened for business on Friday, June 15. It is the first Italian restaurant in the country to offer more than 100 different pizzas and more than 50 pasta dishes, all with an authentic and fresh Italian flair.
Big Italys wide-variety of scrumptious dishes are inspired by Michelangelo Montesantis family restaurant in Capena, Italy. Big Italy will boast the same charming, local feel that only an independently-owned restaurant can bring. The restaurants pizzas are thin-crust, as the Roman tradition demands, and are baked in a wood fired oven to give them the distinct taste and aroma found in an authentic Italian eatery. Succulent pasta dishes are served in generous portions and will satisfy the most discerning palates.
The inspiration for Big Italy began more than two decades ago in a small town in Italy called Capena, located on the outskirts of Rome, where the Montesantis owned a small, family restaurant. They served a variety of pizza and pasta dishes based on local recipes, each made with high-quality, hand-picked fresh produce and featuring homemade sauces.
The family-owned business became a success and a must place for families to dine. Twenty years later, Michelangelo Montesanti teamed up with his friends, Marco Marzocca, famed Italian television and screen actor and comedian, and Paulo Simoes, former executive for Sony Pictures Releasing, a major film distribution company, to bring secret family recipes to the United States through the newly minted Big Italy restaurant.
Big Italy has given us the opportunity to bring our passion for Italian food to Orlando for locals and tourists alike, said Paulo Simoes, co-owner of Big Italy. Were proud to offer great authentic food, big portions and more menu options to choose from than any other Italian restaurant in the country.
Big Italy is more than pizza and pasta; it also offers a variety of antipasti, bruschetta, salads and gelatos, as well as a full bar and Italian wine list hand selected by sommelier Pierluigi Gaeta. The friendly and relaxed atmosphere and delicious dishes make for an authentic and unforgettable Italian dining experience.
Our restaurant is an informal, fun and authentic place to eat and drink, said Montesanti, co-owner of Big Italy. Its a contemporary take on my family recipes, all made with the freshest ingredients and homemade secrets.
The restaurant seats 133people in the main dining room with an additional 20seats at the bar, as well as a 25eat private room for parties, meetings and events. Big Italy also has an outside dining patio that seats 60.
Big Italy also features 10 television monitors, with four dedicated to the bar area alone for patrons to watch sporting events. The other six televisions are located strategically around the restaurant and will have Italian trivia flashing on the screen with fun facts such as Italian gestures, Italian words, recipes and facts about the country.
We want our patrons to leave the restaurant feeling like they just dined in Italy, said Marco Marzocca, co-owner of Big Italy. I used to travel 40 minutes each way to get to Michelangelos restaurant because the food was so delicious, and we are proud to bring that same great flavor and authentic dining experience to Orlando through Big Italy.
Big Italy is open daily for lunch and dinner, from 11 a.m. to 11 p.m. An all-you-can-eat lunch special includes a wide variety of Big Italys appetizing thin-crust, Roman-style pizzas and mouthwatering pasta dishes, as well as a salad bar and mini dessert, served at the table by Big Italys friendly staff. The lunch special is $ 15 for adults and $ 8 for kids. Much like a Brazilian Steakhouse, patrons leave a card green side up on the table during lunch, and the wait staff will continue to bring scrumptious dishes for them to try, all for the very reasonable fixed-lunch price.
The full dinner menu includes more than 100 pizzas and 50 pasta dishes, plus antipasti and appetizer dishes, salad bar and fish and steak entrees. Dinner ranges from $ 7-$ 26 per person.
Big Italy will also offer Big Italy Express, a separate dining counter that features Panini sandwiches and pizza-by-the-slice for diners who are on the go and need to grab lunch in a hurry. Big Italy Express will also sell some of the local ingredients used in its dishes, such as olive oil, jams, pastas and even Italian wine from its impressive wine list.
Big Italy is located near popular tourist sites in Orlando, including Universal Studios, Wet n Wild water park and Prime Outlets.
Big Italys Authentic Italian Cuisine
Big Italys antipasti and appetizers include selections like Fritto Misto (mixed fried eggplant, zucchini, carrots and broccoli florets, dipped in batter and fried to perfection), Arancini and Crocchette (arborio rice balls and golden mashed potato rolls; each item is breaded and features a melted, mozzarella center) and Gamberi Mediterraneo (mediterranean-style black tiger shrimp, grilled butter basted, served with homemade sauce.) There are many other appetizer dishes to choose from as well.
For insalate (salads), there is a delicious, fresh salad bar full of a wide variety of fresh mixed greens, garden fresh vegetables, toppings and dressings.
Big Italy also has Our Familys Favorite Pizzas section of the menu, which includes delicious and authentic pizza, such as the classic Margherita pizza (fresh mozzarella and basil leaves on homemade tomato sauce), as well as Capena (buffalo mozzarella, mushrooms and sausage), Argentario pizza (fresh mozzarella, Italian blue cheese, pine nuts and parmesan cheese) and Brazilian pizza (grilled chicken, catupiry cheese and green olives). The menu also offers 97 other scrumptious pizzas to choose from.
Some of Big Italys Our Family Favorite Pasta Dishes include Rigatoni Brocolli e Salsiccia (broccoli, sausage and garlic), Linguine Frutti di Mare (cherry tomatoes, clams, mussels, shrimp, octopus, calamari and parsley), Fettuccine Gorgonzola e Radicchio (cream, gorgonzola cheese and radicchio) and Penne Romana (fresh mozzarella, garlic, cherry tomatoes and fresh basil).
The menu also offers a few, exceptional carne e pesce (fish and steak) dishes to enjoy, such as Salmone Aspargai (ocean fresh salmon filet with lemon ber-blanc sauce and fresh asparagus), as well as Tagliata Gorgonzola (12 oz. New York strip with gorgonzola cheese, seasoned to perfection and full of flavor).
In addition, the delectable Menu Bambini (kids menu) makes it easy for families to dine at Big Italy. Kids menu items include 10 pizzas or pasta dishes, macaroni and cheese, hot dogs, chicken fingers and even Big Italys infamous hot dog pizza.
Dolci (desserts) include family favorites such as homemade gelato, Pizza Nutella, tiramisu and cheesecake, among other sweet treats.
About Big Italy
Big Italy is an authentic, privately owned Italian restaurant with a fun, friendly and informal ambience located at 5700 International Drive in Orlando, FL. Big Italy offers delicious, high-quality dishes with the freshest ingredients at affordable prices. The expansive menu includes more than 100 pizzas and more than 50 pasta dishes, all based on homemade recipes from the Montesanti family restaurant in Capena, Italy. Big Italy is open for lunch and dinner from 11 a.m. to 11 p.m., seven days a week. For more information or to make a reservation, contact Big Italy at (407) 345-5566 or online at http://www.bigitaly.com.
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MOSCOW (Reuters) - Russia's foreign minister urged parliament on Sunday to agree a tough response to a U.S. law punishing Russian human rights violators, increasing the risk of a chill in relations with Washington.
Moscow announced restrictions on meat imports from the United States on Friday although it denied suggestions it had done so in response to the U.S. Senate's passage a day earlier of the so-called Magnitsky Act.
Foreign Minister Sergei Lavrov said the parliament should now respond and Alexei Pushkov, a senior parliamentary deputy from President Vladimir Putin's party, said the State Duma lower house would discuss retaliatory measures this week.
"As this is an attempt to interfere in our internal affairs, I would be very interested in a reaction by the state Duma that would be collective, on a multi-party basis and representing all party groups," Lavrov said in televised remarks.
Puskhov, who heads the chamber's foreign affairs committee, said a majority of lawmakers wanted a tough response, calling for visa restrictions on U.S. citizens who have violated human rights. He did not say who this might include or what rights violations they were accused of making.
"The Americans have reminded us about the way Russia is viewed on Capitol Hill," Yuri Ushakov, a foreign policy adviser to Putin, was quoted as saying by Interfax news agency.
"Stereotypes about our country persist and no one can get rid of them. So the Americans have made an extremely unfriendly move against us."
President Barack Obama, who launched a "reset" in relations with Russia less than four years ago, is likely to sign the Magnitsky legislation, which will test his and Putin's resolve to improve relations since both won elections this year.
The new U.S. legislation would bar visas for Russian officials linked to the 2009 death in custody of Sergei Magnitsky, a Russian lawyer who accused federal investigators of stealing $230 million from the state.
Lavrov told U.S. Secretary of State Hillary Clinton on Thursday that Russia would bar entry for Americans "guilty of crude human rights abuses."
Moscow has also warned it would respond with "asymmetrical" measures. Areas in which the United States wants Russian cooperation most include nuclear arms control and Iran.
DAMAGE MAY BE LIMITED
But there are also signs that Putin, back in the presidency since May, wants to limit the damage to relations with Russia's former Cold War enemy.
Political analysts say the Magnitsky Act will probably not derail Russian assistance on Afghanistan, affect diplomacy aimed at curbing Iran's nuclear program, or deepen disputes over U.S. missile defense and the conflict in Syria.
Moscow is trying to ensure its interests are protected in Syria. Despite frequent denials that it is shifting position, Moscow appears to be preparing for when President Bashar al-Assad leaves power.
The Senate approved the "Magnitsky Act" as part of a broader bill to lift a Cold War-era restriction and grant Russia "permanent normal trade relations, " or PNTR.
Despite Russian denials, analysts saw a link between the Magnitsky Act and Moscow's announcement of restrictions on meat imports from several countries, including the United States.
In a joint statement on Saturday, U.S. Trade Representative Ron Kirk and Agriculture Secretary Tom Vilsack said Russia's new requirement for imported beef and pork to be certified free of ractopamine, a feed additive used in the U.S. meat industry but banned in some other countries, appeared to be a violation of Moscow's obligations to the World Trade Organisation.
The move could potentially make producers from the United States, which exports more than $500 million a year worth of beef and pork to Russia, less competitive, giving an advantage to China and the European Union, where ractopamine is banned.
Russia's plant and health regulator, Rosselkhoznadzor, said it had warned over a year ago about the "inadmissibility" of meat with ractopamine to Russia.
(Editing by Timothy Heritage and Jason Webb)
Source: http://news.yahoo.com/russian-assembly-set-tough-response-u-rights-bill-145147696.html
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Another day, another step towards technologically tricked out contact lenses. The latest development comes from researchers at the Centre of Microsystems Technology at Ghent University, who've developed a prototype lens with an embedded, spherical curved LCD that isn't limited to a paltry amount of pixels. As opposed to LED-based solutions which could only muster a few pixels, the newly-developed screen can pack enough to display graphics that cover a contact. In its current form, the display can show simple patterns, and demonstrates the technology with a simple dollar sign. What appears on the lens wouldn't be visible to folks who wear it, however, since eyes can't focus at such a close range. Despite the limitation, researchers are trying to tackle the focusing issue and are assessing the feasibility of a version that would effectively act as a heads-up display. In the future, the tech could be leveraged for medical purposes, such as controlling light transmission to the retina when the iris is damaged, cosmetic uses and -- you guessed it -- HUDs. With the technology's foundation established, it's expected that real-world applications are potentially a few of years away. Hit the jump to catch a video of the tech in action.
Continue reading Researchers devise contact lens with built-in LCD (video)
Via: Liliputing
Source: Imec
Source: http://feeds.engadget.com/~r/weblogsinc/engadget/~3/7P7tZyr0T7E/
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Contact: Anna-Sabine Ernst
presse@iqwig.de
49-221-356-850
Institute for Quality and Efficiency in Health Care
For patients in whom a recurrence of bowel cancer is suspected, the study data currently available allow no robust conclusions as to the advantages and disadvantages of using positron emission tomography (PET), alone or in combination with computed tomography (CT). This is because no studies have directly compared the benefits of these imaging techniques in recurrent colorectal carcinoma (bowel cancer) with conventional diagnostic techniques. Although PET or PET/CT show a higher diagnostic accuracy, i.e. in certain cases recurrences can be detected more reliably, it is still unclear how this actually affects patient-relevant outcomes such as quality of life. This is the conclusion of the final report of the German Institute for Quality and Efficiency in Health Care (IQWiG) published on 24th October 2012.
More reliable diagnosis ought to improve treatment
Bowel cancer is the second most common malignant tumour in both men and women. Every year, more than 65,000 people are diagnosed with the disease in Germany and more than 25,000 die from it annually. About 80% of the recurrences occur in the first two years after surgery for bowel cancer. After 5 years, virtually no more recurrences are found. These can arise at the original site - the bowel - or as secondary tumours ("metastases"), for example in the liver. Follow-up after surgery should therefore last for 5 years.
Many experts hope that when a recurrence is suspected, an examination using PET or PET/CT alone or in combination with other methods is better able to distinguish between benign and malignant tumours (recurrence diagnostics) and, if applicable, to classify the stage of the latter correctly, i.e. to determine how advanced the cancer is (recurrence staging). This information should enable patients to be given better treatment recommendations.
Benefits for patients crucial
IQWiG therefore searched the international literature for studies which had examined the consequences of a diagnostic intervention using PET or PET/CT on health aspects of direct relevance to patients. For example, the results of the diagnostic investigation - and appropriately tailored treatment - could contribute to better chances of survival for patients, spare them unnecessary operations or further diagnostic interventions, or improve their quality of life.
As requested by the contracting agency, the Federal Joint Committee (G-BA), this report was to focus on those patients in whom a recurrence had already been detected or in whom there was at least a justified suspicion thereof.
The only benefit study proved to be unsuitable
In its final assessment IQWiG was unable to include any studies that had investigated benefits of relevance to patients. For the preliminary report, i.e. the preliminary results, IQWiG had evaluated one study. This addressed the question as to whether, in patients in whom potentially operable liver metastases were suspected, unnecessary laparotomies (surgical opening of the abdomen) could be avoided if a PET investigation took place following a diagnostic intervention using contrast-medium-enhanced CT.
As IQWiG has since discovered after requesting information from authors, this study was, however, unsuitable for deriving any conclusions regarding benefit. This was because - in contrast to the original plan - the decision to operate or not was not allowed to be made in dependence upon the PET results. The independent advisory committee had advised against this procedure on ethical grounds. But information on this important change in the conduct of the study was provided neither in the publication of the study results nor by entry in a clinical trials registry.
In certain cases, PET/CT can detect recurrences more reliably
For the preliminary report, IQWiG had already made an additional search for studies in which the diagnostic accuracy and prognostic power of PET or PET/CT had been compared with other diagnostic techniques. This referred to the question as to how often a PET investigation provides a correct result. On the one hand, true malignant tumours should be overlooked as rarely as possible, while on the other, false suspicions should not be aroused.
The results of a total of 5 evidence syntheses and 13 individual studies regarding this question could be evaluated. The conclusion on recurrence detection was as follows: PET and PET/CT appear capable of detecting or excluding recurrences more reliably than a conventional diagnostic intervention consisting solely or predominantly of CT. This applies particularly to local recurrences and distant metastases. It is not possible to state with certainty whether PET and PET/CT differ in terms of their diagnostic accuracy.
Further study results needed
Important questions in relation to PET technology remain unanswered. For example, it has not yet been examined whether the higher accuracy of PET or PET/CT has a positive effect on mortality, the burden of disease or quality of life.
As long as this deficiency remains, a patient-relevant benefit of PET or of PET/CT as a supplementation to a suspicion-driven diagnostic investigation with conventional methods is not proven. For instance, it is particularly doubtful whether a recurrence detected by using PET or PET/CT can actually be better treated and thereby produce a perceptible advantage for patients. Experts are therefore eagerly awaiting the results of a Canadian study with more than 400 patients, which is to be published shortly.
Missing information can lead to false conclusions
Stefan Lange, the Deputy Director of IQWiG, commented on the new information gained by IQWiG during the assessment procedure of the study on laparotomies: "The fact that the only benefit study on PET turned out to be unsuitable is extremely regrettable. The rupture of the logical link between diagnosis and treatment devalued the study results." As Lange explained, a basic principle of medicine is that a diagnostic intervention is only of benefit if it enables patients to receive more tailored treatment. The fact that the study authors (Ruers et al., 2009 / Nijmegen University, The Netherlands) had also failed to inform about a fundamental change in their procedure was unacceptable. As Lange stated, because of this there is a danger that researchers, doctors and patients will draw the wrong conclusions.
Procedure of report production
IQWiG published the preliminary results in the form of the preliminary report in September 2011 and interested parties were invited to submit comments. At the end of the commenting procedure, which included an oral scientific debate including parties who had submitted comments, the preliminary report was revised and sent as a final report to the contracting agency, the Federal Joint Committee (G-BA), in August 2012. The written comments were published in a separate document at the same time as the final report. The report was produced in collaboration with external experts.
###
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Contact: Anna-Sabine Ernst
presse@iqwig.de
49-221-356-850
Institute for Quality and Efficiency in Health Care
For patients in whom a recurrence of bowel cancer is suspected, the study data currently available allow no robust conclusions as to the advantages and disadvantages of using positron emission tomography (PET), alone or in combination with computed tomography (CT). This is because no studies have directly compared the benefits of these imaging techniques in recurrent colorectal carcinoma (bowel cancer) with conventional diagnostic techniques. Although PET or PET/CT show a higher diagnostic accuracy, i.e. in certain cases recurrences can be detected more reliably, it is still unclear how this actually affects patient-relevant outcomes such as quality of life. This is the conclusion of the final report of the German Institute for Quality and Efficiency in Health Care (IQWiG) published on 24th October 2012.
More reliable diagnosis ought to improve treatment
Bowel cancer is the second most common malignant tumour in both men and women. Every year, more than 65,000 people are diagnosed with the disease in Germany and more than 25,000 die from it annually. About 80% of the recurrences occur in the first two years after surgery for bowel cancer. After 5 years, virtually no more recurrences are found. These can arise at the original site - the bowel - or as secondary tumours ("metastases"), for example in the liver. Follow-up after surgery should therefore last for 5 years.
Many experts hope that when a recurrence is suspected, an examination using PET or PET/CT alone or in combination with other methods is better able to distinguish between benign and malignant tumours (recurrence diagnostics) and, if applicable, to classify the stage of the latter correctly, i.e. to determine how advanced the cancer is (recurrence staging). This information should enable patients to be given better treatment recommendations.
Benefits for patients crucial
IQWiG therefore searched the international literature for studies which had examined the consequences of a diagnostic intervention using PET or PET/CT on health aspects of direct relevance to patients. For example, the results of the diagnostic investigation - and appropriately tailored treatment - could contribute to better chances of survival for patients, spare them unnecessary operations or further diagnostic interventions, or improve their quality of life.
As requested by the contracting agency, the Federal Joint Committee (G-BA), this report was to focus on those patients in whom a recurrence had already been detected or in whom there was at least a justified suspicion thereof.
The only benefit study proved to be unsuitable
In its final assessment IQWiG was unable to include any studies that had investigated benefits of relevance to patients. For the preliminary report, i.e. the preliminary results, IQWiG had evaluated one study. This addressed the question as to whether, in patients in whom potentially operable liver metastases were suspected, unnecessary laparotomies (surgical opening of the abdomen) could be avoided if a PET investigation took place following a diagnostic intervention using contrast-medium-enhanced CT.
As IQWiG has since discovered after requesting information from authors, this study was, however, unsuitable for deriving any conclusions regarding benefit. This was because - in contrast to the original plan - the decision to operate or not was not allowed to be made in dependence upon the PET results. The independent advisory committee had advised against this procedure on ethical grounds. But information on this important change in the conduct of the study was provided neither in the publication of the study results nor by entry in a clinical trials registry.
In certain cases, PET/CT can detect recurrences more reliably
For the preliminary report, IQWiG had already made an additional search for studies in which the diagnostic accuracy and prognostic power of PET or PET/CT had been compared with other diagnostic techniques. This referred to the question as to how often a PET investigation provides a correct result. On the one hand, true malignant tumours should be overlooked as rarely as possible, while on the other, false suspicions should not be aroused.
The results of a total of 5 evidence syntheses and 13 individual studies regarding this question could be evaluated. The conclusion on recurrence detection was as follows: PET and PET/CT appear capable of detecting or excluding recurrences more reliably than a conventional diagnostic intervention consisting solely or predominantly of CT. This applies particularly to local recurrences and distant metastases. It is not possible to state with certainty whether PET and PET/CT differ in terms of their diagnostic accuracy.
Further study results needed
Important questions in relation to PET technology remain unanswered. For example, it has not yet been examined whether the higher accuracy of PET or PET/CT has a positive effect on mortality, the burden of disease or quality of life.
As long as this deficiency remains, a patient-relevant benefit of PET or of PET/CT as a supplementation to a suspicion-driven diagnostic investigation with conventional methods is not proven. For instance, it is particularly doubtful whether a recurrence detected by using PET or PET/CT can actually be better treated and thereby produce a perceptible advantage for patients. Experts are therefore eagerly awaiting the results of a Canadian study with more than 400 patients, which is to be published shortly.
Missing information can lead to false conclusions
Stefan Lange, the Deputy Director of IQWiG, commented on the new information gained by IQWiG during the assessment procedure of the study on laparotomies: "The fact that the only benefit study on PET turned out to be unsuitable is extremely regrettable. The rupture of the logical link between diagnosis and treatment devalued the study results." As Lange explained, a basic principle of medicine is that a diagnostic intervention is only of benefit if it enables patients to receive more tailored treatment. The fact that the study authors (Ruers et al., 2009 / Nijmegen University, The Netherlands) had also failed to inform about a fundamental change in their procedure was unacceptable. As Lange stated, because of this there is a danger that researchers, doctors and patients will draw the wrong conclusions.
Procedure of report production
IQWiG published the preliminary results in the form of the preliminary report in September 2011 and interested parties were invited to submit comments. At the end of the commenting procedure, which included an oral scientific debate including parties who had submitted comments, the preliminary report was revised and sent as a final report to the contracting agency, the Federal Joint Committee (G-BA), in August 2012. The written comments were published in a separate document at the same time as the final report. The report was produced in collaboration with external experts.
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Source: http://www.eurekalert.org/pub_releases/2012-12/ifqa-bop121012.php
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For just a moment, I'm going to pretend to be in Russia, and I'm going to pretend to jump into my car and take a drive to...oh, let's make it the country, so I head out, drive through streets, then to highways, my car-cam always on (for insurance reasons ? see below) and that's when crazy things start to happen. And when I say crazy, I mean, totally off the charts, ohmygod, this-isn't-happening kind of crazy.
I don't normally watch videos like this one, accidents aren't my thing, but this one I couldn't stop looking at, for the whole 13 minutes. It shows road behavior I've never imagined, find hard to explain, which raises all kinds of questions. Here it is:
Two immediate questions: Is this occasional or typical behavior? And why does everybody seem to have a working camera on their dashboard? Videos like this are a window into different cultures, and this window has made me really curious. Maria Galperina, who blogs for Animal New York, says "dash-cameras" are very common in Russia. You need them to prove or defend insurance claims.
In Russia, everyone should have a camera on their dashboard. It's better than keeping a lead pipe under your seat for protection (but you might still want that lead pipe).
The conditions of Russian roads are perilous, with insane gridlock in cities and gigantic ditches, endless swamps and severe wintry emptiness on the back roads and highways. Then there are large, lawless areas you don't just ride into, the police with a penchant for extortion and deeply frustrated drivers who want to smash your face.
Psychopaths are abundant on Russian roads. You best not cut anyone off or undertake some other type of maneuver that might inconvenience the 200-pound, six-foot-five brawling children you see on YouTube hopping out of their SUVs with their dukes up. They will go ballistic in a snap, drive in front of you, brake suddenly, block you off, jump out and run towards your vehicle. Next thing you start getting punches in your face because you didn't roll up your windows, or getting pulled out of the car and beaten because you didn't lock the doors.
These fights happen all the time and you can't really press charges. Point to your broken nose or smashed windows all you want. The Russian courts don't like verbal claims. They do, however, like to send people to jail for battery and property destruction if there's definite video proof. That is why there's a new, growing crop of dash-cam videos featuring would-be face-beaters backing away to the shouts of "You're on camera, f - - -er! I'm calling the cops!"
Not too long ago, she writes, there were gangsters who'd create small "accidents" by dashing in front of slow moving vehicles and feigning injury. "Bystanders" (really co-conspirators) would then threaten the driver and demand cash payments. When Jason Kottke ran the Russian accident video on his blog last week, someone sent him a "Phony Accident" compilation video, where you can see (because they are identified in oval highlights) the perps waiting to become victims and then throwing themselves in harm's way.
This video, in its way, is as astonishing as the first one, though Cory Jones, the reporter at Mandatory who describes what's going on (the video is in Russian, but the images are vividly obvious), suggests that having a camera in your car, and saying so, often makes the scam artists go away.
If you want to see these criminals doing their daring-do, (and when you see them fall over, hit the ground, looking looking dead, they're not, not at all) here's the video.
The moral of this story? There are obviously better places to go for a drive than Russia. Most places on Earth would probably qualify, but it's the details, the dash-cams, the scam artists, the drunkenness, the anything-can-happen quality (how about that fighter jet roaring up the highway at about 100 feet off the ground?) that remind you, different places on Earth are still richly, oddly, troublesomely, different.
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