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Experimental Technical Readout: Caveat Emptor
Product information
Type Technical Readout
DevelopmentAaron Cahall
Ray Arrastia
Primary writingKeith Hann
Johannes Heidler
David A. Kerber
David Nawton
Joshua Perian
Eric Salzman
Paul Sjardijn
Chris Wheeler
Matthew Wilsbacher
Patrick Wynne
Pages 32
Cover artwork David A. Kerber
IllustrationsMatt Plog
Chris Daranouvong
David A. Kerber
Brent Evans
Publication information
PublisherCatalyst Game Labs
Product codeE-CAT35TR011
First published April 1st, 2021
MSRP Free
Content
EraDark Age Era
Series Experimental Technical Readouts,
Primitives Sub-Series
Preceded byExperimental Technical Readout: Republic, Volume 3

Description[edit]

Published as the 2021 April Fools gag, this is the Thirtieth in CGL's PDF exclusive mini-Technical Readout or TROlet series, Technical Readout: Caveat Emptor (abbreviated as XTRO:CE or XTR:CE). First April Fool gag XTRO since 2014.

Types of units featured in this volume includes BattleMechs.

Publisher's Description of the Product[edit]

Caveat Emptor Pdf Free Download For Windows 7

After Gray Monday, the Republic has descended into a new Dark Age, ploughshares are being turned back into swords, and the jackals are feeding on the confusion. The desperate need for weapons of new militaries arising everywhere sees mundane machines strapped with outlandish weapons, flamboyant arena ’Mechs returning to the battlefield, and renowned manufacturers engaging in uncharacteristic experimental gambles. It is a seller’s market; anything goes and no price is too high. Caveat emptor—the dust will settle quicker on your new acquisition’s battlefield debut than on the transaction that got you there. You won’t have time for buyer’s remorse.

Experimental Technical Readout: Caveat Emptor samples production and prototype machines that have earnt infamy after Gray Monday as inefficient monstrosities sold to the highest bidder. Each unit featured in this book incorporates some of the new technologies that debuted in Tactical Operations (or quirks found in the BattleMech Manual)—now employed on battlefields of brush wars on former Republic worlds. Statistics and Record Sheets are included for 13 new advanced and experimental BattleMechs, ready for play in advanced BattleTech games.

Contents[edit]

INTRODUCTION (by Major Jonas Heathcote, 31 October 3135)
GAME NOTES
HOW TO USE THIS TECHNICAL READOUT

CON-9M-D Carbine ConstructionMech MOD
Crosscut IIC SolahmaMech
Gauss-Buster MilitiaMech
Uni ATAE-70A ArtilleryMech
PRC-3N Porcupine
WSP-3X Wasp
VLK-QD5 Valkyrie
DAD-DX Daedalus
PHX-99 Phoenix Hawk
VKH-68 Volkh
AQS-5 Aquagladius
SCG-WX1 Scourge
OmniMarauder

RECORD SHEETS

Related TROs[edit]

Used Books Bloomington Indiana

Notes[edit]

  • Other illustrators listed in this article, who had created the reused artwork, were not listed in the product's Credits.

Pdf Free Download Windows 10

References[edit]

Book Stores In Bloomington Indiana

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Caveat Emptor Pdf Free Download Windows 10

Editorial
Annals of Internal Medicine
Screening for Asymptomatic Carotid Artery Stenosis: Caveat Emptor
T
he effectiveness of a population-based disease prevention or screening program depends in part on the prevalence of the risk factor or condition in the population, the characteristics of the test used to identify persons who are at risk for or have the disease, the availability of proven interventions that can lead to improvements in clinically important health outcomes without causing undue harm, and the program’s associated costs. These and related issues were raised in recent discussions and debates about the usefulness of several established and new screening initiatives, including mammography for breast cancer, prostatespecific antigen testing for prostate cancer, and chest computed tomography for lung cancer. On the basis of an updated evidence review (1) and in agreement with other organizations (2, 3), the U.S. Preventive Services Task Force has reaffirmed its previous recommendation against screening for asymptomatic carotid artery stenosis (CAS) in the general adult population (4). The estimated prevalence of asymptomatic severe CAS (ⱖ70%) in the general adult population ranges from 0% to 3.1%, with a point estimate of 0.9% for persons older than 60 years (calculated from data in the meta-analysis by de Weerd and colleagues [5]). This includes persons with total, asymptomatic carotid artery occlusion and those with hemodynamically significant tandem intracranial disease who would not be candidates for carotid intervention. After assuming a relative risk of 1.8 associated with asymptomatic CAS (calculated from data from the Cardiovascular Health Study; 0.5% of 5441 persons had CAS ⱖ70%, among whom 5% had ipsilateral stroke over 5 years, compared with 2.0% of those with CAS ⬍70% [6]), the population-attributable risk (PAR) for stroke related to asymptomatic CAS is approximately 0.7%. This is dwarfed by other risk factors, such as hypertension (PAR ⬎95%), atrial fibrillation (PAR, 1.5% to 24%, depending on age and other risk factors), cigarette smoking (PAR, 12% to 14%), and hyperlipidemia (PAR, approximately 9%) (2). The prevalence of asymptomatic CAS would need to be 14 times greater than the 0.9% estimate to reach a PAR for stroke similar to hyperlipidemia. As the U.S. Preventive Services Task Force mentioned, there is no validated riskstratification tool that can reliably identify a subpopulation of persons with a prevalence of asymptomatic CAS approaching this level (4). Carotid duplex ultrasonography is the primary means of noninvasive screening for asymptomatic CAS. The most recent high-quality meta-analysis of the test characteristics of carotid duplex ultrasonography included 47 reports. Forty percent of them were performed in symptomatic persons, and 4% were obtained for other indications (7). The reason for the test was not provided in 55% of the studies. Therefore, the application of the results of this analysis for population screening programs is uncertain. In addition,
because of variation in equipment and the operator dependence of the test, the meta-analysis found significant heterogeneity among studies and the possibility of publication bias. The reported sensitivity of 90% (95% CI, 84% to 94%) and specificity of 94% (CI, 88% to 97%) for the detection of stenosis of 70% or greater are, therefore, probably overestimates that may not accurately reflect realworld test characteristics in population-based screening. Even with the use of these optimistic sensitivity and specificity estimates, given a population prevalence of 0.9%, the positive predictive value (the proportion of persons with a positive test result who have stenosis ⱖ70%) would be 12%, with the others having unnecessary further evaluations or interventions. The premise underlying population-based screening is that it can identify persons with an unrecognized condition who would derive significant health benefits from a treatment they would not have otherwise received. Randomized trials found a statistically significant benefit of carotid endarterectomy versus medical therapy in persons with asymptomatic CAS (relative risk, 0.71 [CI, 0.55 to 0.90], over a mean of 3.3 years), but the absolute risk reduction was small (average of 1% per year) (8). Of importance, medical therapy was not standardized and the trials enrolled participants 11 to 31 years ago. Observational studies suggest that the rate of stroke with medical therapy has decreased considerably over time and may now be near or below the 1% annual rates found in the trials’ surgical groups (9). No trials compared carotid endarterectomy (or angioplasty and stenting) with current best medical therapy. Indirect comparisons are hazardous, and the use of historical controls is not appropriate. Ongoing trials are reassessing the benefit of carotid revascularization in persons with a background of contemporary medical therapy (10). If current estimates of event rates with medical therapy are correct, as suggested by recent guidelines, complication rates associated with interventional procedures (either endarterectomy or carotid angioplasty and stenting) will need to be considerably below the previously recommended ceiling of 3% (2). The cost-effectiveness of a screening program implies that it is effective. Currently, the effectiveness of the interventions compared with medical therapy are uncertain. All risk factors should be managed aggressively, regardless of the presence or absence of asymptomatic CAS. As a result, a discussion of cost-effectiveness of screening is moot. The available data clearly support the U.S. Preventive Services Task Force recommendation against population screening for asymptomatic CAS. However, such screenings are offered throughout the country in health fairs and other settings. The Choosing Wisely initiative from the American Board of Internal Medicine and other physician specialty societies aims to reduce the use of unnecessary
370 © 2014 American College of Physicians
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Screening for Asymptomatic Carotid Artery Stenosis: Caveat Emptor
tests that can lead to patient harm and increase health care costs. Among these recommendations is one from the American Academy of Neurology: “Don’t recommend endarterectomy for asymptomatic carotid stenosis unless the complication rate is low (⬍3%).” Although this may need to be revised in the future, an appropriate additional recommendation could be, “Don’t perform population screening for asymptomatic carotid artery stenosis.” In the interim, potential consumers of these services should be aware that the test is unlikely to prevent them from having a stroke or to lead to improvements in their health. Larry B. Goldstein, MD Duke Stroke Center, Duke University, and Durham Veterans Affairs Medical Center Durham, North Carolina Disclosures: Disclosures can be viewed at www.acponline.org/authors /icmje/ConflictOfInterestForms.do?msNum⫽M14-1332. Requests for Single Reprints: Larry B. Goldstein, MD, Box 3651,
Duke University Medical Center, Durham, NC 27710; e-mail, golds004 @mc.duke.edu. This article was published online first at www.annals.org on 8 July 2014. Ann Intern Med. 2014;161:370-371. doi:10.7326/M14-1332
References 1. Jonas DE, Feltner C, Amick HR, Sheridan S, Zheng ZJ, Watford DJ, et al. Screening for asymptomatic carotid artery stenosis: a systematic review and meta-
Editorial
analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2014;161: 336-46. doi:10.7326/M14-0530 2. Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, et al; American Heart Association Stroke Council. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:517-84. [PMID: 21127304] doi:10.1161/STR.0b013e3181fcb238 3. Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK; Society for Vascular Surgery. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease: executive summary. J Vasc Surg. 2011; 54:832-6. [PMID: 21889705] doi:10.1016/j.jvs.2011.07.004 4. LeFevre ML; U.S. Preventive Services Task Force. Screening for asymptomatic carotid artery stenosis: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161:356-62. doi:10.7326/M14 -1333 5. de Weerd M, Greving JP, Hedblad B, Lorenz MW, Mathiesen EB, O’Leary DH, et al. Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis. Stroke. 2010;41:1294-7. [PMID: 20431077] doi:10.1161/STROKEAHA.110.581058 6. Longstreth WT Jr, Shemanski L, Lefkowitz D, O’Leary DH, Polak JF, Wolfson SK Jr. Asymptomatic internal carotid artery stenosis defined by ultrasound and the risk of subsequent stroke in the elderly. The Cardiovascular Health Study. Stroke. 1998;29:2371-6. [PMID: 9804651] 7. Jahromi AS, Cina` CS, Liu Y, Clase CM. Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis: a systematic review and meta-analysis. J Vasc Surg. 2005;41:962-72. [PMID: 15944595] 8. Chambers BR, Donnan GA. Carotid endarterectomy for asymptomatic carotid stenosis. Cochrane Database Syst Rev. 2005:CD001923. [PMID: 16235289] 9. Naylor AR. What is the current status of invasive treatment of extracranial carotid artery disease? Stroke. 2011;42:2080-5. [PMID: 21659637] doi:10.1161/ STROKEAHA.110.597708 10. Rubin MN, Barrett KM, Brott TG, Meschia JF. Asymptomatic carotid stenosis: what we can learn from the next generation of randomized clinical trials. JRSM Cardiovasc Dis. 2014;3. doi:10.1177/2048004014529419
DOWNLOAD IMPORTANT REFERENCES TO CITATION MANAGERS At www.annals.org, article citations may be directly downloaded to any of the following formats: RlS (Zotero) EndNote, Reference Manager, ProCite, BibTex, RefWorks, or Medlars.
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2 September 2014 Annals of Internal Medicine Volume 161 • Number 5 371
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