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Articles |16 July 2002
Cost-Effectiveness Analyses of Colorectal Cancer Screening: A Systematic Review for the U.S. Preventive Services Task Force Free
Michael Pignone, MD, MPH; Somnath Saha, MD, MPH; Tom Hoerger, PhD; Jeanne Mandelblatt, MD, MPH
Michael Pignone, MD, MPH
From University of North Carolina–Chapel Hill and Research Triangle Institute–University of North Carolina Evidence-based Practice Center, Chapel Hill, and Research Triangle Institute, Research Triangle Park, North Carolina; Oregon Health and Science University Evidence-based Practice Center, Portland, Oregon; and Georgetown University Medical Center, Washington, D.C.
Somnath Saha, MD, MPH
Tom Hoerger, PhD
Jeanne Mandelblatt, MD, MPH
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position from the U. S. Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Acknowledgments: The authors thank the following persons for support and assistance: Mark Helfand, MD, MPH, and Kathryn Krages, AMLS, MA, Oregon Health and Science University Evidence-based Practice Center; Carol Krasnov, Research Triangle Institute–University of North Carolina Evidence-based Practice Center; Martin Brown, PhD, National Cancer Institute; and David Atkins, MD, MPH, and Eve Shapiro, Agency for Healthcare Research and Quality.
Grant Support: By contract 290-97-0011 from the Agency for Healthcare Research and Quality. Dr. Pignone's work was partially supported by an American Cancer Society Career Development Award. Dr. Saha's work was supported by a career development award from the Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. Dr. Mandelblatt's work on this project was partially supported by contract U01CA88283A and grant CA 72908 from the National Cancer Institute and grant CA 74187 from the National Institute on Aging.
Requests for Single Reprints: Reprints are available from the Agency for Healthcare Research and Quality Web site (www.ahrq.gov/clinic/uspstfix.htm) and in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295).
Current Author Addresses: Dr. Pignone: Department of Medicine, Division of General Internal Medicine, University of North Carolina, 5039 Old Clinic Building 226, CB 7110, Chapel Hill, NC 27599.
Dr. Saha: Section of General Internal Medicine, Portland Veterans Affairs Medical Center, Division of Medical Informatics and Outcomes Research, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098.
Dr. Hoerger: Research Triangle Institute, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194.
Dr. Mandelblatt: Cancer Control, Lombardi Cancer Center, Georgetown University Medical Center, 223 Wisconsin Avenue, Suite 430, Washington, DC 20007.
Author Contributions: Conception and design: M. Pignone, S. Saha, T. Hoerger.
Analysis and interpretation of the data: M. Pignone, S. Saha, T. Hoerger, J. Mandelblatt.
Drafting of the article: M. Pignone, S. Saha.
Critical revision of the article for important intellectual content: M. Pignone, S. Saha, T. Hoerger, J. Mandelblatt.
Final approval of the article: M. Pignone, S. Saha, J. Mandelblatt.
Provision of study materials or patients: S. Saha.
Statistical expertise: M. Pignone, T. Hoerger.
Obtaining of funding: J. Mandelblatt.
Administrative, technical, or logistic support: M. Pignone, T. Hoerger, J. Mandelblatt.
Collection and assembly of data: M. Pignone, T. Hoerger.
To perform a systematic review of the cost-effectiveness of colorectal cancer screening for the U.S. Preventive Services Task Force.
MEDLINE and the British National Health Service Economic Evaluation Database, January 1993 through September 2001.
Study Selection:
Original economic evaluations of colorectal cancer screening in average-risk patients were reviewed. The authors sought studies addressing the incremental cost-effectiveness of different screening strategies compared with no screening, of different screening strategies compared with one another, and of different ages of screening initiation and cessation. Two investigators independently reviewed each abstract, and potentially eligible articles were retrieved. A four-member working group reached consensus regarding final inclusion or exclusion of articles.
Data Extraction:
One reviewer extracted data into evidence tables. The results were checked by other members and discrepancies resolved by consensus.
Data Synthesis:
Among 180 potential articles identified, 7 were retained in the final analysis. Compared with no screening, cost-effectiveness ratios for screening with any of the commonly considered methods were generally between $10 000 and $25 000 per life-year saved. No one strategy was consistently found to be the most effective or to have the best incremental cost-effectiveness ratio. Currently available models provided insufficient evidence to determine optimal starting and stopping ages for screening.
Screening for colorectal cancer appears cost-effective compared with no screening, but a single optimal strategy cannot be determined from the currently available data. Additional data regarding adherence with screening over time, complication rates in real-world settings, and colorectal cancer biology are needed. Additional analyses are necessary to determine optimal ages of initiation and cessation.
It is unclear which colorectal cancer screening strategy is most cost-effective.
On behalf of the U.S. Preventive Services Task Force, the authors reviewed seven published analyses that addressed the cost-effectiveness of fecal occult blood testing (single or annual), flexible sigmoidoscopy every 5 years alone or with fetal occult blood testing, barium enema every 5 years, and colonoscopy every 10 years.
The screening strategies all cost $10 000 to $25 000 per year of life saved.
Physicians should discuss the advantages and disadvantages of the various colorectal cancer screening strategies with their patients to decide which test is best for each individual.
Colorectal cancer is the second leading cause of cancer mortality in the United States, with more than 57 000 deaths expected in 2001 (1). Evidence from several studies suggests that screening for, detecting, and removing colorectal cancer and precancerous adenomatous polyps can reduce the incidence of colorectal cancer and colorectal cancer–related mortality (2). Questions remain, however, about which method or methods of screening should be used, how frequently screening should be performed, and at what ages screening should begin and end. In addition, health care policymakers wish to know not only whether screening is effective but also whether it is cost-effective. Existing clinical trials of colorectal cancer screening have not directly compared different screening approaches and have not tested different starting and stopping ages. In the absence of such data, cost-effectiveness analyses using simulation models may provide the best information for answering such questions (3).
To help inform the U.S. Preventive Services Task Force's deliberation on recommendations regarding screening for colorectal cancer, we examined three questions:
What is the cost-effectiveness of colorectal cancer screening by any method compared with no screening?
Can we use incremental cost-effectiveness data to determine the relative effectiveness and cost-effectiveness of different screening options and thus determine whether there is a preferred strategy for screening?
What is the incremental cost-effectiveness of continuing screening to 85 years of age compared with stopping screening at 70, 75, or 80 years of age? What is the incremental cost-effectiveness of starting screening at 40 or 45 years of age compared with 50 years of age?
Search Strategy
The principles and rationale for our approach to conducting systematic reviews of cost-effectiveness studies are described elsewhere (4). We searched MEDLINE and the British National Health Service Economic Evaluation Database (NHS EED) (agatha.york.ac.uk/nhsdhp.htm) between January 1993 and September 2001. We exploded the Medical Subject Headings "colorectal neoplasms" and "mass screening." We used different strategies in each database to identify cost-effectiveness analyses. For our MEDLINE search, we added the exploded Medical Subject Heading "costs and cost analysis." In the NHS EED, we limited the search to "economic evaluations." We chose 1993 as a starting point because it was the year in which the first trial establishing strong evidence for the effectiveness of colorectal cancer screening was published (5). To identify studies not captured by our database searches and studies that are ongoing or unpublished, we manually searched the reference lists of retrieved articles and contacted selected authors and experts in the field.
Two investigators reviewed titles and abstracts of publications identified by the literature searches. Using information in the abstracts, we excluded studies that were not cost-effectiveness or cost–utility analyses, including other types of economic evaluations that did not quantify the health outcomes achieved for a given cost; studies that reported only cost per patient screened, cost per cancer detected, or cost per death prevented; studies that did not contain original analyses; articles that did not address at least one of our three questions of interest; studies performed from perspectives other than the societal perspective or the perspective of public third-party payers; and studies that used cost or disease incidence estimates from outside the United States. When we encountered multiple publications that reported results from the same cost-effectiveness model, we included the most comprehensive analysis and used other papers for supplemental information. When the decision about whether to include a study could not be made by reading the title or abstract, we evaluated the full article. Disagreements on study inclusion were resolved by consensus of the authors.
All authors reviewed each included article. Reviews focused on the assumptions of each study regarding the epidemiology and natural history of colorectal cancer; estimates of variables related to the effectiveness of screening, including test accuracy, adherence rates, and complication rates; estimates of the costs of screening, diagnosis, and treatment; the proportion of cancer cases and cancer deaths prevented by screening; and the effect of varying key variables (sensitivity analyses).
For each study, we used available data to tabulate life-years gained and costs per person for each of the major strategies under consideration: annual fecal occult blood testing, sigmoidoscopy every 5 years, combination of annual fecal occult blood testing and sigmoidoscopy every 5 years, double-contrast barium enema every 5 years, and colonoscopy (every 10 years, at 55 and 65 years of age, or once in a lifetime). The evaluated strategies were arrayed in order of effectiveness. Costs were updated to U.S. dollars in 2000 by using the Consumer Price Index for medical care.
If one strategy was more costly and less effective than another strategy, it was considered to be strongly dominated. If a strategy was both less effective and had a higher cost-effectiveness ratio than another strategy, it was considered to be weakly dominated. Incremental cost-effectiveness ratios were then calculated for all nondominated strategies by using the following formula: (costs strategy 2 − costs strategy 1)/(life-years gained with strategy 2 − life-years gained with strategy 1).
Role of the Funding Source
This evidence report was funded through a contract to the Oregon Health and Science University Evidence-based Practice Center from the U.S. Agency for Healthcare Research and Quality. Staff of the funding agency reviewed the draft and final manuscript and made editing suggestions.
Identification of Cost-Effectiveness Analyses
Our initial searches identified 180 potentially relevant studies. On initial review of titles and abstracts, we excluded 159 articles that were clearly not related to our topic of interest. Of the 21 full articles retrieved and reviewed by the investigators, six met the inclusion criteria. Appendix Table 1 shows the reasons for exclusion of the remaining articles.
Through supplemental searches, we identified two additional studies that met our inclusion criteria. One was identified through manual searching of the reference lists of retrieved articles (6), and the other was identified through contact with experts but was subsequently published and indexed in MEDLINE (7). Because the book chapter by Wagner and colleagues (6) was the most comprehensive description of the model developed by the Office of Technology Assessment, we used it rather than the more recent analysis by Glick (7).
Study Descriptions
Table 1 shows the basic features of the included analyses. All but one were cost-effectiveness analyses that expressed benefits in days of life or life-years gained and costs in U.S. dollars. One study presented results in cost per quality-adjusted life-year gained (13). Each study considered one or more alternative means of screening in addition to the option of no screening. The perspective of the analyses was societal or that of a third-party payer. All studies considered direct costs, including the costs of screening, diagnostic tests, and treatment; no studies considered patient time costs associated with attendance for screening, diagnostic, or surveillance procedures or for treatment of cancer.
Table 1. Study Characteristics
In general, each model used data on the incidence of colorectal neoplasms (adenomatous polyps and cancer) to simulate the natural history of disease in a cohort of adults at average risk, typically those between 50 and 85 years of age. These neoplasms were subject to detection and removal by the different screening strategies as they progressed from adenomas to early-stage cancer and then to late-stage cancer. Survival after detection was generally considered to be stage-related. The costs and complications of screening and treatment were modeled with various degrees of precision.
Benefits and costs were discounted at 3% or 5% in the base-case analyses. Sensitivity analyses were used to examine uncertainty about the variables used to build the models. Most sensitivity analyses were one-way, although some studies examined the effect of setting several variables to the most pessimistic levels. Factors that caused cost-effectiveness ratios to vary more than twofold in sensitivity analyses were polyp dwell time, the proportion of cancer arising from adenomas, adherence rates, and the cost and adverse effects of colonoscopy.
The effectiveness of screening in preventing colorectal cancer and cancer deaths also varied considerably. The analysis by Khandker and associates (9) was the most optimistic: Most strategies prevented more than 60% of cases of cancer and 80% of colorectal cancer deaths. Frazier and colleagues' analysis produced the smallest reductions (8), whereas Vijan and coworkers (11) found reductions in incidence similar to those of Khandker and associates and mortality reductions similar to Frazier and colleagues. The analyses by Loeve and associates (12) and Ness and colleagues (13) were intermediate. The model of Sonnenberg and coworkers (10) produced the lowest estimates of efficacy for fecal occult blood testing and for sigmoidoscopy, but their estimate for the efficacy of colonoscopy was among the highest.
Question 1: Cost-Effectiveness of Screening for Colorectal Cancer with Any Method Compared with No Screening
All studies found that screening for colorectal cancer by any of the included screening strategies reduced deaths from colorectal cancer in adults older than 50 years of age who were at average risk for colorectal cancer. Table 2 shows cost-effectiveness ratios for analyses that examined two or more of the most commonly evaluated strategies: fecal occult blood testing annually, flexible sigmoidoscopy every 5 years, a combination of fecal occult blood testing and sigmoidoscopy, barium enema every 5 years, and colonoscopy every 10 years, each compared with no screening. In base-case analyses, most strategies had average cost-effectiveness ratios, ranging from $10 000 to $25 000 per year of life saved. Among the studies examining single methods of screening, the analysis by Loeve and colleagues found sigmoidoscopy to be cost saving when relatively optimistic cost values were used and the time range for the analysis was extended beyond 35 years (12). Ness and associates found that screening adults with colonoscopy between 50 and 54 years of age had a cost-effectiveness ratio of less than $10 000 per life-year saved (13).
Table 2. Cost-Effectiveness Ratios of Various Tests for Colorectal Cancer Compared with No Screening
Although the results of the different studies are relatively consistent, the base-case assumptions about the effectiveness or costs of screening for colorectal cancer may have been overly optimistic. Alternative sensitivity analyses that assumed "worst-case" scenarios about the biological behavior of neoplasms and effectiveness of treatment generally produced cost-effectiveness ratios of less than $100 000 per life-year saved.
Question 2: Use of Incremental Cost-Effectiveness Data To Determine the Relative Effectiveness and Cost-Effectiveness of Different Screening Options and the Preferred Screening Strategy
Five studies we identified examined multiple screening strategies (annual fecal occult blood testing, sigmoidoscopy every 5 years, double-contrast barium enema every 5 years, colonoscopy every 10 years, and the combination of annual fecal occult blood testing and sigmoidoscopy every 5 years) and reached heterogeneous conclusions about their effectiveness and incremental cost-effectiveness (Table 3; Appendix Table 2).
Table 3. Preferred Strategy at Different Levels of "Acceptable" Costs per Life-Year Saved
With regard to the most effective strategy, defined as that yielding the greatest average number of life-years gained, the analyses by Wagner (6), Frazier (8), and Vijan (11) and their colleagues found the combination of annual fecal occult blood testing and sigmoidoscopy every 5 years to be most effective. Khandker and associates (9) and Sonnenberg and coworkers (10) found colonoscopy every 10 years to be the most effective, although the latter researchers did not consider the combination of fecal occult blood testing and sigmoidoscopy. Of note, four of five multiple-strategy analyses found fecal occult blood testing alone to be more effective than sigmoidoscopy alone for reduction of deaths from colorectal cancer (6, 8, 9, 11).
The most "cost-effective" strategy depends on the cost threshold beyond which one no longer wishes to "pay" for additional years of life saved. If it is assumed that one does not wish to pay more than $20 000 per life-year saved, the five studies reached heterogeneous conclusions about the best strategy. At least one analysis found annual fecal occult blood testing, sigmoidoscopy every 5 years, or colonoscopy every 10 years to be the optimal method of screening. As one's willingness to pay to save more life-years increases, colonoscopy every 10 years or the combination of annual fecal occult blood testing and sigmoidoscopy every 5 years becomes favored.
Factors That Affect Cost-Effectiveness Results
Several important variables differed across the five multiple-strategy analyses and may explain some of the variability in incremental cost-effectiveness ratios (Table 1). However, we could not identify a single variable as being solely responsible for the heterogeneity in the outcomes we detected.
Assumptions about the biological behavior of colorectal cancer are important factors in the ability of the model to accurately simulate real life. Assumptions about the proportion of cancer arising from adenomas are particularly important because screening strategies that work mostly by preventing cancer through the removal of polyps, such as screening colonoscopy, appear to be most effective when it is assumed that all cancer arises from detectable adenomas (8, 11).
Similarly, the duration of the precancerous and early cancer detectable phases (dwell time) affects the relative rank of screening strategies. If the dwell time is long, strategies that involve a highly accurate test at a less frequent interval (for example, screening colonoscopy every 10 years) will appear to perform well compared with a more frequent but less accurate test, such as annual fecal occult blood testing.
Screening adherence is another important factor. No analysis was completely successful in simulating actual patterns of adherence. In all models, the adherence level was changed for all tests equally, an assumption that may not be correct (for example, adherence may differ for fecal occult blood testing and colonoscopy). This assumption of equal adherence among methods again favors the more accurate but more onerous screening methods, such as colonoscopy, particularly when adherence is assumed to be low.
Most of the analyses assumed that survival was based on the stage at diagnosis and estimated stage-specific survival from the National Center of Health Statistics and Surveillance Epidemiology and End Results Survey (14). Of note, Sonnenberg and coworkers made the very conservative assumption that cancer detected early by screening would produce a mortality rate only 18% lower than that detected clinically (10). This assumption makes fecal occult blood testing appear much less effective than a method that relies more on detection and removal of polyps, such as colonoscopy.
Modeling of adverse effects also influences the cost-effectiveness of different strategies. The adverse effects of colorectal cancer screening are mainly those associated with complications of colonoscopy (whether initially for screening or as part of the "diagnostic cascade" after positive results on another screening test), which include perforation; bleeding; or, rarely, death. Studies that fail to model all adverse consequences of colonoscopy will overestimate cost-effectiveness and will favor screening colonoscopy over strategies that involve fewer colonoscopic examinations.
All studies included only the direct costs of screening. No study examined the cost of patient time missed from work for screening and treatment. The effect of considering such costs on the relative cost-effectiveness of each method is unclear: Colonoscopy would have higher patient costs per test but would be required less frequently than other methods. Overall, the cost per life-year saved would probably increase for all methods.
Another important factor is the way in which each analysis models postpolypectomy surveillance for new adenomas and cancer. Studies differed with respect to the interval for repeating colonoscopy after detection and removal of a clinically significant adenomatous polyp. Wagner and colleagues assumed that all patients with adenomatous polyps would undergo surveillance colonoscopy every 4 years and that none of these patients would develop additional polyps or cancer and would die of other causes (6). Frazier and associates assumed that all patients with a "high-risk polyp" (>1 cm in size or having villous histology) would undergo surveillance colonoscopy every 3 years until 85 years of age or death (8). Khandker and coworkers used a more complicated model in which after an initial polyp larger than 1 cm in size was detected, an initial surveillance colonoscopy was performed at 3 years and subsequent follow-up studies were performed every 5 years if polyps were detected on the previous examination (9). In that study, it appears that regular screening was reinitiated if colonoscopy results were negative, but the documentation was unclear on this point. Sonnenberg and colleagues modeled surveillance colonoscopy 3 years after polyp detection but allowed screening to be suspended for 10 years after negative results on colonoscopy (10). Vijan and associates (11) also modeled initial surveillance colonoscopy 3 years after detection of a large adenoma (>1 cm) and lengthened the interval for future surveillance examinations to every 5 years after negative results on examination. More aggressive programs with more frequent examination can increase effectiveness in preventing future cancer but will increase complications and costs.
Question 3: Incremental Cost-Effectiveness of Continuing Screening to 85 Years of Age Compared with Stopping Screening at 70, 75, or 80 Years of Age, or of Starting Screening at 40 or 45 Years of Age Compared with 50 Years of Age
Ness and colleagues (13) examined different ages at which to perform one-time screening colonoscopy and found that for women, screening between 45 and 49 years of age was dominated by one-time screening between 50 and 54 years of age. For men, screening at 45 to 49 years of age compared with screening from 50 to 54 years of age was associated with a cost of $69 000 per quality-adjusted life-year gained. An older study by Eddy (15) found that starting annual fecal occult blood testing at 40 years of age added less than 1 day of average life expectancy and increased costs per person screened almost twofold compared with starting at 50 years of age.
We found no studies that examined the incremental cost-effectiveness of different stopping ages, although Rich and Black (16) used life-table analyses to suggest that by 75 years of age, 68% of the potential mortality reduction from initiating fecal occult blood testing at 50 years of age had been achieved. If screening were continued to 80 years of age, 83% of the potential reduction in mortality would be achieved.
Our systematic review identified seven high-quality cost-effectiveness analyses; five examined multiple colorectal cancer screening strategies, and two examined single strategies. Compared with no screening, all seven analyses found that any of the common screening strategies for adults 50 years of age or older will reduce mortality from colorectal cancer. The cost per life-year saved for colorectal cancer screening ($10 000 to $25 000 for most strategies compared with no screening) compares favorably with other commonly endorsed preventive health care interventions, such as screening mammography for women older than 50 years of age or treatment of moderate hypertension.
Whether one method of colorectal cancer screening is superior to other methods is not clear from these analyses. Many observers have interpreted recent studies (17-19) documenting the relative greater single-test accuracy of colonoscopy compared with sigmoidoscopy, fecal occult blood testing, or double-contrast barium enema for detection of colorectal cancer or adenomas as proof that colonoscopy should be the screening method of choice for colorectal cancer (20). The five multiple-strategy analyses that we identified, however, did not uniformly find that colonoscopic screening was the most effective or cost-effective strategy. The most effective strategy tended to be colonoscopy every 10 years or the combination of annual fecal occult blood testing and sigmoidoscopy every 5 years. The most "cost-effective" strategy identified depended on the level of incremental cost-effectiveness considered to be worthwhile and was not conclusive.
The differences in effectiveness, and hence cost-effectiveness, among the models are related to different assumptions each model makes about the biological behavior of colon cancer, the effectiveness and adverse effects associated with each strategy, and the likelihood that patients will actually complete the tests required for any given strategy. Because the limited available empirical data cannot tell us which set of assumptions is most accurate, we cannot definitively state the most effective or cost-effective strategy for screening. We can say with confidence, however, that any of the methods are effective compared with no screening for adults 50 years of age or older.
Other reviewers have recently examined the literature on the cost-effectiveness of screening for colorectal cancer. Brown and Knopf (21) reviewed cost-effectiveness analyses completed by 1998 and identified four studies for inclusion (6, 12, 15, 22). As with our analysis, they concluded that screening by any of several methods was cost-effective compared with no screening but that the available evidence could not determine the most effective strategy. McMahon and colleagues recently published a reanalysis of four previous cost-effectiveness analyses (23). They included the studies by Eddy (15) and Wagner and coworkers (6) that were examined by Brown and Knopf, as well as Glick's reanalysis (7) of Wagner and coworkers' model. They recalculated incremental cost-effectiveness ratios for the methods considered and concluded that double-contrast barium enema every 3 years or the combination of double-contrast barium enema every 5 years plus fecal occult blood testing annually were the most effective strategies. However, these conclusions were limited by the overly optimistic estimates (compared with data from the best subsequent empirical study [19] of double-contrast barium enema sensitivity and specificity) used in the four analyses that McMahon and colleagues included.
We did not find sufficient evidence about starting and stopping ages for screening to provide useful information for making recommendations. The analyses by Ness and associates (13) and Eddy (15) suggest that the benefits of starting screening at 40 or 45 years of age were small and costly compared with starting at 50 years of age, but further analyses with a range of tests are required. The cost-effectiveness of different stopping ages for screening also was not well examined and may differ substantially depending on the health of the patient being considered for screening (24).
Some potential limitations should be considered in interpreting our results. All but one of our analyses examined cost per life-year gained and did not account for differences in quality of life associated with undergoing screening, surveillance, or treatment for cancer. Differences in model structure, data inputs for key variables, and regimens evaluated limited our ability to draw definitive conclusions about the most effective and cost-effective tests. It is difficult to determine from the data presented in each report whether differences in the results obtained relate mainly to differences in the variables used or in the model structures. We considered only strategies that involved one kind of test (or a pair of tests) and repeated those tests at some regular interval. More complex strategies, including ones that screen younger persons with one test and then switch to a different test at older ages, have not been evaluated. Uncertainty about estimates for different variables was addressed in each study by one-way sensitivity analyses or by testing a set of "optimistic" or "pessimistic" assumptions, but only one of the studies provided probabilistic ranges for its results. Finally, our findings apply only to screening patients at average risk for colorectal cancer; screening higher-risk patients may be even more cost-effective.
Some modelers attempted to validate their models by comparing their results with results of empirical screening trials (6, 8, 11). It would be valuable to have the creators of the different models participate in a validation exercise to compare intermediate and long-term model outcomes by using one common set of variables for a common set of strategies. In this manner, we could confirm that the relative ranking of strategies is similar and not dependent on model structure and assumptions. Nonetheless, the consistent finding that any form of screening is superior to no screening supports the general conclusion that any of the commonly considered strategies are reasonable alternatives.
Our review has important implications for future research and policymaking. It supports the consensus view among major policymaking bodies that screening for colorectal cancer in some form is warranted for adults at average risk who are older than 50 years of age. It also shows that current evidence is insufficient to determine the most effective or cost-effective strategy for screening or to determine the optimal starting and stopping ages for screening. Because no single method of screening is clearly superior to another, patient preferences can play an important role in deciding how screening should be performed (25). Finally, our findings suggest that further research about the natural history of colorectal cancer; the effect of screening, surveillance, and treatment on quality of life; the real-world incidence of complications of screening; and longitudinal data about adherence with different screening strategies in unselected populations could help clarify some of the uncertainty about relative test performance.
Appendix Table 1. Excluded Articles
Appendix Table 2. Calculated Incremental Cost-Effectiveness Ratios from Five Major Cost-Effectiveness Analyses
Cancer Facts and Figures. American Cancer Society
Teutsch
Screening for colorectal cancer adults at average risk: a summary of the evidence for the U.S. Preventive Services Task Force
Ann Intern Med
Mandelblatt
Fryback
Weinstein
Assessing the effectiveness of health interventions for cost-effectiveness analysis. Panel on Cost-Effectiveness in Health and Medicine
Hoerger
Helfand
The art and science of incorporating cost effectiveness into evidence-based recommendations for clinical preventive services
Am J Prev Med
Schuman
Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study
Prevention and Early Detection of Colorectal Cancer
Cost-effectiveness of double-contrast barium enema in screening for colorectal cancer
AJR Am J Roentgenol
Cost-effectiveness of screening for colorectal cancer in the general population
Khandker
Dulski
Kilpatrick
Baine
A decision model and cost-effectiveness analysis of colorectal cancer screening and surveillance guidelines for average-risk adults
Int J Technol Assess Health Care
Delcò
Inadomi
Cost-effectiveness of colonoscopy in screening for colorectal cancer
Vijan
Hwang
Which colon cancer screening test? A comparison of costs, effectiveness, and compliance
Am J Med
Loeve
van Ballegooijen
van Oortmarssen
Habbema
Endoscopic colorectal cancer screening: a cost-saving analysis
J Natl Cancer Inst
Dittus
Cost-utility of one-time colonoscopic screening for colorectal cancer at various ages
Am J Gastroenterol
Ries LA, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L, et al, eds. SEER Cancer Statistics Review, 1973-1997. Accessed at seer.cancer.gov/csr/1973_1997/ on 15 January 2001.
Screening for colorectal cancer
When should we stop screening?
Eff Clin Pract
Ahnen
Garewal
Chejfec
Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380
One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon
Winawer
Waye
A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group
Podolsky
Going the distance—the case for true colorectal-cancer screening [Editorial]
Is colorectal cancer screening really cost-effective?
Prim Care Cancer
Cost-effectiveness model for colon cancer screening
Gleason
Cost-effectiveness of colorectal cancer screening
Covinsky
Cancer screening in elderly patients: a framework for individualized decision making
The best screening test for colorectal cancer—a personal choice [Editorial]
Options for screening for colorectal cancer in the Royal Air Force: a cost-effectiveness evaluation
J R Army Med Corps
Limitations of the faecal occult blood test in screening for colorectal cancer
Ital J Gastroenterol Hepatol
Faivre
Tazi
Autier
Bleiberg
Should there be mass screening using faecal occult blood tests for colorectal cancer?
Eur J Cancer
Gyrd-Hansen
Søgaard
Kronborg
Colorectal cancer screening: efficiency and effectiveness
Health Econ
Wahrendorf
Colorectal cancer screening: methods, benefits and costs
Neilson
Whynes
Cost-effectiveness of screening for colorectal cancer: a simulation model
IMA J Math Appl Med Biol
Norum
Prevention of colorectal cancer: a cost-effectiveness approach to a screening model employing sigmoidoscopy
Ann Oncol
Salkeld
Irwig
Glasziou
Cost-effectiveness analysis of screening by faecal occult blood testing for colorectal cancer in Australia
Aust N Z J Public Health
Shimbo
Cost-effectiveness analysis of strategies for colorectal cancer screening in Japan
Is virtual colonoscopy a cost-effective option to screen for colorectal cancer?
Paduano
Bernardis
Bartoli
Colorectal cancer screening in Italy: feasibility and cost-effectiveness in a model area
Eur J Gastroenterol Hepatol
Hardcastle
Faecal occult blood screening for colorectal cancer: is it cost-effective?
Cost-effectiveness of faecal occult blood screening for colorectal cancer: results of the Nottingham trial
Crit Rev Oncol Hematol
This retraction concerns the article:
Screening for Colorectal Cancer: Recommendations from the United States Preventive Services Task Force
Pignone M, Saha S, Hoerger T, Mandelblatt J. Cost-Effectiveness Analyses of Colorectal Cancer Screening: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;137:96–104. doi: 10.7326/0003-4819-137-2-200207160-00007
Published: Ann Intern Med. 2002;137(2):96-104.
DOI: 10.7326/0003-4819-137-2-200207160-00007
Screening for Colorectal Cancer: Recommendation and Rationale
Screening for Colorectal Cancer in Adults at Average Risk: A Summary of the Evidence for the U.S. Preventive Services Task Force
Evaluating Test Strategies for Colorectal Cancer Screening: A Decision Analysis for the U.S. Preventive Services Task Force
Should Colorectal Cancer Screening Be Considered in Elderly Persons Without Previous Screening?: A Cost-Effectiveness Analysis
Colonoscopy outreach increased CRC screening more than FIT outreach; both were better than usual care
Colorectal cancer screening with fecal immunochemical testing had higher adherence than screening with guaiac-based FOBT
Annals of Internal Medicine; 153 (8): JC4-5
Immunochemical FOBT had higher participation and detection rates than guaiac-based FOBT for colorectal cancer screening
Annals of Internal Medicine; 152 (12): JC6-2
Invitation for flexible sigmoidoscopy screening reduced colorectal cancer and colorectal cancer mortality
Cancer Screening/Prevention
Gastroenterology/Hepatology
Cancer Screening/Prevention, Colorectal Cancer, Gastroenterology/Hepatology, Gastrointestinal Cancer, Healthcare Delivery and Policy.
Mobile Telephone-Delivered Contingency Management interventions promoting behaviour change in individuals with substance use disorders: A meta-analysis.
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Rapid, point-of-care diagnosis of tuberculosis with novel Truenat assay: Cost-effectiveness analysis for India's public sector.
PLoS One 2019;14(7):e0218890.


Set over the course of the Christmas period, Await Further Instructions tells a tale of families at war and their strains that bubble under the surface. Nick Back to Burgundy (Sam Gittins) is on his way home to his family for the Christmas period. Due to tensions with his father this is his first time back in a number of years and this time he's bringing his girlfriend Angie. All should be fine except Angie is Asian and most of Nick's family are semi-closeted racists. Unfortunately for Nick that's not the worse thing he has to contend with this festive year, as on Christmas Day the family wake-up to discover the house surrounded by some sort of barrier that they cannot penetrate. Their phones aren't working and the only thing connecting them to the outside world is a television set that keeps giving them instructions. But who, or what, is writing the messages, and can they be trusted?
A lot of low-budget films, especially those withing the horror genre have little choice but to set their stories within one location. Luckily, in this instance, the single The Son of Bigfoot setting works brilliantly. Await Further Instructions also features one of the most horrifying of all premises, imagine being trapped in a house with your family for days and days, with no end in sight.
Await Further Instructions plays on the pre-existing tensions that The Front Runner exist within the family and cranks them to maximum. As paranoia and cabin fever set in, the family all turn on one another with poor old mum stuck in the middle. Not all of the family make it through, and those of a sensitive (pregnant) nature may wish to give the film a skip, at least for a few months at least.
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The Sinclair method is a method of using naltrexone or another opiate antagonists to treat.Vivitrol, which is better for uses like: Alcoholism, Substance Abuse and Withdrawal Syndrome.
Naltrexone is a type of drug that is prescribed to alcohol dependent people to help them reduce cravings, control or abstain from drinking.Disulfiram (sold under the trade names Antabuse and Antabus) is a drug discovered in the 1920s used to support the treatment of chronic alcoholism by.
This formulation of naltrexone may be useful in patients who have a history of medication nonadherence.Antabuse is one of several prescription treatment options for those battling alcoholism. These medications include naltrexone, acamprosate and disulfiram.
FDA-approved strategies for the treatment of chronic alcoholism today include antabuse (disulfiram), naltrexone (short- and long-acting formulations) and campral.Edward Fruitman, M.D. explains the difference between Antabuse and Vivitrol - medications to treat alcohol addiction.
Campral: Naltrexone: This medication is used to help alcohol-dependent patients keep from drinking alcohol.
In 1994, the use of naltrexone was approved for the treatment of alcoholism.Disulfiram: learn about side effects, dosage, special precautions, and more on MedlinePlus.Alcohol Dependence (Alcoholism) FACT SHEET - 1Alcohol Dependence. addition to disulfiram, naltrexone and acamprosate are now approved for use in treating alcohol.
Unlike disulfiram, another medicine that is sometimes used to treat alcoholism,.Background Although naltrexone, an opiate-receptor antagonist, has been approved by the Food and Drug Administration for the treatment of alcohol dependence, its.Combination of Disulfiram Plus Naltrexone to Treat Both Cocaine- and Alcohol-dependent Individuals. will be randomly assigned to receive disulfiram, naltrexone,. Disulfiram and naltrexone are approved by the Food and Drug Administration (FDA) for the treatment of alcoholism, but these agents have not been rigorously evaluated. Naltrexone blocks opiate receptors and works by decreasing the craving.Aims: To compare the efficacy of naltrexone and disulfiram in preventing an alcoholic relapse in routine clinical practice in an Indian metropolis.
This drug is sold under the brand name Antabuse. Alcohol withdrawal medication can make the process of.Brief Title: Combination of Disulfiram Plus Naltrexone to Treat Both Cocaine- and Alcohol-dependent Individuals - 1: Official Title: Two Medications, Disulfiram and.
Alchoholism. Alcoholism. Disulfiram, also known as Antabuse is one of the most commonly used medications for alcohol addiction. Naltrexone.
Online 99 99 087 0 and use of antabuse dosage instructions If a lady drinks two weeks for an more antabuse and naltrexone 20.
It is not likely that naltrexone will cause liver damage when taken in recommended doses.
Properties naltrexone acamprosate reaction of disulfiram with alcohol dosering buy online uk. Naltrexone may cause liver problems, and using it with other medications that can also affect the liver such as disulfiram may increase that risk.
ADVISORY Acamprosate: A New Medication for Alcohol Use Disorders.
Antabuse vs Vivitrol. Disulfiram works by blocking the processing of alcohol in the body. Naltrexone belongs to a class of drugs known as opiate antagonists.Health and Medicine Reference Covering Thousands of Diseases and Prescription Drugs.Antabuse is a drug that produces unpleasant effects when the person drinks alcohol while taking the drug.
Comparative Trial Of Disulfiram, Naltrexone And Acamprosate In The Treatment Of Alcohol Dependence (DNA).Only three medications are approved by the government to treat alcoholism: Antabuse (disulfiram), Revia (naltrexone) and Campral (acamprosate). None is.


I was working with Nexus theme from Elegant Themes for a project. It was a need to show content of a specific page in the home page itself. To achieve this, a little theme modification was required. Adding following PHP code in proper theme file can do the trick.
Now the question arises – how to find ID of a page / post?
You need plugin Admin Columns.
Open the page / post is open in editing mode, If it is already published, click Save Draft to change Publish status to Draft (Image 1). Place the mouse pointer on Permalink and watch the browser status bar. Information in the status bar will show the page / post (Image 2).
We shall use Admin Columns plugin. Install the plugin from WordPress plugin repository in your WordPress setup and activate it. Visit Settings -> Admin Columns in WordPress Dashboard (Image 3). Select Page or Post from drop down area. By default, there are four options already defined – Title, Author, Comment & Date. Add a new entry by clicking + Add Column big blue button below the list. Find out ID in Type drop down area and click Update button in Store settings area. Check the page / post list and you will find a new column named ID appeared in the list (Image 4).


text:
@import UIKit;

NS_ASSUME_NONNULL_BEGIN

IB_DESIGNABLE
@interface VMKTextField : UITextField
@end

NS_ASSUME_NONNULL_END

redpajama_set_name: RedPajamaGithub


1) cesperanza: Dear Fandom: Could You Please Stop Saying That?
I believe that you are exercising your free speech. I believe you are transforming mass media because you have ideas that are worth expressing and protecting.


text:
Knowing Me Knowing You with Alan Partridge
Knowing Me Knowing You with Alan Partridge is a BBC Television series of six episodes, and a Christmas special in 1995. It is named after the song "Knowing Me, Knowing You" by ABBA, which was used as the show's title music.
Skapare: Armando Iannucci
Skådespelare: David Schneider, Patrick Marber, Rebecca Front, Steve Coogan
Längd: 30m, 35m min
Nätverk: British Broadcasting Corporation
Súmrak bossov
Producers' Workshop
Producers' Workshop is a Canadian dramatic and documentary television series which aired on CBC Television in 1955.
Two Fathers
Over Winnaars
Temný Kraj
The Thanksgiving Day Parade on CBS
Zut!
Zut! was a Canadian sketch comedy television series which aired Saturday evenings from 1970 to 1971 on CBC Television. It was based loosely on relations between Quebec and the rest…
Redigo
Redigo is a 15-week Western dramatic series, set on a New Mexico ranch during the early 1960s, which aired over NBC from September 24 to December 31, 1963. The series…
Genre: Drama, Västern
Vì đó là em
De 5e boog
A Flemish youth fiction series
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redpajama_set_name: RedPajamaCommonCrawl


They may have strange scientific names, but succulents are so inviting as accents for wedding cakes! Wilton gets you ready for this hot trend in wedding cake decorating with the Succulents Gum Paste Cut-Outs Set. Follow the instructions to make the beautiful echeveria and agave plants shown here.
Mix ultra-concentrated color gum paste with white gum paste.
For purple, knead a 3/4 in. ball of ultra-concentrated purple into 3 oz. white gum paste.
For green, knead a 5/8 in. ball of ultra-concentrated green into 3 oz. white gum paste.
For yellow, knead a 5/8 in. ball of ultra-concentrated yellow into 3 oz. white gum paste.
Make purple wired agave three days in advance. Tint 3 oz. gum paste purple. Make a wired agave, with top row of four leaves, middle row of six leaves and bottom row of seven leaves following instructions in cut-outs set. Let dry and assemble following instructions.
Make green echeveria also three days in advance. Tint 3 oz. gum paste green. Make an echeveria following larger plant option described in instructionsin cut-outs set. Let dry and assemble following instructions.
Make yellow echeveria also three days in advance. Tint 3 oz. gum paste yellow. Make a standard size echeveria following instructions in cut-outs set. Let dry and assemble following instructions.
Highlight petals two days in advance. For agave and green echeveria, use brush and combination of purple and deep pink Color Dust edible accents to brush leaves. For green echeveria, use combination of spruce green and white Color Dust to brush edges of leaves. For yellow echeveria, use combination of lime green and white Color Dust to brush leaves.
Make cakes one day in advance. nBake and cool one 8 in. cake layer and two 6 in. cake layers.
Cover cakes with fondant. Level, fill and stack cakes on same-size cake circles for a 1-layer 8 in. cake, 3 in. high and a 2-layer 6 in. cake, 5 in. high. Use spatula and icing to lightly ice cakes smooth.
Tint 24 oz. fondant purple. Cover 8 in. cake with purple fondant and 6 in. cake with white fondant.
Assemble cake. Prepare cakes for stacked construction with center core rods and support rods and caps. Stack cakes on cake plate.
Position succulents. Insert agave in flower spike. Insert flower spikes in cakes. Use brush and gum glue adhesive to attach echeveria to cakes. Use small balls of fondant for additional support as needed.


text:
Attempting to cross SCOTLAND in a completely straight line. (PART 3: PISSED OFF FARMER)
just right now you know i'm seriously pissed off with you welcome back everyone to the mission across scotland you joined lovable rogues welsh greg and i in a remote forest clearing eight miles into a grueling expedition across scotland which we were hoping to be the first known people to cross in a completely straight line although only a fifth of the way through the mission we're actually in a very good place having already winged our way through quite a populated and obstacle laden leg of the journey the day before in complete contrast and quite gladly so today couldn't be more different morning everyone here we are at our campsite greg's just sluggishly packing his things in his bag um and yeah we're about to set off on day two day one was very action-packed day two will be less so won't it i think well we hope so we hope so yeah we've got to get down to the reservoir which has dried up we've checked that out that's not a problem then up a bit of forest and then it's up into the moors for literally eight miles and then we're back down into the sort of farmers fields we're going to see what progress we've made by the time we get to stash point two which is where we we were planning to camp but if we're making really good time we'll soldier on three and a half miles to the next really good camp spot and if we do that we can shave a whole day off the trip it's not totally necessary so we'll see how we go but yeah today is just really about making ground really and getting towards that halfway point of the trip the line is yeah pretty much there yeah let's do it man day two let's do it [Music] carrying our stash bag with us with a view to re-stash somewhere a bit more accessible further downhill we passed through the remaining strips of forest as well as the two remaining grassy veins yeah this is the one where we were going to camp oh yeah no i'm glad we can't swim no so it's good rugby alley rugby bloody next up was the north third reservoir initially one of our most dreaded obstacles due to its worryingly green marshy muddy appearance but upon scouting we were pleasantly surprised to discover that despite lots of heavy rain the levels were very low and we could simply stroll straight across this could be very good we'd be retracing those steps very soon but first we still had an awful lot of descending to do yeah we've got to be careful having this didn't help [Music] well here we are the north third reservoir which as you can see is receded massively yeah to add your life what are we going to do here greg we're going to get a paddle board paddle paddleboard we could longboard it to be honest it looks quite it looks potentially like it could be lethal really but it's an inch of depression lovely place and if we'd have uh traveled about 10 meters to the left i think it would have been a bit trickier yeah look at those cliffs it did get a bit sludgier in the middle definitely not long board territory but gladly there'd be no 8 a.m boot breaches today and there you have it that's it there's a little river down here where we're gonna uh cook breakfast wash our pans brush our teeth we're gonna stash this somewhere and uh dart off into the moors nice move nice just as planned i filled up our water bottles in bannock burn a stream i bet you didn't think you'd heard of while greg cracked on with the breakfast our aim was to be through the forest and away into the moors by half nine to give us a fighting chance of making that 12 mile away camp spot at saint hilda's boarding school well we're all done and dusted here pretty much looks like the trees in this next forest are a bit shorter and as a result much harder to move through but greg's prepared aren't you so this is the technique that we're going for avoid those eyes being poked out right let's go down there so with our bag stashed it was back inside our old friends the christmas trees and for the first time ever we didn't feel like we were going to have our eyes poked out at any given moment it's so good with the glasses yeah nonetheless though i'm staying two meters behind greg at all times to avoid twangs to the face this is exactly the kind of formidable terrain that preceded greg's episode in wales too and he's just battling right through it unfazed is that it okay oh yeah how much longer a bit more 200 meters 100 meters let's do it get it done [Applause] wouldn't be a british straight line mission without one of these woods i think we might be coming up to the end here ah [Applause] oh yes right we are at the moors now eight miles hopefully in um four or five hours there won't be much by way of juicy action or um thrilling shots instead probably a collection of scenic clips set to some incredibly composed electronic music let's go [Music] oh okay yeah that's a leaper isn't it go for it mike oh how have you stayed dry oh no my knee okay we're approaching this farm i think we just skimmed the right hand side of it there's someone there but again like we're so remote here that i don't think it's going to be a problem nice mate scotland flag flying they just glanced couldn't have given less of a ship if they tried the remote country we were now immersed in felt worlds apart from what we had experienced yesterday no danger or stress just a bit of a slog really in fact as we started to reach the mossy tufts that lived higher up on the fell after a two and a half mile steady climb the legs were beginning to burn just take it out of you walking on this spongy ground after a while i mean even an animal has dexterous and suited to its environment as a sheep still likes to build a path for itself but we're not we're going straight through the uneven terrain was clearly not going to make for a swift trek over these hills and high up on the crest of this first one we were able to catch a visual glimpse of just how much more of it there would potentially be okay so we think that today to get to the stash point which is the bare minimum of what we have to do we're going over that far strip of mountain just to the right of greg so a lot to do it does yeah this right it's down and then up isn't it yeah down into a little crevice with a little river in it and back up again hopefully the rivers not too bad it doesn't look too bad does it yeah more worried about the bank the other side but had i invited karma to join us once again oh it's not a good sort of place but to land mate come on thomas lovely mate oh he's gone for that fair play mate that was easier so it was up again pretty sharpish onto the next ridge where we stopped and had some much-needed lunch all right [Music] right we've had our lunch swiftly on the top of that ridge there we've got to go down and up in a big bad way we have no idea at this point whether we'll make the quick plan we're just going to go at a good pace hope there's not too many serious obstacles that slow us down and if we get there for two half two we'll we'll gauge it when we get there oh snow huh watch this oh two six mate just gonna sort the gopro out thankfully along with the odd patch of snow came much more even ground which allowed us to march swiftly on past the halfway point of the moors and down to our first encounter with the endrick so down here is our first river endrick crossing first of four all at very different stages in the rivers course the question is will we need to take our shoes and socks off will it be one of those which will slow us down and impact our plan the closer we got to the endrick the more it looked like it was actually a huge ravine oh my i hope that cliff stops that's high my looks it from here from this angle in the end though it was fine oh my what were we worried about in fact just to the right of our line a layer of flat rock just below the surface of the water made for a jesus-like crossing slightly less graceful though would be this next climb get ready for your legs here mate oh i know a solid 200 meter ascent with the occasional marsh thrown in just to keep us on our toes and a string of false horizons oh you now when we did finally reach the top though the views were totally worth it in more ways than one incredible view of that reservoir mate but then oh god well yeah that's a bit more important wow incredible feels good to be able to see it doesn't it this is the highest point basically yeah all the way then it's rolling up and down but not really ever higher than this yeah we can't see the finish line but we can see the points basically at which we have like six miles to go which is a great feeling it's a great feeling that isn't it yeah lots to go in between now and then so uh let's carry on in high spirits so what exactly did lay between us and that far away hill well after stash two which it was now looking like we would probably have to camp at it was into what was basically a 14 mile stretch of rural countryside mainly consisting of sheep and cattle farms but there was a lot of other stuff in there too this is how it looks with the original and most likely plan first thing tomorrow morning we pass through these properties followed by a farm and a larger end rick then we sneak past this farm the boarding school three more farms two of which we would be going straight through the middle of before camping in these woods the next morning we cross the now considerably larger river hendrick two times and after a load more fields it's through the village of gatochan full of properties and stables and the like and pretty much the last major place where things could go badly wrong people-wise if we survive that we head for the sanctuary of the heavily wooded camp 4 a real milestone at which we could gaze over loch lomond and almost taste the victory in the morning though there would be the small task of crossing it a mile and a half on callum's two-person kayak before negotiating a very tricky looking mangrovy sort of area which we would need callum's wetsuits to actually swim through it was then over the golf course through the biggest ghost patch i've ever seen and to our final camp where we could pick the thorns out of our asses and dream about the final day the final day itself was just a case of walking six miles over this forest littered hill and down to the coast in blair vadak victorious between us and stash 2 however unexpected cracks were beginning to appear in the landscape and in my planning exactly oh bit of a drop here but that was just a baby crack oh look what we have ahead mate oh okay hi it's half two in the scottish moors and uh we've got this little piece to contend with um it may not look that steep looking down on the gopro but it's it's vertical um no it's just about doable we think so we're going to crack on after you sir [Music] oh it will great waterfall incredible waterfall must be a torrent at times wonderful oh my god my that is so steep steep but luckily doable and a nice little obstacle to overcome on what was a pretty repetitive day up next a grassy brow to remember this is it isn't it this is the last descent wow i remember coming near here on that scouting trip yeah being like if we can get to here sunday evening that seeming like a very very long shot at that point given what we have to go through and we're here we're here before we descended the 200 meters down to the stash point there were a couple of steep gradients that i did manage to spot on google earth and earmark as potentially dangerous three days ago though after stashing stash two we ventured halfway up the hill and decided that from where we were standing they didn't seem too bad happily we were correcting our judgment on that occasion with both gradients causing us no real issues however we could not have been more incorrect in our next one on our way back down the hill on the day of the stashing a similar scene to what you can see here we came across a farmer and his son herding sheep we exchanged hellos and smiles and greg and i continued on our way commenting on how friendly and relaxed the farmers were in scotland by this point you've all seen the spoiler and you can probably guess the direction in which this is heading and we'll get there very soon meanwhile a perky greg and i are approaching the stash it's a bit further isn't it it's been a while i can't i can't remember poking out oh there it is let's see yeah everything bottles oh brilliant and we'll camp just over there we think yeah just about 10 meters off the line on some flat ground all right mate get to the crest and we'll clock out for the day yeah that'll do mike that'll do us perfect spot right on the line and that will do us nicely for day two all right let's see what goodies we've slashed in this cumbersome thing yeah charger for phone comped good some very greg sort of bucket loads of sweets custard creams you'd have to sing the titanic but more to the point yeah sainsbury's anchovy stuffed olives could not beat that can you don't knock it till you've tried it oh god happy with our spot which was fairly high up and hidden from the farm below by the trees and the shelf of land we were on we tucked into our anchovy olives and tuned into another corking sporting fixture well it's another sport themed camp tonight it's uh a premier league humdinger really which we didn't even know was on which is chelsea versus man united we're just going to wait an hour or so until it starts to get dark then we'll set our tent up and make a little fire over there um but yeah for now we're just chilling but we weren't chilling for long three yep three dogs gotta be an owner i'm hoping there's an owner yes i know what are they doing yeah there's the owner okay that's kind of really this is the woman oh yeah yeah yeah six it's absolute bonanza out there isn't it right don't know i don't suppose she'll care see this is why you don't put the tent up and make a fire early isn't it yeah she does run the farm she's presumably that husband the wife of the farmer that we saw she has seen us has she i think she's seen this yeah oh is the husband she just like signaled to someone then well we'll see what happens what actually happened next was that one of the dogs sprinted towards us far too fast for me to grab the camera stopped right at our feet and barked aggressively at us a few of the other dogs joined in before all of them were called away by the farmer's wife no problem have a nice evening okay didn't get the best of that on camera but that one dog came bellowing yeah he really came up with him i didn't think he was going to stop us with the power of hindsight this is the exact point having just been seen by the farmer's wife that we should have just packed up our things and gone but to be fair because she just like her presumed husband three days prior had been so friendly and relaxed with us we had no reason to believe that we were unwelcome there so instead just as the sun began to set over loch lomond we pitched the tent and made ourselves a small hopefully untraceable fire and reflected optimistically on our progress so far and position going forward good day it's good solid day i mean it was what we thought it would be really pretty tricky and marshy along the moors ups and downs but ultimately still managing to get to camp 2 pretty easily yeah exactly and tomorrow yeah it's uh it's a fairly unremarkable day there's there are obstacles there are farms there are rivers um there are people's back gardens but yeah it shouldn't be too much of a challenge we should get through it and get over the halfway point and and beyond yeah yeah bring it on see in the morning that was supposed to be the final clip of the day but at 7 30 p.m we heard that dreaded sound once again hi is this unacceptable but essentially we're rex we're on an expedition and uh we're aiming to be the first people to cross scotland in a completely straight line so it's a guinness world record attempt right and now we're on this is our second night so we've come down over the moors today so we kind of did the whole moors we're halfway through halfway through we're heading towards loch lomond and obviously we have to stick fairly close to line so we we hoped that this might be okay for us to what he should have done was come first of all to the to the farm and asked we weren't too sure who who actually was owning it yeah we thought this is like sort of um natural land this is we farm this land and obviously with covert is the next thing that's why i asked you where you're from yeah somewhere of course yeah i'm from wales yeah yeah so i'm not wanting to be awkward no no no no i understand that i like the job but you can see you know we live in a nicer little place yeah sure i can see what you're doing but i am gonna have to you know i don't know i don't you know obviously you've set up your account tonight and if it was me was doing it i would have asked the farmer look you're coming on your land or you're going to set up a tent let me come into your garden and set my tent up in your garden walk in a straight line across wheels yeah that would be the right thing to do i know but it's just that if someone said no to us then we we would like scupper the so we're being a bit cheeky i know but yeah and you can see that i'd be bound to be a bit annoying sure yeah no totally understandable totally understand that yeah yeah and i don't want to be a pain in the ass and i don't want to stop but yeah you know we are trying to be we're just right bang on the mouth alarming the sheep are in tonight to be shorter right they'll be out here in the morning and i just don't my worry is that someone brings covert and i get sick and i get sick alarming time i am in serious i can see exactly what you're doing guys yeah i would have appreciated someone to say to me even the other day like whenever i was working the sheep and you went past me yeah i would have appreciated if you just said we are coming back tomorrow yeah yeah you know then we could have looked at it from there but just right now you know i'm seriously pissed off with you yeah i'm very sorry no you you're dead right back then would have been an ideal opportune opportunity to be honest to let you know yeah the one thing i will ask you like i could share the other package yeah yeah but i'm not going to do that now i'm going to be reasonable about this thank you very much if you can not come down through our yard yes yeah yeah yeah yeah well we're going yeah you need to just walk away when you leave tomorrow if you can make sure it's out so it's this oh [Music] yeah yeah we totally understand yeah okay thank you so much thank you thank you really appreciate it wow so it turns out um yeah this was pretty hot this was as hot as it gets something i don't think we've ever had a cab spot where someone's coming up in the corner no we've we've never had that before and we didn't for one minute i mean i'm more cautious than greg but i didn't think that that that would happen here especially after the the wife waved at us earlier yeah but he is seriously ticked off he was ticked off wasn't there yeah but reasonable though as well in the end no i seem to be northern irish but wow i feel kind of bad but yeah but all of this does make it hotter now for future farms because i think people are a bit para about covid um even though we know we haven't got it but it to them they don't know that it does make the future farm crossings a bit different yeah to what we thought anyway we'll talk about it in the morning we got away with it that was definitely supposed to be the final clip of the day but here's the killer ladies and gents our ordeal was far from over roughly an hour and a half after our encounter with the farmer our senses were alerted again this time instead of the abrupt onslaught of an engine and headlights it was faint men's voices and what looked like handheld torchlight making its way slowly but surely up the same path as the farmer's wife had used two people over there what are they doing up here at this time they're coming at the time we really weren't sure who it could be did the farmer have a change of heart and send two blokes up to remove us or was it just locals on a nighttime trek both seemed unlikely but whoever they were they had spotted our fire they are okay they're coming down the men were now heading straight for us but it wasn't until they were about 10 meters away that we realized who it was and it was probably the worst outcome possible hi hi how you doing i'm okay we've uh spoke to the farmer yep are you still fooling those though ah right okay why are you guys here um i'll cut to the chase we are attempting to cross scotland in a completely straight line right okay um to be the first people to ever do that sort of giving i have recorded attempts yeah i have a youtube channel i've i've walked i'll stand up i've walked across wales in a straight line and norway i know it's a bit of a mad idea bill given us a look down in scotland just now yeah it's not just mad it's illegal yeah so where he came from where are we from yeah um i'm from birmingham okay so again we'll go back to this is illegal yeah yeah so how did we get to scotland and painted we're live we got a uh rented a car and um we drove up and well we started the we're halfway through halfway through now we're coming from just south of stirling and we're going over to lock beyond like towards fast lane so we're halfway through and we know it's um cheeky but we thought look we're not going to come into contact with anyone and we tried to keep it far away as scottish people we're not allowed to cross the border into england yeah no granted but you guys have decided to come the opposite way yes yes so we are looking at things right the fact you didn't speak two days later no no that's because we have to look at the possible points of concern along the way so for example there's ridges up there which we weren't sure how steep they were going to be so we came here we scouted it out a reconnaissance so to speak to look and say is it actually like a makeable ridge right okay can i suggest then yes that you stay here tonight yeah right then you pack up and go back home right okay because you're gonna get stopped by the place again obviously that's somebody that's fun done how long have you been up in scotland like i said we came home yeah technically that's more than a fine then that's being reported to the property for school directly for a culpable necklace if you've been here for four days it's not just a day visit you know you're traveling through council district there as well which again people of scotland aren't allowed to do i can't leave the area of still in council no no no i didn't know that yeah well because you are going to get hit with as my colleague says i report to the fiscal which will require you to attend at a court a future date and listen to this you know this could come into landing season just now yes you've picked the wrong time to do anything like this yes yeah it's tough because we have to do i can't do it in the summer because the rambles and the stinging nettles and the hay fever and the midges so that's why i try and do them in the winter but yeah no i appreciate it i appreciate that and she hadn't been this time last year it would have been fine they would have been fine but just now we are in the current a situation that we are in the lockdown yeah the farmer wouldn't have phoned there's obvious pissed off he wouldn't have all of those with it if it was this time last year no no no no no no because of what it is from a moral point of view we decided look it's okay but to be honest we didn't think we'd see this many people bumped into honestly see if you're heading towards kennel woman and all that yeah yeah you are going to do nothing but bump into people yeah yeah followers will get your details anyway lads okay i would suggest that you camp here tonight because there's obviously no way we can go tonight you pack up in the morning yeah keep will be from that farm yeah yeah when you head back home yes because they're gonna get from causing their booties yes we will uh we will 100 yeah yeah we don't we don't want to do this if we're going to be pissing off people and yeah my name's greg i can't really show most of the footage from this point on as greg and i tell our respective coppers our personal details but during this time we each had more of a chance to really explain the whole idea of the mission in more detail and how for me personally it was a big part of my channel and my career ultimately that made little difference to proceedings but they were intrigued by the concept of what we were doing and did warm to us over time in fact it wasn't long before i was being teased about england's recent losses in the rugby we i love that i love it in the end all threats of fines and court cases were dropped and we ended on almost ridiculously good terms [Laughter] the instruction was clear though we had to piss off home and it didn't take long for the reality of that to sink in yeah ah yeah it's starting to sink in now we we've failed yeah ah yeah bad time and we knew that coming it we knew that it wasn't the we did but not to this exactly we didn't think we'd be seeing people to this extent for a start no anyway we'll see you in the morning guys love some more thoughts then i think yeah we will see you there in the morning i rose early to the breathtaking and dangerously enticing sight of the miss shrouded valley that awaited us and shared my updated thoughts thoughts this morning personally before greg gets up part of me wants to carry on despite all of that just because you know the police are always going to exaggerate they're always going to paint this picture that you're just going to get caught again inevitably but they're gonna say that and part of me just wants to go for it and thinks that we'll be fine um and that this was just a clumsy one-off then the sensible part of me says no there are many farmsteads that we go straight through back gardens that would have to skirt round and maybe it's not the right thing to do morally at this time either way i can't please everyone there will be some of you who will want me to carry on and you'll be disappointed it's another failure but i think most of you will agree that as the cop has said annoyingly we just got the wrong time as the morning progressed and the mist receded down the valley we pondered more over the big decision but ultimately concluded that the many cons of continuing now far outweighed the pros aside from all the covered stuff one of the main things that cemented it for us was the fact that not only were we under strict orders from the police whom we actually have a lot of respect for but we actually had a mutual agreement with them they had trusted us to go home and we had given them our word as a result we don't get fined or go to court and they can go off and fight proper crime and if we carried on now and got caught again not only would we be in deep which greg couldn't afford to risk being in any way with his new career but the coppers would probably be in trouble with their superiors too for letting us go don't get me wrong we were both absolutely gutted the amount of preparation we had put into this trip was ridiculous and we wanted it so bad and everything was lined up for victory so we were gutted but we took some comfort in knowing that by respecting the farmers respecting the police sticking to our word and setting a good rather than a bad example to anyone watching we've done the right thing as for the farmer we'll never quite know why he chose to handle things the way he did maybe he didn't 100 believe our story maybe he found me on youtube after he spoke to us and changed his mind or maybe his intention all along was to put an end to our trip whatever it was if you're out there mr farmer we forgive you and we respect your decision at the end of the day that farm is that man's livelihood and any farmer worth his salt would do whatever they felt necessary to protect it what was next for me and greg then well firstly we had another full day ahead of us collecting all the used and unused stash bags one doll it was a bit heartbreaking to be honest particularly when we ventured out to the glorious loch lomond camp and pictured how we would have felt having reached that point me that is still but we tried our best to look at the many positives we did have an unforgettable first day and all the incredible footage that went with it and we did almost reach the halfway point of the mission without deviating more than 25 meters in a way that does make it even more heartbreaking that we didn't reach the end but nonetheless our tightness to the line here is something to really be proud of maximum deviation 14 meters at ochill view again though testament to the meticulous planning something i'll discuss further in the line review video along with the burdell score a new more accurate way of judging the success of a straight-line mission that i'll now be using to complement the traditional gold silver platinum system so do tune into that video to see all that nerdy stuff and don't forget all the bonus footage for this trip is on the one dollar patreon page for now though having just collected our final stash bag and almost been seen by the police at our final hedgerow police there was just one last thing to do see if our trusty ladder still hadn't been nicked by a bloke called ross i would like it back because it did cost a hundred quid i don't think it is i doubt it's in the same position well the mats up there but the ladder is gone and on that bitter note it's another regretfully premature goodbye from me and especially greg who despite well and truly taming his condition still needs to taste straight-line victory maybe we'll return to scotland soon to try a different line and not in a pandemic or maybe we'll return to wales and conquer that once and for all instead i also have a couple of slightly more exotic straight line missions planned for the near future but until then take care and thanks so much for watching [Music] [Music] my
Must Try Food Tour in Hokkaido | Hakodate Winter Tour 2022-01-19 03:20
Guided VR-tour inside Chernobyl Nuclear Power Plant | Eyemmersive | Ukraine | Nuclear Disaster 2022-01-18 04:31


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Focus on the NCAA
By BTL Staff|2010-04-01T09:00:00-04:00April 1st, 2010|Entertainment|
It's one thing for Apple or Doritos to hawk their wares during the Super Bowl. It's another thing entirely for Focus on the Family to do so.
The right-wing Christian political organization – known for its strident opposition to both abortions and LGBT civil rights – provoked a national uproar when CBS agreed to air an anti-abortion commercial featuring University of Florida quarterback Ted Tebow during what turned out to be the most-watched program in American television history. (The controversy was stoked in part because in 2004 CBS refused to air an ad in which the United Church of Christ showed that it welcomed everyone – including gays and lesbians.) The network said its policy on "advocacy ads" changed in the intervening years.
The anti-abortion spot aired, and the republic survived. But within days, a new controversy arose. Within a few weeks, CBS was televising the men's college basketball tournament – and more Focus on the Family ads were planned.
This time, though, it was not the network that drew activists' fire. It was the organizers themselves: the NCAA.
Pat Griffin has worked closely with the NCAA, as both a former University of Massachusetts coach and director of the Women's Sports Foundation's "It Takes a Team" anti-homophobia project. Now a blogger on LGBT sports issues, she set her sights on the powerful oversees of most American collegiate athletic programs.
The NCAA's own constitutional principles explicitly prohibit discrimination based on sexual orientation, she wrote. Yet Focus on the Family wants to "impose their values on the NCAA tournament … . (The NCAA and CBS) are rolling out the red carpet, and I am deeply offended by the NCAA's complicity in this."
The NCAA, Griffin said, "cannot have it both ways. They cannot claim to care about the quality of the athletic experience for LGBT student-athletes and provide educational programs to assist schools in making sure that LGBT student-athletes can compete with respect and dignity, and (at the same time) allow Focus on the Family to use the NCAA Web site and men's basketball tournament to promote their discriminatory right-wing Christian agenda."
Griffin asked her readers to pass her blog post on to friends – and the NCAA. She urged anyone who attends – or once attended – an NCAA school to call their university presidents.
Other LGBT blogs, including the influential Towleroad, picked up the cause. Within a day, the NCAA relented – a bit.
NCAA spokesman Bob Williams said the decision "came in response to vocal protests from a small number of advocates for gay and lesbian athletes, who complained that the group's views that homosexuality and abortion are immoral is inconsistent with the NCAA's stated non-discrimination policy. Focus on the Family did have a banner ad on NCAA.com. Today, it was decided to remove the ad from the Web site as a result of concerns expressed by our membership."
Williams' words went from combative ("vocal protests," "small number of advocates for gay and lesbian athletes," "complained") to acceptance ("concerns expressed by our membership") in the span of three sentences.
No decision was announced, however, about the television ad – which was, after all, more of a case of the ball being in CBS's court.
And then something really interesting happened. The NCAA statement was changed. Suddenly, the language was less provocative, more objective: "The decision by the NCAA came in response to vocal protests from advocates for gay and lesbian athletes – which quickly grew into a broader audience of critics who sent e-mails and set up what has now become the standard, a Facebook page – who complained that the group's views that homosexuality and abortion are immoral are inconsistent with the NCAA's stated non-discrimination policy."
Griffin wasn't through. She used the NCAA's own Advertising and Promotional Standards to argue that Focus on the Family's ads violated the organization's stated mission. NCAA advertising, the standards say, should support ideals that include diversity, gender equity, non-discrimination, ethical conduct and student-athlete welfare."
The connection between the NCAA and CBS turns out to be quite close. According to Inside Higher Education.com, the ads were part of a larger package deal between CBS – which manages NCAA.com – and Focus on the Family.
Griffin kept up her attack. Focus on the Family's definition of "family," she said, is restricted to those in which heterosexuals marry. The group is "entitled to their perspectives on controversial issues," she said. And of course "they have a right to buy advertising time if their ads meet the standards of CBS or any other for-profit media group."
However, Griffin argued, a line must be drawn when non-profit educational organizations like the NCAA have missions and values that "do not square" with those of groups like Focus on the Family.
Griffin said she would like to follow March Madness with the same excitement she always has. She does not want to feel "sold out" by the NCAA – "or need to go to war about it."
But, she warned, "I will if I have to."


D-Lab students in the D-Lab workshop discussing a spring semester project with visitors.
Students from the seven spring 2018 MIT D-Lab classes presented projects, in addition to one of the D-Lab UROPs. Project teams presented their work and received questions and feedback from other teams of D-Lab students as well as from guests! Download the full program with student lists.
Download the full program with student lists!


Nestled in the lush foothills of Mount Kenya, and with a history as rich and evocative as the surrounding landscape, the Fairmont Mount Kenya Safari Club offers a snapshot of Africa from a bygone era. Enjoy adventure activities, local dining and cultural experiences in Kenya's most famous retreat.
Safari adventures including horse riding through the forest, mountain biking, nature walks, bush dinners and game drives.
Explore the best that Mt Kenya Safari has to offer. Experience the area's most exciting games and hidden treasures.
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Reviews & Insights
Stalkers have been a popular subject of thriller and horror films for many years. The fear of being followed by someone makes a great story for the genre. When we put ourselves in places we're not quite familiar with, we can often feel like the whole world is staring at us. We feel like the odd one out; like we don't belong. And because of these feelings, we can start to believe someone is following us.
That is exactly how Frances McCullen (Chloë Grace Moretz) feels. She's new to the fast paced world of New York City, with only her free-spirited best friend Erica (Maika Monroe) for guidance. So, because of how and where she was raised, she doesn't hesitate to return a lost handbag she found on the subway. The owner of the bag is Greta Hideg (Isabelle Huppert), an elderly woman with an affinity for piano.
Frances finds something comforting about Greta's motherly personality, and soon the two form a true friendship. That is until Frances makes a strange discovery. In one cabinet, she discovers several of the same handbag. She comes to realize that their encounter wasn't so coincidental. She wants nothing more to do with Greta, but she quickly realizes that getting rid of her isn't as easy as it sounds, as Greta soon puts to work a waking nightmare for Frances.
It's not like there are many new places to take the stalker sub-genre. There's only so much you can do with the story of a person getting stalked by another. All kinds of twists have been done to try and reinvent the concept, to the point where there isn't really much else to dive into. Believe it or not, you can get to the point where a certain sub-genre has been played out so many times that there's literally nothing else to cover.
And Greta, from director Neil Jordan (The Crying Game, Interview with A Vampire, and Mona Lisa) falls into this category. Despite being fun and thrilling overall, the film never covers anything we haven't already scene from this genre. There are times where you feel like something new could appear, but then the movie gets right back on the basic path and follows a formula we've seen in many other stalker movies. That ends up being somewhat of a disappointment because you can see where things could've have gone, and the film itself chooses not to go that route.
That being said, Greta is still a fun time because of its B-movie nature. It may have a dark and serious nature, but very little of this film can be taken seriously. There are moments where the movie goes to some very ridiculous levels; almost to the point where it was more hilarious than scary. However, this is what made the film so entertaining. It reached levels of dumb fun that made the overall experience more fun than dumb.
Despite the present campiness of the tone, there are some legitimately thrilling moments. This is mostly due to the expertly crafted set pieces and stylish directing, which captured the claustrophobic nature of New York. This helps to elevate the pressure Moretz's character is feeling due to the presence of Greta. This also helps the audience feel just as claustrophobic as she does, and makes for some genuinely uncomfortable moments.
The film is further saved by the pitch perfect performance of Isabelle Huppert, who continues to make a strong case for her Oscar nomination back in 2016. There isn't any other actress who could have played the role of Greta as well as she did. She perfectly embodies what makes up the character. From her youthful psychotic movements to her unstable mental state, Huppert perfectly captures what makes the film's truly unsettling psychopath.
Chloë Grace Moretz also gives a strong performance. We don't see her in many movies nowadays, at least not in any big ones. Her recent endeavors consist of a lot of independent movies by relatively unknown filmmakers. She doesn't appear to be making the transition from child acting to adult acting very well. However, she still kills it in the roles (for the most part), so to see her in a starring role is kind of a treat. In this film, she shows off some of the best qualities in her acting abilities. Like Huppert, she displays the exact qualities for the character of Frances.
Greta fully relies on a formula we've many times before, and chooses a more campy execution to carry out said familiar storyline. But thanks to Jordan's stylish direction and Huppert's impressive lead performance, the film is elevated from a predictable time-waster to a dumb but very entertaining B-movie. If you're willing a except the reliance on the clichés, then you might find some fun in this solid, if unoriginal, new addition to the stalker sub-genre of horror.
By Ben Rothrock|2019-03-02T15:01:18+00:0003/02/2019|1 Comment
About the Author: Ben Rothrock
Kendra Schultz 03/05/2019 at 10:45 pm - Reply
Saw the movie last night and it was just way too over-the-top and very laughable.
1-1/2 Stars
DVD Pick of the Week
TIFF 2017
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Home Entertainment Members of the K-pop group BTS will be enlisting in the military
Members of the K-pop group BTS will be enlisting in the military
The members of K-pop group BTS will perform mandatory military service in accordance with South Korean law, according to their management company.
The announcement effectively shuts down the debate about the band's release due to their artistic achievements.
Big Hit Music announced that the group's oldest member, Jin, will withdraw his request to defer his military enlistment at the end of the month and take the necessary measures.
Six other members also plan to serve in the military, the company said in a filing with financial regulators, which it described as management-related information that could influence investment decisions.
Big Hit released another statement on Twitter, saying that the company and BTS members "look forward to reuniting as a group around 2025 after their service commitments."
No further information was given on their terms of service.
The band members performed together in Busan over the weekend in support of the city's Expo bid, but it appears only solo projects are planned until 2025.
The announcement comes after Lee Ki-sik, the commissioner of the Military Personnel Administration, told lawmakers this month that it would be "desirable" for BTS members to fulfill their military duties to ensure the fairness of military service in the country.
The question of whether BTS members should serve in the military has been hotly debated in South Korea as Jin faces a possible draft early next year after turning 30 in December.
Under South Korean law, most able-bodied men must complete 18 to 21 months of military service, but special exemptions were granted for athletes and artists who excelled in certain international competitions that were associated with national prestige.
Because conscription in South Korea interrupts young men in their professional careers or studies, draft evasion or exemptions are a highly sensitive issue.
Public opinion polls in recent weeks have shown that the public is divided on whether BTS members should serve in the military.
https://thenewdaily.com.au/news/2022/10/17/k-pop-bts-military-service/
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Cisticola és un gènere d'aus insectívores, molt petites, que eren classificades a la família dels sílvids (Sylviidae) però que ara se situen a la família separada dels cisticòlids (Cisticolidae), juntament amb altres gèneres pròxims.

Totes les espècies d'aquest gènere viuen en Àfrica llevat de tres: la cisticola de Madagascar (Cisticola cherina) que viu a Madagascar, la cistícola capdaurada (Cisticola exilis) que s'estén de l'Àsia fins a l'Austràlia i finalment el trist o brusac (Cisticola juncidis), l'única espècie que tenim als Països Catalans.

Taxonomia
Segons la classificació del Congrés Ornitològic Internacional (versió 12.2, 2022) aquest gènere està format per 53 espècies.
 Cisticola erythrops - cistícola cara-roja.
 Cisticola cantans - cistícola cantaire.
 Cisticola lateralis - cistícola xiuladora.
 Cisticola woosnami - cistícola de Woosnam.
 Cisticola anonymus - cistícola xerraire.
 Cisticola bulliens - cistícola remorejant.
 Cisticola chubbi - cistícola de Chubb.
 Cisticola hunteri - cistícola de Hunter.
 Cisticola bakerorum.
 Cisticola nigriloris - cistícola emmascarada.
 Cisticola aberrans - cistícola mandrosa.
 Cisticola emini - cistícola roquer.
 Cisticola chiniana - cistícola grinyolaire.
 Cisticola bodessa - cistícola borana.
 Cisticola njombe - cistícola de Njombé.
 Cisticola cinereolus - cistícola cendrosa.
 Cisticola restrictus - cistícola del Tana.
 Cisticola rufilatus - cistícola grisa.
 Cisticola subruficapilla - cistícola dorsigrisa.
 Cisticola lais - cistícola ploranera.
 Cisticola distinctus - cistícola de Lynes.
 Cisticola galactotes - cistícola ala-rogenca.
 Cisticola marginatus - cistícola del Nil.
 Cisticola haematocephalus - cistícola costanera.
 Cisticola anderseni - cistícola cuablanca.
 Cisticola lugubris - cistícola d'Etiòpia.
 Cisticola luapula - cistícola del Luapula.
 Cisticola pipiens - cistícola refiladora.
 Cisticola carruthersi - cistícola de Carruthers.
 Cisticola tinniens - cistícola de Levaillant.
 Cisticola robustus - cistícola robusta.
 Cisticola aberdare - cistícola dels Aberdare.
 Cisticola natalensis - cistícola gralladora.
 Cisticola ruficeps - cistícola cap-roja.
 Cisticola guinea - cistícola de Dorst.
 Cisticola nana - cistícola nana.
 Cisticola brachypterus - cistícola alacurta.
 Cisticola rufus - cistícola rogenca.
 Cisticola troglodytes - cistícola vulpina.
 Cisticola fulvicapilla - cistícola de capell rogenc.
 Cisticola angusticauda - cistícola cuallarga.
 Cisticola melanurus - cistícola cuanegra.
 Cisticola juncidis - trist.
 Cisticola haesitatus - cistícola de Socotra.
 Cisticola cherina - cistícola de Madagascar.
 Cisticola aridulus - cistícola del desert.
 Cisticola textrix - cistícola pinc-pinc.
 Cisticola eximius - cistícola dorsinegra.
 Cisticola dambo - cistícola dels dambos.
 Cisticola brunnescens - cistícola bruna.
 Cisticola cinnamomeus - cistícola de coroneta pàl·lida.
 Cisticola ayresii - cistícola d'Ayres.
 Cisticola exilis - cistícola capdaurada.

Tanmateix,  altres obres taxonòmiques, com el Handook of the Birds of the World i la quarta versió de la BirdLife International Checklist of the birds of the world (Desembre 2019),  compten que hi ha 50 espècies dins del gènere Cisticola, considerant les següentes divergències:

- C. bakerorum i C. anderseni no es reconeixen, car tan sols foren descrites i acceptades per l'IOC el 2021.

- Una de les subespècies de C. aberrans (C. aberrans bailunduensis) és considerat una espècie apart:

 Cisticola bailunduensis - cistícola de Huambo.
- C. emini és considerat una subespècie de C. aberrans (C. emini aberrans).

- Finalment, C. distinctus és considetat una subespècie de C. lais: (C. lais distinctus).

Referències

redpajama_set_name: RedPajamaWikipedia


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Q: Laravel 5.2 project - deployment on Linux I am developing an application on Laravel 5.2. I am done with development and deploying the application on a linux server.
I moved the source code using git and executed migrations. I can see everything but when I access the project (any url) it gives 404 error.
The requested URL /project_name/public/ROUTE_NAME was not found on this server.

I checked apache logs, they say
Wed May 25 17:17:15 2016] [error] [client 172.16.17.15] File does not exist: /var/www/html/project_name/public/ROUTE_NAME

Let me know your thoughts.

A: Possible problem is the missing of the module mod_rewrite on the apache.
https://httpd.apache.org/docs/current/mod/mod_rewrite.html
The routing system of laravel works on it. It just takes your url and does it's magic. But without this mode it wont work.
In your index.php in the public folder try
phpinfo();die();
To see if you have the mode activated.
If the mode is not active you can follow this instructions
https://stackoverflow.com/a/24354757/4969969
without the need to modify the entire document root folder of the server:
DocumentRoot "/var/www/html/"
....
<Directory "/var/www/html/project_name/public">
    Allowoverride All
</Directory>

redpajama_set_name: RedPajamaStackExchange