text:
Tackling River Traffic Pollution
By Kristin Espeland
Published February 9, 2010 at 9:00 PM EST
Listen NowOn this morning, Ron Bledsoe, the captain of the James E. Anderson, is in radio contact with one of his deckhands."OK, you need to slide over to your port about seven inches.""Coming up..."They're working together to get their towboat and the 15 barges of coal they're hauling safely through a lock on the Ohio River."That's beautiful right now. Jerking a wire on you."
Each year, diesel powered boats like the Anderson move about 42 million tons of cargo in the Port of Pittsburgh, the second busiest inland port in the country. Jim McCarville directs The Port of Pittsburgh Commission. He says commercial river boats are leaner and greener than some land- based freight carriers."We do move on the waterways cargo more efficiently both in fuel consumption and emission controls just by moving it on the water. "McCarville says if trucks carried all the cargo handled each year in the port, they'd use 50 million more gallons of diesel fuel and spew tons more carbon monoxide and nitrogen oxides."Folks like the Port of Pittsburgh are using valid calculations."That's Jim Corbett , a professor of marine and earth studies at the University of Delaware. Corbett is one of the first people to study riverboat emissions. He found that while tugs and towboats do emit less pollution than trucks, their engines still pollute."We found that the emissions from waterway activity were not negligible . What we're talking about in general is the sort of ambient air quality problems that are associated with human health and their sources."
Corbett's research puts commercial riverboats in this region's top- ten list of nitrogen oxides polluters. Nitrogen oxides help to form smog, particulate matter pollution and acid rain which contribute to serious heart and lung problems. Even so, riverboat emissions escaped regulation for years. The first marine engine emission law was finalized in 1999. Tougher standards were put into place just two years ago. Byron Bunker with EPA's Division of Transportation and Air Quality says the reason is "evolving technology.""It's not that we've forgotten that marine was out there but rather we've been enforcing the introduction of new technology as quickly as it can. Technologies will come from land-based construction and agricultural equipment."Right now, EPA standards call for low-sulfur diesel fuel and emission- reducing upgrades in marine engines. Chuck Minton is president of Campbell Transportation, a small riverboat company in Washington County, Pennsylvania. He's discovered that engine overhauls will pay for themselves pretty quickly."You're looking at a fuel savings in the 10 to 15% range when compared to the older technology."But EPA wants new marine engines that use catalytic technology beginning in 2014.These ultra clean- burning engines could cost anywhere from two to four million dollars apiece. The Environmental Protection Agency figures that most riverboat companies will have new engines in place in about 20 years. The agency projects that will mean an 80% drop in nitrogen oxides and particulate matter and billions in health savings.Back on the James Anderson, chief engineer Austin Davenport keeps his eye on the boat's two huge diesel powered engines."We are responsible carriers. We are all concerned about the environment. You know, the river is what makes our livelihood so we have to give back that which we take from."The Ohio River is a busy highway. From barges piled high with coal to the tug boats that guide them, the traffic never stops from Cairo (KAY-roh) to Pittsburgh. And that traffic is causing more pollution than you might think. For the Ohio River Radio Consortium, Ann Murray takes us to the Port of Pittsburgh to find out what is—and isn't—being done about it.
News porttug boatohio rivercoalairbargespollutionemissions
Kristin Espeland
See stories by Kristin Espeland
Southern Ind. interstate ramp to have alternate lane closures as part of Sherman Minton Renewal
Kentucky coal ash is contaminating groundwater, but companies argue they're in compliance
Coal company CEO indicted on federal money laundering charges
Kentucky AG Cameron On West Virginia Coal Plant: Close It


text:
Q: Relative include paths of different Fortran preprocessors Consider the following directory tree:
test.F90
test/
├─ a.inc
└─ b.inc

With the following file contents:

*

*test.F90:

#include "test/a.inc"
end

*

*a.inc:

#if defined(__GFORTRAN__) | defined(__PGI) | defined(__NVCOMPILER)
#  include "b.inc"
#else
#  include "test/b.inc"
#endif

#include "b.inc"
#include "b.inc"

*

*b.inc:

print*,'!'

The GNU (gfortran 11.1.0) and Nvidia (nvfortran 22.9) compiler preprocessors search for the file to be included in the directory relative to the current file. E.g. b.inc should be included inside of a.inc with #include "b.inc".
The Intel (ifort 2021.8.0, ifx 2023.0.0) and NAG (nagfor 7.1) compiler preprocessors search for the file to be included in the directory relative to the first file to invoke #include. E.g. b.inc should be included inside of a.inc with #include "test/b.inc" because a.inc is included in test.F90. However, it only applies for the first #include command. In all consequent #include commands, the directory is "changed" to test and #include "b.inc" can be used. While multiple #include "test/b.inc" commands also work in the Intel compiler, the code doesn't compile with the NAG compiler if the consequent paths are changed to test/b.inc.
Is this the intended behavior of the Intel and NAG compiler preprocessors? Is there a way to make the behavior of the #include command independent of the used compiler (and avoid the first 5 lines in a.inc)?

A: Intel and NAG have replied and agreed that this behavior is a bug of their preprocessors (fpp and fdfpp, respectively). This bug will be fixed in future releases. (The bug report for the Intel compiler is CMPLRLLVM-45307.)
A somewhat not very elegant solution to make this preprocessor behavior compiler-independent is to change the directory tree: distribute the files in different folders on the same level, and, in the path of #include, always go up one level in the directory tree first and then to the desired file.
Example

*

*Directory tree:

d1/
├─ test.F90
└─ b.inc
d2/
├─ a.inc
└─ b.inc

*

*d1/test.F90:

#include "../d2/a.inc"
end

*

*d2/a.inc:

! Even though "d2/b.inc" is in the same directory as "d2/a.inc", go up one level first
#include "../d2/b.inc"
#include "../d2/b.inc"

#include "../d1/b.inc"

*

*d2/b.inc:

print*,'Hello from d2/b.inc'

*

*d1/b.inc:

print*,'Hello from d1/b.inc'

All compilers will print the expected output:
 Hello from d2/b.inc
 Hello from d2/b.inc
 Hello from d1/b.inc

redpajama_set_name: RedPajamaStackExchange


COLUMBUS - The Savannah Sand Gnats scored three runs in the first inning and held on for a 4-3 victory over the Columbus Catfish Saturday night, snapping a six-game losing streak.
The Sand Gnats (13-35), who entered the game with the worst record in the minor leagues, had three hits in the inning off Columbus starter Jeremy Hellickson.
Josh Thole had an RBI double after a leadoff walk by Joe Holden and a one-out single by Greg Veloz. Leivi Ventura followed with a sacrifice fly to center, scoring Veloz from third, and Brahiam Maldonado had an RBI single with two outs to bring home Thole.
After Columbus (32-17) scored two runs in the bottom of the third, Savannah added a run in the top of the fourth on an RBI single by Daniel Stegall with one out to make it 4-2.
The Catfish rallied for a run in the bottom of the ninth to pull within 4-2 and had a runner on third with two out. But Ryan Meyers got Cesar Suarez to fly out to center to earn his fifth save of the season for the Sand Gnats.
Tobi Stoner picked up the victory for Savannah, allowing just two unearned runs on six hits in six innings.
Hellickson took the loss for Columbus, giving up four runs on seven hits in just four innings.
E-Veloz, Suarez 2. LOB - Savannah 9, Columbus 9. 2B-Thole, Matulia, Dhaenens. SH-Lagares. SF-Ventura. CS-Matulia, Royster.
BK-Noel. HBP-Pellot (by Hellickson). T-2:51. A-1,125.


HEMP IS THE most versatile and useful plant on Earth!
It is an ecological and locally sourced solution to many current problems. All parts of this simple plant can be utilized to create thousands of useful products.
Requiring no insecticides, herbicides or fungicides to grow, hemp is the ecological crop of choice. It is beneficial for soils and is an ideal addition in crop rotations, while being a profitable production for farmers.
Ever heard about hempcrete or hemp insulation? From floor to ceiling, you can build or renovate with healthy, sustainable and renewable products. A great option for self-builders and specialized professionals.
Hemp has unparalleled nutritional qualities. Packed with proteins and omega 3, it has one of the most complete nutritious profiles of all plants. There are many ways to consume it and it is both versatile and delicious!
Forget the "jute bag" look: hemp is used to create refined fabrics and very modern clothes. It's a much more environmentally friendly crop than cotton, and hemp textile is also more durable and comfortable.
Hemp plastics offer an excellent alternative to those made from petroleum! Depending on their composition, they are recyclable or compostable at the end of their usable life. The way to go!
Hemp grows to maturity in 3 to 4 months and contains 25% more cellulose than wood. It also requires a lot less chemical treatments and produces high quality paper and cardboard.
Hemp oil is a champion for moisturizing and nourishing the skin. Incorporated into natural care products, it can be used in shampoos, soaps and skin creams, and replace less sustainable options such as palm oil.
No wonder animals love to eat hemp: they instinctively know it's good for them! And not only as food but also as bedding, care products and even medicines. Animals too can benefit from the benefits of hemp!
Hemp produces a large amount of biomass that can be converted into clean and economical fuels. It is an excellent alternative to non-renewable fossil fuels.
Essential for humanity for 10,000 years, hemp has long since proven its usefulness. Unjustly banned for 60 years but recently legalized, hemp is now regaining its former nobility for its many benefits.
We are the ambassadors of hemp, dedicated to promoting its uses, its benefits, and its products. We want to give it back its nobility and see it everywhere! From pantries to wardrobes, from pharmacies to building materials.
Because we see in this unique plant a way to combine two aspects which are often incompatible: a comprehensive ecological solution to many of today's environmental problems AND a unique opportunity for our local economies. The plant of the future that we need now!
To spread hemp among the greatest number, we combine various means of action, on the internet and in the field. We travel across Canada on our bus to meet the public, the media and industry players. A unique and original approach that we relay also on social networks.
Tour Bus 2019. Follow us, don't miss the bus!
Nicolas Martel, Mayor of Desbiens, hopes to see the development of a hemp processing plant in his municipality. In the eyes of Claude Girard, of Hempen Valley Co Ltd, the next challenge of the sector is industrialization, is the production and processing of hemp on a large scale.
Stay tuned ! Subscribe to our mailing list.


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Women, History, and Theory: The Essays of Joan Kelly 1st Edition by Joan Kelly and Publisher University of Chicago Press. Save up to 80% by choosing the eTextbook option for ISBN: 9780226430294, 0226430294. The print version of this textbook is ISBN: 9780226430287, 0226430286.


Apologies for not blogging yesterday, I simply ran out of time!! Not enough hours in the day hey?
So I'm tired, probably the main reason I didn't blog last night, so, so, so very tired. Darcie's asthma is seemingly at bay and so today its time to get back on the sleep training business!
Jamie had Darcie whilst I worked today, and managed to get her to go to sleep by herself in her cot and so fingers crossed I can do the same tonight. For me and Jamie need our sleep!
.... Just thought I would update we tried cry it out again. I put her in her cot, and left her for 5 mins then we had a min cuddle, put her back and left her for 5 mins then we had a min cuddle, put her back and she feel asleep two minuets later... I think were getting somewhere!!!


text:
6 signs you should sell your home, according to experts
Selling your home is a major life choice that involves your likely most important asset.
We asked experts what the perfect time is for people to sell their home.
They told us six of the biggest signs that it's time to put your home on the market.
Your home is probably your most valuable asset.
So how do you know when it's time to maximize your return on that very important investment?
Unlike buying and selling stocks, your home carries a ton of emotional baggage, so it's not simply a matter of buying low and selling high.
"Selling a home is never really a market-driven issue. It's a lifestyle decision," Holly Mellstrom, associate broker with Julia B. Fee Sotheby's International Realty, told Business Insider.
We asked Mellstrom and financial planner Marc J. Lane for their advice on when the perfect time is to put your home on the market.
Here are their six biggest signs that it's time to sell your home.
SEE ALSO: 8 essential, low-budget renovations that will make your home more appealing to millennial buyers
DON'T MISS: 7 things the average person can flip for a profit
Your family is outgrowing your current home
Urban-dwelling families with young children have a lot more to consider than closets bursting at the seams and tiny apartments chock-full of baby gear.
A neighborhood that was great for a couple or a family with small kids may not be quite so desirable when it's time to start thinking about school.
"The number one reason why people sell their home is that they've outgrown their space because their family is getting bigger and they're shopping for a school district," Mellstrom told Business Insider.
The mortgage and taxes on a bigger home may be intimidating, but so is private school …read more
Source:: Business Insider
Apple slides after analyst downgrades it to… Shares of Apple fell 1.5% in early trading on Monday after Rosenblatt Securities downgraded the iPhone maker from to "sell" from "neutral." Analyst Jun Zhang highlighted flat sales for the iPhone in June and a potential slowdown in production of the iPhone XR as the reasons for the downgrade. Zhang also said Apple's service revenue could begin to slowdown as well. Watch Apple trade live. The future of Apple's most successful product line is looking dim. Apple's stock fell by roughly 1.5% in early trading on Monday morning after receiving a downgrade from Rosenblatt Securities due to slow iPhone sales…
Motorola expands iFixit partnership to sell… Last year, Motorola began making its phones easier to repair by partnering with iFixit to provide official replacement parts and kits directly to customers. Today, the companies announced that they're expanding that program to Europe as well. Like the US program, the European iFixit store will now offer repair parts for a variety of Motorola phones along with premade kits that also include all of the necessary tools. This is designed to go hand-in-hand with iFixit's step-by-step repair guides (which, fittingly for the European expansion) are available in French, German, and English. Official parts will still void your warranty, though…
New Microsoft Azure service helps companies share… Rohan Kumar, corporate vice president for Microsoft Azure Data.A new cloud service unveiled by Microsoft today sets the stage for the company's customers to share and monetize some of their most valuable internal data. The new Azure Data Share service, announced as a preview Thursday afternoon, comes at a time of heightened concerns about the use and monetization of data by big companies. Microsoft, which has largely avoided that minefield in its own business, says it sees big potential in giving other companies a way to easily share data with partners and business customers. In many cases, the internal data…

redpajama_set_name: RedPajamaCommonCrawl


text:
Lily Hohenstein, (* 11. Mai 1896 in Darmstadt, Hessen, Deutschland; † 28. September 1984 ebenda) war eine Schriftstellerin.

Leben
Lily Hohenstein war verheiratet mit Friedrich August Hohenstein (1875–1949). 1928 erhielt sie für ihr Erstlingswerk "Das Kind und die Wundmale" den Jugendpreis Deutscher Erzähler. In ihren Dichter-Biografien (Friedrich Schiller, Johann Wolfgang von Goethe, Adalbert Stifter u. a.) bemühte sie sich, das Schöpferische der jeweiligen Persönlichkeit zu erfassen. 1949 erhielt sie die Goethe-Plakette des Hessischen Staates. Ab 1973 lebte Hohenstein wieder in Darmstadt. Davor lebte sie einige Jahre – vermutlich mit ihrem Mann (Lehrer und Oberstudienrat) – in Wiesbaden, wie viele ist unklar.

Werke (Auswahl)

 Das Kind und die Wundmale, Deutsche Buch-Gemeinschaft, Berlin 1929
 Ilse Bandeloh. Der Weg einer Frau, Reiner Wunderlich, Tübingen 1934
 Manfred. Ein Streiter fürs Reich, Universitas Deutsche Verlagsgesellschaft, Berlin 1937
 Schiller. Der Kämpfer, der Dichter (Biografie), Verlag Deutsche Buchgemeinschaft, Berlin/Darmstadt 1940 und 1954
 Goethe. Wuchs und Schöpfung (Biografie), Neff Verlag, Berlin 1942
 Wolfram von Eschenbach (Biografie), Neff Verlag, Berlin 1944
 Das sanfte Gesetz von Adalbert Stifter (mit Otto Schrader), Limes Verlag, 1946
 Die Legende vom Venezianischen Glas, Metopen Verlag, 1948
 Besuch in Richterswil, Pattloch Verlag, 1949
 Conrad Ferdinand Meyer (Biografie), Athenäum-Verlag, 1957
 Adalbert Stifter. Lebensgeschichte eines Überwinders (Biografie), Athenäum-Verlag, Bonn 1952
 Die Nächte in St.Wendelin. Der Lebensroman Wolframs von Eschenbach, Greifenverlag, 1969

Ehrungen
Jugendpreis Deutscher Erzähler

Einzelnachweise

Autor
Schriftsteller (Darmstadt)
Deutscher
Geboren 1896
Gestorben 1984
Frau

redpajama_set_name: RedPajamaWikipedia


HOUSTON, TX – It was bike city in downtown this morning, as the "Tour de Houston" brought out thousands of cyclists to brave some slick city streets.
Presented by the Apache Corporation, the money raised go to Houston's "RE-plant Houston" headed up by the Houston Parks and Rec Department.
Those riding the 20 mile route finished just ahead of the rain, but those pushing for that 40 mile ride got a little bit wet. As for the 60 mile riders… well they came prepared.
While a wet ride can be dangerous, the trees really needed it.
As riders here gear up for the MS 150 in April, the cash raised at the "Tour de Houston" means a green and beautiful Houston for a long time to come.


Knox Unflavored Gelatin is perfect for making a wide variety of desserts. This unflavored gelatin powder gives you the classic gelatin texture you know and love while letting you add your own unique flavors to your dish. With zero carbs and 5 calories per serving, no sugar gelatin is a great dessert ingredient for all your favorite recipes. These gelatin packets come individually sealed for lasting freshness until you're ready to enjoy. Unsweetened gelatin is a very useful thickening agent that's great for making parfaits, cheesecake or homemade marshmallows. You can also use fruit juice to flavor the gelatin for a classic treat for kids and adults. This 1 ounce box contains four envelopes.


We have just released a new issue of the Brazilian Journal on Presence Studies, nº. 2, Vol. 5, May-August 2015. This number deals with the theme Drama and Education and includes bilingual articles by researchers from Brazil, France, Canada, and Italy. The articles raise important discussions on the relationship between theatre, drama and education, especially on mediation and training. As usual, the section Other Themes brings varied and important contributions. Please visit www.seer.ufrgs.br/presenca. If you are interested in publishing with us, the journal receives (no fees) contributions all year round, in Portuguese, Spanish, English, and French.


text:
Q: How to download batch subtitles in Youtube-dl? How do I download batch subtitles from a list of links?
Generally I use this command: --all-subs --skip-download URL
How do I batch it to download multiple subtitles?


Originally just a comparison of the ringworld Halo from the game series of the same name, afterwards a few scifi relics were throne in for further comparison. A version without Larry Niven's ringworld is also an option, in case the procedurally generated terrain is too much of a strain on your system. It was only in building this project that I can fully appreciate how ludicrous the original Ringworld is. It's too big. The idea of continents and seas become silly. Artistic renditions go for landmasses, something like what is presented here. Really it ought to look more like a mishmash of color.
The Halo ring has the opposite problem, although to a lesser degree. What appears to be continent-like landmasses are more like what we would consider islands.


text:
Together BFM, FJCU & Fulbright Taiwan to branding career and shaping future for outstanding U.S. students
Creating a multicultural learning environment, and establish a transnational professional network to sparkle up innovation
Honourably, under the participation of Dean of the College of Fashion & Textiles, Dr. Sulee, Tsai and Director of the MA program in Brand and Fashion Management, Prof. Don, Kuo Dung Lin, Executive Director of Fulbright Taiwan(FSR), Dr. Randall Nadeau, Brand and Fashion Management(BFM) master's degree program, Fu Jen Catholic University(FJCU) and Fulbright Taiwan(FSR), Foundation for Scholarly Exchange officially signed a collaboration MOU concertedly to establish a scholarship to support outstanding U.S students who are vigorous to pursue their dreams of study in BFM, FJCU, Taiwan. It is rather a great privilege of BFM program could be chosen as the partnership which is the only one in FJCU, the few of five among other universities in Taiwan by Fulbright Taiwan. Hence, the scholarship will jointly provide two scholarships for US students each year, benefit grantees to study in Taiwan with fully support.
Fulbright scholarly plan is the most iconic international exchange program in the United States. Fulbright CEO Randall Nadeau pointed out that FJCU is truly well known with great reputation in the worldwide. He also showed a keen interest in the branding and fashion design of emerging Asian developments; therefore, he hoped to that the collaboration between Fulbright Taiwan and BFM ,FJCU am will give US grantees the opportunity to explore Taiwan and even develop careers in Taiwan. He is looking forward to this new partnership and believes in Fu University. Branded courses will be favored by many American students who are interested in pursuing a master's degree.
Asia was manufacturing base in the past, but now it has been replaced by many developing countries. The only way out is innovation and design, especially branding capabilities. This is also the original intention of BFM program. Meantime, the Fulbright Taiwan, Foundation for Scholarly Exchange feels also rather honoured to choose and cooperate with the BFM, College of Fashion &Textiles, FJCU, It hopes to attract relevant professionals from the United States to Taiwan, communicates with local students, creates a multicultural learning environment, and establish a transnational professional network to sparkle up innovation.
The MA program in Brand and Fashion Management (BFM) is a two-year program, taught wholly in English. We aim to develop branding and fashion professionals with a vigorous interest in the vast Asia-Pacific market. Our curriculum is broad-based, offering training in marketing, luxury brand management, lifestyle and fashion, and innovation with a sustainable future.
The BFM program was founded under the College of Fashion and Textiles at Fu Jen Catholic University, the kind of comprehensive University that is needed to support the wide range of courses offered by the program. The program is structured on the belief that managing a brand and fashion business is not an exercise of relentless pursuit of profits using managerial techniques. It also has to rely on promotion of high quality life-style and appreciation of aesthetics in life. Based on that belief, BFM brings in faculty from five colleges, together with adjunct professors who have profound industrial experience and distinctive accomplishments, to provide a comprehensive curriculum and strong industrial connections that are required to train the BFM students. With the resources from the University as well as industrial connections, the program is able to cultivate students with comprehensive and up-to-date academic training, empathy for the humanities and social care, value-added brand innovation, the integral practice of interdisciplinary and global perspectives through routine lectures, practical workshops, invited guest speeches, field trips, and internships as well.
About BFM
By training students to have a global vision and develop cross-cultural communication skills, the program offers an international academic environment that acts as a springboard for students to step into the promising Asia-Pacific market. To fill the urgent demand in the Greater China Area for expertise in brand and product management, the program cultivates interdisciplinary future leaders from dimensions of branding, marketing, product development, buying and retailing, sales, and strategic choices.
This master's program was created in 2011 in response to President Ma Ying-Chou's globalization policy which was announced while I was the Dean of the International Education Office in Fu Jen Catholic University. The Brand & Fashion Management Program responds to contemporary trends in the region's changing economy which indicate an urgent need for expertise across a variety of industries, especially in the lifestyle- and fashion-related sectors. In particular, I noticed that as the economic power of the Asia-Pacific region rises sharply, there is an increasing demand for well-trained graduates of this kind. I also recognized the special role Taiwan could play in successfully building such a program.
In this internet age, knowledge is easily accessed. Yet, sustained success in today's competitive world relies on the ability to solve problems independently and think creatively while maintaining a sound and solid commitment to humanity. It was with this mindset that the Brand & Fashion Management curriculum was designed.
This is the very first MA degree program of its kind in the Greater China and Asia-Pacific region. The program aims to cultivate interdisciplinary talent and future leaders equipped with a global vision and skills for cross-cultural communication. We do this by concentrating on fashion as the ideal focal point for successful enterprising.
The program provides students with the most up-to-date academic training and builds students' problem-solving capabilities through practical workshops and purpose-centered internships. Graduates leave the program with the know-how, know-what, and know-why to not only meet the demands of the changing Asia-Pacific job market but also the ability to seek careers in global lifestyle and fashion-related enterprises.
It is my hope that this promising program will continue to evolve through the efforts of everyone involved and that it will soon become the most attractive, appreciated, and successful international master's degree program in the Asia-Pacific region.
Professor Su-Lee Tsai
Executive Director Dr. Randall Nadeau, Director Prof. Kuo Dung Lin and Dean Dr. Sulee, Tsai interviewed by campus reporter after the signing ceremony.
Executive Director of Fulbright Taiwan, Dr. Randall Nadeau and the Dean of the College of Fashion & Textiles, Dr. Sulee Tsai signing the agreement together
MA Program in Brand and Fashion Management(BFM), Fu Jen Catholic University


text:
Search || Home » Cook » Three-parent children in UK possible after HFEA report
Three-parent children in UK possible after HFEA report
BioEdge
The UK is moving closer to three-parent children after the fertility regulator informed the government that the public would back a controversial embryo treatment.
After testing the waters of public opinion, the head of the Human Fertilisation and Embryology Authority, Professor Lisa Jardine, feels that "there is broad support for permitting mitochondria replacement, to give families at risk of mitochondrial disease the chance of having a healthy child. Although some people have concerns about the safety of these techniques, we found that they trust the scientific experts and the regulator to know when it is appropriate to make them available to patients."
The HFEA's findings have been passed to the UK Department of Health, which will make recommendations to Parliament.
About 1 in 6,500 children is affected by a mitochondrial disease. Many of these are lethal; some lead to serious life-long complications. The solution favoured by the HFEA is a complex IVF procedure which involves removing the nucleus of an embryo and transferring it into an enucleated donor egg with healthy mitochondria.
A child born from this procedure would carry the genes of three people since mitochondria contain a small amount of DNA.
The HFEA's advice ignored the concerns of critics, who see it as "crossing the Rubicon" and entering a new world of genetic manipulation.
In a letter to the London Times (March 20), more than 30 bioethicists from around the world expressed grave reservations. "It would be the first time such intentional genetic modifications of children and their descendants were expressly permitted and would open the door to further genetic alterations of human beings with unforeseeable consequences," they wrote.
Germline manipulation is banned under a number of international agreements to which the UK is a signatory. "Intentional germ-line interventions are prohibited in every national jurisdiction that has considered the issue," said the bioethicists. "They are also banned under a number of international legal instruments, such as the Council of Europe's Convention on Human Rights and Biomedicine which prohibits the genetic modification of spermatozoa or ova for procreation."
The California-based Center for Genetics and Society suggested that the HFEA had misrepresented the level of public support, which was based on an on-line survey, polls, focus groups and discussion groups. Taking a closer look at the on-line survey, it found that a majority actually opposed the introduction of mitochondrial replacement. "Clearly this report is meant to 'advance' rather than simply document public reaction," it said. "The picture of 'public support' that the HFEA is now painting is misleading at best."
Despite widespread support for allowing donor-conceived children to know the identities of sperm and egg donors, the HFEA insists that "the resulting child should not have a right to identifying information about the donor, although information exchange and contact could be arranged locally by mutual consent."
Media coverage of the HFEA's announcement was largely benign. But the Huffington Post featured a scathing column by Stuart A. Newman, professor of Cell Biology and Anatomy at New York Medical College, which accused the HFEA of promoting eugenics.
"The ironic lesson of the new drive toward DNA-based eugenics (of which the mitochondrial replacement techniques would be the thin end of the wedge), is that despite its being the special initiative of an avowedly progressive sector of biomedicine, it actually brings together some of the most regressive strains of traditional and modern society: valuation of people according to their biological characteristics, parental proprietorship, the marauding entrepreneur and evolution denialism.
"The HFEA's members may imagine that they are taking cautious steps toward a genetically brighter future, but in actuality they are drawing on darker forces promoting the misuse of technology with clear potential for individual and social harms."
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rocking peach...and leopard, of course.
hope your day is filled with love. and chocolates.
tell me all about your plans for today!
Happy Valentine's Day! Great outfit.
happy belated valentines day! the shoulder detail of that top is so pretty!
So pretty !!! happy valentines day !!!!!!!!!!!!!!
Peach and leopard--what a lovely combo!
That's a cool combination Becks! Happy Valentine's Day!
Love that blouse and its interesting sleeves. Very romantic outfit. Hope you had a great V-day!
Another fantastic outfit. Could that blouse be any more fab??


text:
Participation in Breast Cancer Susceptibility Testing Protocols: Influence of Recruitment Source, Altruism, and Family Involvement on Women's Decisions
Gail Geller, Teresa Doksum, Barbara A. Bernhardt and Sharon A. Metz
Gail Geller
Genetics and Public Policy Studies, Department of Pediatrics, School of Medicine, and Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland 21205
Teresa Doksum
Barbara A. Bernhardt
Sharon A. Metz
DOI: Published April 1999
Objectives. We offered education, counseling, and family-based BRCA1/2 testing to women at increased risk of breast cancer and assessed (a) their reasons for participating and (b) whether source of recruitment, desire to help research (altruism), and the need to communicate with their affected relative about testing distinguish those who did and those who did not complete each phase of our protocol.
Materials and Methods. We sent invitations to 403 women who had completed a questionnaire on BRCA1/2 testing, 178 of whom were considered high risk because they had more than one relative on the same side of the family with early-onset breast cancer.
Results. Among the 132 high-risk respondents from the mid-Atlantic states (where testing was offered), 36% (n = 47) were interested in counseling. Those who actually attended counseling were more likely to have some college education, a higher perceived risk of breast cancer, and a greater fear of stigma and were less likely to have a daughter than those who did not attend. The reasons for attending that were rated "very important" were to learn about the test (80%), to have the test (43%), and to help research (38%). High-risk women were eligible for testing only if their affected relative was willing to be tested and tested positive. After the session, 83% intended to ask their affected relative to be tested, but only half of the affected relatives actually came for pretest counseling. The proportion of participants who ultimately involved an affected relative was 2.5 times higher among women from a clinical population (25%) than among those from a registry population (10%); in this latter population, an altruistic desire to help research was a greater motivator for participation than interest in being tested.
Conclusions. Source of recruitment influences both motivations to attend education and counseling and actual testing behavior. These results have implications for interpretation of findings from studies in research settings as well as for informed consent and decision-making in the context of family-based testing.
It is currently recommended that genetic testing for susceptibility to breast and ovarian cancer (BRCA1/2 testing) not be performed directly on an at-risk woman without first testing an affected relative to determine whether there is a detectable mutation in the family (1 , 2) . The question of what sort of barriers are introduced to the testing process for at-risk women by the necessity of first testing an affected relative has received only minimal attention. The early experience with testing for other disorders, such as Huntington's disease, through linkage studies demonstrates that the need to involve relatives is often a reason why testing is declined (3) . Women may be unwilling to discuss family history with certain key relatives, or family rifts may make communication impossible (4) . One study has shown that women diagnosed with cancer are less favorably disposed to genetic testing than are their at-risk relatives, indicating that some women with breast cancer might be unwilling to undergo testing (2) . The reluctance of the affected relative to share his or her test result with the at-risk individual has also been cited as a potential barrier (5) .
Not only do we know little about the decision-making process of women who are offered "family-based" testing, but we also do not know the degree to which participation in testing protocols is motivated by a desire to help research. There is a substantial body of literature exploring the reasons that individuals participate in randomized clinical trials (in which the participants are ill and half are offered some sort of therapy; Refs. 6, 7, 8, 9, 10, 11, 12, 13) and the impact of selection bias on generalizability of results. There are also studies that explore the reasons that healthy individuals participate in research (14 , 15) . It is well documented in most of these studies that individuals who participate in research are a self-selected group, frequently motivated by an altruistic desire to help others.
To our knowledge, there have been no studies that explore the degree to which an altruistic desire to help research motivates at-risk individuals to participate in predictive genetic testing protocols. Although one study acknowledged self-selection in predictive testing for Huntington's disease (3) , it focused on whether those who are most vulnerable psychologically are selected out, rather than on whether those who want to contribute to science are selected in. Little is known about the effect of selection bias on at-risk women's participation in breast cancer susceptibility testing protocols. We observed in our focus groups (16) that some women are likely to be motivated more by curiosity and altruism than by the usefulness of the information the test can provide.
The effect of an altruistic desire to help research on women's decisions to participate in breast cancer susceptibility testing protocols may depend on the population from which they are recruited. Women from families with a strong history of breast and/or ovarian cancer may have contemplated genetic testing and the clinical management options available for high-risk women a great deal, even before being offered testing (4) . Such women, because of higher actual and perceived risk, might also have sought risk assessment through a cancer genetics program. If recruitment into protocols is through clinical services, selection bias is introduced because these women might have more knowledge about testing, have more cancer-related worries, and be more motivated to participate by interest in testing than by altruism. On the other hand, if women are recruited through a registry population (such as through relatives in a cancer registry), they may be less aware of testing, have lower cancer worries, have less appreciation of the possible clinical utility of test results, and be motivated to participate more by their interest in helping research.
As part of a study to develop a model informed consent process for BRCA1/2 testing, we offered education, counseling, and family-based BRCA1/2 testing to women who were at increased risk of breast cancer. Here, we describe: (a) their motivations for attending education and counseling; (b) their interest in and reasons for pursuing testing in their families (i.e., involving their affected relative); and (c) the degree to which source of recruitment, an altruistic desire to help research, and the necessity for at-risk women to communicate with their affected relative about testing help to distinguish between those who completed each phase of our study protocol and those who did not.
Recruitment.
We studied women at increased risk of breast cancer because of family history. They were recruited in two ways. The majority of at-risk women were identified by writing to women who were listed in the Johns Hopkins and Maryland Statewide Tumor Registries as having been diagnosed with breast cancer under the age of 50 and whose diagnoses were made between 1992 and 1994. Eligible probands were sent a letter requesting the names and addresses of their unaffected first-degree relatives between the ages of 21 and 50. Twenty % provided the names of at least one sibling or adult child. We stratified female relatives into sisters and adult daughters, and randomly selected from each category so that we had one female relative per proband. We refer to the women recruited through a registry as our "registry" population. A second source of recruitment was from a group of "outpatients" seen at the Johns Hopkins BOSS5 because of concerns about their increased risk of breast cancer. Our initial ascertainment focused on unaffected women who had at least one first-degree relative diagnosed with breast cancer under the age of 50 and who had been seen at the clinic prior to the incorporation of BRCA1/2 education and counseling (and, therefore, had not received it). We call this our "clinical" population. A questionnaire assessing attitudes toward genetic testing for breast cancer susceptibility was sent to a total of 584 at-risk women.
The response rate to the questionnaire was 71%. One year later, we mailed invitations to 403 Caucasian respondents (there are no data on the sensitivity of the test we were offering among nonwhites) to attend an education and counseling session regarding BRCA1/2 testing. The invitation included an offer of testing if the women's relatives were tested and found to carry a mutation. The invitation for education and counseling included an institutional review board-approved consent form and a detailed family health history form for obtaining information on cancer diagnoses for three generations of relatives. A woman was considered eligible to attend counseling if she completed and returned these forms, if her relative with breast cancer was still living (and, therefore, available for possible genetic testing), and if she herself had not been diagnosed with breast or ovarian cancer. Of the 403 women who were invited to participate in education, counseling, and testing, 132 were considered to be at high risk (defined as having more than one relative on the same side of the family with early-onset breast cancer) and came from the mid-Atlantic states (where testing was offered). Here, we focused our analysis on this subset of women whose family histories might make them appropriate candidates for testing and for whom geographic inconvenience would be less likely to impede their ability to participate.
Content and Process of Counseling.
Counseling was conducted by four genetic counselors and two registered nurses who had undergone training in breast cancer genetics and susceptibility testing. The counseling sessions were offered in four different locations and at several different times to minimize inconvenience for the participant. The education and counseling sessions included a review of each woman's family history and pedigree, general information about breast cancer, risk factors for breast and ovarian cancer, BRCA1/2 mutations, description and limitations of testing, and discussion of the family-based nature of the testing protocol. After the session, women were given a booklet, designed specifically for the study using focus group and survey data reported elsewhere (17, 18, 19) , which summarized the information discussed during the session. Sessions took ≈2 h, including the completion of short pre- and postsession questionnaires. High-risk women were told that, if their affected relative was interested in testing, she would have to come for a separate pretest education and counseling session with a different genetic counselor. The test we were offering was a screening test for the 16 most common BRCA1 and BRCA2 mutations. It was offered by OncorMed, Inc., free of charge to participants.
There were three sources of data. The initial attitudes questionnaire, through which we identified our invitees, included demographic and limited family history information as well as a few previously validated scales. One was a "fear of stigma" scale, which was created from four statements about confidentiality, stigma, and insurance discrimination using a four-point Likert scale [from "strongly disagree" (= 1) to "strongly agree" (= 4)]. Three of these items were used in a previous study (20) . A dichotomous "fear of stigma" variable was created by dividing the total score into "low" (4, 5, 6, 7, 8) versus "high" (9, 10, 11, 12, 13, 14, 15, 16) . "Cancer worries" is another prevalidated scale that consists of four questions regarding the extent to which respondents have thought about their chances of getting breast cancer and how much this interferes with their lives [on a scale from "not at all" (= 1) to "a lot" (= 5); Ref. 21] . This scale was also dichotomized at the median. Perceived risk of breast cancer compared to others was assessed with one question, which asked: "In your opinion, compared to other women your age, what are your chances of getting breast cancer?" Respondents were dichotomized as either "very high" [responding "much higher" (= 5)] or "not very high" [responding "much lower" (= 1) to "a little higher" (=4)]. Respondents were also asked how much they agreed [from "strongly disagree" (= 1) to "strongly agree" (= 4)] with the statement: "Someone can get cancer for no apparent reason." Responses to this item were dichotomized at the median.
There were two other questionnaires associated with the education and counseling phase of our study. Before the education and counseling sessions began, we administered a short questionnaire in which women were asked to rate the importance of four reasons in deciding to attend the counseling session. At the completion of the counseling session, a second short questionnaire was administered that assessed the participant's intention to ask the affected family member to be tested and reasons for doing so. This was how we defined one of our behavioral outcomes because our protocol for testing high-risk women required that an affected relative be tested first. Reasons for attending counseling and for intending to involve an affected relative in testing were assessed on four-point Likert scales ["not at all important" (= 1) to "very important" (= 4)]. Those who rated reasons as "very important" were compared with all others.
Description of Invitees by Source of Recruitment.
A description of the characteristics of the two groups of participants is provided in Table 1⇓ . Of the 132 high-risk women from the mid-Atlantic states, 24 were recruited through the BOSS (clinical), and 108 were recruited through the registries. Although the number of women from the clinical population is small, these women are clearly different from women in the registry population. Respondents from the BOSS were slightly more likely to be Jewish, to have a daughter, to have prior knowledge about BRCA1/2 testing, and to perceive their risk of breast cancer as much higher than that of other women their age. They were significantly less likely to believe that cancer can occur for no apparent reason.
Characteristics of sample invited to counseling session, by recruitment source
Interest in Attending Counseling.
Among the 132 high-risk questionnaire respondents from the mid-Atlantic states, 36% (n = 47) were interested in counseling, 26% (n = 35) were not, and 38% (n = 50) did not respond to the invitation. There were no differences in women's interest in attending by source of recruitment. Of the 47 women who initially expressed interest in education and counseling, 40 (85%) ultimately completed a session. Table 2⇓ shows the characteristics that distinguish those who attended counseling from those who did not (either because they said they were not interested or because they did not respond to the invitation) by source of recruitment. Large enough numbers among women in the registry population allowed us to assess statistically significant differences between attendees and nonattendees. Those who attended counseling were significantly more likely to have at least some college education, to be employed full-time, to have greater fear of stigma, and to perceive their risk of breast cancer as much higher than that of other women their age and were less likely to have a daughter. On multivariate logistic regression, controlling for age, women from the registry population who had high perceived breast cancer risk were 3.9 times more likely (95% CI = 1.4–10.4) than women with lower perceived risk to attend a session; women with at least some college education were 3.0 times more likely (95% CI = 0.9–10.0) than lower educated women to attend a session; women who had high fear of stigma were 3.0 times more likely (95% CI = 1.1–7.8) than women with lower fear to attend a session; and women without a daughter were 3.2 times more likely (95% CI = 1.0–10.4) than women with a daughter to attend a session. Although there are too few women in the clinical population to assess statistically significant differences between attendees and nonattendees, there were some trends. A greater percentage of those who attended counseling had at least some college education, a lower percentage was Jewish, and fewer had high cancer worries or high fear of stigma.
Differences in attendance at counseling session, by recruitment source
Interest in Pursuing Testing in the Family.
The number of eligible participants who responded to the invitation for education and counseling and who ultimately involved an affected family member in testing are presented by recruitment source in Fig. 1⇓ . The proportion of participants offered family-based testing who ultimately involved an affected family member was 2.5 times higher among women from a clinical population (25%) than among women from a registry population (10%). Although there is no difference by recruitment source in the proportion of women who expressed interest in attending counseling, there does appear to be a difference among the women who actually underwent counseling. Of those who expressed interest in attending, 100% of women in the clinical population, in fact, attended, whereas 82% of women in the registry population attended. Of the 40 participants counseled, the reasons for attending rated by women as "very important" were to learn about the test (80%), to have the test (43%), and to help research (38%). We subdivided the women who were counseled into those who rated wanting to have the test as more important versus those who rated wanting to help research as more important. We used this dominant precounseling motivation in subsequent analyses as a proxy for an underlying or an a priori orientation either toward an altruistic desire to help research or toward interest in being tested. Despite small numbers, Fig. 2⇓ suggests a trend toward an association between women's major motivation for attending counseling and the population from which they were drawn. Women from the clinical population were more likely to attend counseling because they wanted to have the test, whereas women from the registry population were more likely to attend counseling because they wanted to help research.
Response rates and test utilization, by source of recruitment.
Relative importance of motivations for those attending education, by recruitment source.
Immediately after counseling, 33 women (83%) said they intended to ask their affected relative to be tested. When asked about reasons for this intention, 79% of these women said the information would be useful for themselves, 61% thought the information would be useful for their affected relative, 67% thought the information would be useful for other family members such as sisters and daughters, and 59% wanted to help research. As shown in Fig. 1⇓ , there was no difference in expressed intention by recruitment source. However, when it came time to actually discuss testing with an affected relative, we observed a greater rate of attrition in the registry population. Whereas only 76.9% of these women discussed testing with a relative, 100% of women from the clinical population had such a discussion. After communicating with an affected relative, there continued to be a greater rate of attrition in the registry population. Overall, of the 33 women who intended to ask their affected relative to be tested, only 17 (51.5%) of the relatives actually came for counseling.
We looked at the association between high-risk women's decision to involve their affected relative in testing and their a priori motivation to attend counseling. Despite small numbers, Fig. 3⇓ suggests a clear trend toward an association. Women who attended counseling primarily because they were interested in being tested rather than because of their desire to help research were more likely to involve their affected relative in testing (64%), whereas those who attended counseling primarily because they wanted to assist research rather than be tested were less likely to involve their affected relative in testing (43%).
Percentage of affected relatives actually presenting for counseling, by at-risk relative's motivation for attending counseling (among those intending to ask affected relative; n = 33).
Reasons Why Affected Relatives Were Not Scheduled for Counseling.
To have a better understanding of the reasons that the affected relatives of 17 high-risk women did not schedule an appointment for counseling, we decided to send a one-page follow-up questionnaire to these high-risk women. The cover letter made clear that we were not intending to pressure them to involve their relative in testing but to explore the status of their decision-making. Eight responded. We then called the remaining nine high-risk women and reached all except one. Fifty-nine % of these 17 high-risk women (n = 10) actually had a discussion with their relative about testing or asked their relative to be tested. Seven of the affected relatives declined testing either for logistic reasons (e.g., time and distance) or because they did not want to be tested because of concerns about insurance or because they thought their case was sporadic. In the other three cases, the high-risk women mainly decided not to pursue testing because they believed the test results would not change anything they were already doing. Four of the 17 high-risk women decided not to ask their affected relative to be tested either because they decided the test results would not change anything they were already doing or because the information they received from counseling or the booklet caused them to change their minds on further reflection. The remaining two postponed their decision about discussing testing with their affected relative because the relative was too ill.
In this study of women at high risk of breast cancer, we observed a relatively low interest in attending education and counseling about BRCA1/2 testing, regardless of whether women were recruited from a clinical or a registry population. However, among the women who came for counseling, we observed a difference by source of recruitment in whether they actually pursued testing in the family. Those who were recruited from a clinical population were more likely to involve their affected relatives in testing than were women recruited from a registry population. Among those who did attend education and counseling and did involve their affected relative in testing, the relative importance that women gave to being tested versus helping research varied by source of recruitment. Women who were recruited from a clinical population were more motivated by their interest in being tested, whereas women who were recruited from a registry population were more motivated by their interest in helping research.
These findings suggest that most women who actually intend to follow through on family-based testing (by asking their affected relative to attend counseling) are a self-selected group of women who have already decided to pursue testing when they consent to attend counseling. In our study, this was particularly true for women who were already seeking care because they had concerns about their risk of breast cancer. However, in the context of family-based testing, a high-risk woman's desire to undergo testing does not necessarily guarantee that she will pursue testing. First, she must decide whether she is willing to engage her affected relative in a discussion about testing. Then, having done so, she is dependent on her affected relative's wishes. Alternatively, the high-risk woman herself may change her mind before, during, or after a discussion with her affected relative. In our study, half of the women who had intended to involve their affected relative but whose relative did not present for testing either had changed their minds about involving the relative or had decided to postpone the decision. Even when they did decide to ask their relative, more than half the relatives declined. Because family-based testing necessitates communication among family members, it is likely to expose complex family dynamics and patterns of communication. Actual rates of testing might have been higher if we were offering direct testing. Whether the need for family communication serves as a barrier to testing deserves further study.
Our data shed light on several previously unanswered questions. (a) How does selection bias operate in women who participate in breast cancer susceptibility testing protocols? (b) To what extent does an altruistic desire to assist research motivate women to participate? (c) What implications do these selection biases have for the conduct and interpretation of research protocols? (d) How do the requirements of family-based testing affect test utilization?
It appears that, in the context of breast cancer susceptibility testing protocols, selection bias reflects a complex interaction between source of recruitment and underlying motivation to participate in research. Women who are recruited from a clinical population and are, therefore, seeking care because they are concerned about their risk of breast cancer, are more likely to attend education and counseling because of their intention to undergo testing and are more likely to involve an affected family member in testing. To the extent that high-risk and affected relatives have similar attitudes, values, and beliefs about testing and research participation, there is unlikely to be significant attrition at successive stages of a family-based testing protocol. If there is consistent follow-through, as there seems to be in a clinical (nonresearch) population, intention may be a good proxy for actual behavior.
In contrast, women who are recruited from a registry population are more likely to attend education and counseling because of their desire to help research but are not as likely to involve an affected family member in testing. (That the women from a registry population who attended counseling were also less likely to have a daughter lends support to our observation that they are motivated for reasons other than to benefit their family members.) To the extent that these women are less likely to follow through at each successive stage of a family-based testing protocol, attendance at counseling, or intention to involve an affected family member may not be accurate proxies for test uptake.
Strengths and Limitations.
Because we were recruiting from among respondents to an initial survey and completion of the survey was a requirement for participation in the education, counseling and testing phase of the study, we were concerned that the women who responded to the first survey would, themselves, be self-selected for their altruistic desire to help research. However, the relatively high rate of response to the survey (22) suggests that the population that was eligible for participation in this testing phase of the study (by virtue of completing a survey) was fairly representative of the eligible population overall. Therefore, our ability to draw conclusions about the target population (women with more than one relative on the same side of the family with early-onset breast cancer) is probably not limited by an incomplete response to the initial questionnaire.
Nevertheless, there are several limitations to our ability to make generalizations based on these findings.
(a) Our data are restricted by the demands of our testing protocol. We required that education and counseling be conducted in-person for both the high-risk woman and her affected relative. Geographic distance and inconvenience were significant barriers to women's participation. We know from previous research that when testing is made as convenient as possible, utilization rates increase (20) .
(b) The generalizability of our findings is limited because our study was conducted through Johns Hopkins Hospital. Many of the women who participated in our study are either Johns Hopkins patients themselves or are relatives of women who received treatment for their breast cancer at Johns Hopkins. To the extent that these women are satisfied with the care offered at Johns Hopkins, they may represent a select group of participants who either trust the health care system or are altruistically motivated to participate in a Johns Hopkins study.
(c) There were statistical limitations associated with small numbers in our study. We were only able to recruit a few participants from the clinical population, and we did not retain the majority of participants the closer women came to the possibility of testing. As a result, we were able to demonstrate only trends, not statistically significant patterns of association. Despite these limitations, our findings have implications for offering family-based testing and understanding testing decisions either in research or clinical settings.
Implications.
Findings from studies in research settings regarding interest in testing should be interpreted with caution because women may be motivated by an altruistic desire to help research. We need to develop a better means of assessing whether and when participation in genetic susceptibility testing protocols is motivated more by an altruistic interest in contributing to science than a desire to be tested. Because some research participants appear to be inspired more by an intention to assist research than by an interest in being tested, uptake of BRCA1/2 testing and motivations may be more accurately assessed under less artificial conditions.
If unable to do research under "real-life" circumstances, greater attention should be paid to the population from which participants are recruited and whether the outcomes being measured are appropriate for that population. In a clinical (nonresearch) population, intention may be a good proxy for actual behavior, but we may not be able to assume from a registry population that hypothetical interest in testing, attendance at education and counseling, or intention to be tested are proxies for actual test utilization.
Enrollees from different recruitment populations may also have unique reasons for participating in each phase of a testing protocol. People for whom testing is likely to become a reality appreciate that the stakes are higher as testing draws near than they are at the counseling stage. In our study, "when push came to shove," an altruistic desire to help research was less of a motivator than the perception that testing would benefit the family. This observation was reassuring from the point of view of informed consent. Particularly among participants recruited from a clinical population, we have less reason to be concerned that an altruistic desire to help research will interfere with autonomous decision-making.
Our findings have other implications for informed consent.
(a) We observed that, even among those who intended to pursue testing, there is significant drop-off when testing is not immediately available. This pattern is consistent with what we observed when we offered cystic fibrosis carrier screening to the general population (20) . Because many people change their minds about testing, a waiting period is advisable after counseling. This is consistent with the recommendations of other studies (3) . Because, in our observation, women seem to use this waiting period to read whatever information they have about testing and to have discussions with family members, we believe that a hiatus facilitates informed and autonomous decision-making. However, this waiting period may result in decreased accrual.
(b) Family-based testing raises questions about the very essence of autonomous decision-making. Not only does such testing require the involvement of an affected family member, but test results affect entire families. Therefore, testing decisions are usually made by families, not by isolated individuals. High-risk women who, after careful consideration, want to be tested, may not be able to obtain testing if they do not have a comfortable enough relationship with their affected relative to ask her to participate or if their affected relative declines. The informed consent process that occurs during pretest education and counseling must include a discussion not only of the technical requirements of family-based testing but of family dynamics as well. We have an obligation to explore with the high-risk woman all of the ways that her affected relative could directly or indirectly influence her decision. A meaningful informed consent process obliges us to prepare high-risk women for the possibility that they will not be eligible for testing. To offer testing in an ethically responsible way, we must learn as much as possible, through research and sensitive observation, about the complexities of autonomy in a family context.
We are indebted to the women who participated in this study. Some of the women were identified with the help of the Maryland Cancer Registry of the Department of Health and Mental Hygiene (Baltimore, MD). The Department of Health and Mental Hygiene specifically disclaims responsibility for any analysis, interpretations, or conclusions. We are also grateful to: our coinvestigators, Drs. Kathy Helzlsouer and Neil A. Holtzman; June Peters and Patti Wilcox for training the counselors; the six individuals who counseled high-risk women; Melanie F. Myers for developing our educational brochure and for counseling affected relatives; and our administrative assistant, Sharon Ennis. We appreciate the support provided by OncorMed, Inc., for genetic testing services.
↵1 Report from the Cancer Genetics Studies Consortium. This work was supported by National Institute of Nursing Research Grant R01 NR04062-01. A variation of this paper was presented at the American Society of Human Genetics Annual Meeting, October 28–November 1, 1997, Baltimore, MD.
↵2 To whom requests for reprints should be addressed, at Johns Hopkins School of Medicine, 550 North Broadway, Suite 511, Baltimore, MD 21205. Phone: (410) 955-7894; Fax: (410) 955-0241; E-mail: ggeller{at}welchlink.welch.jhu.edu
↵3 Present address: Abt Associates, Boston, MA.
↵4 Present address: Palm Beach Institute of Preventive Medicine, Palm Beach Gardens, FL.
↵5 The abbreviations used are: BOSS, Breast and Ovarian Surveillance Service; CI, confidence interval.
Revision received December 15, 1998.
Accepted December 21, 1998.
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Volume 8, Issue suppl 1
You are going to email the following Participation in Breast Cancer Susceptibility Testing Protocols: Influence of Recruitment Source, Altruism, and Family Involvement on Women's Decisions
Cancer Epidemiol Biomarkers Prev April 1 1999 (8) (suppl 1) 377-383;
Testosterone Therapy and Prostate Cancer
Anticoagulants and Breast Cancer Survival
β-Blocker Use and Lung Cancer Mortality


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Webinar: LexisNexis® True Cost of FraudTM APAC study
True Cost of Fraud APAC
Insights on the Fraud Trends in Retail, E-Commerce and Financial Services Industries
Businesses across the Asia Pacific region view fraud as a serious and rapidly growing problem. They recognize that costs go far deeper than transaction values. In fact, every dollar of fraud costs Asia Pacific region businesses 3.4 times the amount of the lost transaction value.
LexisNexis® Risk Solutions conducted a study in 2019 to determine the true cost of fraud for the APAC region. Their survey of 360 businesses across Singapore, Indonesia, Malaysia, and the Philippines revealed an average of almost 400 successful monthly fraudulent transactions, valued at $160,000, recorded by retail, e-commerce, and financial service businesses.
The costs incurred by businesses for fraudulent transactions included
Lost transaction value for which firms are held liable
Replacing or redistributing lost or stolen merchandise
Fees and interest paid to financial institutions
Labor costs for investigation
External costs for expense recovery
According to the study, businesses involved in mobile commerce faced the biggest hurdles for fraud prevention. They recognize that the digital space, which accounts for nearly half of all retail and e-commerce fraud losses, has become a haven for fraudsters. At the heart of the problem is the struggle to accurately verify identities which is crucial to preventing fraud.
Among the other key findings of the study were the following:
Real cost of fraud: The Fraud Multiplier is greatest for businesses in Malaysia (3.57), followed by the Philippines (3.46), Singapore (3.45) and Indonesia (3.25).
Average impact on revenues: Regionally, the average overall costs of fraud is 1.75% of revenues. By country, fraud cost is highest as a percentage of revenue for Philippine businesses (2.03%) and lowest for Singapore (1.57%).
Impact on revenues by type of business: Fraud costs are biggest as a percentage of revenues for e-commerce businesses (2.50%), followed by retail businesses (1.64%) and financial services firms (1.56%).
In all four countries surveyed—Philippines, Indonesia, Singapore and Malaysia—mobile commerce is growing rapidly. Unfortunately, mobile web browsers have historically been less secure, making them an appealing target for fraudsters. Using click flooding and botnet attacks, bad actors have aggressively gone after mobile apps, many of which have sacrificed security in the interest of providing a streamlined experience to their users. Adding to their vulnerability, most businesses in the region track fraudulent transactions either by channel or payment method, instead of using both, which could buttress their anti-fraud strategy.
In summary, the APAC fraud study found the biggest challenges for businesses serving customers through online and mobile channels were:
Verifying customer identities
Malicious botnet orders placed simultaneously
Growing number of synthetic identities
Balancing speed of approval against customer friction
Accessibility (or the lack thereof) of tracking tools
Check out our webinar "Fraud and Business Losses - How bad can it be?" for more details. Get an inside look at the country-specific fraud climate for Indonesia, Malaysia, Philippines and Singapore in our Related Resources below.
Fraud Identity
2019 APAC True Cost of Fraud Study for Indonesia
See how retailers, m-commerce operators and financial services in Indonesia manage the cost of fraud with a multi-layered technology approach.
2019 APAC True Cost of Fraud Study for Malaysia
Highlights and fraud defense strategies to manage and combat identity fraud threats for firms in Malaysia.
2019 APAC True Cost of Fraud Study for Singapore
Learn how multi-layered technology solutions deliver clear advantage in the fight against identity fraud.
2019 APAC True Cost of Fraud Study for Philippines
Key findings on how firms in the Philippines manage and reduce identity fraud impacts with a multi-layered fraud defense strategy.


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Q: How can I read full song title on my iPod touch or iPhone? When I play or select songs on my iPod touch 4G I often can not read the full title of the song when it is very long. In all views (Coverflow front, coverflow back, now playing portrait mode, playlist) it is always truncated. Especially for classical music this is really annoying because the titles are something in the lines of "Beethoven: The Complete String Quartetts" -  "String Quartett #3 in D Op. 18/3 - 1. Allegro". Is there some trick to view the complete title?

A: As of iOS 5, this problem is even simpler. Many views will scroll overflowing information, but you can also simply tap and hold on many sources of text in order to view them in a significantly smaller font size in a back pop-up tooltip, which greatly expands the amount of text that can be fit in the width of the iPhone's screen size.
Note that my previous answer still applies (below), but this tooltip is usually quite a bit faster and much more direct.

For all iOS versions before iOS 5:
My answer on the View Full Podcast Title Question covers this as well. You can use Cover Flow view (rotate your device to Landscape while in the iPod/Music app after selecting a song) in order to greatly increase the amount of room used to display song information.
Your title is particularly large, I don't know what the landscape/Cover Flow view limit is. I don't have any songs that exceed it yet :).