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In the Pacific allergy medicine late period discount 250 mcg seroflo amex, they took a three-week car trip through the Andes of Ecuador allergy testing dermatologist seroflo 250mcg mastercard, rode horses through a sleeping volcano on the island of Santa Isabella allergy medicine list in india cheap seroflo 250 mcg without a prescription, and visited the magical island of Taha Mata allergy forecast lexington ky order 250mcg seroflo mastercard, a place that so enchanted Bernard Moitessier that he named his last boat for it allergy symptoms oregon 250 mcg seroflo sale. But it was impossible not to like Steffan and Carolyne Van Zwaim and their twin teenagers allergy testing johnson city tn order seroflo 250mcg mastercard, Stephanie and Jason. It turned out the crew of Fruity Fruits were in Norfolk preparing for a November crossing to Bermuda, so the two boats agreed to meet up there. After awhile, as the friendship deepened between both the adults and children, the Silverwoods and Below, better days. John and Jean Silverwood and their four children will take stock of all that was lost, and all that was found, on a dark night in June when their 55-foot catamaran slammed into a South Pacific reef - and their 18-month cruise turned from dream to nightmare. For John Silverwood, a 50-year-old real estate developer, the dream began in Florida in March of 2003 when he took possession of a Lagoon 55 catamaran named Emerald Jane. She proved an excellent choice for Silverwood, his wife Jean, 47, and their four growing children: Ben, 13, Amelia, 12, Jack, 7, and Camille, 3. The short-term goal was Australia, with a loose plan to continue on around the world. The first years of the cruise were a dream come true for John and Jean: visits with many friends and relatives at stops along the East Coast and Caribbean, scuba diving in the Virgins, stops at the site in St. Silverwood could even look back and chuckle at his mistake of leaving Aruba for Panama and getting caught in a terrific storm. In January, 2005, John and his family left Emerald Jane at the Careenage in Raiatea and flew home to San Diego. When the rest of the Silverwoods arrived several weeks later, she was ready to go. On the morning of June 24, they cast off the lines and headed west: destination, Australia. When he was 19, he bought a 36ft yawl and sailed her down the East Coast to Florida, the Bahamas, Motu One Jamaica and Mexico. Since moving to San Diego in 1985, the Silverwoods have sailed mostly charter boats out of San Diego Yacht Charters. So when Manuae Atoll in the Society Group loomed into view just before sunset on the 25th, he double-checked its position, then altered course a little south so as to give the place an extra-wide, extra-safe pass. As darkness fell that Saturday, the second night out, they were sailing almost dead downwind under jib alone (the main had been dropped earlier in the day due to a troublesome pin in the boom gooseneck). The radar was on, the skies were overcast, there was no moon, and when darkness came, it was complete. The only warning they had was a slight thump a second before the big cat came to a loud, grinding halt. One of the engines had been running when she hit (to charge the fridge) and he quickly got the other going. Panic ensued for a few moments until John assured his family that they would be okay, and started giving out assignments. Then he and Ben set about assessing the situation while Jean looked after the smaller kids. Flashlights revealed a reef as far to either side of the boat as their beams ing violently. Then he looked under the mast to see that his left leg had been severed between the knee and ankle. He was firmly caught under the mast, and every time a big set of waves came, he had to hold his breath as they passed over. Ben (the cut on his head, though a bleeder, turned out to be the three kids in the center of this photo are Camille, Jack and Amelia Silverwood. He knew he had to prepare to abandon the boat, but that deploying the Switlik canister liferaft would be tricky. So they pulled the lanyard and inflated it on the forward net, hoping that Emerald Jane might eventually get driven over the reef and into the deeper, calmer water of the lagoon on the other side, where the raft could be used. Within 15 minutes of hitting the reef, the boat that had safely sailed the Silverwood family thousands of miles was starting to come apart. Every 7th or 10th wave would break right over the boat and flood the cockpit and interior. The whole structure was shak- T minor) retrieved some line, and he and John were able to tie a makeshift tourniquet around his leg to stop the bleeding. The Silverwoods are a religious family, and they held hands and prayed together, even as the waves washed over them and the boat went to pieces beneath their feet. At some point, says John, a calm came over everyone, and with it a resoluteness that they were going to get through this thing. The combination that finally worked: Ben lifting from the coachroof, Jean pushing up with her legs from the trampoline, John using the last of his waning strength - and a particularly big wave that rocked the boat at just the right moment. Then they moved John and what remained of his leg aft, to the part of the boat that seemed least affected by the waves and pounding. About midnight, Ben and Jean saw a light on the horizon, and, thinking it was a ship coming to rescue them, fired off several flares. As the moon continued to rise, their disappointment was replaced with light: the overcast was breaking up and the moonlight, though dim, revealed more details of their predicament - and possible salvation. Meanwhile, Ben and brother Jack, now 9, used glow sticks to search the reef for useable flotsam. The family had eaten dinner right before the boat hit the reef, so none of them were really hungry, but Ben knew John was dehydrated and needed fluids. Ben again fired flares, and the plane immediately changed course and passed low over them. Manuae is a turtle sanctuary, and no one is supposed to live ashore, but it was well known that a Polynesian fisherman and his family had set up housekeeping there. It was an emotional moment for the Silverwood family when the man and three of his teenage sons appeared in their 20-ft open boat. Although the Polynesian family spoke no English and the Silverwoods spoke no French, important matters like getting the shipwrecked cruisers fed and into dry clothes were taken care of. Along with a pilot and co-pilot, there was a doctor and nurse aboard, as well as a rescue diver. For another, Ben spotted an area about 200 yards from the boat that looked relatively dry, with no waves breaking on it. He gathered his younger brother and sisters together, had them grab cushions and other items to sit on, and walked them over the reef to that safe area. The next order of business was to get John off the boat, which continued to distintegrate around them. Add in broken bulkheads and jagged, flailing bimini supports and staying aboard was becoming an increasingly dangerous proposition. When the capshrouds started pulling the mast backwards at the truck, the deck-mounted mast base shot forward. In addition to hitting John, the mast had wedged the Switlik raft in place on the forward net (and popped its inflatable canopy). Because there was still water around the boat, and the wave action was lessened by the outgoing tide, Jean and Ben formulated a plan to float the raft aft alongside the boat to where John lay, then get him into it. The kids - looked after by Ben and the helo crew - followed later in the helicopter. By the time John was rolled into emergency surgery, Jean had been checked into a room of her own, sedated for a panic attack. Other consulate officials appeared and escorted the kids down to the quay where Fruity Fruits was tied up. When we began our interviews with John in September, he had just started fittings and physical therapy for his prosthetic leg - a painful process that can take up to six months. He was also having trouble with feelings of guilt for putting his family in such a dire situation. Before we started talking, he had not discussed it much with anyone outside the family. According to the charts they had, they were clear of any reefs in that particular area and, as mentioned, had swung slightly south when Manuae was sighted in order to give any fringing coral a wide berth. The only thing John can figure out is that they might have been set north by current. A T the Silverwood family at an awards ceremony held for their rescuers in Tahiti. He will receive the Honor Medal with Crossed Palms, the Boy Scout equivalent to the Medal of Honor. No attempts were made to return to the wreck site to salvage anything from Emerald Jane for the simple fact that, by the time they flew over in the helicopter, there was almost nothing left of the boat. John spent the next 10 days in the hospital in Tahiti, with the exception of an afternoon when he appeared in a wheelchair at an awards ceremony for the helicopter crew who had rescued his family. Among the work done to him was a second amputation - this time above the knee - to make the eventual fitting and use of a prosthetic easier. In the longer term, there will certainly be more sailing in local Southern California waters. Way out on the horizon, the possibility of cruising again is definitely there (although young Jack stipulates, "Not around any reefs! Stewart walked into the offices of Sparkman and Stephens and commissioned a state-of-the-art racing schooner. The way the story is told, Olin Stephens - at 25 already showing the glow of genius that in a few years would give the world such legendary craft as Stormy Weather, Bolero and Ranger (and had already given it Dorade, launched in 1930) - tried to convince Stewart that yawls were the way of the future. Santana was built at the Wilmington Boat Works in San Pedro of mahogany over oak frames. She was launched on October 24, 1935, and almost immediately showed both the pedigree - and the foresight - of her designer. Santana showed her heels to most other schooners of the day, but in her first major ocean race, the 1936 TransPac, Santana took second in division and overall - to Dorade. Undaunted, Stewart put her on the deck of one of his tankers (a stunt unprecendented at the time) and shipped her to Newport, Rhode Island for the 1939 Bermuda Race. She won the schooner division, but overall honors went to Baruna, another S&S yawl. It was a tad on the short side compared with other yawls of the day, so she was still no racing grayhound in Southern California. Continuing what had become something of a Tinseltown tradition, Brent sold her to Ray Milland in 1944. Allyson were next, owning her barely a year - making it an even 5 owners in her first 10 years. Hopelessly outclassed by newer craft, Santana turned in a forgettable performance. If Solari was the last owner to seriously campaign the boat as a racer, she did more sailing under her next owner than any that had come before: Charlie Peet departed the Bay in 1971 and sailed her around the world with his wife, local sailmaker Jim Leech, and an ever changing crew of characters. The old girl could hardly have found two better owners at that point than twin brothers Tom and Ted Eden, lifelong sailors and owners of a San Francisco architectural firm. Although the boat had never been allowed to deteriorate like so many once-grand yachts, the years had taken their toll. So the first order of business was a complete refit, done largely by the brothers themselves along with the new boat captain, Ralph Lucas. He also spent many a weekend aboard Santana at Catalina, drinking with friends and dining on illegally-caught lobster. Willis Short, an interior decorator, bought Santana from the Bogart estate in 1957and made some weird changes below involving plastic panels with seahorses on them. The first thing Babe did was make the seahorses disappear and put the interior back in proper yacht trim. She was quickly pumped much of - was the reception the boat out, but all the machinery, electronics got everywhere she stopped. Little did anyone One was simply to celebrate one of the suspect at the time it would be her last grand dames of West Coast sailing. Yet another was to thank the many man-hours later, the completely refurpeople who contributed countless hours bished Santana went sailing again. The interior was virtually gutted Wherever she goes, they come down to and completely rebuilt. She got a new the docks, many in frail condition and engine, new cockpit, new deck - and supported with a cane. Stewagain remained her mainmast - the art up through Ted Eden and his family original spar was moved back into its - including Lauren Bacall. Although original position, complete with the origiBacall did visit the boat once while the nal 1897 gold $10 coin under the step. Edens had her, she has politely declined Despite the naysayers, the Kaplans most invitations to take part in articles could not be happier with the schooor events which involve the boat. Most but she remioften when the boat goes out, Suitable eye protection is recommended when view- nisced awhile. Bay sailing legend Tom Blackaller was at the helm that sparkling May day, backed by the Eden brothers and their well-oiled crew. Over on the chartered Dorade, Keefe headed a crew hardened by weeks of practicing for the upcoming Master Mariners. After some hard negotiations at the club, it was decided that the 55-ft Santana should give the 52-ft Dorade 7 seconds per mile. In light air, Dorade took an early lead, but as the breeze filled in to a healthy 25 knots, there was no holding Santana back. With Blackaller hooting and hollering down the homestretch - "I bet this boat was never this fast when Bogart sailed it! Zaca has served as a luxury yacht, scientific research vessel, navy patrol boat, and party boat for Hollywood swashbuckler Errol Flynn. Nine years in the making, this documentary film offers a riveting window into the past as seen through the eyes of this historic ship and the survivors of those who sailed on her.
Results: Seventeen participants completed semi-structured interviews and questionnaires (mean age 49 allergy medicine runny nose discount seroflo 250 mcg line. Participants identified as: Latina (n=7); Black (n=2); and non-Latina White (n=8) allergy forecast hong kong discount seroflo 250mcg overnight delivery. Most completed interviews in English (n=15) and over half had lower educational attainment allergy medicine 2013 purchase 250 mcg seroflo free shipping. While the interview included questions addressing chemotherapy delays jacksonville allergy forecast discount 250mcg seroflo mastercard, explicit insight into chemotherapy delay was rare among participants allergy treatment plano buy seroflo 250mcg overnight delivery. When discussing their process to chemotherapy allergy medicine congestion buy generic seroflo 250 mcg on line, participants described barriers and facilitators at the patient, family, medical, and community levels contributing to their timeline to start chemotherapy. At the patient level, participants discussed their fear and anxiety, the command over their diagnosis, and the importance of playing an active role in treatment. Finally, patients described their reliance on the medical team for information, the trust needed to navigate their treatment process, and the challenge of managing information associated with their treatment. Conclusions: Women expressed the importance of managing individual stressors, family roles and support, medical information, and community support. Activating women to be engaged in the treatment process at multiple levels appeared to facilitate initiating chemotherapy. Multilevel interventions that engage the patient, family, medical team, and community may provide the supports to enable the initiation of timely chemotherapy. It is characterized by larger tumor size, higher grade, early peak of recurrence, and a worse 5-year overall survival rate compared to other breast cancer subtypes. Patient will be monitored clinically and radiologically for response to treatment. If there are 1 or fewer responses in these 14 patients, the study will be stopped. The null hypothesis will be rejected if 4 or more responses are observed in 25 patients. The first 6 patients will be enrolled in a staggering interval for the safety run-in phase of the study. Women with MetS had a higher frequency of tumors 2 cm than women without MetS (49. There were no differences in histological grade, staging, or axillary lymph node metastasis (p>0. Patients must enroll within 12 months of last therapy (definitive breast surgery, radiation and/or all intended adjuvant therapy). Secondary objectives include: evaluating efficacy of ipat + atezo in reducing micrometastatic disease after 3 cycles; determining the recurrence risk after treatment with ipat + atezo; and determining the safety and tolerability of the combination. With a sample size of 82, 12 months postaccrual follow-up, and accrual rate of 5 patients per month, the study duration is 30 months. To have 82 evaluable patients with a 15% dropout rate, we would need to enroll 96 patients. Results: Seventy women (One with synchronous bilateral disease) were selected according to selection criteria, median age: 31. Methods this was a retrospective study conducted using the Optum Clinformatics Datamart database. Patients newly diagnosed with breast cancer, continuously enrolled in a health plan for 6 months before and after diagnosis were included in the study. Bofill8, Vanesa Quiroga9, Laura Garcia-Estevez10, Serafin Morales11, Pablo Tolosa12, Pamela Celiz2, Xavier Gonzalez Farre13 and Cristina Saura1. Because of its rarity, there have been no comprehensive studies on characteristics of male breast cancer in Japan. Therefore, there has been few specific treatments developed for male breast cancer. The data are used in domestic research to evaluate the standards of medical care and support clinical research. The median age was 71 years for men (56-87 years, 5-95 percentile) and 61 years for women (40-83 years). Hypertension, diabetes, cardiac disorder and cerebrovascular disorder were more common in men. Statistical methods Patients are stratified by visceral disease, primary vs secondary resistance, and geographic region. The treatment effect will be quantified via a hazard ratio, computed from a stratified Cox proportional-hazards regression, including a 95% confidence interval. The study is open for enrollment and, as of 06/04/2020, eight patients have been enrolled. Tumor and QoL assessments are repeated at baseline, on week 6, 12, then every 12 weeks, and at the end of trial treatment. Study activation process is ongoing in Belgium (8 centers), Italy (15 centers) and Austria (5 centers). MethodsAn Internet based tool designed to provide personalized information on cancer risk was designed by healthcare providers and made publicly available in 2009 (OncoLink. Data from female responders in a convenience sample frame were analyzed as part of this study. They were also more likely to have performed a self-breast exam or to have received one in clinic (Table). Cottu4, Laurence Vanlemmens5, Carine Segura-Djezzar6, Anne Lesur7, Barbara Pistilli1, Florence Joly6, Thomas Ginsbourger8, Bernadette Coquet9, Guillemette Jacob10, Aude Sirven11, Julia Bonastre1, Jennifer A. Patients in the intervention arm are paired with an individual lifestyle coach, who delivers the intervention through 24 semi-structured telephone calls of 30-60 minutes, supplemented by a detailed participant workbook and scheduled as follows: 1) intensive phase (weeks 1-12), 12 weekly calls; 2) consolidation phase (weeks 13-24), 6 bi-weekly calls; 3) maintenance phase (weeks 25-52), 1 monthly call. Regular meetings with study team and investigators assure standardized delivery of the intervention and troubleshooting. Toolbox solutions are offered to tailor the intervention and meet the needs of specific ethnic, socioeconomic or other patient populations with difficulties in achieving intervention goals. All participants in both arms receive a health education program focusing on healthy living. All other measures, time points and analyses will be considered secondary or exploratory. Higher recurrence and mortality rates in very early-onset breast cancer patients may be related to differences in tumor biology, mutation status, clinical or treatment features. Management of those women should comprehend dedicated approach and standard care that are often not available on cancer care centers at low-middle income countries. We aim to describe the clinical and pathological factors associated with very earlyonset breast cancer patients and the challenges associated with treatment of those women in a public health facility in Brazil. Methods: Retrospective review of 748 patients diagnosed and treated at the biggest surgical center for breast cancer in Brasilia - Brazil between 2015 and 2020 was performed and 54 patients with cancer diagnosis age 35 were identified. The most common were invasive carcinoma of no special type (98%) and malignant phyllodes (2%) and 10. Only 22% of the women with hormone receptor tumors were exposed to ovarian suppression alongside hormone therapy. Conclusions: Previous studies showed that breast cancer is diagnosed at an earlier age among Brazilian patients. These findings alongside the restrict acess to genetic counseling and the delay on treatment in the public healthcare system are a clear indication of the challenges for achieving standard care for those patients and could have a significant impact on survival outcomes. These data combined indicate the need for supportive care program for young women with breast cancer. The current strategy of supporting breast cancer patients does not meet their needs due to the limited personalized-based approach in rehabilitation plan and the lack of healthcare, financial and other resources. During the second part of the project, a multicenter prospective longitudinal study is planned. Eligible patients will be followed for one year with validated questionnaires regarding different QoL issues, and wearables that will collect active monitoring data on physical activity, sleep pattern, and heart rate. Eligibility criteria Breast cancer patients planned for curative treatment with surgery with or without oncological therapy or breast cancer patients at least 1 year post-treatment (except endocrine therapy) will be eligible for the prospective study. Regressive counterparts of aforementioned methods will be analyzed for numeric QoL outcome variables including also regression specific methods. The accuracy of trained models will be estimated relying on standard machine learning validation procedures such as the K-fold crossvalidation and leave-one-out cross-validation. Present accrual and target accrual Four retrospective datasets will be used for the first part of the project including approximately 18,000 breast cancer patients. For the prospective study, it is planned to be included about 30 patients monthly during a period of 12 months. Contact information for people with a specific interest in the trial ascape-project. In 2L, the most frequently prescribed regimens were pertuzumab + trastuzumab + taxane (n = 246; 17. Hormone therapy was combined with chemotherapy or targeted therapy in 622 patients (44. Previous studies have shown that these patients have adverse tumour biology including high grade morphology, lymph node involvement and lack of hormone receptor expression. The aim of this study was to assess the outcomes and risk factors associated with the different subtypes of breast cancer as defined by receptor status in a cohort of young patients in a central London cancer centre. The majority of patients presented with stage 1 or 2 disease and a small number presented with metastatic disease, irrespective of subtype. This group of patients would benefit from somatic molecular testing to identify potential treatment targets. Patient demographics, tumor characteristics and biomarkers were analyzed using descriptive statistics. These finding might provide insights for clinicians for the treatment plan for the patients. Mumbai Cancer Registry,Indian Cancer Society, Mumbai, India Introduction: Population based survival provides a measure of the efficacy of cancer control in a defined geographical area. Breast cancer is the commonest cancer in women in Mumbai constituting 30% of all female cancers, and is now the most common cancer in women in India (1, 62,468 in 2018), constituting 27. There have been few reports on breast cancer survival from India, and in this study, we report the survival rate of women diagnosed with breast cancer in Greater Mumbai during the years 2009-13. Social investigators visited hospitals, nursing homes, clinics, hospices and laboratory centers for documenting cancer cases. Mortality data was collected from the Vital Statistics Division of the Municipal Corporation. Follow up was conducted with repeated scrutiny of medical records, death certificates issued by the Municipal Corporation, postal and telephone enquiries, house visits and linkage with electoral database. Expected survival was calculated using the national life-table of India for (Maharashtra) based on Census of India, 2011. The survival rate was compared to that from other regions of India and with developed countries. Results: Of the 9707 breast cancer cases registered during the period 2009-13, 8031 (83%) cases were included in this study. The median age was 55 years (range 18 -96 years) with 2725(34%) 50 years and 5306 (66%) > 50 years. The highest 5-year relative survival was shown by 29 age group (74%) and lowest by >70 age group (60%). Those with localised disease at diagnosis had a higher 5year relative survival rate (84%) compared to 79. The clinical extent of disease and education were significant risk factors affecting survival (p < 0. Conclusion:The 5-year population-based survival of patients treated in Greater Mumbai during the period 2009-2013, is 70%. This compares favourably with previously reported 5-year survival from Mumbai (51-55. The association of survival with educational status and stage at diagnosis highlights the importance of awareness and early detection. Enhanced awareness and detection coupled with easy access to adequate and affordable treatment could help improve breast cancer outcomes. Specific recommendations for breast cancer treatment strategies, such as alterations in sequence, type, and/or frequency, were temporarily implemented from week 12 onwards. The aim of this study was to investigate the impact of the first outbreak on the initial treatment of breast cancer patients. Weeks 2-17 2020 were split up in four periods, based on the number of breast cancer diagnoses: weeks 2-8, weeks 9-11, weeks 12-13, and weeks 14-17. Of these patients 5,504 received their initial treatment in weeks 2-17 2018, 5,641 in weeks 2-17 2019 and 5,408 in weeks 2-17 2020. An increase in the use of endocrine therapy was seen in weeks 12-13 and 1417 2020 compared to weeks 2-17 2018/2019, especially for patients with stage I cancer (12. Age and clinical stage have a negative impact on patient personal life and labor productivity. Patients with missing data were excluded and women older than 60 years, retirement age in Brazil, were not included in this analysis. None of the variables evaluated such as age, educational level, personal income, clinical-stage, molecular subtype, surgery type and systemic treatment, were significantly associated with change of marital status for patients previously married or in common-law marriage. Nonetheless personal income and surgery type were associated with higher chance of unemployment whereas no specific variables were related to marital status change. Whether any of these factors could influence adult breast tissue composition is unclear.
It has gradually spread east and north allergy shots in hip generic seroflo 250mcg with visa, reaching Louisiana and the Mississippi River allergy forecast uk buy 250 mcg seroflo. The cholera epidemic kills several hundred people and affects millions of people nationwide allergy forecast fort wayne discount seroflo 250 mcg amex. As mentioned above allergy forecast today buy seroflo 250 mcg without a prescription, global hazards are awakening a sense of crisis about the safety in Korean society which has 215 readily embraced by the myth of prosperity and technological progress allergy forecast kentucky buy 250 mcg seroflo visa. She states the everyday risks: the other part of a prosperous Korea is the high-risk society allergy symptoms hives and swelling 250 mcg seroflo visa. Koreans have faced risk factors such as terrorism, environmental degradation, greater financial complexity, and uncontrollable technology. The deepest concerns in a prosperous time are health risks, personal lives, and family. The large majority believe that current regulations are not enough to protect people from genetically modified foods and other biotechnology. The disconnection from the smart phone leads to the highest levels of depression for a whole day. Koreans are often buying emergency/disaster kit items and bottled water in an emergency situation. Technological progress, economic growth, and natural disaster are sources of risk. Government uses the concept of risk to control the people and push their policy agenda. Many Koreans believe that what they anticipate from the future is negative change, rather than the continuation of economic growth. In this sense, the language of the risk society can be replaced with a safety oriented discourse, which is related with self-preservation, well-being, threat avoidance, and self-gratification, and ideal security culture. The implement of true democracy and the emphasis of family values are alternative ways to sustain the powerful narrative of safety fever. The latest national smartphone survey finds that about two-thirds of Korean adults say conspicuous consumption creates serious environmental degradation that leads to extreme weather conditions. However, Koreans who feel consumption is related to extreme weather do not want to change their existing consumption patterns dramatically. At the same time, nearly three in 10 Koreans say they are willing to change their consumption patterns to gain long term benefits for environmental concerns. While the majority of Koreans recognize the significant relationship between consumption and environmental problems, most do not pay much attention to sustainable consumption. Some go even further to say that the over-emphasis on environmental threatens hurts competitiveness and profitability. The private chef business has been one of the fastest growing services in the 2010s. Wealthy people demand more personal services and are employing more personal chefs for their specific tastes. The Korean Personal Chef Association says that tens of thousands of Koreans hire personal chefs today compared with only thousands of Koreans 6 years ago. According to the Korean Clean Energy Agency, total energy consumption has grown steadily between 2013 and 2017. High level of energy consumption has remained fundamentally unchanged in the middle of the extreme weather events. They grow 90 percent in Korea between 2013 and 2018, while mass consumer brands only grow 20 percent in the same period. Luxury brands have become an everyday experience for millions of Koreans: Gucci shoes, Prada clothes, Tiffany jewelry, Rolex watches, Burberry bags, etc. Everybody can taste small luxury products under the language, "democratization of luxury goods". The new luxury brands are derived from the time of economic prosperity and high technology in the late twenty century and the early twenty first century, when people are consistently satisfied their material desires. Koreans are looking for post-material waves like "emotional connections," meaningful experiences, and high technology products: robot driven cars, commercial space trips, augmented reality watch, custom tailored spiritual travel, fantasy organizers, household managers, bio-medical smart clothes, wearable universal translation robot, Asian and ancient antiques, and luxury bathrooms. The Most Extreme Weather Year the year 2015 is one of the most extreme weather years in Korean history. The worst yellow dust storm covers the nation, followed by the third hottest month. The cost of extreme weather events is steadily rising and reaches a total of hundreds of billions in damages in 2015. March: Koreans get stuck in the freezing cold weather, showing a dramatic drop in temperature. April: the yellow dust that comes from China causes school closures and health concerns with respiratory problems. May: the continued drought in Jeju Island, locating at the southern tip of Korean peninsula, causes a widespread livestock deaths and severe shortage of water. August: heavy rain and flash floods hit Seoul, one of the greatest rain falls ever recorded in three hours in Korea. September: the worst wildfire burnes more than 10,000 acres and destroys hundreds of homes October: the autumn heat wave hits the southern part of Korea. December: ice storms and extreme cold cause major power outages and property damages. The conservatives argue that government should bring a scaled-back disaster relief fund for the response to extreme weather. They refuse to support the scientific consensus that human activities cause the global warming. It blocks cap-and trade legislation, including a carbon tax, and new energy efficiency bills. However, it does not have the leverage to make their agenda into the law under the harsh political reality. Civil society is concerned about extreme weather to a much greater extent than any other fields. It criticizes the political parties for engaging in "gestural politics" (Giddens 2008) because their grand plans seem to be vague and lacking urgency. The extreme weather events generate a number of new organizations to deal with the issue. In particular, the Korean Civil Society Coalition on Climate Change, which is founded in 2015, pushes environmental protection and climate change mitigation policy. It plays a significant role in climate change policy assessments and sustainable development policy. The government takes "a return to planning" (Giddens 2008) which promotes a long term view to the public and private sectors. The initiatives focus on solar and renewable energy home and a green transportation system. Global warming and extreme weather are sources of risks and opportunities for businesses. They affect the agriculture industry, fishery industry, insurance industry, energy intensive industry, and tourism. Energy intensive industries, such as iron, steel, cement, ceramics, glass, aluminum, paper, and chemicals, are confronted with rising energy costs and international competition. On the other hand, some businesses swiftly 220 move to commercialize low carbon and energy efficiency technologies. Many Koreans believe that recent extreme weather events are evidence of global warming. However, some Korean conservative Christians see the extreme weather as a sign from God or the End Times. Korean Christianity remains one of the most important elements in the dynamism of Korean politics. Some groups of Christians aggressively get involved in politics and try to control the government. On the other hand, the progressive party and a large number of humanist groups criticize Christian theocracy and view the extreme weather as an outcome of modernity. Extreme Weather Divide: "Dark with Envy" Koreans are exposed to severe conditions ranging from disasters to everyday risks. The most vulnerable communities are generally high population-density urban areas, low-lying coastal regions, and river flood plains. The poor tend to have very limited resources with which to protect themselves from severe weather conditions, while the rich spend huge sums of money to protect themselves from deadly conditions. Seoul is reportedly covered by about 40 inches (more than one meter), killing dozens of people 221 and leaving 1 million households without electricity for a week. After the power failure, her wealthy friend invites her family to her house to avoid problems that the power outages caused. Her friend is able to keep lights, home appliances, and the home 3D entertainment room running for several days in a whole-home hydrogen fuel cell generator system. Koreans use them as a status symbol because lower income families cannot afford to buy the expensive hydrogen fuel cell generator. The disaster-resistant vacation house is supported by an impact-resistant roof and window system, and a safe room. It is structured to resist earthquakes, floods, snowstorms, and other natural disasters. The disaster-resistant vacation house allows his family to stay safe during natural disasters. Purchasing disaster-resistant vacation houses are a vogue that becomes more common for upper class and elite groups. Rich people have generally owned beach condos, mountain cabins, and luxury beachfront villas. The Big Arctic Melt: the Golden Age of Cyropolitics the arctic is experiencing an unprecedented transformation. The Arctic sea ice is steadily diminishing, caused by the warmer air over the past decades. The melting of sea ice in the Arctic 222 causes the vicious cycle of rising temperatures and rising sea levels. In 2020, the Oslo World Polar Science Conference claims that the Arctic would be the ice free around 2040. The projection of an ice-free Arctic is a bellwether of what is coming to the entire globe. The melting Arctic brings a number of environmental, economic, and political issues. The melting ice provides new shipping routes between the North Atlantic and the Pacific oceans for goods, fishing, and tourism. Large-scale natural resources such as oil, gas, and minerals, are rapidly developed in the Arctic and subarctic regions. The melting ice induces new territory disputes due to natural resources and shipping routes. The Arctic geopolitically becomes a center of "cryopolitics" for "the competition between states to control emerging resources and territory created by the melting cryosphere" (Haverluk 2007, 1). Eight Arctic states dispatch Arctic patrol vessels and submarines for ship safety and environmental protection. The Arctic is required to have new international agreements and environmental regulations. In particular, the Arctic island of Greenland becomes a fully independent country from Denmark in 2022. Many Greenlanders believe that their independence secure more jobs and wealth produced by oil and mining exploration while Greenland enters a stage for a fierce battle between global oil companies. It has called for severe actions in greenhouse gas emissions and coastal protection measures. In particular, Tuamotu islands in French Polynesia, Tuvalu, a tiny island country in the Pacific, and Maldives, the Indian Ocean islands, are disappearing from sight. The International Environmental Refugee Project establishes the Floating EcoHabitat Project, supported by Global Climate Fund and environmental charities. The project has two branches: the Floating Artificial City Project and Water Floating House Project. The city project builds huge floating artificial islands to provide homes for environmental refugees. It is powered by renewable energies such as solar, thermal, wind energy, hydraulic and a tidal power station. Jinsoo Park leaves his town in the west coast of Korea and moves to a crowded city after a tropical storm raked his home and business. The June flooding and September horrific wildfire kill more than 100 people and destroy at least 5,000 homes. The continuous onslaught of natural disasters turns climate migration into a hot domestic issue and has induced political and civil conflict. The system convenes an emergency meeting to address heavy rain conditions and how to proceed via video conferencing. Most participants of the meeting hear ominous sound of rumbling thunder in the distance. In the spring of 2027, the most disastrous flood in Korean history occurs along the Han River passing through Seoul. The flooding inundates Seoul, Gangwon Province (east part of Korea) and Kyunggi Province (west part of Korea). President declares flooded areas as a special disaster zone to prevent looting and in order to respond to the crisis.
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Table 3 - Cox survival regression model of patients diagnosed and treated for invasive breast carcinoma allergy medicine 9\/3 discount 250 mcg seroflo. In the second model allergy symptoms with eyes buy seroflo 250 mcg overnight delivery, variables with a significant association in model 1 were excluded in order to highlight second order factors independently associated with disease-free survival allergy forecast for philadelphia buy cheap seroflo 250 mcg on-line. In the third model allergy testing eosinophilic esophagitis generic 250 mcg seroflo amex, there were no factors independently associated with disease-free survival allergy to grass treatment buy 250mcg seroflo with amex. Max Smith2 allergy oils cheap seroflo 250mcg with amex, Ian Chang1, Asma Dilawari1, Cody Peer3, Tristan Sissung3, Ming Tan2, W. Our findings should allow clinicians to tailor treatments to maintain therapeutic doses while limiting toxicities. Kirov Military Medical Academy, Saint-Peterburg, Russian Federation Relevance: early breast cancer is detected in more than 60% of cases. Maintaining the quality of life of patients with early breast cancer at the highest possible level is a priority, along with the treatment of patients. Under a complex antitumor treatment as well as after its completion, more than 60% of patients with early breast cancer report the occurrence of functional disorders. An important aspect is to improve the effectiveness of the rehabilitation process of patients with early breast cancer taking into account scientifically-based and proven recommendations. Materials and methods: 228 patients with breast cancer who received complex treatment from 2015 to 2019 were included in the study. The prospective part of the study included 114 patients with early breast cancer undergoing rehabilitation measures within the biopsychosocial approach. The control group which was selected retrospectively, using the method of "pairwise selection", included 114 patients with early breast cancer comparable in age, stage of the disease, volume of surgical treatment and menopausal status, undergoing physical and psychological rehabilitation prescribed by a doctor. Events that were censored were a disease progression, the appearance of metastases, the occurrence of another cancer, a new concomitant disease, an exacerbation of the concomitant pathology and death. Eligibility includes receipt of neratinib in the extended adjuvant setting, signed informed consent for medical record retrieval/data abstraction and age >18 years. Patients who do not complete enrollment procedures, are participating in a clinical trial or have metastatic disease are excluded. Patients are recruited through multiple mechanisms including private social media groups, treating clinicians and patients enrolled in the Puma Texting Program. Patient health records for breast cancer-related treatment are collected from time of diagnosis to 1-year post-enrollment in the registry. Research questions focus on patient and tumor characteristics, receipt of therapy. Preliminary results show that this pilot virtual registry is a feasible and efficient modality to collect important data on descriptive characteristics and treatment patterns for a patient population derived from real-world practice settings. Validation of this method is needed and could be used to evaluate important trends such as the frequency of neoadjuvant therapy and associated outcomes in a larger population. Descriptive analyses were performed by the survey software and analytical statistics were performed using R (v4. Most (65%) reported that the type of post-mastectomy breast reconstruction does not influence their axillary treatment algorithm. Pathology reveals a T1 tumor with 2 of 3 sentinel lymph nodes with 2mm tumor deposits. Pathology demonstrates a T1 tumor and 4 of 4 sentinel nodes with disease but without extra-nodal extension. Most (85%) cited that their decision was based upon clinical trial evidence and/or national guidelines. Physician education on clinical trial inclusion criteria and development of clearer axillary treatment guidelines can aid in appropriate identification of axillary de-escalation opportunities. Overall, we aim to develop a predictive score combining clinical, genomic and immune expression data integrating tumor biology and microenvironment. Once this sample has been collected, registered and assessed for quality, patients will be followed up every 6 months until disease progression, death or withdrawal from the study. Breast cancer in young Korean women (< 40 years) is rare, but the rate of young age breast cancer incidence in Korea is higher than that in western countries. This study was aimed to evaluate the tumor characteristics of young age breast cancer patients (< 40 years) among Korean women. We described the number and percentage of the breast cancer stage distribution, tumor grade and intrinsic subtypes by the patient age groups (< 40 years, 40-49 years, 50-59 years, and 60 years), and evaluated the tumor characteristics in young age breast cancer patients (< 40 years). Young age breast cancer patients were more likely to be diagnosed with larger tumors (T2: 41. Therefore, we need to identify high risk group for young age breast cancer (< 40 years) and support their active surveillance. These findings using national cohort provide important information for establishing a national strategy of cancer care to manage young age breast cancer patients. Adoption of trastuzumab biosimilars may be affected by multiple factors, including physician confidence in biosimilar efficacy and efficacy across stages, practice reimbursement, payer medical policy/redirection. Cases were identified from approved treatment plans for patients with breast cancer by inclusion of brand trastuzumab or trastuzumab + hyaluronidase-oysk, or trastuzumab biosimilars. Results: As of July 1, 2020, 10,557 treatment plans trastuzumab-based therapy were submitted, 1740 (16. Additional analyses to be presented will include Q3 2020 utilization and patterns of utilization across payers with/without medical policy favoring biosimilars. Conclusions: Adoption of trastuzumab biosimilars in this commercial population has been rapid since their introduction. The primary endpoint was complication rates, which were divided into major and minor complications during the first 6 months. Minor complications were defined as those treated conservatively, major complications were those requiring surgical therapy. The secondary endpoint was short-term cosmetic outcome after 6 to 12 months, which was judged by two professionals using the Harvard score (1 = poor, 2 = fair, 3 = good, 4 = excellent). Major complications occured in 7 breasts (n = 7/63; 11,1 %) and minor complications occured in 12 breasts (12/63; 19,0 %). Seventeen cosmetic complications were observed (17/63; 27,0 %) and 6 cosmetic revision surgeries were performed (6/63; 9,5 %). Careful patient selection and preparation techniques considering flap viability are vital in order to achieve acceptable complication rates and satisfying cosmetic results. The protein has been shown to be lost or reduced in a wide range of cancer cells and reduced expression has been noted in a number of human solid cancers, including breast cancer. Similarly, the network expression pattern also appeared as a significant predictor of disease-free survival (p<0. However, registration and coding of cause of death is prone to error since determining the exact underlying condition related to the death is challenging. In this study, an expert review of medical files was done to determine the principal cause of death for breast cancer patients of a Belgian tertiary hospital. The retrieved cause of death was compared to death certificate information to assess concordance between both sources. Results A total of 2,862 patients were included, of whom 354 died after a median follow-up of 54. When comparing to medical files, misattribution of breast cancer-specific death in death certificates (4. Conclusions Overall, substantial agreement of cause of death was seen between death certificates and medical files. Attribution of cause death to comorbidities was the most common reason for discordant reporting of breast cancer-specific death. Five-year breast cancerspecific survival was slightly higher based on cause of death information from medical files, compared to death certificates. Table 1: Discordance for the principal cause of death between medical files and death certificates medical files other causes breast cancer death certificates other causes 136 (38. Although they are potent inhibitors of proliferation, tumor cell death (by apoptosis) may be curtailed. Both palbociclib and venetoclax will be administered on day 1-21 of a 28 day cycle. Tumor assessment will be performed every 8 weeks for 24 weeks and then every 12 weeks until progression. Statistical methods this is a proof-of-concept, dose escalation study and any statistical analysis of responses will be exploratory. Novel therapies such as trastuzumab deruxtecan and tucatinib provided high response rates to a patient subgroup with unmet clinical needs for having effective therapy. Education followed adult learning principles starting with a goal of increasing awareness on novel agents and outcomes presented at national conferences and then integrating these agents into clinical practice, including adverse event management. Panel discussions were utilized to provide multiple faculty perspectives and clinical examples. Results:As of 6/9/2020, 6,473 global physicians had participated in the activities including 3,036 oncologists. These results demonstrate the effectiveness of on-demand education to translate information from data to clinical practice and directly benefit patients. Results: A total of 797 women were included with a median follow-up of 105 months. Besides, our study serves as a hypothesis generator for future confirmations through prospective studies. Such results would be extremely important, given the known difficulty in accessing genomic assays, especially in developing countries. Materials and Methods: We performed a multicentric retrospective cohort study on women who underwent immediate or delayed implant-based reconstruction after curative or prophylactic mastectomy between January 01,2002 and March 30,2010 in three French private health institutions of public interest. Results: We identified 2499 patients with the use of 4106 breast implants between 2002 and 2010. This patient population selected for breast reconstruction had good prognosis criteria (77% T1 and 68% N0). Disease-free survival was also similar between these two populations (Log-rank test: p=0. In Latin America, reports have shown an increased incidence of breast cancer in young women. No information exist regarding breast cancer characteristics in young Guatemalan women. We aimed to describe the clinical-pathological features among women aged 45 years or less treated in a tertiary-level hospital in Guatemala. Methods: We examined data from 119 women aged 45 years or less diagnosed with primary invasive breast cancer at the Oncology Unit Roosevelt Hospital in Guatemala between 2016 and 2020. Data were drawn from medical files on sociodemographic characteristics, histology, clinical stage, and breast cancer subtypes. Results: Of the total sample, breast cancer in women aged 45 years or less represented 31. Regarding treatment, most young patients received surgical treatment, as well as neoadjuvant or adjuvant chemotherapy. Conclusions: Our finding suggested that young women treated for breast cancer at a tertiary-level hospital in Guatemala had a high proportion of aggressive molecular subtypes and a high rate of locally advanced disease. This aggressive cancer behavior among young women is consistent with findings in other Latin American countries. Evidence examining risk factors for aggressive cancer in young women, such as delay in diagnosis and treatment timing, is warranted. Institut Curie, Paris, France Background: There is a lack of data on the use of breast implants and the path of patients reconstructed after breast cancer in France. This study aims to identify the paths of patients reconstructed by breast implant in France and assess their impact on survival, but also estimate the quality of the reconstruction, determined by early removal or replacement of implants. Methods: We performed a multicentric retrospective cohort study on women who underwent immediate or delayed implant-based reconstruction after curative or prophylactic mastectomy between 2002 and 2010 in three French private health institutions of public interest. Results: We identified 9 care pathways according to the type of disease, the type of surgery, the addition or not of adjuvant radiotherapy, and the timing of reconstruction. Theses courses concern 2,499 patients, and 3,191 breasts on which at least one implant has been placed. The number of implants per breast is significantly different according to the reconstruction pathways (p<0. The overall survival and removal incidence of implants are significantly different according to the differents profiles of reconstruction (Log-Rank test: p <0. Conclusion: the profiles of patients reconstructed by implants are very heterogeneous, according to their disease, their surgery, the adjunction of adjuvant radiotherapy, and the reconstruction time. Competence was assessed via post-activity evaluation where participants were asked to identify changes they intended to make in practice and any anticipated barriers that would hinder them from making changes. Case study assessment questions were utilized to see if participants translated knowledge into practice. The follow-up assessments also inquired about changes made and actual barriers experienced in practice. The percentage of those who intended to make changes compared to those actually made changes were also fairly similar. Notably, 40% of participants listed "formulary/insurance" as an anticipated barrier, but 0% reported facing this at followup.
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