12 Weeks is a Long Time to Wait for Breast Cancer Chemotherapy

FIRST PERSON | How long a wait is too long when it comes to treatment of breast cancer? A report published in the Dec. 19 issue of JNCI, Journal of the National Cancer Institute, states that after examining records from 6,622 women, the average time for a woman to wait for adjuvant chemotherapy (chemo given after surgery) for breast cancer is 12 weeks. After my surgery, I waited four weeks before chemotherapy began.

Reconstruction delays

A main cause for delays in starting chemotherapy after surgery was immediate reconstruction. Flap surgeries allow for immediate breast reconstruction. This type of surgery requires a long recuperation period. Chemotherapy impedes healing. All incisions must be healed and all drains removed before chemotherapy can start.

I chose breast implants for reconstruction. This process was partially started during my mastectomy -- consider it partially immediate reconstruction. A tissue expander was put in after they removed my breast. Recovery time is significantly less than with flap surgery. I still had some stitches in when chemo started.

Testing and imaging delays

Testing such as 21-gene reverse-transcription polymerase chain reaction assay testing and MRIs increased the time frame from lumpectomy or mastectomy to the start of chemotherapy. Some doctors use post-surgical MRIs to determine if clear margins were reached. If they are unhappy with the results of the MRI, a second surgery may be required, thus increasing the time before chemo can start.

My oncologist did not feel that any further testing other than a MUGA scan was necessary following my mastectomy. The MUGA scan was performed in order to check heart function before starting on treatment with a monoclonal antibody. Even though I had to go through this imaging, it did not delay the start of chemotherapy.

Other delays

One of the biggest causes of delays in starting chemotherapy treatment in minority women was access to health insurance. Black women who received Medicaid had the longest wait between surgery and the start of chemotherapy when compared to white women with private insurance. This is something that needs to change. When dealing with breast cancer, the faster and more aggressively it is treated, the better the prognosis for survival. There is no reason a woman should have to wait for treatment just because the government is paying for the chemotherapy.

Twelve weeks is too long to wait to start chemotherapy after surgery. Imaging should not have an impact on how long a person waits for chemo. Waiting too long, especially with aggressive forms of breast cancer could be the difference between life and death. I had imaging and started chemo just four weeks after my mastectomy. My outcome might have been very different had I been forced to wait an additional eight weeks before I started chemotherapy.

Lynda Altman was diagnosed with breast cancer in November 2011. She writes a series for Yahoo! Shine called "My battle with breast cancer."

Source: http://news.yahoo.com/12-weeks-long-time-wait-breast-cancer-chemotherapy-173000162.html

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Police: 1 blackjack dealer stabs another in Vegas (Providence Journal)

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Sunday weather forecast: Overcast, chance of rain | NOLA.com

Today: Overcast with a chance of rain in the afternoon. Fog early. High of 66. Winds from the south at 5 to 15 mph. Chance of rain 20%.

Tonight: Overcast. Fog overnight. Low of 59. Winds from the south-southwest at 5 to 10 mph.

REMINDER ... Only two more shopping days left before Christmas!

Source: http://www.nola.com/weather/index.ssf/2012/12/sunday_weather_forecast_overca_2.html

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LG's 2013 Google TVs can be controlled like Siri and?Wii

3 hrs.

Gary Merson , HD Guru

In 2012 LG began selling Google HDTV with just two models. For 2013 LG?s Google TV lineup updates and expands with two series (GA 7900 and GA 6400) consisting of seven models in five screen sizes.? Major new features include a second generation Magic Qwerty remote, the ability to voice search programs and a near borderless screen.

The GA 7900 series (pictured) includes 47 and 55-inch?edge lit LED LCD screen sizes. The Google graphic user interface?permits Internet browsing as well as access to movie services from Netflix and Amazon Instant, apps and premium TV video-on-demand such as HBO GO (provided you have the corresponding subscriptions).

The GUI can be navigated by voice, or tilting the LG Magic Remote control (like a Wii controller). The remote?s built-in microphone allows you?Siri-like control. Say ?go to ABC? and the LG Google TV will change channels. Or speak a search term like ?romantic comedy? and the LG Google TV will provide an on-screen list of programs available in that genre. In addition, LG?s PrimeTime Quick Guide permits browsing of more than 100,000 movies and Tv programs.

Other features in the include the ?Home Dashboard? which offers folders LG calls ?cards? to display apps and other content. For example, the ?My Interest? card can display customized weather and news information.

LG also includes the OnLive app preinstalled which turns the TV into a gaming platform without a separate console. This app offers hundreds of video games available instantly from the Internet cloud.

Have a question for the HD Guru? Send an?email.

More?from HD Guru:

Source: http://www.nbcnews.com/technology/gadgetbox/lg-2013-google-tv-line-can-be-controlled-siri-wii-1C7657752

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The Most Comprehensive Account Of How Fiscal ... - Business Insider

The Wall Street Journal's Patrick O'Connor and Peter Nicholas?are out today with?a detailed breakdown of how negotiations to avert the year-end fiscal cliff broke down this week.

AP

The Journal's account paints a picture of President Barack Obama and House Speaker John Boehner being fairly close to a comprehensive deal last weekend. That's when Boehner conceded for the first time on income tax rate increases and a lift on the debt ceiling, and Obama blinked on entitlements by being open to a tweak in Social Security CPI.

But neither side was willing to blink further. The WSJ details one meeting early in the week:

Mr. Obama repeatedly lost patience with the speaker as negotiations faltered. In an Oval Office meeting last week, he told Mr. Boehner that if the sides didn't reach agreement, he would use his inaugural address and his State of the Union speech to tell the country the Republicans were at fault.

At one point, according to notes taken by a participant, Mr. Boehner told the president, "I put $800 billion [in tax revenue] on the table. What do I get for that?"

"You get nothing," the president said. "I get that for free."

Politico's Mike Allen provided more context to Obama's quote ? since Rep. Tom Cole and other Republicans had been open to rate increases, so Obama didn't feel like he had to give up anything in return.

Boehner also became frustrated earlier in negotiations at the White House's request to permanently lift the debt ceiling and demanded reform to Medicare and other programs.

"You're asking me to accept Mitt Romney's tax plan. Why would I do that?" Obama said.

But a comprehensive deal finally fell apart in a meeting Monday, spurring Boehner to move to "Plan B," which he ultimately failed to bring to a vote. Obama insisted on $1.2 trillion in new tax revenue and would not commit to an additional $100 billion in spending cuts. Boehner held a meeting with other Republican leaders.

His lieutenants made clear they preferred Plan B to the one Mr. Boehner was trying to broker.

The speaker called the president with news the House would move ahead with the backup bill, which would preserve Bush-era rates for all income below $1 million. The president was incensed.

On Thursday, Boehner failed to earn enough broad Republican support to bring the bill for a vote. On Friday evening before flying to Hawaii,?Obama said he was still optimistic about a comprehensive deal, but he urged Congress to pass at least a scaled-back deal that held off planned tax increases and some spending cuts while extending unemployment benefits.

Read the full WSJ story here >

Source: http://www.businessinsider.com/fiscal-cliff-deal-talks-negotiations-obama-boehner-taxes-cuts-2012-12

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Obama starts Hawaiian vacation, leaving Washington on ice

KAILUA, Hawaii (Reuters) - Taking what promised to be a very brief Christmas break from the ongoing struggle to avoid the "fiscal cliff" of tax hikes and spending cuts, President Barack Obama relaxed with his family on Saturday at a beach retreat in Hawaii.

Congress was to return to Washington next Thursday and Obama has pledged to work with lawmakers to strike a deal to avoid the economic shock from tax and spending measures set to take effect on January 1 if a deal can't be reached, which many economists say could push the U.S. economy back into recession.

The president is expected to indulge in some of his favorite pastimes on the island where he was born and raised: golf, an expedition for the local treat "shave ice," and an evening out with family and friends. He hit the links at the nearby Marine Corps base under sunny skies on Saturday afternoon.

On Sunday, he is expected to attend funeral services for Senator Daniel Inouye, the long-serving Democrat from Hawaii who died on Monday, but the president has no other public events on his schedule.

On Saturday, Democratic Senate Majority Leader Harry Reid said he had urged Hawaii Governor Neil Abercrombie, a Democrat, to name Inouye's successor "with due haste."

"It is critically important to ensure that the people of Hawaii are fully represented in the pivotal decisions the Senate will be making before the end of the year," Reid, of Nevada, said in a statement.

Obama's idyll was not expected to last more than four days, and he will likely retrace the more than 4,800-mile trip from the Aloha State to Washington after Christmas in a bid to cut a deal with Republicans, who failed on Thursday to agree on competing tax and spending bills of their own.

Before leaving Washington on Friday evening, Obama urged Congress to come up with a stopgap measure to spare the U.S. economy the jolt of $600 billion in tax increases and spending cuts economists say would likely derail the economy.

The president asked lawmakers for a stripped-down deal to continue lower tax rates on middle income earners and extend unemployment insurance benefits to avoid some of the worst effects of the "fiscal cliff" in the new year.

Obama's family holiday, in a quiet beach front community on the other side of the island from bustling Honolulu, should also provide some respite from the somber focus on the Newtown, Connecticut, school massacre and the consequent bitter debate over measures to change America's gun culture and prevent violence.

The president's weekly radio and Internet addresses, which in recent weeks have centered on his argument for extending tax cuts for all but the wealthiest Americans, on Saturday offered holiday greetings to U.S. military forces.

(Reporting By Mark Felsenthal and Richard Cowan; Editing by Vicki Allen, Todd Eastham and Paul Simao)

Source: http://news.yahoo.com/obama-starts-hawaii-vacation-expected-brief-212902160--business.html

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EU tackles smart grid security for next-gen energy

The EU?s 27 member states have pledged to collectively get to the point of using 20% renewable energy, reduce CO_? emissions by 20% and increase energy efficiency by 20% by, you guessed it, 2020. However, to get there requires the migration of the aging legacy utility grid to an IP-based, connected ?smart grid? system that can optimize energy production and distribution according to actual consumption requirements. The problem, of course, is the potential for opening the doors to critical infrastructure systems to hackers.

The European Network and Information Security Agency (ENISA) is rushing to be proactive with an exhaustive study entitled, ?Appropriate security measures for smart grids: Guidelines to assess the sophistication of security measures implementation.?

?The development of an efficient, reliable and sustainable environment for the production and distribution of energy in the future is linked to the use of smart grids,? ENISA noted in the report. ?Various market drivers, regulatory or standardization initiatives have appeared or gained importance as tools to help involved stakeholders to be prepared against smart grids security vulnerabilities and attacks.?

The perception and the approach taken on this topic differ among stakeholders, ENISA noted, which is prompting it to tackle the creation of a common approach to addressing smart grid cybersecurity measures.

The ENISA propositions fall into 10 research areas: Security governance and risk management, management of third parties, secure lifecycle process for smart grid components/systems and operating procedures, personnel security, awareness and training, incident response and information knowledge sharing, audit and accountability, continuity of operations, physical security, information systems security and network security.

ENISA also noted that advanced ICT systems are at the core of an effective smart grid implementation. Also industrial control systems (ICS) and related operational technology (OT) need to be taken into account, and all processes across the whole value chain are heavily based on these infrastructures and technologies.

?Smart grids give clear advantages and benefits to the whole society, but the dependency on ICT components (e.g. computer networks, intelligent devices, etc.), ICS (e.g. supervisory control and data acquisition systems, distributed control system, etc.), OT (e.g. firmware, operating systems, etc.) and the internet makes our society more vulnerable to malicious attacks with potentially devastating results on smart grids,? said ENISA. ?This can happen in particular because vulnerabilities in smart grid related communication networks and information systems may be exploited for financial or political motivation to shut off power to large areas or directing cyber-attacks against power generation plants.?
Some say that the US could take a page from the EU?s approach, particularly in the wake of the discovered SCADA vulnerabilities that make industrial info-infrastructure a startlingly vulnerable area.

?It?s a pretty much common knowledge among IT professionals that the state of security within US critical infrastructure systems is laughable,? noted Threatpost blogger Brian Donahue. ?So the EU?s intention to implement security into its smart grid as it is expands is praiseworthy. For our part though, the Federal Energy Regulatory Commission (FERC), America?s energy watchdog, announced the creation of a new office in September, the Office of Energy Infrastructure Security (OEIS), tasked with identifying, communicating and advising on risks to FERC facilities stemming from cyber attacks and physical attacks.?

Source: http://www.thecre.com/fnews/?p=3981

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