1st U.S. most expensive car

The Bugatti Veyron 16.4 Super Sport “World Record Edition”

If your passion for performance and luxury autos cannot be stopped, and your McLaren F1 is becoming a bore along with the rest of your exotic cars, it might be time to check out Top Gear’s “Car of the Decade,” the Bugatti Veyron. The most recent model, the Bugatti Veyron 16.4 Super Sport, has an estimated price tag of $2.3 million and, if that figure is even close to the ultimate price, will be the most expensive car in the world.

If your passion for performance and luxury autos cannot be stopped, and your McLaren F1 is becoming a bore along with the rest of your exotic cars, it might be time to check out Top Gear’s “Car of the Decade,” the Bugatti Veyron. The most recent model, the Bugatti Veyron 16.4 Super Sport, has an estimated price tag of $2.3 million and, if that figure is even close to the ultimate price, will be the most expensive car in the world.

The Veyron is named after Pierre Veyron, who won the 1939 24 Hours of Le Mans while driving a Bugatti Type 57 with Jean-Pierre Wimille.

Specification

 

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Ideal car for your needs

Don Sherman opinion says, whether you’re single and “active” (whatever that means) or a mom with three screaming kids, how you live points directly toward the kind of car you’ll need.

Commuting many miles to work makes gas mileage a primary concern, but you should also include reliability as a major purchase consideration you don’t ever want to be stranded on the side of a busy highway. Also bear in mind that some people feel safer in larger cars and with more powerful engines the better to accelerate away from danger, they may reason and these typically get fewer miles to the gallon than smaller cars with less power.

Maintenance requirements such as oil-change intervals can be an excellent means of breaking ties for road warriors who pile up the miles, whether on the highway or in the city. While most cars today can be driven longer between routine maintenance stops than a decade ago, some luxury brands, such asw BMW and Volvo, include the cost of such upkeep in the price of many models. Let that be a guide for your purchase to the extent that trouble- and cost-free maintenance matter to you.

The more stops you make to pick up or deliver kids to their appointed activities, the more doors you need to minimize their entry-exit hassles. When kids factor in, coupes and convertibles naturally migrate to the special-occasions spot in the garage, if you’re lucky enough to have kids and more than two parking stalls and special occasions.

Let’s say you’re a young couple or single with the ability to indulge weekend trips, hobbies and athletic activities. You’ll need a ride that’s long-legged for ski trips, fuel efficient so you have funds left over for lift tickets and flexible enough to sacrifice at least one of its rear seating positions to accommodate your skis. While most coupes and sedans provide split-folding rear seats, they’re not always standard equipment. For example, that handy feature costs an extra $290 on the Mercedes C-Class.

Feel free to convert our downhill example to the leisure activity of your choice without forgetting that the car you choose will probably play some role in landscaping, remodeling, camping or mall-browsing. In other words, if you’re building the ultimate surround-sound theater experience, you might as well own a wagon to skip delivery charges during this phase of your life. Unlike the one your grandparents owned, today’s wagons can be cool.

Speaking of that impossible-to-pin-down dimension, you will know cool when you see it. Of course an $87,375 Mercedes CLS55 AMG four-door coupe is cool, but don’t stop with the window sticker. Mazda’s RX-8 is a very chic way to carry your grade-school twins or your loveable lab at one-third the price. If style is your thing, turn toward the coupes and convertibles in this guide.

If you’ve earned a treat and don’t mind flaunting your fine fortune, the scope of the luxuries awaiting your investment dollars will astound you. Pile on the optional gear leather-wrapped seats and steering wheel, air suspension, in-dash navigation and you can boost a $40,000 Audi A6 to more than $60,000. A top Audi, BMW, Jaguar or Mercedes-Benz costs well over $100,000. When you have big bucks to spend, the power and panache for sale is practically unlimited.

But let’s say you’re a city-bound working stiff who can’t live without wheels. In L.A. or New York, a car well worth considering is the Toyota Prius, because its hybrid powertrain (combination of combustion and electric power sources) excels in producing the maximum number of city miles versus the fuel consumed and the pollution produced. Short-wheelbase coupes (Acura RSX) and compact sedans (Lexus IS) are adept at punching clean holes through clotted traffic. Larger, more expensive sedans are harder to maneuver and more susceptible to theft, vandalism and bashed corners.

Read on to search for a car that suits your lifestyle and tastes according to size, body style or specialty.

Do not forget, Supplemental accident insurance helps by giving you specified benefits for hospitalization, emergency room care, recovery income, outpatient surgery and more. Combined Insurance's Accident and Sickness Protector offerings help you fill in the gaps in your major medical insurance coverage.

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HSBC Bank announced as new patron of the Open Champions

According to news from http hsbcgolf.com, This Bank was today named as a Patron of the Open Championship for the next five years.

The partnership means that HSBC will become the 'Official Banking Partner' of The Open Championship, which next year will return to Royal St George's (14-17 July, 2011), Sandwich, Kent.

The R&A's Chief Executive, Peter Dawson said: "We are very pleased to welcome HSBC. The Open is golf’s oldest major championship and its most international. For many years, The R&A has looked to establish relationships that help golf’s growth globally. As The R&A seeks to engage in and support activities to grow the game, a partnership with 'the world's local bank' is a natural progression."

Over the last five years, HSBC has been at the forefront of the expansion of the game in Asia with the creation of the HSBC Champions in China, which it has helped develop from inception in 2005 to become Asia’s first World Golf Championship tournament. It has also created a comprehensive programme of grassroots activity across China designed to increase both interest and participation in the game.

Giles Morgan, Group Head of Sponsorship at HSBC commented: “The Open Championship is, without a doubt, one of the world’s most important golf tournaments and HSBC is very honoured to become a Patron. Golf sponsorship continues to be an important investment tool for us to grow and sustain our business and brand. This new partnership is an exciting opportunity to take our current activity with professional and grassroots golf in both established and emerging markets to a new level.”

2010 Open Champion Louis Oosthuizen said: “Winning The Open, particularly at St Andrews, is the pinnacle of any golfer’s career. I could not have got there without the great support I’ve received from within the game and I hope this announcement will lead to further opportunities for The R&A to do even more to help the game to grow around the world.”

The R&A is the governing body of world golf outside the US, with affiliated national governing bodies in 126 countries around the world. In 2010, 200,000 spectators attended The Open Championship and over 3,000 hours of television coverage were broadcast to 193 countries worldwide. There were over three million unique visitors to The Open’s official website (www.opengolf.com) during this year’s Championship, with 300,000 hours of streamed coverage via the internet.

Playing a role in helping to develop and grow the game globally is typical of the way HSBC does business, particularly in emerging markets. Helping The R&A realise its full potential is consistent with the way HSBC works with all of its partners and customers.

Buy tickets soon to see the match live
Event Schedule	Wednesday, 3rd November --- Pro-Am Competition Thursday, 4th November --- 1st round Friday, 5th November --- 2nd round Saturday, 6th November --- 3rd round Sunday, 7th November --- Final round
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Become professional PGA golfer

"The PGA's training courses are tried and tested and helped put me on the pathway to success."
Ian Poulter, PGA Professional

"Every golfer dreams of success, and I was certainly no different when starting out on my career to become a professional golfer.

"Your vision may be crystal clear, but without a plan it's just a dream, which is why becoming a qualified member of the PGA has provided me with a secret weapon and the solid foundations and springboard for my playing career.

"Today's programme is even more technologically advanced than when I completed the diploma in 2000 and even if you pursue a career on the Tour the depth of knowledge and understanding of the game will always stand you in good stead.

A Career in Golf

Becoming a PGA professional unlocks the door to a rewarding and exciting career in a sport that spans the globe and is played by 60 million people. Many young golfers set their hearts on playing on tour alongside Tiger Woods and Co. but plenty of other opportunities exist in professional golf far beyond the confines of the golf course and PGA professionals fill many of these roles while also successfully playing. See Careers in Golf and for a revealing insight into becoming a PGA professional read the account by former Ladies European Tour star Alison Munt who graduated in 2009 and shares her experiences of taking the PGA Foundation Degree here.

Opportunities

The PGA, both regionally and nationally, organises upwards of 900 tournaments a year with prize money in excess of 3.5m. Joining the ranks of the PGA unlocks the door to a broad spectrum of career opportunities. PGA pros are top class players but are also experts in other areas of the golf industry whether managing and running clubs in a club pro role, coaching and teaching, utilising their equipment knowledge as custom-fit technicians or pursuing senior management roles such as director of golf posts.

Qualifying

Qualifying as a PGA professional is done via two routes. The first, and most popular, is by becoming a registered assistant at a PGA recognised golf facility where trainees complete a three year Foundation Degree in Professional Golf Studies, accredited by the University of Birmingham. The degree involves working through study guides, assignments, residential weeks at the National Training Academy at the PGA's Belfry headquarters, exams and attaining coaching awards. Among the subjects studied are golf coaching, sports science, equipment technology, business management, marketing, golf rules and tournament administration.

The second route into the PGA is via a three year BA Hons Degree in Applied Golf Management Studies at the University of Birmingham. The AGMS is the first degree of its kind in the UK and is ideal for golfers interested in pursuing senior managerial roles in golf.

More Information

The PGA offers a three-year Foundation Degree leading to full PGA membership. The university has a number of set open days and students are encouraged to visit, see the campus and facilities and talk to our students and staff - visit the University of Birmingham for more information. There are also specific AGMS open days at The Belfry, which are by invitation only. For further information on the course, prospective students are asked to register their interest by contacting: Dr Martin Toms AGMS Programme Manager School of Education University of Birmingham Edgbaston, Birmingham B15 2TT Tel: 0121 415 8392 m.r.toms@bham.ac.uk The partnership between the School of Education and the PGA is an innovative and exciting collaborative venture. It provides the basis for combining aspects of professional and vocational practice with rigorous scholarship. In an increasingly differentiated market-place for sports-related programmes of study, it is ground-breaking. - Dr Martin Toms, Programme Manager Gary Jackson Business Skills Development Manager PGA National Training Academy, PING House The Belfry Sutton Coldfield, West Midlands B76 9PW Tel: 01675 470333 gary.jackson@pga.org.uk

U.S. Masters Tournament - History

History at a Glance

Looking to provide a service to golf by hosting a tournament, Bobby Jones and Clifford Roberts decided to hold an annual event beginning in 1934. The final decision was made at a meeting in New York at the office of member W. Alton Jones. Roberts proposed the event be called the Masters Tournament, but Bobby Jones objected thinking it too presumptuous. The name Augusta National Invitation Tournament was adopted and the title was used for five years until 1939 when Jones relented and the name was officially changed. An early decision was whether Jones would play or serve as an official. Jones preferred not to compete but was persuaded by the Club's members to join the field. In the 12 Tournaments that Jones played, his best finish was 13th in 1934.

Many decisions made in the early days of the Tournament remain today. Among these are the four-day stroke playing of 18 holes each day instead of the then customary 36 holes on the third day, eliminating qualifying rounds, and denying permission for anyone except the player and caddie to be in the playing area. A complimentary pairing sheet and a spectator booklet were provided, and commercialization in any form of the Tournament was limited.


The first Tournament was held March 22, 1934, and beginning in 1940, the Masters was scheduled each year during the first full week in April. That first Tournament was won by Horton Smith, and in the Fall of 1934 the nines were reversed. In 1935 Gene Sarazen hit "the shot heard 'round the world" scoring a double eagle on the par 5 15th hole, tying Craig Wood and forcing a playoff. Sarazen won the 36-hole playoff the following day by five strokes. In 1942 Byron Nelson defeated Ben Hogan 69-70 in an 18-hole playoff and the Tournament was not played the following three years, 1943, 1944 and 1945, during the war. To assist the war effort, cattle and turkeys were raised on the Augusta National grounds.

The 1950's included two victories by Ben Hogan, and the first of four for Arnold Palmer. Palmer's 1958 win began the tradition of Amen Corner. In 1960 the Par 3 Contest was begun, and in 1965-1966 Jack Nicklaus became the first Masters champion to defend his title successfully. During the decade of the 1970's the two founders of the Masters Tournament passed away. Both Jones and Roberts left indelible impressions on the Masters and on the world of golf. The following decade Spaniard Seve Ballesteros won twice and Tom Watson captured his second title. In 1986 at age 46, Nicklaus donned his sixth Green Jacket. And in 1997, Tiger Woods broke the Tournament four-day scoring record that had stood for 32 years. At the 2001 Masters, Woods won his fourth consecutive professional major, and in 2002 became only the third player to win consecutive Masters titles. In 2005 he became the third person to win at least four Tournaments.

History of the Club

Upon his retirement from championship golf in 1930, Bobby Jones had hoped to realize his dream of building a golf course. Following a brief conversation with Clifford Roberts, with whom Jones had met several times during the mid-1920s, it was decided the club would be built near Augusta, Georgia, provided a suitable piece of ground was available. According to Jones' plans, the course would utilize the natural advantages of the property and use mounds rather than too many bunkers. It was hoped the property would have a natural creek to use as a water hazard. Jones wanted this concept of golf course architecture to make a contribution to the game as well as give expression to his ideas about golf course design. This club would be open during the winter season only.

A mutual friend of Jones and Roberts, Thomas Barrett, Jr., was consulted and recommended a 365-acre property called Fruitland Nurseries. Once an indigo plantation, it was purchased in 1857 by Belgian Baron Louis Mathieu Edouard Berckmans who was a horticulturist by hobby. Berckmans' son, Prosper Julius Alphonse, was an agronomist and horticulturist by profession and the two formed a partnership in 1858. Operating under the name Fruitland Nurseries, the company imported many trees and plants from various countries. The Baron died in 1883. Prosper's death followed in 1910 and the nursery ceased operations by the time its charter expired in 1918. A great variety of flowering plants and trees, including a long row of magnolias which were planted before the Civil War and a plant Prosper popularized called the azalea, remained on the property.

Upon seeing the property from what is now the practice putting green, Jones said, "Perfect! And to think this ground has been lying here all these years waiting for someone to come along and lay a golf course on it."

An option was taken on the property for $70,000. It was decided to establish a national membership for the club, and Jones proposed Augusta National would be an appropriate name. Jones also decided in the planning stage that he wanted Dr. Alister Mackenzie of Scotland to serve as the course architect since the pair held similar views. Before coming to Augusta, Mackenzie had designed two courses in California, Pasatiempo and Cypress Point. Mackenzie died in January 1934, two months before the first Tournament.

Construction on the new course began in the first half of 1931 and the course opened in December 1932 with a limited amount of member play. Formal opening took place in January 1933.

Bobby Jones	Clifford Roberts
Robert (Bobby) Tyre Jones, Jr., was born on St. Patrick's Day, March 17, 1902, in Atlanta, Georgia. The amateur golfer Bobby Jones dominated the game of golf from the early 1920's through 1930. From 1923 through 1930, Jones won 13 of 21 major championships he entered. His record includes five U. S. Amateur	Clifford Roberts was born on a farm in Morning Sun, Iowa, in 1894. He was the co-founder with Bobby Jones of Augusta National Golf Club. Roberts served as Chairman of Augusta National from 1931 through 1976 and was named Chairman in Memoriam after his death in 1977. He was Chairman of the Masters Tournament

Fred-Couples surges to victory at The Woodlands

THE WOODLANDS, Texas (AP) -- Fred Couples left Corey Pavin and everybody else way behind in the Administaff Small Business Classic, shooting a 9-under 63 on Sunday for a seven-stroke victory.

Two strokes behind Pavin after 10 holes in the final round, the 50-year-old Couples played the final eight in 7 under, making an eagle -- his second of the round -- and five birdies.

"I don't know if I putted like that on the PGA Tour, ever," said Couples, who had only 24 putts in the final round. "I used to putt well and once you hit your mid-40s, every putt is important."

The former University of Houston star finished at 17-under 199 on The Woodlands Country Club course and earned $255,000 for his fourth Champions Tour victory of the year.

Mark Wiebe (71) was second, Dan Forsman (66) and Brad Bryant (66) followed at 9 under, and Pavin (74) and John Cook (67) tied for fifth at 8 under.

Couples birdied Nos. 11 and 12 to tie Pavin, then made a long eagle putt on the par-5 13th. After Couples' eagle, Pavin made a bogey, missing a 7-foot putt.

"That was something," Couples said. "I played well yesterday and I felt I'd play well today. I assumed one of us (in lead threesome) would win. To be honest, I hit the ball well and made a lot of putts and it all added up to a 63."

Couples moved two more shots ahead on the next hole with another birdie and Pavin's bogey.

Couples also birdied Nos. 16 and 18.

"Fred played great, it was a pretty amazing nine holes," Pavin said. "It was tough to keep up with him. I wasn't playing well anyway. I was out in front of the ball today. I struggled all day and it never turned around. ... Things weren't clicking, I'll try again next week. I haven't played much golf lately, only the second event since Oregon. I hope to compete the next two weeks. It would be nice to get a win."

Bernhard Langer, 535 points ahead of second-place Couples in the Charles Schwab Cup standings, shot a 66 to tie for 13th at 3 under. Kenny Perry tied for 35th in his first start on the 50-and-over tour, closing with a 70 to finish at 1 over.

Couples is skipping the AT&T Championship this week in San Antonio.

"I'd have to say it is important, but I physically couldn't play next week," Couples said. "I'm exhausted. If I played next week, I wouldn't be ready for the Schwab Cup.

"I physically couldn't play next week I'm drained. I'd get a couple of days off and then have to play in the Wednesday pro-am and the Thursday pro-am."

Quoted from: http://www.pgatour.com

Daily-Wrap-up: Round 4, Shriners Hospitals

LAS VEGAS (AP) -- In a swift and shocking finish, Jonathan Byrd won a three-man playoff Sunday with a hole-in-one on the fourth extra hole in the Justin Timberlake Shriners Hospital Open.

Moments earlier, Byrd stood on the 18th green with Martin Laird and Cameron Percy as they discussed whether there was enough light to continue. They agreed to play one more hole -- the 204-yard 17th at the TPC Summerlin.

And the playoff essentially ended with one swing.

It was too dark for Byrd to see his ball land about 10 feet short of the flag and roll into the cup, and even the cheers from a smattering of fans around the green weren't convincing.

"Did that go in?" Byrd asked his caddie.

Almost as stunning was that Byrd remained in the playoff. On the third playoff hole, the par-4 18th, Byrd's approach tumbled over the green and was one hop away from going into the water. Instead, it settled in a clump of grass, he chipped up to 7 feet and made the par putt just to stay alive.

One swing later, he only had to wait for Laird and Percy to hit their shots -- and they both hit into the water -- to come up with his first win of the year.

"I'm in shock," Byrd said, certainly speaking for everyone watching another Fall Series thriller.

Only a week ago, Rocco Mediate won the Frys.com Open at CordeValle by holing a wedge for eagle on the 17th hole of the final round, right after Alex Prugh came within inches of holing out from the tee box with a driver.

This one was even more incredible, and it came at just the right time. Byrd was No. 117 on the money list going into Las Vegas, and his fourth career victory gives him a two-year exemption.

Players have made an eagle with a full swing on the final hole to win tournaments -- Isao Aoki in the Hawaiian Open -- but a walk-off ace is among the rarest moments in golf.

Byrd closed with a 68, and he had to watch four times -- once in regulation, three times in a playoff -- as Laird stood over a birdie putt with a chance to win. That sequence started in regulation, when Laird had a 30-foot birdie try. Laird, the defending champion, shot 69.

Percy, the Australian rookie who needed to win to keep his job on the PGA Tour, earlier holed a 15-foot birdie putt on the last hole for a 67 that allowed him to get into the playoff. They finished at 21-under 263.

Byrd won $774,000 for his first win since the 2007 John Deere Classic.

Webb Simpson was at 22 under and had a one-shot lead until he pulled his tee shot into the water on the 17th and made double bogey. He finished with a 68 and wound up one shot out of the playoff, along with Spencer Levin, who had a 66.

Nick Watney, who lives in Las Vegas and was playing his final tournament before his wedding, had a 66 and tied for sixth with Cameron Beckman, who had a 67.

For those chasing a PGA TOUR card, they now wait two weeks before the final tournament at Disney.

quoted from: http://www.pgatour.com

Insurance

In law and economics, insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for payment. An insurer is a company selling the insurance; an insured or policyholder is the person or entity buying the insurance policy. The insurance rate is a factor used to determine the amount to be charged for a certain amount of insurance coverage, called the premium. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice.

The transaction involves the insured assuming a guaranteed and known relatively small loss in the form of payment to the insurer in exchange for the insurer's promise to compensate (indemnify) the insured in the case of a large, possibly devastating loss. The insured receives a contract called the insurance policy which details the conditions and circumstances under which the insured will be compensated.




1. Health insurance

Health insurance, like other forms of insurance, is a form of collectivism by means of which people collectively pool their risk, in this case the risk of incurring medical expenses. The collective is usually publicly owned or else is organized on a non-profit basis for the members of the pool, though in some countries health insurance pools may also be managed by for-profit companies. It is sometimes used more broadly to include insurance covering disability or long-term nursing or custodial care needs. It may be provided through a government-sponsored social insurance program, or from private insurance companies. It may be purchased on a group basis (e.g., by a firm to cover its employees) or purchased by an individual. In each case, the covered groups or individuals pay a fee, premium, or tax---to help protect themselves from unexpected healthcare expenses. Similar benefits paying for medical expenses may also be provided through social welfare programs funded by the government.

By estimating the overall risk of healthcare expenses, a routine finance structure (such as a monthly premium or annual tax) can be developed, ensuring that money is available to pay for the healthcare benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity.

2. Accidental death and dismemberment insurance

Accidental Death and Dismemberment (also known as AD&D) is a term used to describe a policy that pays benefits to the beneficiary if the cause of death is due to an accident.

In the event of an accidental death, this insurance will pay benefits in addition to any life insurance held. Some of the covered accidents include traffic accidents, exposure, homicide, falls, heavy equipment accidents, and drowning. Accidental deaths are the fifth leading cause of death in the US[2]. Death by illness, suicide, or natural causes are generally not covered by AD&D. Some insurers will even cover an accidental death caused from war or terrorism.

3. Dismemberment
Fractional amounts of the policy will be paid out if the covered employee loses a bodily appendage or sight because of an accident. Additionally, AD&D generally pays benefits for the loss of limbs, fingers, sight and permanent paralysis. The types of injuries covered and the amount paid vary by insurer and package, and are explicitly enumerated in the insurance policy.

4. Coverage Types

There are four common types of group AD&D plans offered in the United States:

• Group Life Supplement - the AD&D benefit is included as part of a group life insurance contract, and the benefit amount is usually the same as that of the group life benefit;
• Voluntary - the AD&D is offered to members of a group as a separate, elective benefit, and premiums are generally paid as a payroll deduction;
• Travel Accident (Business Trip) - the AD&D benefit is provided through an employee benefit plan and provides supplemental accident protection to workers while they are traveling on company business (the entire premium is usually paid by the employer);
• Dependents - Some group AD&D plans also provide coverage for dependents.

General information

American General Life and Accident Insurance Company 1. History of American General Life and Accident Insurance Company American General Life and Accident Insurance Company (AGLA) is committed to serving the needs of today's middle market. We offer a focused, supported approach to provide a secure future for our customers through affordable solutions that help meet a lifetime of financial needs–solutions such as protecting loved ones, bringing college dreams to life and providing for retirement. We back these solutions with personal customer service, an increasingly sought-after service in the middle-market segment. Competitively priced life insurance, annuity and accident and health products are available to satisfy the financial needs and risk tolerance of our customer base. 2. Our History American General Life and Accident Insurance Company was incorporated February 28, 1900 under the laws of the State of Tennessee as “The National Sick and Accident Association of Nashville.” The Company became a wholly owned subsidiary of NLT Corporation (NLT) in 1968. In 1982, American General Corporation (AGC), based in Houston, Texas, acquired NLT and its subsidiaries. The Company adopted its current name in 1984. In 1991, Gulf Life Insurance Company was merged into American General Life and Accident. In 1997, The Independent Life and Accident Insurance Company merged into American General Life and Accident. Also in 1997, Home Beneficial Insurance Company merged into American General Life and Accident. 3. Contact Questions? Need Help? Click here to Contact Customer Service 1-800-888-2452 American General Life and Accident Insurance Company American General Center MC 338N Nashville TN 37250

Symptoms and Diagnosis of Cancer

Diagnosis Cancer is suspected based on a person's symptoms, the results of a physical examination, and sometimes the results of screening tests. Occasionally, x-rays obtained for other reasons such as an injury, show abnormalities that might be cancer. Confirmation that cancer is present requires other tests (termed diagnostic tests). After cancer is diagnosed, it is staged. Staging is a way of describing how advanced the cancer has become, including such criteria as how big it is and whether it has spread to neighboring tissue or more distantly to lymph nodes or other organs. Screening Screening tests serve to detect the possibility that a cancer is present before symptoms occur. Screening tests usually are not definitive; results are confirmed or disproved with further examinations and tests. Diagnostic tests are performed once a doctor suspects that a person has cancer. Although screening tests can help save lives, they can be costly and sometimes have psychologic or physical repercussions. Screening tests can produce false-positive results—results that suggest a cancer is present when it actually is not. False-positive results can create undue psychologic stress and can lead to other tests that are expensive and risky. Screening tests can also produce false-negative results—results that show no hint of a cancer that is actually present. False-negative results can lull people into a false sense of security. For these reasons, there are only a small number of screening tests that are considered reliable enough for doctors to use routinely. Doctors determine whether a particular person is at special risk for cancer—because of age, sex, family history, previous history, or lifestyle—before they choose to perform screening tests. The American Cancer Society has provided cancer screening guidelines that are widely used. Other groups have also developed screening guidelines. Sometimes recommendations vary among different groups, depending on how the groups' experts weigh the relative strength and importance of available scientific evidence. In women, two of the most widely used screening tests are the Papanicolaou (Pap) test to detect cervical cancer and mammography to detect breast cancer. Both screening tests have been successful in reducing the death rates from these cancers in certain age groups. In men, prostate-specific antigen (PSA) levels in the blood may be used to screen for prostate cancer. PSA levels are high in men with prostate cancer, but levels also are elevated in men with noncancerous (benign) enlargement of the prostate. As such, the main drawback to its use as a screening test is the large number of false-positive results, which generally lead to more invasive tests. Whether the PSA test should be used routinely to screen for prostate cancer is unresolved, with varying recommendations from different groups. Men over 50 should discuss the PSA test with their doctor. A common screening test for colon cancer involves checking the stool for blood that cannot be seen by the naked eye (occult blood). Finding occult blood in the stool is an indication that something is wrong somewhere in the gastrointestinal tract. The problem may be cancer, although many other disorders, such as ulcers, hemorrhoids, diverticulosis (small pouches in the colon wall), and abnormal blood vessels in the intestinal walls, can also cause small amounts of blood to leak into the stool. In addition, taking an aspirin or another nonsteroidal anti-inflammatory drug (NSAID) or even eating red meat can temporarily produce a positive result. Positive results on the most commonly used test can occasionally be caused by consuming certain raw fruits and vegetables (turnips, cauliflower, broccoli, melons, radishes, and parsnips). Some people with blood in the stool may have negative test results because they have consumed vitamin C. Newer screening tests for occult blood that use a different technique are much less susceptible to such errors but are somewhat more costly. Outpatient procedures such as sigmoidoscopy and colonoscopy are also often used for colon cancer screening. Some screening tests can be done at home. For example, monthly breast self-examinations may help women detect breast cancer. Periodically examining the testes may help men detect testicular cancer, one of the most curable forms of cancer, especially when diagnosed early. Checking the mouth for sores may help detect mouth cancer in an early stage.

Cancer Screening Recommendations
Procedure	Frequency
Skin cancer
Physical examination	Should be part of a routine checkup; more frequent examinations may be needed for people at high risk for developing skin cancer
Whole-body photography	Not routinely needed; may be helpful for people with multiple moles or in whom examination of the skin is difficult
Lung cancer
Chest x-ray	Not recommended on a routine basis
Sputum cytology	Not recommended on a routine basis
Low-dose spiral computed tomography	Not recommended on a routine basis, but is under investigation
Rectal and colon cancer
Stool examination for occult blood	Yearly after age 50†
Sigmoidoscopic or colonoscopic examination	Every 5 years beginning at age 50 (sigmoidoscopy)† Every 10 years beginning at age 50 (colonoscopy)
Prostate cancer
Rectal examination	Yearly after age 50
Blood test for prostate-specific antigen	Yearly after age 50
Cervical cancer
Papanicolaou (Pap) test	Annual regular Pap test (or newer liquid-based Pap test every 2 years) beginning between ages 18 and 21. Some women 70 years of age or older who have had 3 or more normal Pap tests in a row may choose to stop having cervical cancer screening. For women over 30, some doctors recommend testing every 3 years with a conventional Pap test plus the human papillomavirus DNA test
Breast cancer
Breast self-examination	Consider monthly self-examinations after age 20
Breast physical examination by health care provider	Every 3 years between ages 20 and 39, then yearly
Mammography	Yearly, starting at age 40
*Recommendations for screening are influenced by many factors. These screening recommendations are for asymptomatic people with an average risk of cancer. For people with a higher risk, such as those with a strong family history of certain cancers or those who have had a previous cancer, screening may be recommended more frequently or to start at a younger age. Screening tests other than those listed here may also be recommended. Furthermore, other organizations, such as the U.S. Preventive Services Task Force, may have slightly different recommendations. A person's physician can help the person decide when to begin screening and which tests should be used. †The combination of yearly stool examination for occult blood and sigmoidoscopy every 5 years is preferred over either of these options alone.

Diagnostic Tests and Staging

Diagnosis

Usually, when a doctor first suspects cancer, some type of imaging study, such as x-ray, ultrasonography, or computed tomography (CT), is performed. For example, a person with chronic cough and weight loss might have a chest x-ray; a person with recurrent headaches and trouble seeing might have a CT scan or magnetic resonance imaging (MRI) of their head. Although these tests can show the presence, location, and size of an abnormal mass, they cannot confirm that cancer is the cause. Cancer is confirmed by finding cancer cells on microscopic examination of samples from the suspected area. Usually, the sample must be a piece of tissue, although sometimes examination of the blood is adequate (such as in leukemia). Obtaining a tissue sample is termed a biopsy. Biopsies can be performed by cutting out a small piece of tissue with a scalpel, but very commonly the sample is obtained using a hollow needle. Such tests are commonly done without the need for an overnight hospital stay (outpatient procedure). Doctors often use ultrasonography or a CT scan to guide the needle to the right location. Because biopsies can be painful, the person is usually given a local anesthetic to numb the area.

In people with findings on examination or imaging tests that suggest cancer, measuring blood levels of tumor markers may provide additional evidence for or against the diagnosis of cancer. In people who have been diagnosed with certain types of cancer, tumor markers may be useful to monitor the effectiveness of treatment and to detect possible recurrence of the cancer. For some cancers, the level of a tumor marker drops following treatment and increases if the cancer recurs

Selected Tumor Markers
Tumor Marker	Description	Comment About Testing
Alpha-fetoprotein (AFP)	Levels may be raised in the blood of people with cancer of the colon. Blood levels may also be elevated in patients with other cancers or noncancerous conditions.	Testing can be useful in diagnosing these cancers and in monitoring treatment.
Beta-human chorionic gonadotropin (ß-HCG)	This hormone is produced during pregnancy but also occurs in women who have a cancer originating in the placenta and in men with various types of testicular cancer.	Testing can be useful in diagnosing such cancers and in monitoring treatment.
Beta2 (ß2)-microglobulin	Levels may be raised in people with multiple myeloma or other cancers of blood cells.	This test cannot be recommended for cancer screening.
Calcitonin	Produced by certain cells in the thyroid gland (C cells). Blood levels elevated in medullary thyroid cancer.	May be used to monitor response to treatment of medullary thyroid cancer.
Carbohydrate antigen 125 (CA-125)	Levels may be increased in women with a variety of gynecological diseases, including ovarian cancer.	This is not recommended for routine cancer screening.
Carbohydrate antigen 19-9 (CA 19-9)	Levels may be increased raised in people with cancers of the digestive tract, particularly pancreatic cancer.	This test cannot be recommended for cancer screening.
Carbohydrate antigen 27.29 (CA27.29)	Levels may be increased in people with breast cancer.	This test cannot be recommended for cancer screening.
Carcinoembryonic antigen (CEA)	Levels may be raised in the blood of people with cancer of the colon. Blood levels may also be elevated in patients with other cancers or noncancerous conditions.	After surgery for colon cancer, testing can be useful in monitoring treatment and detecting recurrence.
Lactate dehydrogenase	Levels can be raised for a variety of reasons.	This test cannot be recommended for cancer screening. However, it is useful in assessing prognosis and monitoring treatment, particularly for people with testicular cancer, melanomas, and lymphomas.
Prostate-specific antigen (PSA)	Levels are raised in men with noncancerous (benign) enlargement of the prostate and often are considerably higher in men with prostate cancer. What constitutes a meaningfully abnormal level is somewhat uncertain, but men with an elevated PSA level should be evaluated further by a doctor.	Testing can be useful in screening for cancer and in monitoring its treatment.
Thyroglobulin	Elevated blood levels may occur in patients with thyroid cancer or benign thyroid conditions.	This test cannot be recommended for routine screening but may be helpful for monitoring response to treatment of thyroid cancer.
*Because tumor markers can also be produced by noncancerous tissue, doctors generally do not use them to screen healthy people. Exceptions may include PSA for prostate cancer and AFP for patients at risk for hepatoma. In families with inherited medullary thyroid cancer, a rare condition, calcitonin blood levels also may be a useful screening test.

Staging

When cancer is diagnosed, staging tests help determine how extensive the cancer is in terms of its location, size, growth into nearby structures, and spread to other parts of the body. People with cancer sometimes become impatient and anxious during staging tests, wishing for a prompt start of treatment. However, staging allows doctors to determine the most appropriate treatment as well as helping to determine prognosis.

Staging may use scans or other imaging tests, such as x-ray, CT, MRI, bone scintigraphy, or positron emission tomography (PET). The choice of staging test(s) depends on the type of cancer, as different cancers involve different parts of the body. CT scanning is used to detect cancer in many parts of the body, including the brain and lungs and parts of the abdomen, including the adrenal glands, lymph nodes, liver, and spleen. MRI is of particular value in detecting cancers of the brain, bone, and spinal cord.

Biopsies are often needed for staging and can sometimes be done together with the initial surgical treatment of a cancer. For example, during a laparotomy (an abdominal operation) to remove colon cancer, a surgeon removes nearby lymph nodes to check for spread of the cancer. During surgery for breast cancer, the surgeon biopsies or removes lymph nodes located in the armpit to determine whether the breast cancer has spread there; this information along with features of the primary tumor helps the doctor determine whether further treatment is needed. When staging is based only on initial biopsy results, physical examination, and imaging, the stage is referred to as clinical. When the doctor uses results of a surgical procedure or additional biopsies, the stage is referred to as pathologic. The clinical and pathologic stage may differ

In addition to imaging tests, doctors often obtain blood tests to see if the cancer has begun to affect the liver, bone, or kidneys.

Quoted from: http://www.merck.com

Aids diabetics with peer support

Pairing people with diabetes who are struggling to control their blood sugar levels with their peers for weekly support sessions could be an effective and inexpensive way to help manage the disease, researchers say.

Such a program was linked with significantly reduced blood sugar levels in male veterans with diabetes, according to a new study appearing in the Oct. 19 issue of the Archives of Internal Medicine.

The authors initially identified almost 1,700 veterans who might be eligible for the trial, but were only able to enroll 244. The 200-plus participants, all male, were randomized either to be matched up with another diabetes patient for weekly peer support and the option of attending group sessions, or to undergo one educational training and then receive care from a nurse care manager. 

According to study author Dr. Michele Heisler, this model of peer support is less hierarchical than most systems in the United States.

“We explicitly wanted to test whether patients who were having self-management challenges and … [who] had dangerously high blood sugar levels over the prior three months … might be better motivated themselves if given the opportunity to both help and receive help from another participant facing similar self-management challenges and who also had poor control,” explained Heisler, who is a research scientist with the Center for Clinical Management Research at the Ann Arbor VA. 

This appeared to be the case: Men in the peer-support group saw a significant drop in their HbA1c levels (a measure of blood sugar over time) — from an average of 8.02 to 7.73 percent over six months, which represented a 0.58 percent decrease from those in the control group, who received care from a nurse. 

“That is equivalent to adding a new oral anti-hyperglycemic medication and a very clinically significant difference,” said Heisler, who is also associate professor of internal medicine and health behavior and health education at the University of Michigan Medical School. 

Blood pressure dropped slightly (although not significantly) in both groups, and no adverse effects were noted in either. Eight patients in the peer group also started on insulin during the trial, as opposed to just one in the control group, indicating that peer support may also be instrumental in convincing often-resistant patients to initiate insulin therapy, the authors stated. 

Further study is needed to tease out which parts of a peer group intervention are most successful, concluded the authors, who noted that their research was limited in that it involved only men, lasted just six months, and was not a double-blind study.

In addition to the weekly telephone calls, patients in the peer group met about four-and-a-half hours more than those in the control group, which probably accounted for at least some of the improvement, said Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City. 

“In diabetes, every time we spend more time with the patient – it could be a [nurse], a physician, or a Johnny-do-gooder, it reminds the patient to do something or to be more engaged,” he said. “The outcomes short-term tend to be better.”

Zonszein pointed out that almost 1,000 veterans contacted declined to participate, a fact which he said may not bode well for the success of this type of system in the real world.

However, he said, such programs may “play a role, especially in minority populations where either language or ethnicity is very different from our traditional American population. They really help the bridging between health-care providers.”

Peer educators may “almost be better suited for [certain] important ingredients of diabetes self-management,” added Sharon Movsas, a certified diabetes educator who, like Zonszein, is with Montefiore Clinical Diabetes Center. “The patient needs to feel empowered and confident… It’s not so much knowing what to eat but ‘how am I going to change my behavior?’ That involves problem-solving and goal-setting skills and the evidence shows that … the person can relate better to a peer who might have more similarities than a teacher in the front of the room.”

quoted from: http://news.health.com

Harvard lawyer Write "Fight Less, Love More"

Harvard lawyer and couples mediator Laurie Puhn has written Fight Less, Love More: 5-Minute Conversations to Change Your Relationship without Blowing Up or Giving In. As Puhn explains, “Many of my clients have these foolish disagreements with their partner but they don’t realize it until I point it out to them." Below, an excerpt of her book reveals two common types of arguments couples often have--and how to avoid them the healthy way.

1. The Dumb Premature Argument

Hector and Maria live in an apartment but hope to buy a house someday. Every time they visit a friend who lives in a house, their drive home provides ample time for squabbling about whether they should buy a ranch-style home like the one Maria grew up in or a two-story colonial like the one Hector’s family had. They argue vehemently about the pros and cons of each style, but the silly thing is, they aren’t planning to move out of their apartment until their toddler is ready for kindergarten, at least 3 years from now. Even if they managed to argue their way to a decision now, in all likelihood they would have to reargue the same issue in 3 years anyway, because people’s preferences, incomes, and family situations change over time.

The Wise Tactic

If the outcome of any argument can’t be acted upon for a long time, it’s a dumb premature argument. As much as you might want to voice your side now, you’ll only be wasting time and energy—and adding unnecessary conflict to your relationship. When you realize that you’re arguing about something that doesn’t need an immediate decision, it’s wise to short-circuit the fight by saying, “Why don’t we wait to have this discussion until we actually need to?” In the case of Hector and Maria, one of them simply needs to say, “Why are we wasting our time arguing about this now? Let’s make a pact not to debate our design preferences until we’re actually ready to buy a house!” This will give your partner the ability to retreat gracefully with a comment like “That’s a good idea. I don’t know why we started talking about this now anyway.”

2. The Dumb Factual Argument

My husband and I were driving to a 99¢ store to buy some party supplies. I mentioned, “You know, a lot of these so-called 99¢ stores charge more than 99¢ for many of the items they sell.”

“Not possible,” he said. “All 99¢ stores sell everything at that price. That’s why they’re called 99¢ stores.”

“That’s not true. You don’t know because you haven’t been to one. The 99¢ thing is just a way to get more people into the store,” I explained.

“Why would they call it a 99¢ store if it’s not one?” he shot back, still trying to convince me.

“Wait a minute,” I blurted out. “This is a dumb argument. We’re arguing about a fact. Why don’t we just hold on for 10 minutes, get to the store, and we’ll have our answer?” He agreed, so we shut our mouths and found the answer in the store. (I was right!).

The Wise Tactic:

Have you ever found yourself getting agitated because your partner says you’re wrong when you’re sure you’re right? Or have you found yourself trading “It’s true” and “No, it isn’t” until you’re both blue in the face? Those are all familiar set-up words for the dumb factual argument. Instead, when you are bickering about a fact like an address, a name, or a statistic, recognize this and say, “Hey, we’re arguing about a fact. Let’s just find out the information instead of fighting about it.” In less than 5 minutes, you’ll have your answer and avoid an argument over nothing.

The 5-minute Conversation: Short-Circuit a Dumb Argument

1. Admit Your Error
Switch gears as soon as you realize you shouldn’t have picked this foolish battle. Recognize that you are engaged in a premature argument or arguing about a fact, or any of the other common tiffs I discuss in my book Fight Less, Love More. Then, hold up your hands as if to surrender and admit your error with a simple comment that identifies why you’re having a dumb argument. For example, you could say, “Wait a second. I shouldn’t have said that. This is silly because we are having a dumb argument about something that’s a fact.”

2. No Buts About It
If your mate doesn’t want to short-circuit the argument and tries to continue with a comment like “But just let me explain,” let him or her talk and then short-circuit the potential argument again by saying, “Well, that could be, but there’s no point in debating it.” Just keep up that response and your partner will eventually have to let the argument go.

quoted from: http://www.womenshealthmag.com