Know it’s cold .2
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The document discusses the risks of cold water immersion on the Columbia and Willamette Rivers. It notes that the water temperatures are usually less than 60°F and can drop below 50°F for 4-6 months each year. Cold water can cause gasp reflex, cold shock, hypothermia and loss of swimming ability within minutes of entering the water. It emphasizes the importance of understanding the risks, wearing a life jacket, having proper safety equipment on boats, and using protective gear like dry suits in cold water conditions to help prevent hypothermia and increase chances of survival if entering the water.
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Here are the key points to remember when using a lifejacket:
- Practice putting it on and adjusting it properly so you know how to do it quickly in an emergency.
- Children should learn to put on their own lifejackets.
- Practice wearing it in the water so you understand how it functions and positions your body for flotation.
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Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Pharmacology of 5-hydroxytryptamine and Antagonist
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Skin Diseases That Happen During Summer.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
SENSORY NEEDS B.SC. NURSING SEMESTER II.
Sensation is the neurological process by which we become aware of surrounding environment.
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdfChulalongkorn Allergy and Clinical Immunology Research Group
Pollen and Fungal allergy
Presented by Chaloemchai Chumsaengchotsakul, MD.
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Know it’s cold .2
- 1. Know it’s cold Preparing for the risks of cold water on the Columbia and Willamette Rivers
- 2. Our water is cold Brrrrrr….. It’s cold in there
- 3. Snow fed rivers Creative Commons by Flickr user uyen.tran http://flickr.com/photos/dopeshit/339228636/sizes/l/
- 5. Our water is cold Whoops … and there are so many ways to go in
- 6. Our water is cold Your vessel can sink
- 7. Our water is cold Your vessel can capsize
- 8. Our water is cold Your can fall overboard
- 9. Our water is cold Your can be ejected at speed
- 10. Our water is cold Or you can simply misstep
- 11. Our water is cold Once you are in … things can go downhill very quickly
- 12. Gasp reflex Cold water causes a gasp on contact which often results in inhalation of water
- 13. A little bit of inhaled water will set you to coughing which usually leads to more inhaled water…
- 14. … and you can drown with only 5 ounces of water in your lungs
- 15. Cold shock In seconds to minutes you will begin to experience shock with very rapid breathing while your heart rate and blood pressure will increase.
- 16. Cold shock These factors reduce your physical and mental abilities making it very difficult to rescue yourself
- 17. Swim failure After as little as 3 minutes there is a loss of coordination in your limbs and you loose the ability to hold your breath
- 18. Swim failure You will be unable to maintain a body position that allows swimming
- 19. Hypothermia
- 20. 25X 1X Water is 25 times more effective than air at thermal transfer so your body cools very rapidly
- 21. Hypothermia At some point your body is no longer able to regulate your core temperature which, untreated will result in death
- 22. Post rescue collapse Even after rescue the effects of hypothermia can cause death, seek medical attention after any prolonged cold water exposure
- 23. Our water is cold Prevention What to do to protect yourself
- 24. Know the risks Understand the effects of cold water and how you may end up in it
- 26. Life Jacket ALWAYS wear your
- 27. Prepare for the cold
- 28. Our water is cold Dry suit What is he wearing?
- 29. Our water is cold Because we have learned the hard way that hypothermia protection save lives Why?
- 30. Our water is cold When: Coast Guard requirements for USCG boat operations Rescue and Survival Systems Manual COMDTINST M10470.10E
- 31. Our water is cold Water temperature under 60 °F Water & air temperature under 50 °F Anti-exposure coverall Dry suit
- 33. Be prepared