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Genetic Counseling
Familial Cancer Susceptibility Syndromes
Genome-wide Association Studies (GWAS)
Structure and Content of PDQ Summaries
Genetic Resources
Changes to This Summary (08/08/2012)
About This PDQ Summary
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[Note: Many of the medical and scientific terms used in this summary are found in the NCI Dictionary of Genetics Terms. When a linked term is clicked, the definition will appear in a separate window.]
The etiology of cancer is multifactorial, with genetic, environmental, medical, and lifestyle factors interacting to produce a given malignancy. Knowledge of cancer genetics is rapidly improving our understanding of cancer biology, helping to identify at-risk individuals, furthering the ability to characterize malignancies, establishing treatment tailored to the molecular fingerprint of the disease, and leading to the development of new therapeutic modalities. As a consequence, this expanding knowledge base has implications for all aspects of cancer management, including prevention, screening, and treatment.
Genetic information provides a means to identify people who have an increased risk of cancer. Sources of genetic information include biologic samples of DNA, information derived from a person's family history of disease, findings from physical examinations, and medical records. DNA-based information can be gathered, stored, and analyzed at any time during an individual's life span, from before conception to after death. Family history may identify people with a modest to moderately increased risk of cancer or may serve as the first step in the identification of an inherited cancer predisposition that confers a very high lifetime risk of cancer. For an increasing number of diseases, DNA-based testing can be used to identify a specific mutation as the cause of inherited risk and to determine whether family members have inherited the disease-related mutation.
Throughout this summary, the term "mutation" will be used to refer to a change in the usual DNA sequence of a particular gene. Mutations can have harmful, beneficial, neutral, or uncertain effects on health and may be inherited as autosomal dominant, autosomal recessive, or X-linked traits. Mutations that cause serious disability early in life are usually rare because of their adverse effect on life expectancy and reproduction. However, if the mutation is autosomal recessive—that is, if the health effect of the mutation is caused only when two copies (one from each parent) of the mutated gene are inherited—mutation carriers (healthy people carrying one copy of the altered gene) may be relatively common in the general population. "Common" in this context refers, by convention, to a prevalence of 1% or more. Mutations that cause health effects in middle and older age, including several mutations known to cause a predisposition to cancer, may also be relatively common. Many cancer-predisposing traits are inherited in an autosomal dominant fashion, that is, the cancer susceptibility occurs when only one copy of the altered gene is inherited. For autosomal dominant conditions, the term "carrier" is often used in a less formal manner to denote people who have inherited the genetic predisposition conferred by the mutation. Refer to individual PDQ summaries focused on the genetics of specific cancers for detailed information on known cancer-susceptibility syndromes.
Increasingly, the public is turning to the Internet for information related both to familial and genetic susceptibility to cancer and to genetic risk assessment and testing. Direct-to-consumer marketing of genetic testing for hereditary breast and colon cancer is also taking place in some communities. This wider availability of information related to inherited cancer risk may raise concerns among persons previously unaware of the implications inherent in their family histories and may lead some of these individuals to consult their primary care physicians for management advice and recommendations. In many instances, the evaluation and advice will be relatively straightforward for physicians with a basic knowledge of familial cancer. In a subset of patients, the evaluation may be more complex, calling for referral to genetics professionals for further evaluation and counseling.
Correctly recognizing and identifying individuals and families at increased risk of developing cancer is one of countless important roles for primary care and other health care providers. Once identified, these individuals can then be appropriately referred for genetic counseling, risk assessment, consideration of genetic testing, and development of a management plan. When medical and family histories reveal cardinal clues to the presence of an underlying familial or genetic cancer susceptibility disorder (see list below),[1] further evaluation may be warranted. (Refer to the PDQ summary on Cancer Genetics Risk Assessment and Counseling for more information about the components of a genetics cancer risk assessment.)
Features of hereditary cancer include the following:
- In the individual patient:
- Multiple primary tumors in the same organ.
- Multiple primary tumors in different organs.
- Bilateral primary tumors in paired organs.
- Multifocality within a single organ (e.g., multiple tumors in the same breast, all of which have risen from one original tumor).
- Younger-than-usual age at tumor diagnosis.
- Tumors with rare histology.
- Tumors occurring in the sex not usually affected (e.g., breast cancer in men).
- Tumors associated with other genetic traits.
- Tumors associated with congenital defects.
- Tumors associated with an inherited precursor lesion.
- Tumors associated with another rare disease.
- Tumors associated with cutaneous lesions known to be related to cancer susceptibility disorders (e.g., the genodermatoses).
- In the patient's family:
- One first-degree relative with the same or a related tumor and one of the individual features listed.
- Two or more first-degree relatives with tumors of the same site.
- Two or more first-degree relatives with tumor types belonging to a known familial cancer syndrome.
- Two or more first-degree relatives with rare tumors.
- Three or more relatives in two generations with tumors of the same site or etiologically related sites.
Concluding that an individual is at increased risk of developing cancer may have important, potentially life-saving management implications and may lead to specific interventions aimed at reducing risk (e.g., tamoxifen for breast cancer, colonoscopy for colon cancer, or risk-reducing salpingo-oophorectomy for ovarian cancer). Information about familial cancer risk may also inform a person's ability to plan for the future (lifestyle and health care decisions, family planning, or other decisions). Genetic information may also provide a direct health benefit by demonstrating the lack of an inherited cancer susceptibility. For example, if a family is known to carry a cancer-predisposing mutation in a particular gene, a family member may experience reduced worry and lower health care costs if his or her genetic test indicates that he or she does not carry the family's disease-related mutation. Conversely, information about familial cancer risk may have psychological effects or social costs (e.g., worry, guilt, or increased health care costs). Family dynamics also may be affected. For instance, the involvement of one or more family members may be required for genetic testing to be informative, and parents may feel guilt about passing inherited risk on to their children.
Knowledge about a cancer-predisposing mutation can be informative not only for the individual tested but also for other family members. Family members who previously had not considered the implications of their family history for their own health may be led to do so, and some will undergo genetic testing, resulting in more definitive information on whether they are at increased genetic risk. Some relatives may learn their mutation status without being directly tested, for example, when a biological parent of a child who is a known mutation carrier is identified as an obligate carrier. Founder effects may result in the recognition that specific ethnic groups have a higher prevalence of certain mutations, knowledge that can be either clinically useful (permitting more rational genetic testing strategies) or potentially stigmatizing. Testing may reveal the presence of nonpaternity in a family. There is the theoretical possibility that genetic information may be misused, and concerns about the potential for insurance and/or employment discrimination may arise. Genetic information may also affect medical and lifestyle decisions.
Refer to individual PDQ summaries for available evidence addressing all ancillary issues.
- Lindor NM, McMaster ML, Lindor CJ, et al.: Concise handbook of familial cancer susceptibility syndromes - second edition. J Natl Cancer Inst Monogr (38): 1-93, 2008. [PUBMED Abstract]
Genetic Counseling
Genetic counseling is a process of communication between genetics professionals and patients with the goal of providing individuals and families with information on the relevant aspects of their genetic health, available testing and management options, and support as they move toward understanding and incorporating this information into their daily lives. Genetic counseling generally involves the following six steps:
- Family and medical history assessment.
- Analysis of genetic information.
- Communication of genetic information.
- Education about inheritance, genetic testing, management, risk reduction, resources, and research opportunities.
- Supportive counseling to facilitate informed choices and adaptation to the risk or condition.
- Follow up.[1]
Genetic evaluation involves an interaction with a medical geneticist or other genetics professional and may include a physical examination and diagnostic testing, in addition to genetic counseling. The principles of voluntary and informed decision making, nondirective and noncoercive counseling, and protection of client confidentiality and privacy are central to the philosophy of genetic counseling.[1-5] (Refer to the PDQ summary on Cancer Genetics Risk Assessment and Counseling for more information on the nature and history of genetic counseling.)
From the mid-1990s to the mid-2000s, genetic counseling expanded to include discussion of genetic testing for cancer risk, as more genes associated with inherited cancer risk were discovered. Cancer genetic counseling often involves a multidisciplinary team of health professionals that may include a genetic counselor, an advanced practice genetics nurse, or a medical geneticist; a mental health professional; and various medical experts such as an oncologist, surgeon, or internist. The process of counseling may require a number of visits to address medical, genetic testing, and psychosocial issues. Even when cancer risk counseling is initiated by an individual, inherited cancer risk has implications for the entire family. Because genetic risk affects biological relatives, contact with these relatives is often essential to collect accurate family and medical histories. Cancer genetic counseling may involve several family members, some of whom will have had cancer and others who have not.
The impact of risk assessment and predisposition genetic testing is improved health outcomes. The information derived from risk assessment and/or genetic testing allows the health care provider to tailor an individual approach to health promotion and optimize long-term health outcomes through the identification of at-risk individuals before cancer develops. The health care provider can thus intervene earlier either to reduce the risk or diagnose a cancer at an earlier stage, when the chances for effective treatment are greatest. The information may be used to modify the management approach to an initial cancer, clarify the risks of other cancers, or predict the response of an existing cancer to specific forms of treatment, all of which may alter treatment recommendations and long-term follow-up.
- Resta R, Biesecker BB, Bennett RL, et al.: A new definition of Genetic Counseling: National Society of Genetic Counselors' Task Force report. J Genet Couns 15 (2): 77-83, 2006. [PUBMED Abstract]
- Baker DL, Schuette JL, Uhlmann WR, eds.: A Guide to Genetic Counseling. New York, NY: Wiley-Liss, 1998.
- Bartels DM, LeRoy BS, Caplan AL, eds.: Prescribing Our Future: Ethical Challenges in Genetic Counseling. New York, NY: Aldine de Gruyter, 1993.
- Kenen RH: Genetic counseling: the development of a new interdisciplinary occupational field. Soc Sci Med 18 (7): 541-9, 1984. [PUBMED Abstract]
- Kenen RH, Smith AC: Genetic counseling for the next 25 years: models for the future. J Genet Couns 4(2): 115-124, 1995.
Familial Cancer Susceptibility Syndromes
Individual PDQ summaries focused on the genetics of specific cancers contain detailed information about many known cancer susceptibility syndromes. Although this is not a complete list, the following cancer susceptibility syndromes are discussed in the PDQ cancer genetics summaries:
- Basal Cell Nevus Syndrome, Gorlin Syndrome, Gorlin-Goltz Syndrome, or Nevoid Basal Cell Carcinoma Syndrome (Genetics of Skin Cancer).
- Bloom Syndrome (Genetics of Skin Cancer).
- Breast/Ovarian Cancer, Hereditary (Genetics of Breast and Ovarian Cancer).
- Colon Cancer, Hereditary Nonpolyposis or Lynch Syndrome (Genetics of Colorectal Cancer).
- Cowden Syndrome (Genetics of Breast and Ovarian Cancer; Genetics of Colorectal Cancer).
- Fanconi Anemia (Genetics of Skin Cancer).
- Hyperparathyroidism, Familial (Genetics of Medullary Thyroid Cancer).
- Li-Fraumeni Syndrome (Genetics of Breast and Ovarian Cancer).
- Medullary Thyroid Cancer, Familial (Genetics of Medullary Thyroid Cancer).
- Melanoma, Hereditary (Genetics of Skin Cancer).
- Multiple Endocrine Neoplasia Type 2A, 2B (Sipple Syndrome) (Genetics of Medullary Thyroid Cancer).
- Peutz-Jeghers Syndrome (Genetics of Colorectal Cancer; Genetics of Breast and Ovarian Cancer).
- Polyposis, Familial Adenomatous and Attenuated Familial Adenomatous Polyposis (Genetics of Colorectal Cancer).
- Polyposis, Familial Juvenile (Genetics of Colorectal Cancer).
- Polyposis, MYH-Associated (Genetics of Colorectal Cancer).
- Prostate Cancer, Hereditary (Genetics of Prostate Cancer).
- Xeroderma Pigmentosum (Genetics of Skin Cancer).
Genome-wide Association Studies (GWAS)
GWAS are showing great promise in identifying common, low-penetrance susceptibility alleles for many complex diseases,[1] including cancer. This approach can be contrasted with linkage analysis, which searches for genetic-risk variants cosegregating within families that have a high prevalence of disease. While linkage analyses are designed to uncover rare, highly penetrant variants that segregate in predictable heritance patterns (e.g., autosomal dominant, autosomal recessive, X-linked, and mitochondrial), GWAS are best suited to identify multiple, common, low-penetrance genetic polymorphisms. GWAS are conducted under the assumption that the genetic underpinnings of complex phenotypes, such as prostate cancer, are governed by many alleles, each conferring modest risk. Most genetic polymorphisms genotyped in GWAS are common, with minor allele frequencies greater than 1% to 5% within a given population (e.g., men of European ancestry). GWAS capture a large portion of common variation across the genome.[2,3] The strong correlation between many alleles located close to one another on a given chromosome (called linkage disequilibrium) allows one to "scan" the genome without having to test all 10 million known single nucleotide polymorphisms (SNPs). With GWAS, researchers can test 500,000 to 1 million SNPs per study and ascertain almost all common inherited variants in the genome.
In a GWAS, allele frequency for each SNP is compared between cases and controls. Promising signals–in which allele frequencies deviate significantly in case and control populations–are validated in replication cohorts. To have adequate statistical power to identify variants associated with a phenotype, large numbers of cases and controls, typically thousands of each, are studied. Since up to 1 million SNPs are evaluated in a GWAS, false-positive findings are expected to occur frequently when using standard statistical thresholds. Therefore, stringent statistical rules are used to declare a positive finding, usually using a threshold of P < 1 × 10-7.[4-6]
To date, well over 100 cancer-risk variants have been identified by well-powered GWAS and validated in independent cohorts. These studies have revealed convincing associations between specific inherited variants and cancer risk. However, the findings should be qualified with a few important considerations:
- GWAS reported thus far have been designed to identify relatively common genetic polymorphisms. It is very unlikely that an allele with high frequency in the population by itself contributes substantially to cancer risk. This, coupled with the polygenic nature of tumorigenesis, means that the contribution by any single variant identified by GWAS to date is quite small, generally with an odds ratio for disease risk of less than 1.5. In addition, despite extensive genome-wide interrogation of common polymorphisms in tens of thousands of cases and controls, GWAS findings to date do not account for even half of the genetic component of cancer risk.[7]
- Variants uncovered by GWAS are not likely to directly contribute to disease risk. As mentioned above, SNPs exist in linkage disequilibrium blocks and are merely proxies for a set of variants–both known and previously undiscovered–within a given block. The causal allele is located somewhere within that linkage disequilibrium block.
- Admixture by groups of different ancestry can confound GWAS findings (i.e., a statistically significant finding could reflect a disproportionate number of subjects in the cases versus controls, rather than a true association with disease). Therefore, GWAS are typically powered to analyze a single predominant ancestral group. As a result, many populations remain underrepresented in genome-wide analyses.
The implications of these points are discussed in greater detail in the following PDQ summaries: Genetics of Breast and Ovarian Cancer, Genetics of Colorectal Cancer, and Genetics of Prostate Cancer. Additional details can be found elsewhere.[8]
- Wellcome Trust Case Control Consortium.: Genome-wide association study of 14,000 cases of seven common diseases and 3,000 shared controls. Nature 447 (7145): 661-78, 2007. [PUBMED Abstract]
- The International HapMap Consortium.: The International HapMap Project. Nature 426 (6968): 789-96, 2003. [PUBMED Abstract]
- Thorisson GA, Smith AV, Krishnan L, et al.: The International HapMap Project Web site. Genome Res 15 (11): 1592-3, 2005. [PUBMED Abstract]
- Evans DM, Cardon LR: Genome-wide association: a promising start to a long race. Trends Genet 22 (7): 350-4, 2006. [PUBMED Abstract]
- Cardon LR: Genetics. Delivering new disease genes. Science 314 (5804): 1403-5, 2006. [PUBMED Abstract]
- Chanock SJ, Manolio T, Boehnke M, et al.: Replicating genotype-phenotype associations. Nature 447 (7145): 655-60, 2007. [PUBMED Abstract]
- Ioannidis JP, Castaldi P, Evangelou E: A compendium of genome-wide associations for cancer: critical synopsis and reappraisal. J Natl Cancer Inst 102 (12): 846-58, 2010. [PUBMED Abstract]
- Jorgenson E, Witte JS: Genome-wide association studies of cancer. Future Oncol 3 (4): 419-27, 2007. [PUBMED Abstract]
Structure and Content of PDQ Summaries
PDQ cancer genetics summaries focus on the genetics of specific cancers, inherited cancer syndromes, and the ethical, social, and psychological implications of cancer genetics knowledge. Sections on the genetics of specific cancers include syndrome-specific information on the risk implications of a family history of cancer, the prevalence and characteristics of cancer-predisposing mutations, known modifiers of genetic risk, opportunities for genetic testing, outcomes of genetic counseling and testing, and interventions available for people with increased cancer risk resulting from an inherited predisposition.
The source of medical literature cited in PDQ cancer genetics summaries is peer-reviewed scientific publications, the quality and reliability of which is evaluated in terms of levels of evidence. Where relevant, the level of evidence is cited, or particular strengths of a study or limitations of the evidence are described.
Refer to the Levels of Evidence for Cancer Genetics Studies summary for more information on the levels of evidence utilized in the PDQ cancer genetics summaries.
Genetic Resources
Health care providers who deliver genetic services, including genetic counseling, can be located through local, regional, and national professional genetics organizations; through the NCI Web site Cancer Genetics Services Directory; and through the GeneTests Web site. Providers of cancer genetic services are not limited to one specialty and include medical geneticists, genetic counselors, advanced practice genetics nurses, oncologists (medical, radiation, or surgical), other surgeons, internists, family practitioners, and mental health professionals. A cancer genetics health care provider will assist in constructing and evaluating a pedigree, eliciting and evaluating personal and family medical histories, and calculating and providing information about cancer risk and/or probability of a mutation being associated with cancer in the family. In addition, if a genetic test is available, these providers can assist in pretest counseling, laboratory selection, informed consent, test interpretation, posttest counseling, and follow-up. The printable view of this summary contains a Table of Links at the end of the summary with the URLs of the Web sites listed in the Genetics Resources section.Table 1. Clinical Genetics Information
|Information for health professionals about hundreds of genetic tests and the laboratories performing those tests.
|Human Genome Epidemiology Network (HuGENet)
|Network for sharing population-based human genome epidemiologic information.
|National Institutes of Health Genetic Testing Registry (GTR)
|Central location for voluntary submission of genetic test information by providers. The scope includes the test's purpose, methodology, validity, evidence of the test's usefulness, and laboratory contacts and credentials.
|Online Mendelian Inheritance in Man (OMIM)
|Catalog of human genes and genetic disorders.
Table 2. Clinical Management Information
|Clinical Practice Guidelines from the American College of Medical Genetics (ACMG)
|Clinical practice guidelines developed by expert panels for risk assessment, testing, and counseling of individuals with various inherited conditions, including some cancers, or individuals with a high risk of developing these conditions.
|Clinical Practice Guidelines from the American Society of Clinical Oncology (ASCO)
|Clinical practice guidelines developed by expert panels for specific clinical situations (disease-oriented) or use of approved medical products, procedures, or tests (modality-oriented).
|National Comprehensive Cancer Network (NCCN) Guidelines
|Clinical practice guidelines developed by expert panels that detail the sequential management decisions and interventions for the malignant cancers that affect 97% of all patients with cancer. In addition, separate guidelines relate to major prevention and screening topics, and another set of pathways focuses on the major supportive care areas.
|National Guideline Clearinghouse from the Agency for Healthcare Research and Quality (AHRQ)
|A public resource for evidence-based clinical practice guidelines.
Table 3. Consumer/Client: General Information
|Cancer Genetics Services Directory (National Cancer Institute [NCI])
|Directory lists professionals who provide cancer genetics services (cancer risk assessment, genetic counseling, genetic susceptibility testing, and others).
|Dictionary of Genetics Terms (NCI)
|Definitions of more than 150 terms related to genetics.
|The DNA Files
|Series of 14 one-hour public radio documentaries and related information.
|Dolan DNA Learning Center
|Variety of educational resources, including an interactive DNA timeline.
|Facing Our Risk of Cancer Empowered (FORCE)
|Support and information to individuals and families affected by hereditary breast and ovarian cancer through a toll-free help line, message boards, chat rooms, and support groups.
|Genetic and Rare Diseases Information Center (National Human Genome Research Institute [NHGRI]):
|Information service for the general public, including patients and their families, and for health care professionals and biomedical researchers.
|Genetic Science Learning Center (The University of Utah)
|Information about basic genetics, genetic disorders, genetics in society, and several thematic units.
|Genetics Education Center
|Material for educators.
|Genetics Home Reference (National Library of Medicine)
|Consumer information about genetic conditions and the genes or chromosomes responsible for those conditions.
|Talking Glossary of Genetics Terms (NHGRI)
|Contains definitions of more than 200 terms related to genetics and a quiz to test your knowledge of genetic terminology. Many terms also have images, animations, and descriptions by specialists in the field of genetics.
|Understanding Cancer Series (NCI)
|Primers on cancer genomics, genetic testing, genome-wide profiling, and other topics.
|Understanding the Human Genome Project (NHGRI)
|An education kit that includes a dynamic timeline, a 3-D computer-animated video on basic molecular biology, and other classroom activities.
Table 4. Ethical, Legal, and Social Implications; Policy; and Legislation Information
|Links to articles on genetics and bioethics.
|Bioethics Resources on the Web
|Links to bioethics resources.
|DNA Patent Database
|Searchable database of U.S. DNA-based patents and patent applications issued by the U.S. Patent and Patent Applications Trademark Office.
|Ethical, Legal, and Social Issues (U.S. Department of Energy)
|Information, articles, and links on a wide range of genetics issues.
|Information on the social, ethical, and policy issues associated with genetic and genomic knowledge and technology.
|Genetic Information Nondiscrimination Act (GINA) of 2008 (National Human Genome Research Institute [NHGRI])
|Fact sheet that describes genetic discrimination and GINA for the public.
|GINA: An Overview (Coalition for Genetic Fairness)
|Describes GINA's protections, including a history of the legislation, key examples, and definitions.
|GINA of 2008 Information for Researchers and Health Care Professionals (NHGRI)
|Fact sheet that describes GINA for researchers and health professionals.
|Genetics and Public Policy Center
|Information on public policy related to human genetic technologies for the public, media, and policy makers.
|Genome Technology and Reproduction: Values and Public Policy and Communities of Color and Genetics Policy Project
|Two subprojects combined to form a 5-year project designed to provide policy recommendations based on public perceptions and responses to the explosion of genetic information and technology.
|HumGen International
|Comprehensive international database on the legal, social, and ethical aspects of human genetics.
|National Conference of State Legislatures Genetic Technologies Project
|Resources on a variety of genetics public policy and related issues for state legislators, legislative staff, and other policy makers.
|National Information Resource on Ethics and Human Genetics (Georgetown University)
|Links to resources and databases on ethics and human genetics. Also includes annotated bibliographies on various genetics and ethics issues.
|National Society of Genetic Counselors Code of Ethics
|A statement to clarify and guide the ethical conduct of genetic counselors.
|Policy and Legislation Database (NHGRI)
|Searchable database of federal and state laws/statutes, federal legislative materials, and federal administrative and executive materials about privacy of genetic information/confidentiality; informed consent; insurance and employment discrimination; genetic testing and counseling; and commercialization and patenting.
|THOMAS Legislative Information (The Library of Congress)
|Searchable database of U.S. legislation (current and previous Congresses).
|Your Genes, Your Choices: Exploring the Issues Raised by Genetic Research
|Description of the Human Genome Project, the science behind it, and the ethical, legal, and social issues raised by the project.
Table 5. Family History Tools
|Family Health History (Genetic Alliance)
|Tips for collecting family history information and links to resources.
|Family History Public Health Initiative (Centers for Disease Control and Prevention)
|Web site devoted to using family history to promote health.
|Family Medical History (American Medical Association)
|Tools for gathering family history and links to resources.
|My Family Health Portrait (U.S. Surgeon General)
|Web-based family history tool.
|Your Family History (National Society of Genetic Counselors)
|Information on collecting a family health history.
Table 6. Genome Research Information
|BLAST = Basic Local Alignment Search Tool; COSMIC = Catalogue Of Somatic Mutations In Cancer; iHOP = information hyperlinked over proteins; SARS = severe acute respiratory syndrome; SNPs = single nucleotide polymorphisms; UCSC = University of California, Santa Cruz.
|BLAST Search (part of the Ensembl Project; see below)
|Search protein or DNA sequence against metazoan genomes.
|The Cancer Genome Anatomy Project (CGAP)
|Access to all CGAP data and biological resources.
|Combines gene lists annotated by experts with information from key public databases such as Entrez Gene, COSMIC, and iHOP.
|Cancer Genome Workbench (CGWB)
|Integrates clinical tumor mutation profiles with the reference human genome to improve the accuracy of mutation identification.
|Chromosomal Variation in Man
|Searchable database of literature citations on chromosomal variants and anomalies.
|Ensembl (Joint software project between the European Bioinformatics Institute and the Wellcome Trust Sanger Institute)
|Data sets resulting from an automated genome analysis and annotation process.
|Genome Channel
|Java viewers for human genome data.
|Genome Sequencing Center: Homo sapiens Maps
|Links to clone and accession maps of the human genome.
|International Cancer Genome Consortium Data Portal
|A collection of genome data from more than 25 cancer projects consisting of over 3,500 tumor genomes from 13 cancer types and subtypes. Most data are available with open access.
|International HapMap Project
|A variety of ways to query for SNPs in the human genome.
|Leiden Open Variation Database
|A flexible, free tool for gene-centered collection, curation, and display of DNA variation.
|Human gene mutation database with graphical display of molecular information for cancer-related genes.
|National Center for Biotechnology Information: Genomic Biology
|Views of chromosomes, maps, and loci; links to other NCBI resources.
|Online Mendelian Inheritance in Man (OMIM)
|Catalog of human genes and genetic disorders.
|UCSC Genome Bioinformatics
|Reference sequence for the human and C. elegans genomes and working drafts for the mouse, rat, Fugu, Drosophila, C. briggsae, yeast, and SARS genomes.
Table 7. Health Professional Practice and Genetic Education Information
|Centre for Education in Medical Genetics
|Develops, provides, and evaluates genetics education opportunities and resources.
|Centre for Genetics Education
|Education and service resources for patients and professionals.
|Dolan DNA Learning Center
|Interactive multimedia genetics education resources.
|Essentials of Genetic and Genomic Nursing: Competencies, Curricula Guidelines, and Outcome Indicators, 2nd edition
|Establishes minimum basis to prepare the nursing workforce to deliver competent genetic and genomic-focused nursing care.
|Evaluation of Genomic Applications in Practice and Prevention (EGAPP)
|Provides an evidence-based review of genetic tests and other genomic applications that are in transition from research to clinical and public health practice in the United States.
|Genetics & Your Practice
|Online modules for health care professionals designed for exploration of a topic rather than a sequential presentation of material. Includes fact sheets and sample clinical forms. Free registration required for access
|Genetics and Social Science: Expanding Translational Research
|A free, online education program designed to provide social and behavioral scientists with sufficient genetics background to support the integration of genetics concepts in their own research and allow for collaborative studies with geneticists.
|Genetics Education Center
|Online center for educators interested in human genetics and the Human Genome Project.
|Genetics Education Program for Nurses (GEPN)
|Sample genetics nursing course syllabi and other genetics educational opportunities and resources for nurses.
|Genetics/Genomics Competency Center for Education (G2C2)
|A repository of genetics/genomics education resources for nursing and physician assistant educators.
|Genetics in Clinical Practice: A Team Approach
|Interactive virtual genetics clinic with case scenarios and case discussions. Target audience is primary care professionals.
|Genetics in Primary Care
|Training program curriculum materials.
|Genomic Applications in Practice and Prevention Network (GAPPNet)
|A collaborative initiative that aims to bring together stakeholders in order to accelerate and streamline effective and responsible use of validated and useful genomic knowledge and applications, such as genetic tests, technologies, and family history, into clinical and public health practice.
|Medical School Core Curriculum in Genetics
|Medical school course competencies, skills, knowledge, and behaviors that should be covered in a genetics curriculum developed by the Association of Professors of Human and Medical Genetics and the American Society of Human Genetics.
|National Coalition for Health Professional Education in Genetics (NCHPEG)
|Core competencies in genetics and reviews of education programs. Descriptions of available instructional resources, courses, and institutes.
|Six Weeks to Genomic Awareness
|Webcast of six lessons in genomics for public health professionals.
Table 8. Institutional Review Boards (IRBs)
|Genetic Testing and Screening in the Age of Genomic Medicine. New York State Task Force on Life and the Law.
|Includes general and state-specific information in a bulleted report.
|Pharmacogenetics: Ethical Issues. Nuffield Council on Bioethics.
|Includes a section discussing the use of pharmacogenetics in clinical trials.
|Protecting Human Research Subjects Institutional Review Board Guidebook, Chapter V, Section H: Human Genetic Research. Office for Human Research Protections.
|Discusses many issues that continue to challenge IRBs, investigators, and policy makers today.
Table 9. Professional Organizations: Genetics
|American Board of Genetic Counseling (ABGC)
|Information about certification of genetic counselors.
|American Board of Medical Genetics (ABMG)
|Information about medical genetic training programs and certification of geneticists.
|American College of Medical Genetics (ACMG)
|Resources, policy statements, and practice guidelines about medical genetics.
|American Society for Human Genetics (ASHG)
|Resources, projects, and policies concerning human genetics.
|Genetics Nursing Credentialing Commission (GNCC)
|Information about credentialing of genetics nurses.
|Genetics Society of America (GSA)
|Links to teaching Web sites, general educational courses, and journals and publications about genetics.
|International Society of Nurses in Genetics (ISONG)
|Resources to help nurses incorporate new knowledge about human genetics into practice, education, and research.
|National Society of Genetic Counselors (NSGC)
|Information about genetic counseling: practice guidelines, links to genetic counselors, and genetic discrimination resources.
Table 10. Risk Assessment Information
|Breast Cancer Risk Assessment Tool (National Cancer Institute [NCI])
|Interactive tool for estimating a woman's risk of developing invasive breast cancer.
|Colorectal Cancer Risk Assessment Tool (NCI)
|Interactive tool for estimating the risk of developing colorectal cancer in a non-Hispanic white man or woman aged 50 to 85 years.
|Disease Risk Index (Harvard School of Public Health)
|Personalized estimation of cancer risk and tips for prevention.
|Family HealthLink (The Ohio State University Medical Center)
|Interactive tool that estimates cancer risk by reviewing patterns of cancer in a family.
|Melanoma Risk Assessment Tool (NCI)
|Interactive tool for estimating an individual's absolute risk of developing melanoma.
|Interactive tool that estimates cancer risk by reviewing patterns of cancer in a family.
Table 11. Online Gene Mutation Prediction Programs
|HuGE = Human Genome Epidemiology; MMR = mismatch repair; MRC = Medical Research Council.
|HuGE Risk Translator
|Calculates the predictive value of genetic markers.
|MRC Human Genetics Unit, Edinburgh
|Predicts the likelihood of mutations in one of the MMR genes in persons with colon cancer.
|The Penn II Risk Model
|Estimates the probability that an individual has a BRCA1 or BRCA2 mutation.
|PREMM1,2,6 Model: Prediction Model for MLH1, MSH2, and MSH6 Gene Mutations
|Estimates the probability that an individual carries a mutation in one of the MMR genes.
Table 12. Search Engines Specializing in Genetics and Genomics
|GAMAdb = Genome-wide Association and Meta Analyses Database; GWAS = genome-wide association studies; HuGE = Human Genome Epidemiology; SNP = single nucleotide polymorphism.
|Cancer GAMAdb
|An online database of published GWAS and meta-analyses for genetic polymorphisms and cancer risk.[1]
|Catalog of Published Genome-Wide Association Studies
|An online catalog of SNP-trait associations from published GWAS for use in investigating genomic characteristics of trait/disease-associated SNPs.
|HuGE Navigator
|An integrated, searchable knowledge base of genetic associations and human genome epidemiology.
|National Information Resource on Ethics and Human Genetics (Georgetown University)
|Search engine for literature on specific issues related to ethics and human genetics.
Table 13. United States Government Agencies
|HRSA = Health Resources and Services Administration; NIH = National Institutes of Health.
|Centers for Disease Control and Prevention Office of Public Health Genomics
|Information on how human genomic discoveries can be used to improve health and prevent disease, including links to many resources.
|Genetic Modification Clinical Research Information System (GeMCRIS)
|Information about human gene transfer trials registered with NIH.
|National Cancer Institute
|Summaries of cancer genetics–related information.
|National Human Genome Research Institute
|Research, policy, ethics, education, and training information and resources about genetic and rare diseases.
|National Institute of Environmental Health Sciences (NIEHS) Environmental Genome Project
|Information on project to improve understanding of human genetic susceptibility to environmental exposures.
|U.S. Department of Energy Office of Science
|Genomics educational resources.
|U.S. Department of Health and Human Services
|Links to publications and materials available for purchase or download from the HRSA Information Center.
- Schully SD, Yu W, McCallum V, et al.: Cancer GAMAdb: database of cancer genetic associations from meta-analyses and genome-wide association studies. Eur J Hum Genet 19 (8): 928-30, 2011. [PUBMED Abstract]
Changes to This Summary (08/08/2012)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
This summary is written and maintained by the PDQ Cancer Genetics Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.
About This PDQ Summary
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about cancer genetics. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Cancer Genetics Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
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Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Cancer Genetics Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.Permission to Use This Summary
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National Cancer Institute: PDQ® Cancer Genetics Overview. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://www.cancer.gov/cancertopics/pdq/genetics/overview/healthprofessional. Accessed <MM/DD/YYYY>.
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I was introduced to Kevyn Aucoin's makeup mastery when I was about 13, browsing the books at Barnes and Noble. I can remember flipping to the page in Face Forward with Martha Stewart styled as Veronica Lake and having my MIND BLOWN. You're telling me that makeup can do that?
I've been a fan of his work ever since. I still have that book (along with his other bestseller, Making Faces) sitting on my bookshelf.
He was a brilliant artist, one of the masters that inspired me from the very beginning. His legacy lives on through his brand of amazing beauty products – most of which I'm hopelessly devoted to in my daily beauty routine. I've been addicted to the Kevyn Aucoin Beauty Sensual Skin Enhancer for a while and am now hooked on the Kevyn Aucoin lipstick too!
This particular purple shade (Persistence) is totally on trend and perfectly pigmented. The rich matte cream also looks beautiful with Cloudaine gloss worn atop it to change up the finish for a glossier look. Not willing to rock a lip this bold? Kevyn Aucoin Beauty boasts a range of more natural shades in the same great formula. For Keeps is one of my more muted favorites. 🙂

subset: commoncrawl


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There is no question that today's political rhetoric can get heated on both side of the aisle. Whether you are a Democrat or a Republican, people want the truth from their politicians and pundits. Since 2007, the St. Petersburg Times' Pulitzer Prize-winning PolitiFact.com has provided insight into the American politics. It helps users find the truth in politics by examining statements by members of Congress, the president, cabinet secretaries, lobbyists, people who testify before Congress and other Washington D.C. gadflies. Then, it rates the accuracy on the Truth-O-Meter – True, Mostly True, Half True, Barely True, False and the lowest rating, Pants on Fire.
Using multiple Adobe technologies including Adobe Flash Builder 4.5.1, Flex 4.5.1 and Adobe Illustrator, PolitiFact has gone mobile. Now, the truth can go anywhere you go with the new PolitiFact Truth-O-Meter mobile application, available for download on the Android Market, BlackBerry App World and iTunes. Unique to the mobile application is the Truth Index that provides the ups and downs of Truth-O-Meter ratings across the entire American political scene in real-time on a daily basis.
Using Flash Builder, the PolitiFact team created the app within three weeks. Flash Builder and the Flex framework made it possible to develop in just one code base and quickly leverage content from the existing PolitiFact website. By developing the application with one code base with Adobe technologies, the development team i saved time and money by not having to build and test a separate native application for each individual device. The app has really taken off and was the number one news app in iTunes when it launched!
To learn more about how PolitiFact used Adobe technologies to bring the politics to mobile, read more here.


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Jay-Z Facing Plagiarism Lawsuit Over 'Decoded' Book
Hip-hop king Jay-Z has been slapped with a lawsuit by a man who claims that sections of the Throne rapper's 2010 book 'Decoded' were in some way stolen from him, reports AllHipHop.com.
In a handwritten lawsuit, filed on June 13 in California, Patrick White asserts that his laptop was stolen in 2009 and somehow his information from the computer now appears in Hov's lyrics book. "The book contains various expressions, colors, phrases, which correlates to my work," he scribbles in his lawsuit.
White also claims he unsuccessfully tried to contact Jay-Z and 'Decoded' co-author Dream Hampton about the alleged plagiarism but hasn't heard a word from both parties. "After contacting or attempting to contact the co-author, I got no reply," he writes in his suit.
We wonder why?
White is suing for copyright infringement and invasion of public property. He is also seeking statutory damages related to the profits of the book.
We doubt that this lawsuit has any merit, considering that 'Decoded' is mostly a song book of Jay-Z's self-penned (or memorized) rhymes that he has recorded over his illustrious career. We are quite sure that Hov will brush this lawsuit over his shoulders.
Nevertheless, Jay-Z, nor his attorneys, had no comment on the matter.
Watch Jay-Z Perform 'Dirt Off Your Shoulder (Amex Sync Show)


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The third day of conference is a half day. There are three morning sessions and the grand finale of our conference is always the Author Celebration Luncheon.
"Meet the Author" Chris Crutcher
I have long been a fan of Chris Crutcher and looked forward to his session. His characters ring true with compelling, heartbreaking stories. Chris shared some of his life experiences that have inspired his fictional characters and situations. He had us alternately laughing and crying, but always wanting to read (or reread) the stories inspired by the children who had touched his heart.
"Unwritten Research Paper: Projects for Busy Teachers and Bored Students" Cathy Nelson
Cathy Nelson lives and breathes instructional technology! Never one to be satisfied with the status quo, she is always in search of ways to enrich her students' educational experiences – often with technology.
One of her pet peeves is the "KMN" PowerPoint presentation. We have all suffered through them: slides with too much text that the presenter just reads to his/her audience. You know, those presentations where you think "Kill Me Now!" (KMN) rather than see another slide with several bullet points.
Her session offered suggestions on improving those PowerPoint presentations – information that MUST be shared with our teachers and students. Then she shared her recent collaborative experiences where students were allowed to choose a means to share what they learned through their research (no three page papers here).
Cathy has shared both her PowerPoint on improving PowerPoints (!) and her ideas for the unwritten research paper on her wiki.
Side note: This is NOT how Cathy appeared when she was presenting at the 2012 SCASL Conference. But it is a favorite picture of mine that captures Cathy's spontaneity and willingness to try new experiences.
"eEk and eCstacy: Incorporating eReaders and eBooks into Your Curriculum" Jen Chesney
This was the second session I attended focusing on eReaders. Jen Chesney, media specialist at Powdersville High School, shared her experiences with eBooks and eReaders as she opened a new library last year.
Her nonfiction eBooks haven't been as successful as she would like. Students want instant access; having to visit different sites to reach the library's Infobase and Marshall Cavendish eBooks is off-putting for them. Publishers are still exploring the new frontier of eBooks. Until there is a "one size fits all" solution, nonfiction eBooks are not going to be our students' first choice for information.
Jen chose to go with Nooks for her fiction eBook collection. She purchased enough Nooks to take advantage of the Barnes and Noble management program and devised a way to keep track of titles on each device. Because students check out the devices rather than the books, she has no way of tracking which titles are being read on each device other than to ask students when they return the Nook.
The Nooks have been extremely popular. One of the "eCstasies" that Jen has discovered: no more having to wait days or weeks after publication of the newest book in a series! If you purchase these on eReaders, the books will be there the day they are released.
Although earlier in the school year I had decided to wait a bit longer until the dust settled (and prices on devices are bound to drop), Jen's success has me wondering whether I should purchase a few Nooks and see how successful they would be in my library program.
Final Thoughts
In this and my past two posts, I have attempted to share some of what I learned at the 2012 SCASL Conference. Our keynote speakers were topnotch this year and the talent of my fellow South Carolina school librarians never ceases to amaze me.
I am never able to attend all of the sessions I would like to; two or three will be going on simultaneously and I must make a choice. However, thanks to the generosity of this year's presenters, I can at least get a taste for sessions I was unable to experience in person. Their presentations/handouts/materials can be found on the Conference page of scasl.net.


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What did you think of Sim 1? Here's the place to post your thoughts.
What would you rate it out of ten and would you recommend it to other cricket fans?
You don't need to be a member to post but we still recommend you join our forum, it's well worth it and it means you can participate in our many other discussions.
Yours in Cricket


text: Naturally, Quentin Tarantino's new saddles-and-spurs flick Django Unchained has probably attracted at least a few fans of Westerns. But fans of one more recent Western may recognize some of its environs a little too well. It was partially shot on the same set at HBO's series Deadwood. The Melody Ranch in Santa Clarita served as the frontier for Django (Jamie Foxx) and Dr. King Schultz (Christoph Waltz) and as the home of the foul-mouthed denizens of Deadwood, South Dakota. But that's just a set. Many of the locations used by Tarantino in the past are actual places that you — yes, you! — can visit anytime. (Well, most of them. The infamous diner from Pulp Fiction got torn down some time after the film's release. There's an auto parts store there now.) Click through the gallery above for names and locations to guide your Tarantino pilgrimage. (Also, check out Badass Digest's video pilgrimage through Tarantino's LA here.) Above: The Wild West/South of Django Unchained Location: Melody Ranch in Santa Clarita, California Set the scene: The first half of Django follows the eponymous lead character as he's shown the ropes of bounty hunting by Dr. Schultz in small frontier towns in the American South and West — most of which were filmed at Melody Ranch. Location fun fact: Singing cowboy Gene Autry once owned the place. Gunsmoke was filmed there. Map: View Larger Map Photo courtesy The Weinstein CompanyBig Daddy's Bennett Manor in Django Unchained Location: Evergreen Plantation in Edgard, Louisiana Set the scene: Dr. Schultz enlists Django's help with his bounty hunting because as a slave Django worked on a plantation overseen by the Brittle brothers, whom the good doctor is trying to hunt down. The pair track them to this plantation run by Big Daddy (Don Johnson). Even though the plantation is supposed to be in Tennessee, it was filmed at this location between New Orleans and Baton Rouge. Location fun fact: The property's slave quarters were also used in the film. It also offers tours, if you'd like to see it for yourself. Map: View Larger Map Photo: shoshanah/FlickrThe Church from the Kill Bill Movies Location: Church in Lancaster, California Set the scene: The El Paso, Texas, place of Kill Bill's gruesome "Massacre at Two Pines" where The Bride's wedding goes terribly, terribly wrong. Location fun fact: The church is actually in an unincorporated community called Hi Vista. Map: View Larger Map Photo: WikipediaThe Chili Restaurant from Death Proof Location: Texas Chili Parlor in Austin, Texas Set the scene: In Death Proof a group of young women meet a murderous misogynist named Stuntman Mike at the Texas Chili Parlor. One of them breaks him off a lap dance. Also, there are nachos. Location fun fact: It doesn't really have that awesome back porch. Map: View Texas Chili Parlor in a larger map Photo courtesy The Weinstein CompanyVernita Green's House from Kill Bill: Vol. 1 Location: House in Los Angeles, California Set the scene: When The Bride (Uma Thurman) goes to track down the members of the Deadly Viper Assassination Squad, she heads to this house in L.A. to find "Copperhead" (aka Vernita Green, played by Vivica A. Fox). It's a little brighter in the movie than it is in real life. Location fun fact: In the film The Bride refers to Copperhead as a Pasadena homemaker; in reality the house is just a few clicks south of there. Map: View Larger MapThe Diner from Pulp Fiction Location: Hawthorne Grill in Hawthorne, California Set the scene: Pulp Fiction, even thought it's told in non-chronological order, begins and ends at the same place — Hawthorne Grill diner. It's the place that Pumpkin (Tim Roth) and Honey Bunny (Amanda Plummer) stick up, and where Vincent Vega (John Travolta) and Jules Winnfield (Samuel L. Jackson) end up for breakfast after the Wolf helps them disappear the guy Vincent shot in the face. Location fun fact: OK, this one isn't fun at all: Hawthorne Grill is gone. There's an AutoZone there now. Map: View Larger MapThe Hide-Out Motel from True Romance Location: Safari Inn in Burbank, California Set the scene: After Clarence (Christian Slater) and Alabama (Patricia Arquette) make the great trek West to Southern California they hide out here while trying to sell that suitcase full of coke acquired from Alabama's pimp. Location fun fact: The hotel also makes a cameo in Apollo 13. Map: View Larger MapThe Pawn Shop with a Gimp from Pulp Fiction Location: A Strip Mall of Sorts in Los Angeles, California Set the scene: Following the shoot-out between Butch (Bruce Willis) and Marsellus Wallace (Ving Rhames) they land in a pawn shop, where — in a twist that could only be dreamed up by Tarantino — they get ball-gagged in a basement and introduced to "the gimp" by a pair of hillbillies. Location fun fact: You can probably still pawn your stuff there. Map: View Larger Map Screengrab: WiredThe Coffee Shop from Reservoir Dogs Location: Pat and Lorraine's Coffee Shop in Los Angeles, California Set the scene: In probably one of the most famous conversations about Madonna ever, the black-suited gangsters of Reservoir Dogs argued about "Like a Virgin" (and the importance of tipping) in this very diner. Location fun fact: People have been known to wait for the table where the gangster breakfast went down. Map: View Larger MapThe Diner from True Romance __Location:__Rae's Restaurant in Santa Monica, California Set the scene: First off, yes, this one is a bit of a cheat. Tony Scott directed True Romance, but since Tarantino wrote the story, it seems worthy of inclusion here. Now, on to the scene. After Clarence and Alabama meet in the movie theater she asks him if he likes to get a piece of pie after a movie. Then they head to Rae's, which even though they're supposed to be in Detroit is actually in Santa Monica, California. Location fun fact: It's not far from the theater exterior used in the previous scene in the movie — the Vista Theater in the Los Angeles neighborhood of Los Feliz. Map: View Larger Map


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YESTERDAY'S unexpectedly drinkable Perła Chmielowa, I'm rather looking forward to my next Polish beer. Fortunately, I don't have long to wait. That's because here in front of me is a bottle of Leżajsk Beer. Actually it isn't. The 'Z' looking character in the name is supposed to have a sort of dash through it. Sadly, I couldn't find that character on my computer, so I've substituted it for a 'Z' with a dot on top of it. Polish speakers, have I made a huge gaff? Undeterred by this, here is the bottle.
The bottle is dull and brown. The labels are bright and white. It looks cheap-ish.
The neck label doesn't say anything about the beer. It doesn't say much at all really. What it does have is the crest logo, featuring a crown, barley, hops and the letter 'L'. It also has what must be the established date, in the form of "Premium Polonia A.D. 1525". That's a long time ago. About as far back as any Polish beer I've tried so far.
The roundel that is the front label does a good job. The border has those reassuring words "Product of Poland". No imitation here. And clearly visible, under the vague word "Beer" are those all important vital statistics. This is the regular 500 ml size. And the alcoholic volume is a reasonably strong 5.5%. Which, in Poland, makes this weak. All bottles should have that on the front. It makes it sop much easier to know what you're getting yourself in for.
This is a proper, imported bottle of beer. Hence, it has an ugly big sticker on one side.
This one was imported by the same people who imported yesterday's bottle: BDD Limited. Their telephone number and North-West London address are on there, in case you want to get in touch. There's no sign of their website though. Which, I learnt yesterday, was www.bdd.net. This big label also has a small list of ingredients. Why? Whatever the (probably regulatory) reason, the ones they list are water, malted barley and hops.
Fortunately, the proper back label hasn't been dispensed with. This one even has some English writing, so we're in luck. This one tells the story of how King Zygmunt Stary gave the rights to brew beer in Leżaysk all the way back in 1525. And that it's now one of the most renowned beers in Poland, made from natural ingredients. All of which is splendid. Heritage is good. Natural ingredients are even better.
It doesn't stop there. That's because this one has an award. In transpires that Leżajsk Beer won a Gold Medal at the World Beer Championships. Well done chaps. I hope that translates into a tasty beer.
Time now to crack open this bottle. What will it taste like? How will it compare to the current Polish favourites? Let's find out.
There's no head to worry about. Within moments, what little there was has dissipated into a few patches of bubbles. Not very impressive. The colour makes up for the lack of head. It's a good, deep shade of amber. No cheap, pale yellow here.
Maybe it's my somewhat blocked nose, but I can't smell much of an odour with Leżajsk Beer. Sniffing as hard as my huge, blocked nose will allow, and there are some weak odours hidden away in there. My untrained nostrils detected something like malted barley, and also something floral. Are my nostrils deceiving me? Or is there really something flowery about Leżajsk Beer? Now that would be a gigantic surprise. As always, leave your comments at the end of the post.
How does it taste? After a couple of gulps, in a word, it's good. For a start, it has something I haven't had for a while: flavour. It tastes a bit of crops and flowers. Which very smoothly turns into a full, light bitter aftertaste. That bitterness hardly lingers at all. Instead, it's all very light, fresh and tasty. Leżajsk Beer, in my uninformed opinion, is the most ale-like of any Polish beer I've tried. I was afraid this would be another, boring lager. But it just isn't.
If you buy Leżajsk Beer, what will you like about it? Or, more accurately, what do I enjoy about it? I like the flavour. I like the taste. I like how easy to drink it is. I like the quality and care with which it was made. You can tell when a beer was made with all the natural ingredients of a Pot Noodle. And this doesn't taste anything like a pot of instant noodles. It tastes natural, which is more than you can say about any of the Polish "Mocne" beers. The last thing to say about Leżajsk Beer is that it isn't gassy. There is a lot to like here.
What won't you like about Leżajsk Beer? Or, what don't I like about Leżajsk Beer? I get the feeling that it's trying to be like an ale. That makes it a zillion times better than most Polish beers. But not as good as proper ales. It simply can't match them for flavour and body. It's also so light and drinkable, that it makes you think it's on the watery side. Besides those minor complaints, the biggest problem is how hard it is to find. Unlike the big-name, yet disgusting Polish lagers, you just can't find this easily. This one came on the recommendation of the woman at a Polish shop up in Wealdstone.
So what is Leżajsk Beer all about? This is the least lagery and most ale-like of any Polish beer that I've tried. It has flavour, tastes good and is very drinkable. None of which I expected to report about Leżajsk Beer. I didn't think I would say this, but it tops even Perła Chmielowa. Ladies and gentlemen, this is my new favourite Polish beer. If you somehow find a bottle, it's worth your time. If you're weighing it up against a selection of fine ales, it won't quite match the competition. Overall, very good.
Rating: 4.05
Have you tried Leżajsk Beer? Can you offer up any translations, pronunciations or information? Then do please leave your comments, opinions, corrections, requests and recommendations here.


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The purpose of this blog is to communicate aspects of life such as philosophy, spiritual, education, psychology, mathematics and science. This blog does not mean political, business oriented, pornography, gender and racial issues. This blog is open and accessible for all peoples. Google Translator may useful to translate Indonesian into English or vise versa. (Marsigit, Yogyakarta Indonesia)
Apr 19, 2013
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Apple is going to be trading sideways for the next twelve months, says Pacific Crest analysts Andy Hargreaves and Corey Barrett in a note this morning.
They are downgrading the stock to "sector perform" and giving it a price target between $440 and $550 for the next twelve months.
They believe Apple has real long term problems.
The high-end market for smartphones and tablets are going to be saturated sooner than expected which will lead to poor growth for Apple.
They say that demand for "incremental" hardware improvements is "waning." Essentially, they don't believe people will continue to upgrade to a new iPhone. If the market for new iPhone buyers is already maxed-out, and the market for upgrading iPhones is weak, then Apple's iPhone business is going to struggle.
While the iPad should pick up the slack for Apple in terms of slowing iPhone growth, the truth is the iPad Mini, which is relatively inexpensive will hurt Apple's revenue and EPS growth.
There is nothing on the horizon that will provide a jolt of growth, either, they argue.
An Apple television isn't going to be a huge business like the iPhone. It will make less money and sell in smaller units.
A cheaper iPhone will create the same problems the cheaper iPad Mini creates — cannibalization of existing sales and profits.
Software and services revenue from products like iTunes and iCloud aren't going to be enough to accelerate the earnings of a company as big as Apple.
In short, Apple is an iPhone company. The days of the iPhone's mega growth are over and thus, Apple's fantastic stock run is too.
Don't Miss: The iPhone Was A Once-In-A-Lifetime Opportunity And Now It's Over


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It's tedious, it doesn't have any story to speak of, the game world is vast but repetetive and makes the world of WoW look immersive and full of life. Combat comes down to button mashing, and fails to challenge even at the highest difficulty. Must I go on?
See, to my ears, your describing Fable.
It's basically like playing an MMO alone.
Which technically makes sense as that's how the project started. In fact, I bet that would explain a lot of your complaints. If you went back and replayed it with the mentality that you'd be walking into a world with tons of people, you'd probably think "Oooooh...."Or maybe not. I dunno. I just played the opening of the game before the demo froze on me.
But the bottom line is .. what's the point? Where's the demand for a sub par MMO that you play by yourself?
Is Skyrim the holy grail of "single player MMO" style games at this point? The stick by which we measure all others? I've only heard people rave and rave about it...I've yet to drop the $60 and time commitment myself, though.Did anyone else fall in love with Morrowind growing up? I know two games Skyrim's prequel, the game mechanics are awful now. But during its time it was absolutely fantastic. The environment and music were amazing, the landscape surreal and different...this fit very well with the plot line, in which I was a foreign prisoner being set free to explore this strange new land. Other characters were believable, too. They treated me like a foreigner, and were suspicious of me! I had to earn their trust with favors, bribes, and my personality. The stories were intriguing and compelling. And for whatever reason, the memory of travelling through the night and finally arriving in a peaceful city as the sun rises and the silt strider calls...the nostalgia of this experience is incredible.The combination of the harsh storms and deadly battles with the stark beauty and peaceful places; everywhere I traveled filled with stories and lore...yes, I was immersed.
Chip, Skyrim is one of the few games I consider to be as good as the hype. Personally, I can't play it vanilla now that I've tried mods, but even if you picked up an Xbox version or you didn't care about mods, it's still a great game. Definitely worth your time and money.
If all you've heard is ranting and raving, you are about to hear something different. Is it a good game? yes. Is it worth the money? More than likely. But is it the holy grail? Hardly. It just felt like it was missing something when compared to previous Elder Scrolls games. They simplified the mechanics and character creation so much that it just didnt feel like there was enough customization as before.
So fuck the mainstream. When the clowns at Obsidian get their hands on the Skyrim engine ( hah, I wish! ), maybe they'll make a decent TES game.
Thanks for the critical review, it's good to hear both sides of things!
I'm more curious about the Witcher II, now. I never played that series, and always passed it off as something that would be too linear, all action and little depth, way more than Oblivion and Skyrim. But when you think about it, it's not the ridiculous huge amount of quests that make a game deep...it's the characters, the stories, and the overall feel. So even with fewer paths and a mostly linear styled story, I can see it being much more immersive if the characters are interesting and well developed. Plus, I'm just gonna be honest here. Some of those cut scene options look...fun. Thanks again for your time and perspective.
After pressure from Konami and death threats from fans, Hideo Kojima tried to make Metal Gear Solid 4 as depressing as possible.
The Witcher 2 = $40 on Steam, down to $20 or even less used at various online stores...
Playing Dead Space 2, New Game+. Trying a gun I never touched the first time, because it sounded pretty useless... a sniper rifle? Really? A pinpoint accurate long ranged weapon in a game where enemies usually appear three inches from my face and need to be decapitated? Pass.Tried it, and in typical Dead Space fashion, the conventional weapons are actually more useful then the mining tools the entire 'strategic decapitation' gimmick is based around. Still, looks fucking awesome to tear an arm off at the shoulder so hard the fucker goes cartwheeling fountaining blood.
Actually, in Dead Space the assault rifle was the only non-mining tool and it blew so hard. It's better in 2, especially with the grenade alt-function. However, it still doesn't save you from the final boss on freaking Zealot difficulty. Fuck Zealot difficulty. The final boss is literally, hit, hit, hit, dead. That's not counting the actual one-hit-kill of the final boss...The seeker rifle is mainly used to hunt seekers, but I figured out a long time ago that it's way too specialized. So I blow the leg off a seeker and use kenisis to throw a seeker claw into another seeker. If you're good you'll never run out. >:]
You should try playing The Witcher 2 on Dark difficulty. I was playing it last night, and some fucking Nekker warrior
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Spa Bella Medispa uses new Invasix Fractora Firm technology for optimal results in non-surgical lifting and dermal contraction, or skin tightening. This thermal skin rejuvenation treatment allows us to provide the precise optimal skin contraction temperature in a manner that is both much more effective and more comfortable for the patient. Results for this new thermal treatment have been amazing.
Radio-frequency delivers heat to the skin and subcutaneous tissue below. By reaching and maintaining a specific temperature, fat is released from the underlying fat cells and skin tightening is triggered. The treatment also stimulates collagen production through deep heating, which helps rebuild the structural integrity of the skin. Results are seen after the first treatment, with peak results after 6-12 months. Most patients require a series of 6-10 treatments for optimal results, depending on the individual and the area being treated.
The treatment is pain free and any area with skin looseness can be treated. Common treatment areas include the jowl, chin, neck, face, arms, abdomen, hips and thighs. There is no downtime and patients can resume their normal daily routine immediately post treatment.


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Legit Kicks is a Sneaker and streetwear store located in Spruce Grove Alberta, Canada. We specialize in Brand name Sneakers and streetwear Apparels from brands like Nike, Air Jordan, New Balance, Puma, Champion, Kuwallatee, Adidas, Timberland, Saucony, Clae, HUF, Brixton, Asics, Mitchell and Ness, Diamond Supply Co, Fila, Herschel Supply co, Converse, Vans, Publish brand, Fairplay brand, Kappa and Obey.


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SUNWAPTA VALLEY — Against her better judgment, Chris Gitelson follows her childhood friend Aileen Sesso onto the glass floor of the Glacier Skywalk and sits down to soak in the mountain vistas.
They're sitting 280 metres above the Sunwapta Valley, a craggy canyon with a winding river in Jasper National Park, on the controversial development's opening day.
"I love it," Sesso said Thursday. "I have a keen sense of adventure, so this is not scary for me."
Gitelson, covering her eyes, isn't so sure.
"I haven't really looked down yet," she said, taking a peek. "Oh, my God. Oh, I can't stay here. I can't. I can't believe I'm sitting out here. You made me do this."
Sesso, who has been friends with Gitelson for 62 years since they were Grade 1 classmates in Brooklyn, N.Y., just laughs.
"You don't even want to know the things I made her do when we were kids," said Sesso, as the pair embarks on their latest adventure with their husbands in the Canadian Rockies.
It's a perfect blue-sky day to kick off the inaugural season of the skywalk.
The $21-million, award-winning project is an accessible walkway on the edge of a cliff that leads to the glass-bottomed observation platform extending 30 metres over the Sunwapta Valley on the Icefields Parkway.
It passed an environmental assessment in 2012, but has drawn opposition from environmentalists and Jasper residents due to concerns about the privatization of a national park site and the potential ecological impact — particularly for mountain goats.
Visitors from Alberta said they weren't sure what to expect, due to the controversy, but suggested the structure fits with the natural environment.
"It's amazing," Adele Schwartz and Dawn Kuzio, both from Morinville, said in unison.
The structure, which required 200 metric tonnes of steel, is anchored into the cliff face of the mountain.
David Brady, a Cochrane resident, said he doesn't see any major environmental issues.
"I was questioning how is it going to blend in, and it's blending in well," he said. "Time will tell. Coming down the highway, it's not a huge eyesore."
Officials with Brewster Travel Canada, which owns the skywalk, said they've dealt with any outstanding concerns.
"To us, now that it's here and it's built, that controversy no longer surrounds the project," said Juliette Recompsat, communications manager for Brewster. "We did extensive environmental monitoring and assessment just to make sure the wildlife in the area wouldn't be affected, and what that's shown is that there hasn't been a change at all.
"That's great, because that means people get to come up here and interact with wildlife."
On Thursday, several bighorn sheep were spotted in the area.
Recompsat said one of the priorities for the project is to get people out of their cars and connecting with the environment in the national park.
"It's one of those places where everything stops. Nothing else matters," she said. "You're here with your family and doing something you've never done before.
"It's a unique experience," added Recompsat.


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JYJ's Kim Jun Su was recently selected as the most popular foreign artist in China.
Kim received 63.7 percent of the approval rating and was selected as the most popular foreign artist by BTV variety show Music Billboard. Justin Beiber ranked second and Madonna ranked eighth.
On the January 8 episode of the show, Kim ranked first thanks to his single "Thank U For," which was released in Christmas season.
Kim has become even more popular in China in 2012. Music videos for his first solo EP title "Tarantallegra" and his single "Uncommitted" ranked first on Yin Yue Tai, the biggest Chinese music video chart.
When Kim arrived at Shanghai Pudong International Airport in July, 2012 to hold his concert, over 1,000 fans and 20 media outlets have gathered to see him.
Kim successfully completed the '2012 XIA Ballad & Musical Concert with Orchestra' at the end of the last year.
Source: Starnews
Credit: en.Korea via JYJ3
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SBA Honors Nation's Top Small Businesses
Winners Will Gather in Washington During National Small Business Week
WASHINGTON – This isn't like the competition we see on today's popular entertainment television shows. No, it's far more serious competition and recognition of small businesses that create jobs, produce revenue, lift local economies, support the local infrastructure and give back charitably to the communities where they live and work. It's about the business of America.
Small Business Person of the Year winners from 50 states, the District of Columbia, Puerto Rico, U.S. Virgin Islands and Guam will converge on Washington, D.C. June 20-21, when one of them will be selected as the National Small Business Person of the Year during the U.S. Small Business Administration's National Small Business Week, (June 16-21). While in D.C., the winners will have opportunities to meet with top administration officials, and national business leaders.
Leading up to the Washington, D.C. event there are regional events that week in Seattle, Dallas, St. Louis, and Pittsburgh designed to help small businesses start, grow and succeed.
The participating state small business winners represent a broad range of business products, services and innovations, including a helicopter pilot school in Arizona, a native foods restaurant in Guam, a pet resort in Illinois, a tool and die company in Massachusetts, a structural steel contractor in California and 49 others from across the country.
Events on the schedule will be available for viewing virtually through SBA's free, live webcasting, which will be accessible at www.sba.gov/smallbusinessweek. Interested parties can register online at the same site, where additional information (updated weekly) is available regarding registration, awards ceremonies, small business forums and educational and matchmaking sessions.
Those wishing to attend events can register online:
- in Washington D.C. at http://nsbwdc.eventbrite.com
- in Seattle at http://2013nsbwseattle.eventbrite.com
- in Dallas at http://2013nsbwdallas.eventbrite.com
- in St. Louis at http://2013nsbwstlouis.eventbrite.com
- in Pittsburgh, at http://2013nsbwpittsburgh.eventbrite.com
Every year since 1963, the U.S. Small Business Administration takes the opportunity to highlight through National Small Business Week the impact of outstanding entrepreneurs, small business owners, and others from all 50 states and U.S. territories. This year's events will be held
June 16-21, in Seattle, Dallas, St. Louis, Pittsburgh and Washington, D.C. offering tips, tools and trainings for small businesses to start, succeed and grow. In addition to in-person events, small business owners can participate in online-only panel discussions on hot topics like social media and business financing starting daily at 4pm ET. All events, in-person and online, will be streamed live on www.sba.gov/smallbusinessweek. Also visit this site for a full schedule of events and additional information. The event hashtag is #SBW2013.
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Editor's note: Attached is the list of state winners.
The U.S. Small Business Administration's participation in this cosponsored activity does not constitute an express or implied endorsement of any cosponsor's, donor's, grantee's, contractor's or participant's opinions, products, or services. All SBA programs and cosponsored programs are extended to the public on a nondiscriminatory basis. Reasonable arrangements for persons with disabilities will be made, if requested at least 2 weeks in advance, by contacting email@example.com. Cosponsorship Authorization #SBW2013.


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The Hunt Library makes room for collaboration by keeping most of its collection of more than 1.5 million books in on-site storage, where they occupy one-ninth of the space they'd take up in traditional stacks. Out of sight, they're still close at hand: the library's bookBot can deliver any volume in about five minutes.
Flexible, inspiring spaces have been created in the areas vacated by the stacks. The Hunt Library's 100 group study rooms have whiteboard walls and video conferencing technology that make them canvases for creative solutions. The graduate student commons features open study spaces and group study rooms, and the faculty research commons facilitates collaboration across disciplines.
The Fishbowl space features transparent walls that bring outsiders into the room and multi-touch displays that allow several people to interact with screens simultaneously.
The Hunt Library's sharp focus on collaboration is part of a trend displayed across the shifting landscape of higher education.
"Instructors are assigning more team projects and encouraging group study to help students engage more deeply with the course content through collaboration, as well as to enhance their communication and teamwork skills," observes Kim Duckett, principal librarian for digital technologies and learning.
Collaboration is just as essential to real-world problem-solving. The Institute for Emerging Issues, a public policy organization housed at the Hunt Library, brings people together around complex issues to ensure North Carolina's future competitiveness.
The Hunt Library is located at the heart of Centennial Campus, a pioneering public-private research park that exists to spur collaboration. At Centennial, NC State students and faculty work with industry leaders to craft the innovations that will shape tomorrow.