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This talk focuses on the health care services allocated to the Bedouin during military rule. I draw on archival material from Israel Defense Forces, the Ministry of Health, and the Tuviyahu Archive of the Negev to examine how discourses of rights and obligations, citizen and enemy come to be negotiated during this period and how these conflicting relationships translated into what and how medical care was allocated. Tensions during this period set the stage for the current tenuous relationship between Bedouin citizens and the Israeli state. Examining the dynamics of the tensions, provide a lens to understand the contemporary landscape of healthcare in southern Israel. Understand the distribution and impact of the southern Military Rule on Bedouin community between 1948-1966 2. Gain insight into the challenge government officials faced in allocating medical care to Bedouin citizens within the Military Rule 3. Understand the long term links between medicine and military established during this time period 37 Old Wisdom is New Wisdom: What Kind of Ethics Would Osler Teach in 21st Century Medical Training Roberto is a young and active member of this society, having spent over 140 hours researching and writing about Osler last year during his fourth year of medical school. Prior to entering medical school, he studied Philosophy and Humanities abroad at the prestigious Oxford University in Oxford, England. He is currently a resident in Internal Medicine at Wright State University in Dayton, Ohio, and, inspired greatly by our dear friend Osler, he is earnestly pursuing a life in academic medicine. Despite advances in medical education, over sixty percent of medical students continue to report a degree of erosion in their ethical principles and ideals by the end of medical school. To date, medical ethics education has focused disproportionately on outward behavior as the basis of professionalism. There is concern by medical faculty whether or not students are learning to fake outwardly ethical behaviors, while missing the core of professional conduct. Medical professionalism education continues to be an important cornerstone of training. Spoken or unspoken, ethics both reflect and inform our professional direction as physicians. In facing the challenging educational landscape, we will do well to look for wisdom from one of the greatest forerunners of modern medicine. Osler educated students towards a compassionate, wise, and patient-centered practice of medicine. Virtue ethics is self-symmetrically balanced, emphasizing the behavioral outworking of inner virtues while simultaneously prioritizing inner moral development. Yet despite this knowledge, few medical schools have a structured, integrated medical ethics component integrated into the clerkship years. The culture of medicine will shift as the language, didactics, and training of its practitioners change. Recognize the current situation of professionalism and ethics in medical training 2. Outline methods of application to medical education of professionalism today 38 Medical Self-Regulation, the Joint Commission, and the Vanishing Hospital Autopsy Harold Sanchez Harry Sanchez is Associate Chief of Pathology at the Hospital of Central Connecticut, Assistant Clinical Professor of Laboratory Medicine at the Yale School of Medicine, and Associate Clinical Professor of Pathology at the Frank Netter School of Medicine. This historical vignette is offered as an illustration of the potential shortcomings of self-regulation without outside oversight, no matter how well intentioned. Gain an enhanced appreciation for the power of a historical perspective of medicine in explaining current medical practice and shaping future medical policy 2. Become familiar with the data that demonstrates the untapped potential of the autopsy as a quality control measure and with the non-data driven factors that limit its use 3. Professor Jean-Martin Charcot is considered by many historians to be the father of modern neurology, not unlike that of Sir William Osler who is considered the father of internal medicine. Yet many are unaware that Charcot was also a pioneer in arthritis/rheumatology and its overlap with neurology as supported in the following quotation by Charcot: "We should think of arthritis as a tree whose main branches are gout, rheumatism, certain migraines, skin rashes, etc. On the other hand, the neurological tree has for its branches neurasthenia, hysteria, epilepsy, all the types of mental conditions, progressive paralysis, gait ataxia, etc.

However stage 3C describes the spread of tumor up to 10 or more than 10 axillary lymph nodes and it also have involved the lymph nodes above and below the clavicle [104]. Stage 4 this is the advanced and metastatic stage of cancer and this stage describes the spread to other organs of the body that is lungs, bones, liver brain etc [105]. Diagnosis History and physical examination the clinical history of patients with breast cancer is aimed at investigating cancer threat and demonstrating the occurrence or lack of manifestations indicative of breast illness [106]. It must comprise age at menarche, Usefulness of the breast self-examination is contentious because the advantage in conditions of reduced deaths has not been established [109]. Gynecologists gave printed materials and text messages regarding facts of breast cancer and breast cancer tests. Self administered structured questionnaire was used to investigate practices of self examination and knowledge. These researches have shown that continuous education program about breast cancer can raise the awareness among the population. He further stated that one out of seven patients with breast cancer is diagnosed in time. Beydag and Karaoglan [118] investigated the awareness about breast self examination in 1st and 4th years students and concluded that 4th years students have more knowledge about breast examination than the 1st years students. Biol Res (2017) 50:33 Page 8 of 23 Ultrasound breast imaging There are numerous researches behind the application of adjunctive screening ultrasound in elevated hazard women with thick breast tissue, which reveals a significant but established figure of false positives [119, 120]. There is no randomized clinical study conducted for investigation of impact of screening ultrasonography on mortality rates of breast cancer. Entire breast ultrasound might permit the Physicians to display for breast tumors not measured by long-established mammography, particularly in thick breasts wherever mammography sensitivity is lesser [121]. Ultrasound breast imaging shows the size and position of tumour whether it is filled with fluid or is solid and needs to be biopsied to rule out cancer. This examination is quickly becoming a routine procedure for diagnosing lumps in young women [122, 123]. Nuclear medicine of loco-regional lymph nodal extent and/or far-away metastases not obvious by regular imaging, therefore altering staging in up to 25% of the patients. This procedure is employed for the management planning by describing spread of primary illness. It is also employed in re-staging after management ailment relapse and treatment follow up [125]. Thirteen verities of tumor markers of breast cancer are measured, six out of 13 are novel for the guideline. The different varieties displayed proof of clinical use and are suggested for utilization in practice [127]. It is particularly significant that the comparative autonomy of the markers in reference to other accessible markers to demonstrated so as to evade the gratuitous price and expenditure of redundancy [128]. Furthermore, it is significant that the physician be attentive of the restrictions in together specificity and sensitivity of every marker so because not to specificity and sensitivity of every marker so since not to over- or under-interpret the prognostic worth of a few investigation. With these caveats in intelligence, trial submission of tissue, germ-line and soluble tumor markers can recover medical care of individuals at threat for and with breast cancer. Ca 153 this procedure utilizes solitary photon radionuclides including gallium-67, iodine-131 and technicium-99 m that discharge gamma rays. It can also be employed to the entire body, is comparatively secure in expressions of radiation quantity and is fine in recognition of primary and metastatic cancers. High blood levels are seen in <10% of patients in the beginning of breast cancer and in approximately 70% of patients with advanced stage of breast cancer. The frequently utilized tracer in positron emission tomography is a radioactive type of glucose such as [18F]fluoro-2-deoxy-d-glucose. Tissues with enhanced metabolic requirements including developing cancer cells, demonstrate increased uptake of the tracer and displays on the scan.

This implies that bad risk policyholders will find insurance very attractive and will demand considerable insurance, but the demand for insurance by good risks will be light and might disappear altogether. Thus, asymmetric information "crowds out" the good risks, and insurance is only fairly priced for the bad risks. The insurance market ends up with an adverse selection problem, with the insured population representing primarily the higher risk clients. The costs of adverse selection fall on policyholders, particularly the good risks, who may have to pay excessive rates or accept diminished coverage. Insurers recognize the problems caused by lack of information, and this is reflected in the prices and coverage they offer. But these policies are designed such that some policies will be appealing to people who know they are of low risk, while other policies are appealing to people who know themselves to be high risk. For example, consider a choice between policy A, a high priced policy for auto insurance which provides full coverage at a price that is self-supporting if the policy is purchased by high risks, and policy B, a policy offering partial coverage at a price that is self-supporting if it is purchased by low risks. Those who know they are high risks (and know they are likely to crash their car) will tend to choose policy A (full coverage), while the low risks will favor policy B (partial coverage at a lower unit price). There are other ways the menu can be designed, but the common theme is that low risk policyholders still bear the costs of adverse selection by having to choose between full coverage at unfairly high prices or reduced coverage at fair prices. Because the high risks are offered full coverage at a price which is actuarially fair for their risk characteristics, they choose to buy these policies, and the market stabilizes. Benefit of Commissions the idea that contingent commissions can actually benefit the policyholder follows quite simply from the model represented by Graph 8-1. The model shows that, when policyholders know their own level of risk, but the insurer does not, market failure will occur if the insurer tries to offer insurance at the average price to both high and low risks. At the average price, high risks are subsidized and low risks pay premiums that are actuarially unfair. Rothschild and Stiglitz show that the insurer may be able to finesse the informational problem and create a viable market by offering a menu of policies, some of which appeal to low risks and others to high risks. Buyers are thus induced to "self select" into a set of policies which enable the insurer to cover its costs. The high price line 97 shows a premium rate for different levels of coverage for high risks which just allow the insurer to break even. This shows combinations of price and coverage that deliver the same level of satisfaction to a person who knows he is high risk. Clearly, if the high risk person could get a combination of premium and coverage below this line (more coverage at a lower premium) he would be better off. Equivalently, any combination above the curve (less coverage at a higher premium) makes the high risk worse off. The fact that this is less steep reflects that the insurance buyer knows they have a lower probability of loss than the high risk, and consequently, he or she is willing to sacrifice more coverage to get a better premium. Now if insurers could identify high and low risks, they could offer policies H and L2 respectively to each type. However, if the insurer cannot identify applicants by risk class, it cannot offer these policies (it simply does not know which person to offer the low priced policy). At this point, the insurer does not know which applicant is low risk and which is high risk. The insurer can, through an analytical process, induce the types to reveal themselves. Notice they both lie on the high risk indifference curve, so high risk types would not really care which they bought. Indeed, if "L" is drawn a little above this indifference curve, the high risks will choose H. Now the low risk indifference curve is not as steep because these types know they have a lower chance of a loss. This solution requires that low risks "signal" their risk status by being willing to accept lower coverage. In particular, the costs fall on the lower risk policyholders who simply cannot purchase adequate coverage at a 98 price that reflects their low risk status.

None of us spoke for a while; but, at length, George turned to the new comer, and said: "I beg your pardon, I hope you will forgive the liberty that we - perfect strangers in the neighbourhood - are taking, but my friend here and myself would be so much obliged if you would tell us how you caught that trout up there. We said that nobody had told us so, but somehow or other we felt instinctively that it was he who had done it. He said he had weighed it carefully when he reached home, and it had turned the scale at thirty- four pounds. We told him the various histories we had heard about his trout, and he was immensely amused, and we all laughed very heartily. It seemed that he had caught it himself, years ago, when he was quite a lad; not by any art or skill, but by that unaccountable luck that appears to always wait upon a boy when he plays the wag from school, and goes out fishing on a sunny afternoon, with a bit of string tied on to the end of a tree. He said that bringing home that trout had saved him from a whacking, and that even his school-master had said it was worth the rule-of-three and practice put together. He was called out of the room at this point, and George and I again turned our gaze upon the fish. It excited George so much that he climbed up on the back of a chair to get a better view of it. And then the chair slipped, and George clutched wildly at the trout-case to save himself, and down it came with a crash, George and the chair on top of it. That trout lay shattered into a thousand fragments - I say a thousand, but they may have only been nine hundred. We thought it strange and unaccountable that a stuffed trout should break up into little pieces like that. And so it would have been strange and unaccountable, if it had been a stuffed trout, but it was not. I believe this is the longest uninterrupted stretch anywhere above Teddington, and the Oxford Club make use of it for their trial eights. But however satisfactory this absence of locks may be to rowing-men, it is to be regretted by the mere pleasure-seeker. I like sitting in the boat and slowly rising out of the cool depths up into new reaches and fresh views; or sinking down, as it were, out of the world, and then waiting, while the gloomy gates creak, and the narrow strip of day-light between them widens till the fair smiling river lies full before you, and you push your little boat out from its brief prison on to the welcoming waters once again. The stout old lock- keeper, or his cheerful-looking wife, or bright-eyed daughter, are pleasant folk to have a passing chat with. The Conservancy of late seems to have constituted itself into a society for the employment of idiots. A good many of the new lock-keepers, especially in the more crowded portions of the river, are excitable, nervous old men, quite unfitted for their post. It was a glorious day, and the lock was crowded; and, as is a common practice up the river, a speculative photographer was taking a picture of us all as we lay upon the rising waters. I did not catch what was going on at first, and was, therefore, extremely surprised at noticing George hurriedly smooth out his trousers, ruffle up his hair, and stick his cap on in a rakish manner at the back of his head, and then, assuming an expression of mingled affability and sadness, sit down in a graceful attitude, and try to hide his feet. My first idea was that he had suddenly caught sight of some girl he knew, and I looked about to see who it was. They were all standing or sitting about in the most quaint and curious attitudes I have ever seen off a Japanese fan. And then, at last, the truth flashed across me, and I wondered if I should be in time. So I faced round quickly, and took up a position in the prow, where I leant with careless grace upon the hitcher, in an attitude suggestive of agility and strength. I arranged my hair with a curl over the forehead, and threw an air of tender wistfulness into my expression, mingled with a touch of cynicism, which I am told suits me. As we stood, waiting for the eventful moment, I heard someone behind call out: "Hi! It was all right - at all events, there was nothing wrong with it that could be altered. But now the whole lock started yelling, and a stentorian voice from the back shouted: "Look at your boat, sir; you in the red and black caps. Quick as thought, we each seized an oar, and a vigorous blow against the side of the lock with the butt-ends released the boat, and sent us sprawling on our backs.

When carcinomas form in the breast, they are usually a more specific type called adenocarcinoma, which starts in cells in the ducts (the milk ducts) or the lobules (milk-producing glands). The term invasive (or infiltrating) breast cancer is used to describe any type of breast cancer that has spread (invaded) into the surrounding breast tissue. The most common types are invasive ductal carcinoma and invasive lobular carcinoma. Special types of invasive breast cancers Some invasive breast cancers have special features or develop in different ways that affect their treatment and outlook. Triple-negative breast cancer Triple-negative breast cancer is an aggressive type of invasive breast cancer that accounts for about 15% of all breast cancers. Inflammatory breast cancer Inflammatory breast cancer is an uncommon type of invasive breast cancer. Less common types of breast cancer There are other types of breast cancers that affect other types of cells in the breast. These cancers are much less common, and sometimes need different types of treatment. Paget disease of the breast Paget disease of the breast starts in the breast ducts and spreads to the skin of the nipple and then to the areola (the dark circle around the nipple). They develop in the connective tissue (stroma) of the breast, in contrast to carcinomas, which develop in the ducts or lobules. Angiosarcoma Sarcomas of the breast are rare making up less than 1% of all breast cancers. This means the cells that line the ducts have changed to cancer cells but they have not spread through the walls of the ducts into the nearby breast tissue. At that time, the cancer has spread out of the duct into nearby tissue, and from there, it could metastasize to other parts of the body. Chapter 21: Ductal Carcinoma In Situ and Other Intraductal Lesions: Pathology, Immunohistochemistry, and Molecular Alterations. Most breast cancers are invasive, but there are different types of invasive breast cancer. Inflammatory breast cancer and triple negative breast cancer are also types of invasive breast cancer. From there, the cancer breaks through the wall of the duct, and grows into the nearby breast tissues. At this point, it may be able to spread (metastasize) to other parts of the body through the lymph system and bloodstream. Invasive lobular carcinoma may be harder to detect on physical exam and imaging, like mammograms, than invasive ductal carcinoma. Less common types of invasive breast cancer There are some special types of breast cancer that are sub-types of invasive carcinoma. They are less common than the breast cancers named above and each typically make up fewer than 5% of all breast cancers. These are often named after features seen when they are viewed under the microscope, like the ways the cells are arranged. These include: q Metaplastic carcinoma (most types, including spindle cell and squamous, except low grade adenosquamous carcinoma) 13 American Cancer Society cancer. Treating invasive breast cancer Treatment of invasive breast cancer depends on how advanced the cancer is (the stage of the cancer) and other factors. Depending on the type of breast cancer and how advanced it is, you might need other types of treatment as well, either before or after surgery, or sometimes both. See Treating Breast Cancer1 for details on different types of treatment, as well as common treatment approaches based on the stage or other factors. Triple-negative breast cancer differs from other types of invasive breast cancer in that they grow and spread faster, have limited treatment options, and a worse prognosis (outcome). Signs and symptoms of triple-negative breast cancer Triple-negative breast cancer can have the same signs and symptoms3 as other common types of breast cancer.