Riobard

Well interestingly one critique made regarding the Canadian guidelines, in fact by clinicians that opine that the age-based recommendations should be more flexible, is that they are too narrowly constructed, overly weighted by clinical evidence review, and in fact miss the boat on person-specific variables that should temper the assertion of screening non-value as well as overlook financial cost considerations that should constrain flexibility in guidance due to burden on resources. While deficiencies in approach to recommendations exist, I don’t think that one can satisfactorily argue that bureaucratic influence is a major determinant of the health protection guidance for PSA screening.

For Kryst sake, man, do you need to be so selectively contrarian and pompously oriented to shaming attempts when you add potentially interesting and illuminating content that would go down better with a spoonful of sugar? Why would a truly bright and informed person almost consistently require a salvo accompanying their input? Surely the average reader could pick up that I haven’t objected to the age 70 cutoff and that what I mean by arbitrary is not the randomly whimsical connotation but rather the meaning that is based on choice and discretion, as patient self-determination in shared decision-making is a constant running theme through the related literature and 70 could be considered more an inappropriately rigidly delineated threshold at which screening is not recommended if general life and health preservation benefit were to be established as, say, 15 years as opposed to 10 years past the cutoff, given that even 2nd standard deviation bounds around the average age of male mortality nevertheless bins millions of men whose ancient life status nevertheless has objective value? Who is to say that zero sum is exactly one decade? A person being arbitrary.

Our situations are similar in terms of bundled sequential testing but actually don’t support the value of screening past age 70. Other posters are suggesting the value of screening is that prostate cancer is ubiquitous; the rates are high and only ambiguous in terms of the grade of risk they pose. A clean bill of prostate health is nevertheless tempered by the increasing probability of prostate cancer with age, notwithstanding that the older one’s age at diagnosis the less likely prostate cancer as future cause of death. What perhaps changes the picture is the advantage of early detection in the context of prostate-sparing and pelvic nerve complex protection intervention developments that I think have not yet been adequately integrated into surveillance guidance. The simple binary of mortality or increased longevity seems to me to be a perspective that lacks attention to progressively emerging early intervention possibilities that preserve life quality and function. At this point, follow up of PSA and MRI in one’s 70s … and I’m in that parade … is often pursued as if diagnosis is an inevitable eventuality in spite of no evidence of risk higher than the next guy without having had any screening or disease. The negative result prompts follow up surveillance but we’d likely never have had an MRI but for the combination of PSA above normal range and BPH, both inadequate prognosticators at which juncture MRI is the next step. Essentially, a negative MRI has triggered the next scan, ie, 2 years on. Blood draws and MRI with/out gadolinium contrast are tolerable, but in the same way a PSA value prompts MR imaging, the latter often prompts the far more invasive procedure of needle core biopsy. Perhaps the relief and gratitude of a clear MRI PI-RADS score promotes willingness to undertake more MRI regularly. But an equivocal score then graduates you to the prospect of a negative initial biopsy result as determinant of repeat routine biopsy procedures because they are also equivocal in accuracy. There has be a point at which further surveillance breaks the imperative of harm avoidance. So much invasiveness to just get to the step of sufficiently differential diagnosis to explore novel intervention such as brachytherapy radiotherapy seeds gland insertion, focused laser ablation, etc. This insidious cascade effect that begins with the no biggie PSA test surely influences guidance according to progressive age category. We are in the same state of health as would occur without screening ever having entered our thoughts. Only a reasonably accurate diagnosis of prostate cancer would have augmented the point of view that screening is salutary. In contrast, repeat and routine STI retesting is not so much a hamster wheel scenario; it’s done based on true behavioural risk accompanying the notion of community prevalence, not merely because the last one was clear.

Well perhaps I can assist in damping down the hyperventilating. @unicornwas making the distinction between all cause mortality (any cause of death) that is not robustly affected by PSA surveillance versus prostate cancer mortality (death attributed to prostate cancer and associated metastasis) that may be more subject to attenuation by screening because some cases present early and are caught by PSA testing that may spur further investigation. That said, it is not definitive that your PSA values age 40-50 were causally predictive of the unfortunate cancer diagnosis that was eventually made by the more reliable diagnostic procedures of MRI and biopsy that (I presume) were instigated by PSA values, perhaps a dual blood draw spread apart by standard time lapse for confirming legitimacy of next level assessment, some years following the age 50 guidance threshold in which PSA screening is considered prognostically superior, more accurately in semantic terms less prognostically inferior. Your specific category and presentation of prostate disease has not been dismissed by academic and clinical bodies that nevertheless do not generally support routine PSA screening below age 50. Your argument related to the liabilities of non-testing before age 50 was not supported by the timelines you provided. Perhaps you weren’t deliberately cherry-picking given that our personal experience naturally lends itself to confirmation bias in opinion.

Right, the arbitrary recommended age cut-off for discretionary PSA screening is 70 (+ / - the relatively small differences of opinion), notwithstanding the parallel guidance for younger age and the less robust evidence for non-screening in the age category leading up to 70. For example, I think Amer Urology Assoc stretches it to 75. This is largely governed in Canada by the average male life expectancy of 79 years. Diagnosis of prostate cancer at age 75 combined with expected post-diagnosis survival of minimally 10 years approaches age 85 or greater, and collective life expectancy currently for age 75 is about 10 years (95% confidence interval bounds round to 10), as standard deviation around the mean of age 79 upticks the likelihood of death delayed to about age 85. This doesn’t mean that absolutely zero PCa cases could be caught upon triggering by PSA values alone at old age with some possibility of mitigating associated disease and extending life that otherwise would have been truncated by PCa prior to when other cause mortality would otherwise kick in, but diminishing returns for widespread screening obviously dictate surveillance legitimacy in spite of outliers essentially not served well by the arbitrary screening guidance cut-off.

I think that some of the confusion and lack of consensus regarding screening benefit is related to the inappropriate interchangeability of the terms ‘harmful’, on the one hand, and on the other hand ‘superfluous’. Harmful seems to relate to more invasive physical diagnostic procedures (I am deliberating omitting considerations of associated psychological stress of diagnostic procedures at this point), the threshold that strikes me as invasive being needle biopsy, as well as diagnostic financial cost burden to public funds particularly where depletion is in public income taxes paid to support health infrastructure. The latter considers the number of men needed to assess at a cumulative financial cost that is justifiable (yes, subjectively of course) in terms of the predicted offset of morbidity and mortality rate. I submitted to PSA screening beginning at age early 60’s based on lab costs covered by social medicine insurance based on primary care recommendations and family history of metastasized prostate cancer that at that time and remains a risk marker. It’s just venipuncture in the context of other routine blood draws. Along with consistent PSA elevation and eventual manageable (no intervention) BPH I began prostate/bladder MRI screening every few years commencing mid-60’s. However, I chose to pay out of pocket for private clinic imaging and at that time consistently paid out of pocket for PSA, GP check-up in general, Urologist consultation, and once only biomarker 4K. Almost 10 years on I am not among the proportionally high number of men at my age with prostate cancer. However, I personally undertook the financial cost and responsibility of testing, essentially capitulating to practitioners’ urging from the point of view of “being on the safe side”. My MRI PI-RADS score consistently at level 2 or lower, where level 3 is equivocal in terms of the possible next step of biopsy, has spared me the conundrum and complications as well as diagnostic limits of invasive needle biopsy. So, on balance no regrets, I didn’t burden public coffers, and I spent money I won’t miss for some degree of peace of mind. I haven’t been unnecessarily treated or had my prostate prematurely yanked out when in fact it will not have been implicated in my eventual demise. One size does not fit all. I paid and stayed within the bounds of the “uselessness” aspect of screening that itself should not be conflated with the level of true harm implicit as foundational for those guidelines that lean towards non-screening. If the appended article content had been accessible a dozen years ago I doubt my trajectory of testing would have been different. The key is shared decision-making. I have no idea what Biden’s check-up history is but I don’t think being in high office necessarily influences the breadth of medical check-up routine that does or should occur. That said, I would personally certainly drill down deeply into the literature if faced with the prospect of ground zero surveillance commencing today. I have likely turned the corner on the necessity and soft value of routine MRI procedures as nearing age 75, based on the life expectancy aspect. One fly in the ointment is that age longevity way way beyond 77 runs in the family even where the grim reaper’s scroll had prostate cancer listed. Decisions decisions. I think there may be at least one typo in the article but if you notice it simply apply logic by looking at theme and sentence structure to determine author intent. https://www.ncbi.nlm.nih.gov/sites/books/NBK556081/

Yes, the west side as depicted several times in this forum. That shot was not my search. It was how the club pinned it within its social media, illustrating how helpful they are when the location is ambiguous in the first place.

Typo surpassing edit window: should be Av Vergueiro.

I’ve done it in but there have been wooden board barriers extending quite a hike around street repair, obscuring visibility upon exiting São Joaquim station. They may have since cleared. If you leave the station using exit A that emerges directly to the busy intersection where Liberdade northerly becomes Vegueiro southerly, cross westerly to the notably red building Habib’s Restaurant, immediately bear left/south to Pedroso, then right/west on Pedroso that bridges over the tangle of thoroughfares below. If you exit the station by the secondary exit B you will be directly on the west side and of course Habib’s will be to your right, then proceed to Pedroso, etc. Alternatively, Uber one way was trending at 25-30 reais before tip from Hotel Renaissance near Paulista/Augusta, not much distance difference from 555 via vehicle. The latter operates Fri, Sat, Sun.

No. This has been discussed a few times. What came up for you is a different venue not that far away, as Google Maps is likely confounded by the fact that the street numbers where Clube 11 is located defy logic. Some lower number street addresses occur interspersed among higher numbers. Clube 11 is given the address #11 that should be near the Joana Angelica intersection but is actually situated further south around where #110 would logically be expected. That said, it’s less than 10 buildings south of Joana Angelica, as well as on the even number side, not the approximately 50 structures you’d expect based on a conventional staggered even number basis. To map search it you must enter its formal but logically incorrect address: Rua José Duarte, 11. Even then the venue name won’t come up in the same way some other establishments on that street are depicted. The address may have been assigned on a bingo night when the venue had a different name within a series of name changes and incorrect pins according to side of street. Let the countdown begin to the next eventual post querying location.

Erm, no. And no proof of financial means for travel. Also, there are legislative developments in play that may culminate in a reinstatement of visa exemption that had been in place during the previous 6 years, possibly as soon as this coming Wednesday, though perhaps involving some lag time to formalization.

At least 5 seconds to creat a diversion with respect to the off duty mamasan tracking your every move for rolling it into the subsequent night’s negotiations.

The New York Post article is one of the most manipulative and distorted media articles I’ve read this year. All it suggests is the degree to which indignation shapes perspective and undermines objectivity. There is no a priori loophole that underpins the automatic allocation of 45 days of paid medical leave for the events that transpired and for this particular job class. The article is intended to undermine the current or recent FAA administration, exaggerating the labour-wide federal policy of any prerogative for stress leave as misguided “woke-ism”. The employees involved have no choice but to apply officially for trauma leave because the policy language is such that any medical leave is subsumed under the nomenclature heading trauma. This is an artefact of the language that was chosen to categorize being off due to illness or physical injury of any federal employee, not a misappropriation of therapy culture. Breaking a limb due to accidentally tripping at work will generate trauma leave if job capacity or light duties are rendered impossible. The associated misnomer of trauma in the case under discussion easily gets conflated with staking claims to such terms as PTSD. The article conveys a hair-trigger tendency to rage and create divisiveness, compared to which any indignation arising from poor infrastructure management that may be attributed to the employees’ pursuit of some amount of paid stress leave pales. That said, a rigorous application of stress assessment is appropriate in these cases; the duration beyond which a reasonable limited period of recovery extends is subject to clinical manpower limitations that parallel that of the traffic controller Human Resources problem itself. If one day will suffice, it may ridiculously take much longer to access the formal adjudication that will have legitimized one day’s absentee pay. This is not to say that individualistic work ethics and other attitudinal factors do not influence response to stressful events and views regarding tapping, even opportunistically, into accessible benefits. I expect that many of us have seen people carry their occupational weight unequally. However, the media article supports the prevailing ‘victim culture’ by spurring argumentativeness about who is victimized and who is blameworthy.

If it’s in some way integratively multi-axial, one’s perspective transcends the notion of honesty. The reason this discussion even exists is that workplace stress in general is incontrovertible but in this case exacerbated by unresolved systemic problems within this domain of safety / security. Surely the phenomenon of inertia with respect to identified and uniformly agreed upon infrastructure failings will elevate workplace stress and its expression. That said, the word “trauma” has no place in the discussion but is unfortunately the overarching term for workplace injury. A disaster would legitimately be deemed to produce trauma. Otherwise, what is traumatogenic sits on a continuum and the possibility of disaster based on systemic neglect has made its way on to the continuum. Such conceptualization muddies true clinical trauma because anticipatory disaster is stressful yet gets folded into definitional criteria for trauma, criteria for one word that by the way happen to be arbitrary. If an employee is sexually harassed it would be deemed stressful at minimum. A clinically supported leave would acknowledge both psychological impact and workplace dynamics. The systemic inadequacies combined with individual discomfort get labelled as traumatogenic. The language that conveys that air traffic control requires a huge and expensive overhaul is understandably going to put a particular spin on stressful events that exemplify the need for same. The workers in question are receiving the meta message that the triggering events are stressful and that associated leave aimed at rebalancing falls under the jurisdiction of trauma because even a single day of stress leave hinges on fitting into the trauma leave mold in order to receive pay; in fact, failing to acknowledge and live up to the associated symptoms may be labelled as a type of denialism that itself represents psychological disturbance. Be entitled or be a pushover. So, yes, true stress say hello to indignation. How very dare you apparently wilfully sustain the conditions that generate my authentic stress? At this point there is lacking an identifiable threshold at which solutions to systemic problems will alleviate trauma leave patterns to a degree in which consensus may manifest in terms of compensation contingencies perfectly commensurate with stress. It doesn’t help matters when a reductionist claim is made that exactly 45 days paid leave is demanded as a penalty for transient radar blackout.

I don’t think it’s employee union specific for that job class, and may apply to non-unionized management as well, assuming everybody has a superior within hierarchical structure, but attempts to investigate patterns go back decades. I just skimmed the appended document but it appears there is a range of leave in which the mean or median is under 45 days at the time of this dated analysis. Hence, 45 days is apparently both discretionary and arbitrary for the sake of delimiting within stages of occupational leave compensation. Air traffic control personnel may be backed into a corner if longstanding expressed infrastructure concerns go unheeded, in contrast to firefighters that may face drought as a natural disaster more than the inadequacies of water supply leadership where scarcity could possibly be mitigated. https://www.oig.dot.gov/sites/default/files/av2003011.pdf

I don’t disagree that judicious stoicism and collegial commonality / support may be an effective means of occupational stress endurance and recovery for many. Health care, first response, armed forces, etc etc. BUT the policy looks very complicated and it’s easy to get into the weeds trying to interpret it. However, as I understand it, the only way to not lose pay for absence due specifically to a stressful workplace event (ie, “trauma”, however broad the definition) whether explicitly including bodily injury / illness or not is to trigger the 45-day max absence pay via standard application. Having a high fever or slipping and falling hard would trigger legitimacy for sick leave without question; it might be a few days of medical leave but could be up to 45 days of temp leave and bridging pay. If shaken up by failed radar infrastructure, in contrast, not staying at post or failing to coming in for next scheduled shift seems to be considered AWOL if not initiating the trauma leave adjudication formally. It would not necessarily be arbitrarily 45 days and would be subject to approval but the adjudication takes time and guarantees not being docked pay up to the point of disposition if rejected or truncated prior to the 45 calendar days. I don’t think any of the applicants asserted the entitlement of the full discretionary period, upon eventual formal adjudication, of 45 calendar days. Media hyperbole, generating uproar, is the prevailing trend. In addition, paradoxically, the only way for them to extricate self from being castigated for apparently exacerbating faulty infrastructure by amplifying personnel shortages would be to uptick expressed trauma symptomatology since such is largely based on self-report. I’m certain there is no lack of YouTube vids demonstrating how to come off as dissociating. https://www.dol.gov/sites/dolgov/files/OWCP/dfec/icstraining/cop/cop.pdf

The pontifical name shortlist based on historical antecedents, should the smoke emerge orange, consists of Hilarius II, Simplicius II, and Conon II.

The pronouncement now should optionally be hubbie and wife or hubbie and hubbie.

Because you can combine retail therapy and hormone therapy.

Your “l” on your keyboard may be sticky. I believe that’s it’s possible to acquire a free 30-day premium membership to Fatalmodel without needing to engage with their payment platform that I think is Pix+CPF or card+CPF. That trial option popped up randomly today but now I cannot find it so you may have to email the management for instructions. That may be a way to temporarily gather the data you seek. I haven’t tried so I don’t know if the first step will then bring you to the necessity of registering with a payment hold that kicks in if not cancelled prior to the one-month expiry. Otherwise, their expansion to Europe will surely require a non-CPF option if they wish to increase profit margins with a paid tier. Incidentally, in a preliminary search I’m not coming across profiles whose phone contact is blocked by a paywall.

What moe could be said.

I read the article in its entirety. In my mostly honest opinion I think the verification will only work for animated film categories.

[Deleted]

Interestingly, the Uber platform seems to have figured out the ambiguity.