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Professor, Medical College of Wisconsin
The 5year survival rates for patients with typical and atypical lung carcinoids are around 95% and 70% blood pressure medication usa buy metoprolol 12.5 mg fast delivery, respectively blood pressure medication increased heart rate cheap metoprolol 50 mg online. The ranges reflect different survival rates quoted by several medical journal articles heart attack upset stomach order metoprolol on line amex. For both types of carcinoids, the 10year survival rates are about 10% lower than the 5year rates. The 5year survival rate for patients whose carcinoid tumors have not spread (metastasized) to their lymph nodes is 85%. These numbers will be higher for patients with typical carcinoids and lower for those with atypical carcinoids. The 5year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Many of these patients live much longer than 5 years after diagnosis, and 5year rates are used to produce a standard way of discussing prognosis. Fiveyear relative survival rates exclude from the calculations patients dying of other diseases and are considered to be a more accurate way to describe the prognosis for patients with a particular type and stage of cancer. Of course, 5year survival rates are based on patients diagnosed and initially treated more than 5 years ago. Improvements in treatment often result in a more favorable outlook for recently diagnosed patients. A risk factor is anything that increases your chance of getting a disease such as of cancer. For example, smoking is responsible for about 80% of cases of lung carcinoma (the usual and more serious type of lung cancer). In contrast, very little is known about why lung carcinoid tumors develop in some people but not in others. Chemical exposure: Lung carcinoid tumors are not associated with smoking or with any known chemicals in the environment or workplace. Family History: A genetic tendency to develop lung carcinoid tumors can be inherited. Rare families have been described in which several members have been diagnosed with this cancer. Also, in general children of parents with this disease have a higher chance of developing carcinoid. And, most people with carcinoid tumors do not have a parent with this form of cancer. Researchers have learned a lot about how certain risk factors like cancercausing chemicals or radiation cause lung cells to become carcinomas, the usual type of lung cancer. Sometimes, tiny clusters of neuroendocrine cells that are similar to those seen in lung carcinoid tumors are seen under the microscope as an unexpected finding in lung biopsies done to treat or diagnose other conditions. Under the microscope, tumorlets have a striking resemblance to peripheral carcinoid tumors, except that they are usually much smaller (fi inch). Central carcinoid tumors are believed to develop from the glands under the surface of the large air passages. Researchers still do not understand how carcinoid tumorlets develop from lung neuroendocrine cells or why some tumorlets may eventually grow to become carcinoid tumors. Research has not found any avoidable risk factors yet, so there is no way to prevent carcinoid tumors. Because carcinoid tumors usually grow and spread slowly, most are found at an early or localized stage. Most patients with peripheral carcinoid tumors or with small central carcinoid tumors have no symptoms. Carcinoids that do not cause symptoms often are found when you have a chest xray during a routine examination or to look into unrelated medical problems, such as some heart diseases. Signs and Symptoms Some patients with central carcinoid tumors may have a cough, may cough up bloody sputum, or may have wheezing symptoms like asthma. When a large carcinoid causes partial or complete blockage of a large air passage, the patient may develop a lung infection called postobstructive pneumonia. Sometimes your doctor may suspect a tumor only after treatment with antibiotics fails to cure the pneumonia.
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Your censor can holler fiThat sounds dumbfi or fiThat‘s trashy writingfi but simply putting one word after another is the same as saying fiI‘m going to pulse pressure wave discount metoprolol 100 mg otc keep right on expressing myself whats prehypertension mean buy cheap metoprolol 50mg on line, so don‘t waste your time arterial purchase discount metoprolol on-line. All of us react and all of us create but our orientation or dominance is determined by where we spend most of our time. If your life is organized around reacting to the circumstances in your life that is a very different life than one where you go with the flow, following the river, writing it down. The great poet, Rilke, wrote this (and I still have it above my computer): fiBe attentive to what is arising within you, and place that above everything you perceive around you. What is happening in your innermost self is worthy of your entire love; somehow you must find a way to work at it and not lose too much time. These very days of your transition are perhaps the time when everything in you is working at Him, as you once worked at Him in your childhood, breathless ly. Be patient and without bitterness and realize that the least we can do is to make coming into existence no more difficult for Him than the earth does for spring when it wants to come. This seemed very important to me: if I am ignoring my own Voice, no growth is possible. By putting words on the page day after day, I saw a body of work pile up and this body of work were my words, my observations, my way of seeing the world. Writing shaped me, determined how I spent my time and gave me insight into what was going on with stuttering. When the flowing part of myself was running free, it was natural for me to pick up paper and pen and write. Every day at the end of a day of freewriting, I would know many things that evening that I hadn‘t known that morning. The words were from me and ended on the page because I allowed the river to flow and find expression. Einstein recalled his relief at ending his formal education: fiIt is nothing short of a mi racle that the modern methods of instruction have not yet entirely strangled the holy curiosity of inquiry, for this delicate little plant, aside from stimulation, stands most in need of freedom; without this it goes to wreck and ruin without fail. It is a grave mistake to think that the enjoy ment of seeing and searching can be promoted by means of coercion and a sense of duty. Lawrence believed there was nothing new under the sun until, at the age of 40, he began to paint. When I revealed my fideep selffi on paper, what I was doing was reveal ing myself to me. And to experience a release from stuttering was success enough, but to find a work meaningful enough to engage my brains and energy for a lifetime was pure gravy. When I feel there is no fight left in me, no energy, then I pick up my pen and flow begins again. Sark wrote: fiWhatever coaxes us out of hiding to notice, record and express is a revo lutionary act. This inner natural spontaneity located somewhere behind my face (as Bradbury described it) is the source of speech. So I splash words on the page in a hurry, before I have even a moment to think or censor or correct or fix. In delay comes the effort for a style, instead of leaping upon truth which is the only style worth dead falling or tigertrapping. When I freewrite without stopping to correct or edit or criticize what I write, my writing speeds up. The best antidote to a critical defensive conscious mind is simply to write so fast that a slow sluggish critical mind, as deliberate and methodical as it is, simply can‘t keep up. Remember that Little Me is your fiWriterfi and when you keep it busy, writing fast, it doesn‘t have time to judge and edit and criticize. All it has time to do is write as fast as it can in an ef fort to keep up with your natural flow. When you refuse to plan words, your words will then have to come from the freeflowing part of yourself rather than the effortful will ful fitryingfi part of your mind, which is the conscious mind powered by willpower. Flow can only be experienced through surrender to what is already going on inside of you, simply allowing flow to happen.
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In his first year in office blood pressure 9040 cheap metoprolol 50mg overnight delivery, the Governor spearheaded the effort to blood pressure medication and weight loss cheap 50mg metoprolol with visa authorize the use of the “designbuild” procurement method at five state 25 agencies arteria coronaria purchase 100mg metoprolol visa, which encourages innovation and creativity from the private sector in the engineering and construction of major infrastructure projects. This legislation, which was renewed in 2015, has been utilized by state agencies and authorities to accelerate the completion dates for dozens of stalled projects and has saved taxpayers billions of dollars. The twin spans of the bridge between Rockland and Westchester counties are already rising out of the Hudson River and are on time and on budget, with the first span scheduled to open next year. Since 2011, Governor Cuomo has awarded over $70 million for broadband projects across the state, reaching approximately 160, 000 households, 8, 000 businesses, and 400 anchor institutions across more than 6, 000 square miles of New York. The program launched in January 2016 and will achieve its goals through publicprivate 26 partnerships, which require a private sector co investment targeted to match the state’s commitment across the program. Taken together, these historic capital investments will create hundreds of thousands of new jobs and provide the framework to support New York’s growing and dynamic economy. The program supports the replacement of over 3, 100 buses and 1, 400 subway cars; invests $2. This historic spending program will also benefit New York transitrelated manufacturing firms that make rail cars, buses, and needed electronic components. A recent study found that this fullyfunded capital program will create more than 400, 000 jobs across the state and generate nearly $52 billion in economic activity. All new buses will be delivered with cameras preinstalled, and the use of surveillance cameras in subways cars will be tested for the first time later this year. The length of time to complete a station redevelopment will shrink from two to three years to six to twelve months. These two airports serve over 80 million passengers a year and support more than $50 billion in economic activity for the region15 but are outdated relics of a bygone era. The Governor has committed to demolishing LaGuardia and will replace it with a new, unified worldclass terminal, as well as building a new AirTrain that will increase access to the airport. Proposal: Build a New Empire Station Complex to Replace Penn Station Pennsylvania (Penn) Station is New York City’s transportation hub and America’s busiest passenger transportation facility. The station already operates well beyond capacity and will experience a growing passenger load in the coming years thanks to the growth of the Midtown Manhattan business district and new development on the West Side at Hudson Yards. Governor Cuomo proposes the construction of a new $3 billion Empire Station Complex that will expand and reimagine Penn Station and create a worldclass transportation hub befitting the Empire State. The project will widen existing corridors, reconfiguring ticketing and waiting 34 areas; improve connectivity between the lower levels and street level; bring natural light into the facility, improve signage; simplify navigation and reduce congestion; and expand and upgrade the retail offerings and passenger amenities on all levels of the station. The new station will include WiFi, modernized train information displays, and streamlined ticketing. Several design alternatives will be considered, including major exterior renovations involving 33rd Street, Seventh Avenue, Eighth Avenue, and potentially, the Madison Square Garden Theater. The simultaneous redevelopments will be advanced by a publicprivate partnership that will operate on an unprecedented scale. The state will issue solicitations to developers in January and will request responses back in 90 days, with groundbreaking targeted for late 2016. The construction cost is expected to be in excess of $3 billion, including $2 billion to redevelop Farley and Penn and at least $1 billion for ancillary retail and commercial developments between Seventh and Ninth avenues. Department of Transportation, Port Authority, and Amtrak will contribute $325 million in investment and the remaining cost will be funded by 35 private investment, in exchange for an interest in the longterm revenue stream generated by the retail and commercial rents. Proposal: Expand and Enhance the Javits Center Since its opening in 1986, the Jacob K. The $1 billion redevelopment project will increase the size of the Javits Center by 62 percent, from 2. The proposal includes the installation of a 34, 000 squarefoot solar energy array, the largest of its kind on a public building in New York. The expansion will generate $393 million annually in new economic activity and create 4, 000 full time jobs, 2, 000 parttime jobs, and 3, 100 construction jobs. Over the decades, these tunnels have served as the lynchpin of Amtrak’s heavily traveled Northeast Corridor and a vital link for daily commuters between New York and New Jersey. These essential pieces of infrastructure, however, have been deteriorating for years and were inundated with corrosive saltwater during Superstorm Sandy. Governor Cuomo recognizes that these tunnels are critical to the future of New York and the regional economy. This year, at the direction of the two governors, the Port Authority of New York and New Jersey will create the Gateway Development Corporation to oversee the financing and jumpstart the construction of this massive passenger rail project.
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