Buy renova with free samples

Buy renova with free samples

Buy renova with free samples

Buy renova with free samples

I love a great adventure. The anticipation, the rush of getting ready, the exhilaration of pushing your comfort zone and experiencing all that is foreign adds to the thrill. There’s nothing that compares to stepping into the great unknown and pushing your boundaries to the limit. That excites me. So at any given moment I’m always ready for the chaos that comes with being spontaneous. It’s my nature.

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Last Friday, I got the call. Steve in Little Orleans, MD had heard about me four years ago when I rode through his town, in the western part of Maryland, during my cross-country trek on horseback. Steve tracked me down on Friday. Did I know of anyone with a horse trailer who would trailer a horse to West Virginia?

It seems a long rider had left his lead horse with Steve for six weeks while the horse healed. In due time, the rope burn on the horse’s hock had finally healed and the horse was ready to be reunited with its owner.

The long rider, whom Steve described as a short Atilla the Hun and whom I’ll call Jack, started his cross-country trek in Harpers Ferry with a lead horse, a pack horse, and two other men and their horses.

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It probably took Jack five days, give or take a day or two, to journey the 100 miles to Little Orleans. A trip that would normally take an hour and 38 minutes by car takes five days for a long rider on horseback. The long rider’s horse is imperative to the success of the journey. Trying to make 4000 miles over the long-haul, means the long rider needs his horse to pace at 20 miles a day. For me, that averaged out to be three miles an hour—with breaks, fan fare, interviews and the like, I was in the saddle for eight or nine hours a day. Long hard days, but there’s nothing like seeing America at three miles an hour.

The first three weeks of any long rider’s journey are the hardest. Those weeks make or break the long rider, the horse and the journey. It’s not an adventure for the faint of heart. Jack’s companions bailed on him when they arrived in Little Orleans. After three weeks of staying with Steve while his horse was healing, Jack made the decision to push on with his pack horse, alone. Would it be possible for Steve to make arrangements for the horse to meet up with Jack when the horse healed?

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That’s where I came in. Did I know of anyone who would trailer the horse to Jack? You betcha. Me. It was a fellow “wanna-be” long rider in need. So I texted my partner, who was in the Doctor’s office on a late Friday afternoon. Did he want to join me? The Plan—to head out with the truck and trailer with an overnight stop at the Little Orleans Lodge, au gratis, from the owner Steve. In the morning we would load Jack’s horse and head out to Davis, WV where Jack and his pack horse were staying overnight. The trip would take a total of ten hours. Five there. Five back. I had no choice. I had to “pay it forward” for everyone who had been so kind-hearted in my time of need on my journey. This I had to do for them. Plus, I love a good adventure.

My partner, being the great sport that he is, was game. He’d be ready to leave in two hours. With a spring in my step, I packed up, made a picnic dinner to eat in the car and grabbed a great bottle of red, two wine glasses and a corkscrew. After all we were going to be staying in a rustic bed and breakfast for the night.—why not take full advantage of the evening?

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We arrived well into the evening, greeted by Steve, an affable retired post master, who had worked on the lodge since buying it for his wife and children back in the early 70s. When he retired, Steve turned it into a B&B on the C&O canal, a 184.5 mile long trail that winds around the Potomac River following the towpath of the Chesapeake and Ohio Canal. Steve was happy to host the eclectic group of trail-goers who by chance stumbled into his lodge on foot, bicycle or even horseback. Over a glass of wine, he shared the stories of those in his register: hippies, loners and couples, all who had set out on a journey to find themselves.

After a morning breakfast of two eggs over easy, sausage, potatoes and the most mouth-watering, sweetest biscuits I ever had, we loaded up Jack’s horse and headed on down the road to Davis, WV to meet up with the long rider, Jack.

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Steve was wrong. Jack looked more like Johnny Depp in the Pirates of the Caribbean. He acted like him too. In spite of himself, you couldn’t help but like him. Jack was a 31 year-old man with a black bandanna and tongue piercing, trying to figure life out from a horse’s point of view. He was ecstatic to have his lead horse back. I knew the feeling. Rocky, my lead horse, had injured himself when another horse kicked him in Illinois. I had to leave him behind to heal. Parting with him ripped my heart out. When we were reunited three weeks later, the joy in having him back defied description. I was lost without him. I knew the elation that Jack experienced in being reunited with his horse on their great adventure.

Before leaving, Jack asked me to write in his journal, to offer him advice or wisdom that I had garnered on my solo trek. I simply wrote, “Discover the joy, discover the journey, discover yourself.” Because that’s what it’s all about—on any adventure.

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Tomorrow I head out on another adventure. Australia. For two weeks. Part of the journey will be a 4WD trip to the Outback where I’ll be backpacking, tenting and dining with the Aborigines. Wish me luck and hope that I discover the joy, the journey and perhaps even myself. When I return from this Aussie Adventure, I’ll certainly share with you. Till then, G’day mate.

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When someone loses a pet and says to me in grief, “I know it’s not the same as losing a child, but it hurts so much,” my heart aches. Not because I know the pain of losing not one, but two children, but because I also know the pain of losing a dearly loved animal.

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Nothing, and I mean, nothing compares to the pain of losing a child, but that doesn’t diminish the heartache of any loss. Human or animal. The void in life after loss is incredible. Where there was once life, a huge black hole looms when death takes over. Where there was once love, heartache. Smiles. Sadness. Happiness. Loneliness. The loss of life fills your heart with an overwhelming emptiness and pain. The moment of loss—that incredible moment of pain—in the passing of life is unavoidably deep. It rips your heart out. Loss causes heartache and there’s just no getting around that. It’s a part of life.

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This past February I had to put down Eric’s beloved Shadow. It was so painfully hard, perhaps extra so, because it was Eric’s dog, my living link to my dead son. Shadow was the kindest, gentlest black lab I’d ever known. He had a huge heart with big soulful brown eyes. When the decision came to put him down, I left that to my surviving son, Peter. He had taken over Shadow’s care in Eric’s passing.

Shadow had developed brain cancer with severe epileptic seizures and it was Pete’s responsibility to ensure Shadow’s comfort in his final debilitating days. Pete rose to the occasion and gently helped Shadow every time he experienced a seizure. Pete was also there in the middle of the night to clean up the blood and excrement from Shadow’s thrashing. And Pete found the courage to tell me it was time to euthanize him. As Shadow’s big black head with the soulful eyes lay quietly in Peter’s lap as the vet administered the needle, my heart screamed in pain at yet another loss in our lives. Shadow. Eric’s big black lab with the soft soul. My heart ached and I cried.

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I was so thankful he didn’t die alone; Shadow deserved more than that. Nothing should die alone. Any—no all–life deserves more than that.

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This past spring, I was headed down York Road and had to come to a creeping crawl to avoid the growing crowd on the shoulder of the road. Some members of the crowd were crying, others didn’t know what to do, but all eyes looked toward the middle of the road. My eyes followed their gazes. In the middle of the road was a beautiful brindle pit bull, smashed and dying on York Road. No one was near him; he was dying alone. God no. I pulled over and ran to him. “Has anyone comforted the poor thing?” I screamed. “No,” came their replies in unison. “We didn’t know if he’d bite.” I was spitting mad with grief, pain and tears as I watched the poor dog hold on to dear life. Where was their compassion? I didn’t understand. As I knelt down and stroked the dog’s big beautiful head, his blood spilling over onto my knees, his tail gave a tiny wag as he tried to look at me. I held him, comforted him, and loved him in his final moments.

I was so thankful he didn’t die alone. I didn’t know him, but he deserved more than that.

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Monday morning I headed to the farm to tend to my two horses and the other ten horses I’ve cared for over the past five years. My routine always starts out the same. I whistle for my horses and say hi to the others gathered at the gate. Where was Blaze, the leader of the herd? I headed into the stall barn to dish up the grain. Still no Blaze. That’s odd. Where was she? I called for her. No Blaze.

After putting the other 11 horses in their respective feeding stations. I shlepped through the field, over the bridge, over the stream, and into the 50 acre field to find Blaze. There, just beyond the stream, she lay—struggling to get up, bloated, and covered with flies. She had colicked sometime during the night and the others had left her for dead. My God. My God. No. No. No. The poor thing. Tears streamed down my face as I knelt beside her. She moved her head and laid it on my foot, looking at me through bleeding eyes as she let out a soft whinny.

I fumbled for my cell phone and called my girlfriend, leaving a terrifying message, “Call the vet. Call the vet now!” I screamed through my sobs. Then I crumpled beside Blaze in the field and stroked her big beautiful brown head with the white blaze. She labored to breathe. “Hang on. Hang on.” I whispered in her ear. “He’s coming. He’s coming.”

The vet arrived but couldn’t get his SUV across the stream. Could we get her up? Blaze tried, oh she tried so hard, but she didn’t have enough left in her. With a heavy heart the vet returned to his car to get the needle to euthanize her.

“Blaze, get up. Get up. You can do it. Everyone’s waiting on the other side. Don’t die her alone. Come on honey….get up.” I sobbed in her ear. With one valiant effort the gentle leader rose off her barrel belly onto her buckled knees and stood. With painful, labored steps this beautiful beast made her way to the stream where her herd was waiting. It took her fifteen minutes but she finally crossed to the other side where she was greeted with whinies and neighs from her delighted followers. She grew stronger with every painful step through the support and love of her herd, owners and caretakers, and finally made it to the paddock where she was enveloped and loved as she was laid to rest.

An imperial leader, of the gentlest nature, Blaze. I loved Blaze and was thankful she didn’t have to die alone. She deserved more than that, as do all creatures, great and small.

Rest in Peace Blaze, our gentle leader

Rest in Peace Blaze, our gentle leader

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When something turns out way better than expected it brings such joy to life. I love pleasant surprises and this 4th of July weekend has been full of them.

Friday night kicked the weekend off with one. I was driving home from work and saw crabs for $20/doz. at what I thought was a local down and dirty pub with a bad reputation. Or at least that’s what I had been told. Twenty dollars for a dozen crabs was worth the risk of a bad reputation.

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Arriving home, I asked my partner if he wanted to go out for the deal. The catch? He had to at least look the part of a red neck. He couldn’t walk into the down and dirty bar as a prep. Could he do it? He tried. He came bounding down the stairs in an old worn out t-shirt. Perfect. Till my eyes rolled to his bottom half. The crease in the jeans still gave him away. No matter how hard he tries he just can’t look down and dirty. I guess that’s not really a flaw though. I smiled; he tried. He then looked me up and down and said, “Well you’re not really down and dirty either. “Ah, but no,” was my reply, “I just need to look good to a red neck guy.”

When we got out of the car in the parking lot and headed for the bar door, a Harley roared by. My partner said “Man, he couldn’t keep his eyes off you.”  I laughed, “Actually he couldn’t take his eyes off the crease in your jeans.”

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We pulled the door open, expecting the worse. To our pleasant surprise the restaurant was cute, the bar great, and the prices were fabulous. The owner came out, engaged us in conversation, and threw four extra crabs into our to-go bag. We’re definitely going to hit that down and dirty pub up for our weekly cheap date night. Pushing one’s comfort zone is grand.

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Saturday, the 4th of July, started out with a 5:45 am wake up call for me to get ready for my first parade in the Cavalry. My partner, coming along for pure support, rolled out of bed at the ungodly weekend hour to help me get Rocky, my horse, ready for the 4th of July parade in Takoma Park in Washington, DC.

Our first pleasant surprise came as we arrived in Takoma Park. Expecting an urban area with lots of noise, cars and pollution, we were greeted with a charming bedroom community with tree-lined sidewalks stretching in front of historic homes. Lawns were filled with a thousand or more  children, parents and grandparents decked out in red, white and blue, waving flags of all sizes. The weather was perfect and the air was filled with a patriotic hum, no matter which side of the political fence the flag was flying on.

In fact one long-haired silver woman in a purple tye-dyed flowing skirt came up to me in my military dress blues as I was mounting up on Rocky. She leaned in and thanked me for protecting her right to her far different views. She smiled as she pointed to the flower in her hair. I smiled back, knowing what she meant, and thanked her. Two different sides of the fence coming together as Americans to enjoy a parade in a small home-town.

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As we assembled for the parade, the Sergeant who was supposed to be carrying the flag for the hour-long parade was suffering from the flu. He grew weezy and weak and, unfortunately, had to withdraw. My commander turned to me and Rocky and said, “Step up, it’s your honor.” My second pleasant surprise. As we started off with the large flag flapping over Rocky’s ears, the crowd stood and erupted into cheers and applause. My heart surged, filling with pride and patriotism. I whispered to my commander, “I’m going to cry sir. I’m going to lose it.” “Hold on PFC Losey. Hang in there.” And I did, for the hour long ceremony as we paraded through the streets to thousands of red-blooded Americans celebrating our independence. Truth be told, tears streamed down my face, as we celebrated as one.

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After arriving home, we had no plans. So we took an afternoon of leisure hanging out in the pool, swimming side-by-side and then tying two floats together as we held hands and napped. Totally unlike us, and it felt so good, another pleasant surprise. I told my partner it would be a perfect day if I could once again hear the squeal of children playing in a pool. The phone rang.

My sister-in-law from my first marriage, whom I’ve been friends with for 27 years, was at Wegman’s. “Hey,” I said, “Why don’t you grab a 5 lb. bag of Sahlen hot dogs and bring the kids on over for a picnic and swim?” “I already have the hot dogs in the cart, along with cole slaw, strawberries and stuff to make shortcake. Game?” she asked.”You bet I am.” I replied. I ran upstairs and uncovered the goggles, the flippers, the frisbee and ball that Eric and Sam used to play on the beach with Cara and Peter far too many years ago.

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When my in-laws arrived, we baked the shortcake and headed out to the deck to grill the dogs, drink, and listen to the squeal of children once again playing in the pool. I sighed perfectly contented with my weekend full of patriotism and pleasant surprises. God I love the small joys of life.

Takoma Park Parade, July 4th 2009

Takoma Park Parade, July 4th 2009

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Driving the 350 miles up to my hometown of Buffalo for my nephew’s high school graduation, revealed to me an “aha” moment: people handle driving the way they handle life. Lead, follow or get out of the way! Please.

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As I was driving on an open stretch of route 15 in Pennsylvania, a silver Kia sedan sped up as it approached my rearview mirror. As it passed me, I noticed the twenty-something girl behind the wheel, who immediately slowed down once she pulled back into my lane in front of me. As I then pulled out to pass her, she immediately sped up, only to slow down again when I resumed my position behind her. She slowed down. I went to pass. She sped up. I’d pull back in. She’d slow down. This went on for a number of miles, when the “aha” moment hit me. She wanted to lead, but didn’t have the courage to be the leader.

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Along the way, the highway was strewn with state troopers pulling people over as they sped by. The twenty-something girl flying by me wanted to be in the lead but didn’t have the courage to be the lead driver. She wouldn’t commit. She wasn’t willing to take the risk of being pulled over for speeding. But she wanted to BE the leader, forcing the other drivers to either drive her speed or pass her. It was an unsafe practice for those following. Speed up. Slow down. Speed up. Slow down. It was an accident waiting to happen. She was not lead driver material. She needed to be following at a safe speed. I’m confident her approach to driving was the same as her approach to life. A young girl be-bopping along, accelerating, de-accelerating, pulling in and passing, trying to find the rhythm of her life.

When it comes to driving and life, I’m a leader but have no problem following—IF I’m behind a confident leader who makes good decisions. If not, get out of the way, ’cause I’ll take over and pass. I don’t have a lot of patience for hesitant leaders or drivers. Commit. Make a decision or move over and let someone else lead.

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En route to Buffalo, I encountered fierce thunderstorms with pelting rain and winds. Hail storm like conditions, just shy of hailstones coming down. As a pretty fearless driver, severe winter storms don’t stop me, let alone a little rain. Yet people were driving 25 mph hour on an interstate with their flashers on. People, please. It’s a little rain. Well a lot of rain. Eventually most of the drivers pulled over. Ah, relief. An open road where I could go. I led the drivers, confidently, to salvation, er, sunshine. It just took someone willing to commit and lead. I have no problem stepping up if need be. That’s who I am as I driver and who I am in life.

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My partner has an interesting approach to driving and to life. He meanders in both. If there’s a straight line to get from point A to E, he’ll drive from A to D to K to N back to C over to J and eventually he’ll make it to E, his end destination. This is his approach to most things in life. In the meantime, he’s made a lot of stops, said hi to many people and eventually accomplished what he sets out to do. If I’m on a mission and need to get from A to E in record time, and I’m with him, I have to restrain myself from pushing down on his knee to accelerate to 65 mph. It drives me bonkers. But if I’m not on a mission, and willing to meander, it makes for a very pleasant journey. That’s why I think we make good partners—one forces the other to stay on task, the other forces the other to stop and smell the roses.

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Although I stay on task, I am an adventurer. I love the journey, the drive, the discovery, the ability to make choices. My brother has a GPS named Lucille. I hate her. No, I will not turn because you told me to. I’ll turn because I choose to. No wait, I WANTED to go to the Ben and Jerry’s. It’s an unscheduled stop, don’t recalculate. Shut up. Stop it. Let me drive. Let me choose. Let me discover their new Mission to Marzipan flavor. Stop it. Stop it. Stop it. I don’t want to stay on task I want to stop and smell the roses. But she won’t let me, without giving me a huge headache. Big mouth Lucile shows no restraint. Recently, someone stole her. God Bless them.

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Did you know a study recently stated that people with lots of bumper stickers on their cars are aggressive drivers? I find that hilarious, because the cars that I usually see plastered with bumper stickers are Subarus touting world peace.

You’ll be happy to know that I don’t place bumper stickers on my vehicles. But if I were to sport a bumper sticker on my 4×4 F-150 it would simply be, “Visualize whirled peas.”

visualize-whirled-peas-bumper-sticker-5781

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“When the going gets tough, the tough eat donuts”–Ziggy

I love Ziggy. Do you remember him—the fat little bald guy in the 70’s comic strip by Tom Wilson? Ziggy had a “woe is me” perspective on life but offered simple words of wisdom.

The cartoon quote from above was lovingly cut out of the paper by my dad and taped to my mirror when I was 18. I’m sure it’s now tucked away in an attic box piled on top of other boxes from far too many moves. Every time I think of Ziggy, I think of my dad who passed away at an early age of 59, fifteen years ago.

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My dad didn’t cut that cartoon out to suggest I was getting fat. He simply cut it out because the humor struck a chord with him. When I was 18 I worked in the deli of a local grocery store. Oftentimes, at the end of the shift, I had to box up the fresh donuts from the bakery to be put out for the “day old” dollar sale the next day. So each night I’d box them up–and then buy ‘em. My particular favorites were the peanut donuts. Oh my, they were good. But, alas, they are not made anymore because of all the peanut allergen sufferers out there. Sigh. I loved a good peanut donut. The memory of biting into a fresh donut with falling nuts and crumbs waiting to be scooped up, filling my nose with the warm, nutty sensation, still makes my mouth water.

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The humor that my dad found in the comic strip was that I was a love-sick teen who had just broken up with my first forever boyfriend, who brought home a box of donuts at the end of the night to eat away the pain. When the going got tough, I ate donuts. My dad was trying to get me to move through the “woe is me” attitude from the teen-age breakup with humor. I loved that about my dad—he moved through life with humor and I couldn’t help but be sucked into it.

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That particular Ziggy cartoon was based on the quote from Joseph P. Kennedy, father of our 35th president John F. Kennedy, “When the going gets tough, the tough get going.” I’m sure the fiercely ambitious businessman and political figure, who thrived on competition and winning, gave that fatherly advice to his 9 children with a stern striking of his fist with emphasis on every word.

Not my dad. He cut out cartoons from the paper and taped them to my mirror. He peeled off Chiquita banana labels and pasted them somewhere in my school lunch box for me to discover with love. He’d sneak away early from work and show up unexpectedly for the last 15 minutes of my soccer game. He didn’t rule with an iron fist, rather with respect, love and humor.

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The humor that he used to get me through my first forever boyfriend break-up still makes me smile to this day. He was letting me know that life goes on, it’s what you make of it, it’s how you choose to move through it that makes all the difference.

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I had to stop eating donuts, not because they landed on my hips, but because I got sick of them. To this day I have a hard time eating donuts because I ate too much of a good thing way back when. As Marie Lloyd so simply states, ” A little of what you fancy does you good.” The lesson from Ziggy and my dad: taking it to the extreme is not necessarily a good thing. Although I have to admit when I see a “Hot Donuts Now” sign flashing at a Krispy Kreme, my car automatically pulls into the drive-thru. I’m just taking them home to the kids. Honest.

“A LITTLE of what you fancy does you good.” For sure.

Ziggy

Ziggy

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Sock. Shoe. Sock. Shoe. No. Sock. Sock. Shoe. Shoe. I do sock, sock, shoe, shoe. How do you approach your morning routine?In the end does it really matter? In Ted Menton’s After Goodbye, he tells the story of two children in the throes of cancer arguing in the cancer ward about which is better. Sock. Shoe. Sock. Shoe. or Sock. Sock. Shoe. Shoe.

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In spite of the cancer scenario, I find it amusing that two children facing the fight of their lives still find their individual routine’s worth fighting about. Sock. Shoe. vs. Sock. Sock. I have never been a routine person. Not me. In fact, if you ever placed me into a box, I’d scrape and claw my way out of it.

All my life, I’ve been known for my spontaneous nature. Until my children died. Then, I took great comfort in my routine. It was what got me up in the morning. Linda, first put on your sock, then your shoe. Nope. Put on your sock. Now put on your other sock. Okay, put on your shoe. Now your other shoe. Now put one foot in front of the other. Now take a step. Okay. Move the other foot. Move forward. Step by step. Move through the pain. You can do it. Sock. Sock. Shoe. Shoe. Move. Move. And that’s how I’ve moved through the passing pain of losing two children.

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Most of you know Monday marked the five year anniversary of Sam’s passing. My 10 year old son. I have been in a routine for the past five years in learning how to live again through the loss. Sock. Sock. Shoe. Shoe. Move. Move. Don’t you take that routine away from me. Like the children on the cancer ward, I took great comfort in owning my routine. It was the only thing I had control over. God forbid I put on Sock. Shoe. Sock. Shoe. It didn’t feel right. Just like my life without my children. Come to think of it, before the passing of my children I think I did Sock. Shoe. Sock. Shoe. But I couldn’t go back to the same routine. It wasn’t right. I needed a new routine. It was new, but a routine, just the same. Just like living and breathing without half my family. I had to learn to do it all over again. The basics of living.

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Know how I celebrated Sam’s anniversary? The “non-celebration,” as it were, ended up in my mowing the lawn. Now my partner prides himself on the perfectly parallel lines in the lawn. I never got that. I don’t. To me a lawn is a lawn. And this just isn’t a lawn; it’s a field, a three acre field next to a stream. It deserves to be a field. But nope. He wants it to be a lawn. Not me. I want it to be a field with dancing grass blowing in the breeze, next to the stream. I want it mowed three times a season. He wants it mowed once a week. Now I love to mow, so I took on the chore. On Sunday, I started running the perfectly parallel lines of the routine. Sock. Sock. Shoe. Shoe. Up. Down. Up. Down. Forty-five inches over from whence I started. Now another 45 inch wide mowing deck over. Then a dragon fly landed on the dancing grass next to the stream in the field I was cutting into a routine.

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Sam followed me across the country on my horse trip. Thousands of dragon flies followed me. They had my back. As Sam did. I wear a dragon fly bracelet as a remembrance of Sam. So I couldn’t do it. I couldn’t cut the field in parallel lines. I couldn’t cut the field so the dragon fly had no where to land. I couldn’t cut the field by way of routine. So in honor of Sam, I cut whoopsi-doodles. No rhyme or reason. Just by happen-chance, I have a field full of perfectly un-parallel lines. Perfect whoopsi-doodles where dragon flies can land on the missed grass of the 45 inch mowing deck. In the outskirts of the circles where 45 inches didn’t meet the other 45 inches. Where shoes come before socks. Where dragon flies land before parallel lines are cut. Where routines are lost and spirits soar. Where perhaps even socks are worn without shoes. For in the end, it just doesn’t matter.

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“Wow, Linda, you look fabulous and fit!” was the statement I heard Tuesday night at my Toastmaster’s meeting. Little did that person know I have, over the past 4 months, unintentionally dropped 1/5 of my weight.  Now, I’ve never had a problem with weight. I had four children and managed to stay relatively thin chasing after them through the years. But I found it truly ironic that I’m the thinnest I’ve ever been—even before my high school years—and was being rewarded with a “Wow, you look fit and fabulous.”  I didn’t feel it.

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Yesterday I nearly collapsed at work, drove to a 24/7 healthcare center, to be told I’m severely anemic. This coupled with the five other symptoms that have crept up on me over the past four months and the doctor scared me with the big C.

My dad died of cancer and it wasn’t something I was prepared to hear. Now lots more tests need to be done, so don’t get all melodramatic on me. I have lots of years left to live, I know that, and feel that, with every fiber of my being. The point to all of this is that you just don’t know what the day may bring. Are you living the life you were born to lead?

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“Always be a first-rate version of yourself, instead of a second-rate version of somebody else.”
–Judy Garland

This from a woman who played somebody else for 45 of her 47 years. This from a woman who attempted suicide numerous times throughout her tragic life. This from a woman who struggled with insecurities and addictions. This from a woman who was told by her producers that she was unattractive and overweight. This from a woman who died at 47, the same age I’m about to turn in three weeks. Was Judy Garland ever a first-rate version of herself?

Judy Garland will always be remembered as Dorothy in the Wizard of Oz, with her ruby red slippers, clicked three times, as she closed her eyes and chanted,  “There’s no place like home. There’s no place like home. There’s no place like home.” Ironically, Judy Garland never felt at home anywhere. I can only imagine why she never revealed her true self, always hiding it away—for fear that her adoring fans would cast aside the real Judy. They always wanted Dorothy. The cute little, pig-tailed girl from Kansas.

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I also imagine that Judy Garland did live the life she was born to lead. She was a wonderful actress and a beautiful singer with her deep contralto voice. No one does honor to Somewhere Over the Rainbow the way Judy performed it half a century ago. But she never believed she deserved to be Judy Garland and all that she achieved. She was just Frances Ethel Gumm from Grand Rapids, MN. When she was pushed into acting, Frances’ confidence was sucked out of her and for years she was only able to portray a second-rate version of somebody else.

When the big C is thrown at you, your life hits replay over and over again in your mind. “Have you lived the life you wanted? Have you achieved what you set out to achieve? What more do you have left to do?”  It begs the question, “What is your legacy?”

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So what is your legacy? If you were to die tomorrow, did you live the life you were born to lead? Will you leave behind something to remember? Did you live a first-rate version of yourself?

I hope I have.

I know my youngest son Sammy did. On Monday, he’ll be gone 5 years. On June 22. But I still remember his great grin. His aqua blue eyes. His mischevious sense of humor. And his terrific hugs. In his short 10 years, Sammy was a first-rate version of himself. There will never be another.  In the end, all you have are memories, and the ones spent with family and friends are the ones you treasure most.

So as I remember Sammy and Frances Ethel Gumm, who co-incidentally also died on June 22, as I head into the doctors for a follow-up visit to the big C scare, I hope to see a rainbow smiling down on me.

Somewhere Over the Rainbow (click, for a beautiful version by 6 year-old Connie Talbot on YouTube)

Somewhere over the rainbow
Way up high,
There’s a land that I heard of
Once in a lullaby.

Somewhere over the rainbow
Skies are blue,
And the dreams that you dare to dream
Really do come true.

Someday I’ll wish upon a star
And wake up where the clouds are far
Behind me.
Where troubles melt like lemon drops
Away above the chimney tops
That’s where you’ll find me.

Somewhere over the rainbow
Bluebirds fly.
Birds fly over the rainbow.
Why then, oh why can’t I?

If happy little bluebirds fly
Beyond the rainbow
Why, oh why can’t I? 1

I hope we all live the life we were born to lead—the way Sammy did, so beautifully and innocently with a verve for life and love. Love and miss you tons, my little Sammer Dam.

Sam Losey, 3/29/94 - 6/22/2004

Sam Losey, 3/29/94 - 6/22/2004

1 Somewhere Over the Rainbow, music by Harold Arlen and lyrics by E.Y. Harburg

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Many moons ago, when my mother was the age I am now, and I was but a girl of 16, my father came home one memorable day and announced to us that we were moving. To a farm. Although I was a tomboy with three older brothers, I was a city girl through and through. It’s all I had known.

As a family, we would be moving to a 10 acre farm, next to 3000 acres of state land, to a public school with a graduating class of 32.  Yep, I was downsizing as president of my class of 400, to 32 classmates, and upsizing from an 1/8 of an acre lot in the city, to thousands of acres in my backyard.

In order to get me to go without kicking and screaming, my father bribed me with a horse. He was a smart man.

Most of you know that horses are a huge part of my life and I have no problem getting down and dirty with ‘em. And others know me as a gussied up artist, author, and speaker. As Kippling writes, “Never the twain shall meet.” My wardrobe is determined by the activity of the day, yet whatever I’m wearing on the outside, doesn’t change the me I am on the inside. The old idiom, “Don’t judge a book by its cover,” is, well, cliché-like, but, it’s still relevant today.

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A month after we moved to the farm, on a blazingly hot summer day, my father ordered manure from our neighbor’s farm to fertilize the small garden he was tilling. I remember the moment the manure arrived. The fresh droppings reeked and steamed. But that’s not what I remember the most. Our neighbor’s ten year old daughter was sitting plop on top of the manure pile, with a wide grin, happy as a pig in….well you know.

My mother, father and I grabbed our shovels to start pushing the manure off the wagon into the garden. The little girl with the huge smile sitting in the stewing cow chips, looked at my mother incredulously. “What are you afraid to get them rings dirty?” she asked as she pushed the shit off with her bare feet. My mother stared back in horror.

Now my mother is not an outdoor person per se, but she did a great job of humoring her five children and outdoor-loving husband through countless camping trips, homeless animals, moves to the country, etc. But I don’t think I could ever picture her shoveling dung with her feet. On the other-hand I don’t think that grinning girl on top of that manure mountain would ever sit still in a theater either. But I don’t know, I lost track of her. Who am I to judge that she couldn’t or wouldn’t?

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On my solo cross-country journey by horseback, I did a lot of wilderness camping and would go days without eating or showering. Yep, I reeked, I’m sure, like the compost on that hot summer day, but there was something about the solace of the wilderness that helped to heal me on that long journey.

One stop in particular reminded me of that long-ago judgment day with my neighbor’s little girl. Camping for two days in a park outside of a penitentiary in rural Indiana, I was sitting under a tree journaling when a truck hauling a two-horse trailer arrived. I paid them no mind and continued writing. After tacking and mounting up, the owners made their way to me. They were retirees out for a late-summer ride and had never before encountered in their horse park a wild-haired, dirty, lone woman parked under a tree writing with two horses grazing beside her. Was she an escapee from the penitentiary—or worse yet, waiting to help a convict escape on her other horse? Still I paid them no attention as they inched in closer with their mounts—until the wife leaned over and whispered, “Is that a boy or a girl?” I looked up with a smile and said, “I’m a girl with a Master’s and perfectly good hearing.” But I sure didn’t look it.

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Last night, as I was mounting up for a high profile event with my horse, I had to pee. With no facilities around, I sheepishly entered my horse trailer, closed the door, and had to make do sitting plop on top of a manure bucket with freshly steaming dung, just like that little girl from my childhood. Who knew that would be me someday?

This morning after getting all-gussied up for work, I had to stop by my partner’s office to drop something off. He introduced me to the office cleaning lady, a nice enough woman, who totally misread me. She leaned over and said to him, “She’s very pretty, but it looks like she’s afraid to get those nails dirty.” He laughed, “Of anybody I know Linda has no problem getting down and dirty, but she cleans up real ‘purdy!’”

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Although the idiom, “Don’t judge a book by its cover” came about in the journal, American Speech in 1944, the idea has been around for centuries. Heed these wise words written by François Rabelais in La vie de Gargantua et de Pantagruel, “But it’s wrong to be so superficial when you’re weighing men’s work in the balance. Wouldn’t you yourself say that the monk’s robes hardly determine who the monk is? Or that there are some wearing monks’ robes who, on the inside, couldn’t be less monkish? Or that there are people wearing Spanish capes who, when it comes to courage, couldn’t have less of the fearless Spanish in them? And that’s why you have to actually open a book and carefully weigh what’s written there.”1

You have to actually open a book and carefully weigh what’s written there… Relevant words an incredible five centuries later. God, I love words! Down and dirty, but real “purdy!”

1 Wikipedia

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Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, where to get renova speaks with Alex Azar, secretary of Health and Human Services (HHS), not pictured, before they receive the Moderna Inc. skin care products treatment during an event at the NIH Clinical Center Masur Auditorium in Bethesda, Maryland, U.S., on Tuesday, Dec, 22, 2020 where to get renova. The National Institutes of Health is holding a livestreamed vaccination event to kick-off the organization's efforts for its employees on the front line of the renova.

Photographer. Patrick Semansky/Associated Press/Bloomberg via Getty ImagesBloomberg | Bloomberg | Getty ImagesThe slower-than-expected skin care products treatment rollout in the United States has been "disappointing," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Thursday.Officials from Operation Warp Speed, President Donald Trump's treatment program, had previously said the country would immunize 20 million people with the first of the two-dose skin care products treatment in December.

But the Centers for Disease Control and Prevention says that of more than 12.4 million doses distributed, just under 2.8 million have actually been administered."We would've liked to have seen it run smoothly and have 20 million doses into people today, by the end of the (year) 2020, which was the projection. Obviously, it didn't happen and that's disappointing," Fauci said on NBC's "Today" show. "Hopefully, as you get into the first couple of weeks in January, the gaining of momentum will get us to the point where we want to be."States and counties need more resources to accelerate the pace of vaccination, Fauci said.

Trump, in recent days, has sought to defend his administration's treatment rollout by saying it's the responsibility of the states to administer the shots once they're delivered by Operation Warp Speed.Michael Pratt, a spokesman for the program, said earlier this week that the CDC's data is likely off due to delays in reporting."Operation Warp Speed remains on track to have approximately 40 million doses of treatment and allocate 20 million doses for first vaccinations by the end of December 2020, with distribution of the 20 million first doses spanning into the first week of January as states place orders for them," he said in a statement.Dr. Paul Offit, director of the treatment Education Center at Children's Hospital of Pennsylvania, said Thursday on CNN that the federal government invested massively in treatment development, but has failed to match that effort when it comes to distribution and administration."The urgency that we brought to making a treatment and the money that we brought to making a treatment, we spent $24 billion doing essentially a Manhattan Project-like response ... That's the treatment part," he said.

"Now comes the vaccination part, which is equally hard and is equally going to go to require this Manhattan Project-like response.""The federal government does need to step up their response to vaccination in the same way that they stepped up the response to making the treatment," said Offit, who is also a voting member of the Food and Drug Administration's treatments and Related Biological Products Advisory Committee.Dr. Jonathan Reiner, professor of medicine and surgery at George Washington University school of medicine and health services, on Thursday called for "mass vaccination" events. He said the government should consider turning places like election polling stations, football stadiums and race tracks into temporary vaccination clinics."We need to be vaccinating about two million people a day…as opposed to 150,000 people a day.

And I just don't see the urgency," he told CNN. "We need to go into mass vaccination mode, and we need to do it now.".

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News ReleaseMonday, September 6, 2021A genomic analysis of lung cancer in people with no history of smoking has found that a majority of these tumors arise from the accumulation of mutations caused by natural processes in the body buy renova with free samples. This study was conducted by an international team led by researchers at the National Cancer Institute (NCI), part of the National Institutes of Health (NIH), and describes for the first time three molecular subtypes of lung cancer in people who have never smoked. These insights will help unlock the mystery of how lung cancer arises in people who have no history of smoking and may guide buy renova with free samples the development of more precise clinical treatments.

The findings were published September 6, 2021, in Nature Genetics. €œWhat we’re seeing is that there are different subtypes of lung cancer in never smokers that have distinct molecular characteristics and evolutionary processes,” said epidemiologist Maria Teresa Landi, M.D., Ph.D., of the Integrative Tumor Epidemiology Branch in NCI’s Division of Cancer Epidemiology and Genetics, who led the study, which was done in collaboration with researchers at the National Institute of Environmental Health Sciences, another part of NIH, and other institutions. €œIn the future we may be able to have different treatments based on buy renova with free samples these subtypes.” Lung cancer is the leading cause of cancer-related deaths worldwide.

Every year, more than 2 million people around the world are diagnosed with the disease. Most people who develop lung cancer have a history of tobacco smoking, but 10% to 20% of people who develop lung cancer have never smoked. Lung cancer in buy renova with free samples never smokers occurs more frequently in women and at an earlier age than lung cancer in smokers.

Environmental risk factors, such as exposure to secondhand tobacco smoke, radon, air pollution, and asbestos, or having had previous lung diseases, may explain some lung cancers among never smokers, but scientists still don’t know what causes the majority of these cancers. In this large epidemiologic study, the researchers used whole-genome sequencing to buy renova with free samples characterize the genomic changes in tumor tissue and matched normal tissue from 232 never smokers, predominantly of European descent, who had been diagnosed with non-small cell lung cancer. The tumors included 189 adenocarcinomas (the most common type of lung cancer), 36 carcinoids, and seven other tumors of various types.

The patients had not yet undergone treatment for their cancer. The researchers combed the buy renova with free samples tumor genomes for mutational signatures, which are patterns of mutations associated with specific mutational processes, such as damage from natural activities in the body (for example, faulty DNA repair or oxidative stress) or from exposure to carcinogens. Mutational signatures act like a tumor’s archive of activities that led up to the accumulation of mutations, providing clues into what caused the cancer to develop.

A catalogue of known mutational signatures now exists, although some signatures have no known cause. In this study, the researchers discovered that a majority of the tumor genomes of never smokers buy renova with free samples bore mutational signatures associated with damage from endogenous processes, that is, natural processes that happen inside the body. As expected, because the study was limited to never smokers, the researchers did not find any mutational signatures that have previously been associated with direct exposure to tobacco smoking.

Nor did they find those signatures among the 62 patients who had been exposed to secondhand tobacco smoke. However, Dr buy renova with free samples. Landi cautioned that the sample size was small and the level of exposure highly variable.

€œWe need a larger sample size with detailed information on exposure to really study buy renova with free samples the impact of secondhand tobacco smoking on the development of lung cancer in never smokers,” Dr. Landi said. The genomic analyses also revealed three novel subtypes of lung cancer in never smokers, to which the researchers assigned musical names based on the level of “noise” (that is, the number of genomic changes) in the tumors.

The predominant “piano” subtype had the fewest buy renova with free samples mutations. It appeared to be associated with the activation of progenitor cells, which are involved in the creation of new cells. This subtype of tumor grows extremely slowly, over many years, and is difficult to treat because it can have many different driver mutations.

The “mezzo-forte” subtype had specific chromosomal changes as well as mutations in the growth factor receptor gene EGFR, which is commonly altered in lung cancer, and exhibited faster buy renova with free samples tumor growth. The “forte” subtype exhibited whole-genome doubling, a genomic change that is often seen in lung cancers in smokers. This subtype buy renova with free samples of tumor also grows quickly.

€œWe’re starting to distinguish subtypes that could potentially have different approaches for prevention and treatment,” said Dr. Landi. For example, buy renova with free samples the slow-growing piano subtype could give clinicians a window of opportunity to detect these tumors earlier when they are less difficult to treat.

In contrast, the mezzo-forte and forte subtypes have only a few major driver mutations, suggesting that these tumors could be identified by a single biopsy and could benefit from targeted treatments, she said. A future direction of this research will be to study people of different ethnic backgrounds and geographic locations, and whose exposure history to lung cancer risk factors is well described. €œWe’re at the beginning of understanding how these tumors buy renova with free samples evolve,” Dr.

Landi said. This analysis shows that there is heterogeneity, or diversity, in lung cancers in never smokers.” Stephen J. Chanock, M.D., director of NCI’s Division of Cancer Epidemiology and Genetics, noted, “We expect this detective-style investigation of genomic tumor characteristics buy renova with free samples to unlock new avenues of discovery for multiple cancer types.” The study was conducted by the Intramural Research Program of NCI and National Institute of Environmental Health Sciences.

About the National Cancer Institute (NCI). NCI leads the National Cancer Program and NIH’s efforts to dramatically reduce the prevalence of cancer and improve the lives of cancer patients and their families, through buy renova with free samples research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI website at cancer.gov or call NCI’s contact center, the Cancer Information Service, at 1-800-4-CANCER (1-800-422-6237).About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S.

Department of Health and Human Services. NIH is buy renova with free samples the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health®###A study published today by researchers at the National Institutes of Health revealed that about half of individuals who said they don’t want to receive secondary genomic findings changed their mind after their healthcare provider gave them more detailed information. The paper, published in Genomics in Medicine, buy renova with free samples examines people's attitudes about receiving secondary genomic findings related to treatable or preventable diseases. The study was led by scientists at the National Human Genome Research Institute (NHGRI) and the National Institute of Environmental Health Sciences (NIEHS), both part of NIH.

Your browser does not support the video tag. Animation of patient filling out an informed consent form and checking the "YES" checkboxes for both buy renova with free samples Expected Outcome and Secondary Findings. Credit.

Ernesto del Aguila III, buy renova with free samples NHGRI. With the broader adoption of genome sequencing in clinical care, researchers and the bioethics community are considering options for how to navigate the discovery of secondary genomic findings. Secondary findings that come out of genome sequencing reflect information that is separate from the primary reason for an individual's medical care or participation in a study.

For example, the genomic data of a patient who undergoes genome sequencing to address an autoimmune problem might reveal genomic variants that are associated buy renova with free samples with a heightened risk for breast cancer. Based on the American College of Medical Genetics and Genomics recommendations in 2021, individuals who have their genomes sequenced for a clinical reason should also be screened for genomic variants in 73 genes, including BRCA1 and BRCA2, both of which are linked to an increased risk of breast and ovarian cancer. All 59 genes are associated with treatable or potentially severe diseases.

Proponents of a person’s right to not know their secondary genomic findings have argued that, to maintain autonomy, individuals should have buy renova with free samples the opportunity to decide whether to be provided information about genomic variants in these additional genes. "Because these genomic findings can have life-saving implications, we wanted to ask the question. Are people really understanding what they are saying no to? buy renova with free samples.

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Out of 8,843 participants, 8,678 elected to receive secondary genomic findings, while 165 opted out. Researchers assessed those 165 individuals to determine how strongly and consistently they maintained their "right not to know" decision. The researchers wanted to determine buy renova with free samples whether providing additional information to people about their genomic variants influenced their decision and to better understand why some people still refused their secondary genomic findings after they received the additional information.

Following the intervention, the researchers found that the 165 people sorted into two groups. "reversible refusers" who switched their decision to accept to know their secondary genomic findings and "persistent refusers" who still refused. Because these genomic findings can have life-saving implications, we wanted buy renova with free samples to ask the question.

Are people really understanding what they are saying no to?. If they get more context, or a second buy renova with free samples opportunity to decide, do they change their mind?. "It is worth noting that nearly three-quarters of reversible refusers thought they had originally agreed to receive secondary genomic findings," said Will Schupmann, a doctoral candidate at UCLA and first author on the study.

"This means that we should be skeptical about whether checkbox choices are accurately capturing people’s preferences.” Based on the results, the researchers question whether healthcare providers should ask people who have their genome sequenced if they want to receive clinically important secondary genomic findings. Investigators argue that enough data supports a default practice buy renova with free samples of returning secondary genomic findings without first asking participants if they would like to receive them. But research studies should create a system that also allows people who do not want to know their secondary genomic findings to opt out.

The researchers suggest that if healthcare providers actively seek their patients’ preferences to know or not know about their secondary genomic findings, the providers should give the individuals multiple opportunities to make and revise their choice. "The right not to know has been buy renova with free samples a contentious topic in the genomics research community, but we believe that our real-world data can help move the field towards a new policy consensus," said Berkman. Researchers at the NIH Department of Bioethics, NIEHS, Harvard University and Social &.

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News ReleaseMonday, September 6, 2021A genomic analysis of lung cancer in people where to get renova with no history of smoking has found that a majority of these tumors arise from Buy kamagra oral jelly thailand the accumulation of mutations caused by natural processes in the body. This study was conducted by an international team led by researchers at the National Cancer Institute (NCI), part of the National Institutes of Health (NIH), and describes for the first time three molecular subtypes of lung cancer in people who have never smoked. These insights will help unlock the where to get renova mystery of how lung cancer arises in people who have no history of smoking and may guide the development of more precise clinical treatments. The findings were published September 6, 2021, in Nature Genetics.

€œWhat we’re seeing is that there are different subtypes of lung cancer in never smokers that have distinct molecular characteristics and evolutionary processes,” said epidemiologist Maria Teresa Landi, M.D., Ph.D., of the Integrative Tumor Epidemiology Branch in NCI’s Division of Cancer Epidemiology and Genetics, who led the study, which was done in collaboration with researchers at the National Institute of Environmental Health Sciences, another part of NIH, and other institutions. €œIn the future we may be able to have different treatments based on these subtypes.” Lung cancer is where to get renova the leading cause of cancer-related deaths worldwide. Every year, more than 2 million people around the world are diagnosed with the disease. Most people who develop lung cancer have a history of tobacco smoking, but 10% to 20% of people who develop lung cancer have never smoked.

Lung cancer in never smokers occurs more frequently in women and where to get renova at an earlier age than lung cancer in smokers. Environmental risk factors, such as exposure to secondhand tobacco smoke, radon, air pollution, and asbestos, or having had previous lung diseases, may explain some lung cancers among never smokers, but scientists still don’t know what causes the majority of these cancers. In this large epidemiologic study, the researchers used whole-genome sequencing to characterize the genomic changes in tumor tissue and matched normal tissue from 232 never where to get renova smokers, predominantly of European descent, who had been diagnosed with non-small cell lung cancer. The tumors included 189 adenocarcinomas (the most common type of lung cancer), 36 carcinoids, and seven other tumors of various types.

The patients had not yet undergone treatment for their cancer. The researchers combed the where to get renova tumor genomes for mutational signatures, which are patterns of mutations associated with specific mutational processes, such as damage from natural activities in the body (for example, faulty DNA repair or oxidative stress) or from exposure to carcinogens. Mutational signatures act like a tumor’s archive of activities that led up to the accumulation of mutations, providing clues into what caused the cancer to develop. A catalogue of known mutational signatures now exists, although some signatures have no known cause.

In this study, the researchers discovered that a majority of the tumor genomes of never smokers bore where to get renova mutational signatures associated with damage from endogenous processes, that is, natural processes that happen inside the body. As expected, because the study was limited to never smokers, the researchers did not find any mutational signatures that have previously been associated with direct exposure to tobacco smoking. Nor did they find those signatures among the 62 patients who had been exposed to secondhand tobacco smoke. However, Dr where to get renova.

Landi cautioned that the sample size was small and the level of exposure highly variable. €œWe need a larger sample size with detailed information on exposure to really study the impact of secondhand tobacco smoking on the where to get renova development of lung cancer in never smokers,” Dr. Landi said. The genomic analyses also revealed three novel subtypes of lung cancer in never smokers, to which the researchers assigned musical names based on the level of “noise” (that is, the number of genomic changes) in the tumors.

The predominant “piano” subtype had the fewest mutations where to get renova. It appeared to be associated with the activation of progenitor cells, which are involved in the creation of new cells. This subtype of tumor grows extremely slowly, over many years, and is difficult to treat because it can have many different driver mutations. The “mezzo-forte” subtype had specific chromosomal changes as well as mutations in the growth factor receptor gene EGFR, where to get renova which is commonly altered in lung cancer, and exhibited faster tumor growth.

The “forte” subtype exhibited whole-genome doubling, a genomic change that is often seen in lung cancers in smokers. This subtype of tumor also grows quickly where to get renova. €œWe’re starting to distinguish subtypes that could potentially have different approaches for prevention and treatment,” said Dr. Landi.

For example, the slow-growing piano subtype could give clinicians a window of opportunity to detect these tumors earlier when where to get renova they are less difficult to treat. In contrast, the mezzo-forte and forte subtypes have only a few major driver mutations, suggesting that these tumors could be identified by a single biopsy and could benefit from targeted treatments, she said. A future direction of this research will be to study people of different ethnic backgrounds and geographic locations, and whose exposure history to lung cancer risk factors is well described. €œWe’re at the beginning of understanding how these tumors evolve,” Dr where to get renova.

Landi said. This analysis shows that there is heterogeneity, or diversity, in lung cancers in never smokers.” Stephen J. Chanock, M.D., director of NCI’s Division of Cancer Epidemiology and Genetics, noted, “We expect this detective-style investigation of genomic tumor characteristics to unlock new avenues of where to get renova discovery for multiple cancer types.” The study was conducted by the Intramural Research Program of NCI and National Institute of Environmental Health Sciences. About the National Cancer Institute (NCI).

NCI leads the National Cancer Program and NIH’s efforts to dramatically reduce the prevalence of cancer and improve the lives of where to get renova cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI website at cancer.gov or call NCI’s contact center, the Cancer Information Service, at 1-800-4-CANCER (1-800-422-6237).About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases where to get renova.

For more information about NIH and its programs, visit www.nih.gov. NIH…Turning Discovery Into Health®###A study published today by researchers at the National Institutes of Health revealed that about half of individuals who said they don’t want to receive secondary genomic findings changed their mind after their healthcare provider gave them more detailed information. The paper, published in Genomics in Medicine, examines people's attitudes where to get renova about receiving secondary genomic findings related to treatable or preventable diseases. The study was led by scientists at the National Human Genome Research Institute (NHGRI) and the National Institute of Environmental Health Sciences (NIEHS), both part of NIH.

Your browser does not support the video tag. Animation of patient filling out an informed consent form and checking the "YES" checkboxes for both Expected Outcome and where to get renova Secondary Findings. Credit. Ernesto del where to get renova Aguila III, NHGRI.

With the broader adoption of genome sequencing in clinical care, researchers and the bioethics community are considering options for how to navigate the discovery of secondary genomic findings. Secondary findings that come out of genome sequencing reflect information that is separate from the primary reason for an individual's medical care or participation in a study. For example, the genomic data of a patient who undergoes genome sequencing to address an autoimmune problem might reveal genomic where to get renova variants that are associated with a heightened risk for breast cancer. Based on the American College of Medical Genetics and Genomics recommendations in 2021, individuals who have their genomes sequenced for a clinical reason should also be screened for genomic variants in 73 genes, including BRCA1 and BRCA2, both of which are linked to an increased risk of breast and ovarian cancer.

All 59 genes are associated with treatable or potentially severe diseases. Proponents of a person’s right to not know their secondary genomic findings have argued where to get renova that, to maintain autonomy, individuals should have the opportunity to decide whether to be provided information about genomic variants in these additional genes. "Because these genomic findings can have life-saving implications, we wanted to ask the question. Are people really understanding what where to get renova they are saying no to?.

If they get more context, or a second opportunity to decide, do they change their mind?. " said Benjamin Berkman, J.D., M.P.H., deputy director of the NHGRI Bioethics Core and senior author on the study. The research group worked with participants from where to get renova the Environmental Polymorphisms Registry, an NIEHS study examining how genetic and environmental factors influence human health. Out of 8,843 participants, 8,678 elected to receive secondary genomic findings, while 165 opted out.

Researchers assessed those 165 individuals to determine how strongly and consistently they maintained their "right not to know" decision. The researchers wanted to determine whether providing additional information to people about their genomic variants influenced their decision and to better understand why some people still refused their where to get renova secondary genomic findings after they received the additional information. Following the intervention, the researchers found that the 165 people sorted into two groups. "reversible refusers" who switched their decision to accept to know their secondary genomic findings and "persistent refusers" who still refused.

Because these genomic findings where to get renova can have life-saving implications, we wanted to ask the question. Are people really understanding what they are saying no to?. If they get more context, or a second opportunity to decide, do they change where to get renova their mind?. "It is worth noting that nearly three-quarters of reversible refusers thought they had originally agreed to receive secondary genomic findings," said Will Schupmann, a doctoral candidate at UCLA and first author on the study.

"This means that we should be skeptical about whether checkbox choices are accurately capturing people’s preferences.” Based on the results, the researchers question whether healthcare providers should ask people who have their genome sequenced if they want to receive clinically important secondary genomic findings. Investigators argue that enough data supports a default practice of where to get renova returning secondary genomic findings without first asking participants if they would like to receive them. But research studies should create a system that also allows people who do not want to know their secondary genomic findings to opt out. The researchers suggest that if healthcare providers actively seek their patients’ preferences to know or not know about their secondary genomic findings, the providers should give the individuals multiple opportunities to make and revise their choice.

"The right not to know has been a contentious topic in the genomics research community, but we believe that our real-world data where to get renova can help move the field towards a new policy consensus," said Berkman. Researchers at the NIH Department of Bioethics, NIEHS, Harvard University and Social &. Scientific Systems collaborated on the study..

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MISSOULA, Mont tienda renova Buy cialis online. €” There was something a little different on stage at a recent performance of the musical “Sister Amnesia’s Country Western Nunsense Jamboree,” the first production for the Missoula Community Theatre since the beginning of the renova. All the actors wore tienda renova clear face masks. That way, the audience could better see the actors’ expressions, which is “a pretty big deal in live theater,” said Jess Heuermann, who played Sister Mary Wilhelm in the show. Theater companies and musical ensembles looking to resume live performances are coming up with creative ways to make sure the show goes on safely, particularly in states that ban venues from imposing treatment or mask requirements.

In states without such bans, productions can require tienda renova proof of treatments for cast, crew, administrative staffers and audience members to protect against transmission of the renova that causes skin care products. That’s what all 41 Broadway theaters in New York City have done. Other performers and venues are taking additional measures. The Chicago Symphony, for example, is for now limiting performances to 90 minutes or less, with no tienda renova intermission. A Rock Hall, Maryland, venue left the first row of seats empty, in addition to requiring masks and proof of vaccination, for a recent musical performance.

But raising the curtain has been more of a struggle in states like Montana, Florida and Texas, where the politicization of public health measures has found its way inside theaters. Florida and Montana ban state and local governments from requiring tienda renova masks, but private businesses and entities are allowed to do so. Montana prohibits both private employers and government entities from “discrimination based on treatment status.” Florida Gov. Ron DeSantis barred businesses from requiring customers to show proof that they’d been vaccinated against skin care products. In October, Texas tienda renova Gov.

Greg Abbott banned private employers from issuing skin care products treatment mandates. Nine states — Arizona, Arkansas, Georgia, tienda renova Indiana, New Hampshire, North Dakota, Oklahoma, Tennessee and Utah — also have varied restrictions on requiring proof of treatments. Some big-name performers are canceling shows over treatment or mask bans. Singer Michael Bublé, for example, canceled a September show in Austin because the University of Texas arena said it could not impose a treatment requirement for audience members. University officials said they were confident in their health and safety protocols tienda renova.

Country singer Travis Tritt took the opposite stance. He canceled a series of shows at venues with mask and treatment mandates or “pushing testing protocols on my fans.” Local troupes and performers who had been on a renova hiatus don’t have that luxury. They must work with — or around — their tienda renova state’s rules if they want to work at all. A survey by the advocacy group Americans for the Arts found 99% of nonprofit arts groups canceled events during the renova, amounting to 557 million lost ticketed admissions as of July. Though some losses have been offset by federal aid, most arts groups and performers are reporting significant financial losses.

In Montana, the Missoula Community Theatre has reduced capacity and eliminated assigned seating, allowing patrons to be spaced apart while tienda renova still sitting next to their “bubble” of friends and family for performances. Some people who had lowered their masks after taking their seats raised them up again after an announcement just before the performance began that it was required. €œPeople came to the theater tonight because they know the theater is trying to keep everyone safe,” said Paula Jones, a retired nurse in attendance. But some theater operators seem anxious about scaring away tienda renova potential patrons with such rules. For instance, the recently renovated Alberta Bair Theater in Billings, Montana, whose normal capacity is 1,376, recommends patrons wear masks but does not require it.

In Florida, tienda renova nine theaters in Sarasota, along with others in Miami and Tampa, joined to create a uniform set of requirements for theatergoers meant to get around that state’s ban on treatment mandates. Audience members must show proof of vaccination or proof of a negative skin care products test conducted less than 72 hours before any performance. Some people have complained about the policy to the Florida Department of Health, which can impose a $5,000 daily fine for violators of the state’s treatment passport ban. Department officials have not acted on those complaints, but one small Sarasota theater canceled a scheduled November show, saying it feared the owners of the small tienda renova operation couldn’t afford any fines. Theater owners are also finding that a small percentage of people will resist their mask mandates, even after multiple reminders.

If they try to impose a skin care products safety measure that isn’t barred by state law, individuals opposed to the rules will ignore it. €œIt’s like playing whack-a-mole,” said Rebecca Hopkins, tienda renova managing director of the Florida Studio Theatre in Sarasota. €œAs soon as you walk away from some people, they pull their masks down. We’ve had to tell people that ‘We’ve asked you three times politely that we require masks and if you can’t comply, you’ll have to go.’” In Utah, the 360 singers in the Tabernacle Choir at Temple Square in Salt Lake City are vaccinated, along with the orchestra and anybody else who enters the rehearsal and performance space. A handful of singers declined vaccinations and were put on leave, according to choir president Michael Leavitt, the former Republican governor of Utah and tienda renova President George W.

Bush’s Health and Human Services secretary. Additionally, every choir member is tested for skin care products before each rehearsal and performance. Performers are instructed to stay home if experiencing possible skin care products symptoms, including tienda renova sniffles. The choir did, however, drop a mask mandate for singers during rehearsals after complaints that voices were being muffled. Mask-wearing is still required when the choir is not singing tienda renova.

Orchestra members have the option to take off their masks while performing if they feel a mask inhibits their performance. Most important, Leavitt said, the choir, which still hasn’t scheduled its first performance before an audience, is prepared to pull back rehearsals and performances if things go wrong. It hasn’t tienda renova set rules for audiences when performances begin. Some state lawmakers have proposed blocking treatment mandates. €œI have used the analogy of walking into a newly frozen lake.

Take one tienda renova step at a time. Listen for cracking and if we don’t hear any, we’ll move forward. If we do, we’ll scamper back to shore,” Leavitt said. Jess Heuermann performs in a clear mask tienda renova during Missoula Community Theatre’s production of “Sister Amnesia’s Country Western Nunsense Jamboree.” The entire cast wore clear masks so the audience could better see each actor’s expressions. (Terri Elander) Since skin care products, performance groups are relying increasingly on members with medical backgrounds to advise them how to perform safely.

That person for the Atlanta Symphony Orchestra is Dr. Susan Ray, tienda renova a hospital epidemiologist and a soprano with the orchestra’s chorus. Orchestra members now wear masks for both rehearsals and concerts. The choir is masked for rehearsals and plans to be masked tienda renova for its first concert with the symphony, in December. The newly appointed conductor, Nathalie Stutzmann, does not wear a mask so she can better communicate with orchestra members, but is tested daily for skin care products.

Ray is confident the orchestra is taking all the right steps to protect the choir audience, including a requirement that audience members show proof of vaccination or a negative skin care products test. €œBut I’m tienda renova still nervous,” Ray said. €œWe have a lot of chorus members with gray hair, and not everyone is nice and thin.” People 65 and older are among those more likely to experience serious medical issues from skin care products, and obesity increases the risk. Researchers from the University of Colorado-Boulder and the University of Maryland recently advised that while masks reduce the flow of droplets for both singers and instrumentalists, the quality of the filtering material and fit are key components of effectiveness. They also found that the longer that musicians play tienda renova and sing together, the greater the risk.

They recommend breaks after rehearsing or performing for 30 minutes indoors and 60 minutes outdoors. And they also suggest leaving several feet of distance between musical instrument players and singers to reduce “aerosol flow.” “I want to acknowledge the courage of the music directors and the teachers to go ahead and follow our suggestions in the face of all of this adversity, fear and worry,” said Shelly Miller, co-author of the study and a professor of mechanical and environmental engineering at Colorado-Boulder. The Centers for Disease Control and Prevention says that more than 15 minutes of exposure in an enclosed space with poor ventilation tienda renova in which an infectious person is shouting, singing or exercising can increase the risk of transmitting the renova. Some college students hoping to prepare for future employment in the arts worried that canceled classes and performances due to skin care products might limit their future opportunities. Lauren Bergen, 22, a senior theater student at Wagner College in Staten Island, New York, was so worried that she took the 2020-21 academic year off because of “so much potential for things to go wrong.” Now, she’s back acting in Wagner College theater productions, and the school is following the same safety protocols required for Broadway shows.

Bergen’s first fall semester show was “Small Mouth Sounds,” a play chosen, in part, because it required actors to be “mostly silent,” according tienda renova to Felicia Ruff, a Wagner College theater professor. €œWe’ve very strategic in selecting shows that can be done safely,” Ruff said. Related Topics Contact Us Submit a Story Tip.

MISSOULA, Mont where to get renova. €” There was something a little different on stage at a recent performance of the musical “Sister Amnesia’s Country Western Nunsense Jamboree,” the first production for the Missoula Community Theatre since the beginning of the renova. All the actors wore clear face where to get renova masks. That way, the audience could better see the actors’ expressions, which is “a pretty big deal in live theater,” said Jess Heuermann, who played Sister Mary Wilhelm in the show. Theater companies and musical ensembles looking to resume live performances are coming up with creative ways to make sure the show goes on safely, particularly in states that ban venues from imposing treatment or mask requirements.

In states without such bans, productions can require proof of treatments for cast, crew, administrative staffers and audience members to protect against transmission of where to get renova the renova that causes skin care products. That’s what all 41 Broadway theaters in New York City have done. Other performers and venues are taking additional measures. The Chicago where to get renova Symphony, for example, is for now limiting performances to 90 minutes or less, with no intermission. A Rock Hall, Maryland, venue left the first row of seats empty, in addition to requiring masks and proof of vaccination, for a recent musical performance.

But raising the curtain has been more of a struggle in states like Montana, Florida and Texas, where the politicization of public health measures has found its way inside theaters. Florida and Montana ban state and local governments from requiring masks, but private businesses and entities are allowed to do where to get renova so. Montana prohibits both private employers and government entities from “discrimination based on treatment status.” Florida Gov. Ron DeSantis barred businesses from requiring customers to show proof that they’d been vaccinated against skin care products. In October, where to get renova Texas Gov.

Greg Abbott banned private employers from issuing skin care products treatment mandates. Nine states — Arizona, Arkansas, Georgia, Indiana, New Hampshire, North where to get renova Dakota, Oklahoma, Tennessee and Utah — also have varied restrictions on requiring proof of treatments. Some big-name performers are canceling shows over treatment or mask bans. Singer Michael Bublé, for example, canceled a September show in Austin because the University of Texas arena said it could not impose a treatment requirement for audience members. University officials said they were confident in where to get renova their health and safety protocols.

Country singer Travis Tritt took the opposite stance. He canceled a series of shows at venues with mask and treatment mandates or “pushing testing protocols on my fans.” Local troupes and performers who had been on a renova hiatus don’t have that luxury. They must work with — or where to get renova around — their state’s rules if they want to work at all. A survey by the advocacy group Americans for the Arts found 99% of nonprofit arts groups canceled events during the renova, amounting to 557 million lost ticketed admissions as of July. Though some losses have been offset by federal aid, most arts groups and performers are reporting significant financial losses.

In Montana, the Missoula where to get renova Community Theatre has reduced capacity and eliminated assigned seating, allowing patrons to be spaced apart while still sitting next to their “bubble” of friends and family for performances. Some people who had lowered their masks after taking their seats raised them up again after an announcement just before the performance began that it was required. €œPeople came to the theater tonight because they know the theater is trying to keep everyone safe,” said Paula Jones, a retired nurse in attendance. But some theater operators where to get renova seem anxious about scaring away potential patrons with such rules. For instance, the recently renovated Alberta Bair Theater in Billings, Montana, whose normal capacity is 1,376, recommends patrons wear masks but does not require it.

In Florida, nine theaters in Sarasota, along with others in Miami and Tampa, joined to create a uniform set of requirements for theatergoers meant to get where to get renova around that state’s ban on treatment mandates. Audience members must show proof of vaccination or proof of a negative skin care products test conducted less than 72 hours before any performance. Some people have complained about the policy to the Florida Department of Health, which can impose a $5,000 daily fine for violators of the state’s treatment passport ban. Department officials have not acted on those complaints, but one small Sarasota theater canceled a scheduled November show, saying it feared the owners of the where to get renova small operation couldn’t afford any fines. Theater owners are also finding that a small percentage of people will resist their mask mandates, even after multiple reminders.

If they try to impose a skin care products safety measure that isn’t barred by state law, individuals opposed to the rules will ignore it. €œIt’s like playing whack-a-mole,” said Rebecca Hopkins, managing where to get renova director of the Florida Studio Theatre in Sarasota. €œAs soon as you walk away from some people, they pull their masks down. We’ve had to tell people that ‘We’ve asked you three times politely that we require masks and if you can’t comply, you’ll have to go.’” In Utah, the 360 singers in the Tabernacle Choir at Temple Square in Salt Lake City are vaccinated, along with the orchestra and anybody else who enters the rehearsal and performance space. A handful of where to get renova singers declined vaccinations and were put on leave, according to choir president Michael Leavitt, the former Republican governor of Utah and President George W.

Bush’s Health and Human Services secretary. Additionally, every choir member is tested for skin care products before each rehearsal and performance. Performers are where to get renova instructed to stay home if experiencing possible skin care products symptoms, including sniffles. The choir did, however, drop a mask mandate for singers during rehearsals after complaints that voices were being muffled. Mask-wearing is still required when the choir is not singing where to get renova.

Orchestra members have the option to take off their masks while performing if they feel a mask inhibits their performance. Most important, Leavitt said, the choir, which still hasn’t scheduled its first performance before an audience, is prepared to pull back rehearsals and performances if things go wrong. It hasn’t set rules for audiences when performances begin where to get renova. Some state lawmakers have proposed blocking treatment mandates. €œI have used the analogy of walking into a newly frozen lake.

Take one step at a where to get renova time. Listen for cracking and if we don’t hear any, we’ll move forward. If we do, we’ll scamper back to shore,” Leavitt said. Jess Heuermann performs in a clear mask during Missoula Community Theatre’s production of where to get renova “Sister Amnesia’s Country Western Nunsense Jamboree.” The entire cast wore clear masks so the audience could better see each actor’s expressions. (Terri Elander) Since skin care products, performance groups are relying increasingly on members with medical backgrounds to advise them how to perform safely.

That person for the Atlanta Symphony Orchestra is Dr. Susan Ray, a hospital where to get renova epidemiologist and a soprano with the orchestra’s chorus. Orchestra members now wear masks for both rehearsals and concerts. The choir where to get renova is masked for rehearsals and plans to be masked for its first concert with the symphony, in December. The newly appointed conductor, Nathalie Stutzmann, does not wear a mask so she can better communicate with orchestra members, but is tested daily for skin care products.

Ray is confident the orchestra is taking all the right steps to protect the choir audience, including a requirement that audience members show proof of vaccination or a negative skin care products test. €œBut I’m where to get renova still nervous,” Ray said. €œWe have a lot of chorus members with gray hair, and not everyone is nice and thin.” People 65 and older are among those more likely to experience serious medical issues from skin care products, and obesity increases the risk. Researchers from the University of Colorado-Boulder and the University of Maryland recently advised that while masks reduce the flow of droplets for both singers and instrumentalists, the quality of the filtering material and fit are key components of effectiveness. They also found that the longer that musicians play where to get renova and sing together, the greater the risk.

They recommend breaks after rehearsing or performing for 30 minutes indoors and 60 minutes outdoors. And they also suggest leaving several feet of distance between musical instrument players and singers to reduce “aerosol flow.” “I want to acknowledge the courage of the music directors and the teachers to go ahead and follow our suggestions in the face of all of this adversity, fear and worry,” said Shelly Miller, co-author of the study and a professor of mechanical and environmental engineering at Colorado-Boulder. The Centers for Disease Control and Prevention says that more than 15 minutes of exposure in an enclosed space with poor ventilation in which an infectious person is shouting, singing or exercising can increase the where to get renova risk of transmitting the renova. Some college students hoping to prepare for future employment in the arts worried that canceled classes and performances due to skin care products might limit their future opportunities. Lauren Bergen, 22, a senior theater student at Wagner College in Staten Island, New York, was so worried that she took the 2020-21 academic year off because of “so much potential for things to go wrong.” Now, she’s back acting in Wagner College theater productions, and the school is following the same safety protocols required for Broadway shows.

Bergen’s first fall semester show was “Small Mouth where to get renova Sounds,” a play chosen, in part, because it required actors to be “mostly silent,” according to Felicia Ruff, a Wagner College theater professor. €œWe’ve very strategic in selecting shows that can be done safely,” Ruff said. Related Topics Contact Us Submit a Story Tip.

Theavit renova crema

The now-dominant Delta variant of the theavit renova crema skin care products renova continues to plague the Hudson Valley, which renova tretinoin cream 0.02 buy saw another rise in its positive rate.In the Hudson Valley, the average seven-day positive rate of those tested rose to 3.36 percent on Wednesday, Aug. 18 after holding steady at 3.25 percent the theavit renova crema previous two days. Statewide, the average rate dipped for the first time in two weeks, from 3.16 percent on Tuesday, Aug. 17 down theavit renova crema slightly to 3.15 on Aug.

18. New renova-related deaths were recorded in Orange and Dutchess counties.Four other deaths were reported in the Bronx, three in Suffolk County, two in Kings County, and single renova-related fatalities in Chautauqua, Chenango, Monroe, Queens, Rensselaer, and Warren counties.Average seven-day rates in the state’s 10 regions on theavit renova crema Aug. 18, according to the state Department of Health:Central New York. 4.57 percent (down .04 theavit renova crema percent);Capital Region.

4.70 percent theavit renova crema (up .09 percent);North Country. 4.46 percent (up .06 percent);Finger Lakes. 4.07 percent (down .07 percent);Long theavit renova crema Island. 3.96 percent (up .02 percent);Southern Tier.

3.86 percent (down .05 percent);Hudson Valley theavit renova crema. 3.36 percent (up .11 percent);Mohawk Valley. 3.35 percent theavit renova crema (down .12 percent);Western New York. 3.28 percent (down .09 percent);New York City.

2.59 percent (down .03 percent).Each of the 10 regions has seen a marked spike in rates in the past several weeks as the renova continues spreading.At theavit renova crema the beginning of July, no single region had an rate above 1.50 percent.New skin care products cases in the Hudson Valley, according to the Department of Health on Aug. 18 by theavit renova crema county:Westchester. 343 new (134,833 since the renova began);Orange County. 112 (50,837);Dutchess theavit renova crema.

86 (31,087);Rockland. 72 (48,569);Ulster theavit renova crema. 66 (14,479);Sullivan. 28 (7,092);Putnam theavit renova crema.

26 (11,081).A breakdown of skin care products deaths in the theavit renova crema Hudson Valley as of Aug. 19:Westchester. 2,301;Rockland. 761;Orange County.

729;Dutchess. 461;Ulster. 259;Putnam. 94;Sullivan.

76.There were renova cream price 169,710 skin care products tests administered in New York on Aug. 17, according to the Department of Health, resulting in 5,138 newly confirmed s for a 3.03 percent daily rate, down nearly a full percent from the previous day.Forty-nine new skin care products patients were admitted to New York hospitals with the renova as the number rose to 1,937 being treated statewide, up more dramatically from earlier in the summer.A total of 77.9 percent of New Yorkers over the age of 18 have received at least one dose of the skin care products treatment, while 70.2 percent are fully vaccinated. Officials said that 65.6 percent of all New Yorkers have received at least one dose, with 58.6 percent completing the vaccination process.As of Aug. 19, 1,340,401 (3,746 new) first doses have been administered to Hudson Valley residents, while 1,196,843 (2,207 new) have completed the process, both among the highest rates in the state."New Yorkers who have not yet received their vaccination are leaving themselves, their communities, and their loved ones at heightened risk of contracting skin care products, especially with the ongoing spread of the Delta variant," New York Gov.

Andrew Cuomo said. "We have made so much progress thus far and now is not the time to rest. There are no more excuses - the treatment is safe, effective, and free. "If you haven't already, now is the time to get vaccinated as soon as possible." Click here to sign up for Daily Voice's free daily emails and news alerts.Officers rescued a jet ski operator who had been stranded in the Long Island Sound for about three hours.At about 6:30 p.m.

On Wednesday, Aug. 18, a friend of the 60-year-old man notified the United States Coast Guard that the man was more than three hours overdue to return to Rocky Point, according to the Suffolk County Police Department. SCPD said a police helicopter responded just before 7 p.m. And located the jet ski floating in the water with no occupant.

SCPD officers Michael Malone and Shawn Mooney responded onboard the Marine Delta and found the man about a quarter of a mile away from the jet ski and three-quarters of a mile from the shore. Police said the man, a Rocky Point resident, was wearing a life jacket, and he had been trying to swim to the shore.The man was taken on board and brought to shore. He declined medical attention. Click here to sign up for Daily Voice's free daily emails and news alerts.A woman who is the granddaughter of one of the FBI's most wanted men is furious after the agency raided her Hudson Valley home on a tip.The raid took place on Tuesday, Aug.

17, in Orange County in Warwick at the home of Eugene Palmer's granddaughter, Jamie Lynn Rose, said Amy Thoreson, an FBI spokesperson.Thoreson said it happened after the agency "received information early Tuesday morning regarding the possible whereabouts of Eugene Palmer, an FBI Ten Most Wanted Fugitive, who is believed to be armed and dangerous."Palmer is wanted for shooting his daughter-in-law Tammy Palmer three times on Sept. 24, 2012, in the driveway after she sent her two children to school.At the time, Tammy Palmer was estranged from his son, John, whom she had accused of assault.After the murder, Eugene Palmer then drove to his niece's home shortly after and confessed to the crime, left money for his taxes, and then asked for an hour's lead time before she reported the homicide, police said.He is believed to have fled into Harriman State Park where his scent was picked up by bloodhounds near a campsite in the park, police said.Eugene Palmer has been added to the FBI's Most Wanted ListFBISince that time, Palmer has been in the wind, but not forgotten by being added to the FBI's Ten Most Wanted List.After Tuesday's raid, Rose posted on social media that more than 40 gun-wielding agents swarmed her house. She said agents were in trees on her property, as well as her roof, and that she and her children were handcuffed, as agents searched every inch of her property, destroying property in the process.Thoreson said the FBI responds to every lead, call, or tip with all appropriate resources as they continue to seek to locate "this dangerous fugitive, and we take every legal precaution to assure the safety of citizens and law enforcement when responding."Rose said on Facebook that she has bruises and is afraid to open her door. €œThanks for wasting my time, traumatizing my children, and wasting taxpayers’ money.

I literally still feel like I can’t breathe. LEAVE MY FAMILY ALONE," she wrote. Palmer's family claims their father died in Harriman State Park that borders the family's property, but police and the FBI believe that he is still alive and living in another state under an assumed name.On a wanted reward poster, the FBI describes Palmer as being interested in auto racing and as a car enthusiast. He is also an experienced hunter and outdoorsman, they said.

His left thumb is deformed.They are also warning anyone who may know where he is or sees him, that he is considered armed and dangerous.Thoreson added that Palmer is still on the loose, and the FBI asks anyone with information about him to contact the agency at 1-800-CALL-FBI. Click here to sign up for Daily Voice's free daily emails and news alerts.Two fatalities have been confirmed after a crash involving two passenger vehicles and a cement truck in Westchester.It happened around 8:25 a.m. Thursday, Aug. 19 on I-287 eastbound, in the town of Harrison, between Exit 10 (Purchase/Port Chester) and Exit 11 (Port Chester/Rye), state police said.

All eastbound lanes are blocked while accident reconstruction is being conducted. Traffic is being diverted at exit 10 Purchase/Port Chester.The identities of the victim have not yet been released, and more information will be released when it becomes available, state police said.This is a developing story. Check back to Daily Voice for updates. Click here to sign up for Daily Voice's free daily emails and news alerts..

The now-dominant Delta variant of the skin care products renova continues to plague the Hudson Valley, which saw where to get renova another rise in its positive rate.In the Hudson Valley, the average seven-day positive rate of those tested rose to 3.36 percent on Wednesday, Aug learn this here now. 18 after holding where to get renova steady at 3.25 percent the previous two days. Statewide, the average rate dipped for the first time in two weeks, from 3.16 percent on Tuesday, Aug. 17 down slightly to 3.15 on Aug where to get renova.

18. New renova-related deaths were recorded in Orange and Dutchess counties.Four other deaths were reported in the Bronx, three in Suffolk County, two in where to get renova Kings County, and single renova-related fatalities in Chautauqua, Chenango, Monroe, Queens, Rensselaer, and Warren counties.Average seven-day rates in the state’s 10 regions on Aug. 18, according to the state Department of Health:Central New York. 4.57 percent (down .04 percent);Capital Region where to get renova.

4.70 percent (up where to get renova .09 percent);North Country. 4.46 percent (up .06 percent);Finger Lakes. 4.07 percent (down .07 percent);Long Island where to get renova. 3.96 percent (up .02 percent);Southern Tier.

3.86 percent where to get renova (down .05 percent);Hudson Valley. 3.36 percent (up .11 percent);Mohawk Valley. 3.35 percent (down .12 percent);Western where to get renova New York. 3.28 percent (down .09 percent);New York City.

2.59 percent (down .03 percent).Each of the 10 regions has seen a marked spike in where to get renova rates in the past several weeks as the renova continues spreading.At the beginning of July, no single region had an rate above 1.50 percent.New skin care products cases in the Hudson Valley, according to the Department of Health on Aug. 18 by county:Westchester where to get renova. 343 new (134,833 since the renova began);Orange County. 112 (50,837);Dutchess where to get renova.

86 (31,087);Rockland. 72 (48,569);Ulster where to get renova. 66 (14,479);Sullivan. 28 (7,092);Putnam where to get renova.

26 (11,081).A breakdown of skin care products where to get renova deaths in the Hudson Valley as of Aug. 19:Westchester. 2,301;Rockland. 761;Orange County.

729;Dutchess. 461;Ulster. 259;Putnam. 94;Sullivan.

76.There were 169,710 skin care products tests visit our website administered in New York on Aug. 17, according to the Department of Health, resulting in 5,138 newly confirmed s for a 3.03 percent daily rate, down nearly a full percent from the previous day.Forty-nine new skin care products patients were admitted to New York hospitals with the renova as the number rose to 1,937 being treated statewide, up more dramatically from earlier in the summer.A total of 77.9 percent of New Yorkers over the age of 18 have received at least one dose of the skin care products treatment, while 70.2 percent are fully vaccinated. Officials said that 65.6 percent of all New Yorkers have received at least one dose, with 58.6 percent completing the vaccination process.As of Aug. 19, 1,340,401 (3,746 new) first doses have been administered to Hudson Valley residents, while 1,196,843 (2,207 new) have completed the process, both among the highest rates in the state."New Yorkers who have not yet received their vaccination are leaving themselves, their communities, and their loved ones at heightened risk of contracting skin care products, especially with the ongoing spread of the Delta variant," New York Gov.

Andrew Cuomo said. "We have made so much progress thus far and now is not the time to rest. There are no more excuses - the treatment is safe, effective, and free. "If you haven't already, now is the time to get vaccinated as soon as possible." Click here to sign up for Daily Voice's free daily emails and news alerts.Officers rescued a jet ski operator who had been stranded in the Long Island Sound for about three hours.At about 6:30 p.m.

On Wednesday, Aug. 18, a friend of the 60-year-old man notified the United States Coast Guard that the man was more than three hours overdue to return to Rocky Point, according to the Suffolk County Police Department. SCPD said a police helicopter responded just before 7 p.m. And located the jet ski floating in the water with no occupant.

SCPD officers Michael Malone and Shawn Mooney responded onboard the Marine Delta and found the man about a quarter of a mile away from the jet ski and three-quarters of a mile from the shore. Police said the man, a Rocky Point resident, was wearing a life jacket, and he had been trying to swim to the shore.The man was taken on board and brought to shore. He declined medical attention. Click here to sign up for Daily Voice's free daily emails and news alerts.A woman who is the granddaughter of one of the FBI's most wanted men is furious after the agency raided her Hudson Valley home on a tip.The raid took place on Tuesday, Aug.

17, in Orange County in Warwick at the home of Eugene Palmer's granddaughter, Jamie Lynn Rose, said Amy Thoreson, an FBI spokesperson.Thoreson said it happened after the agency "received information early Tuesday morning regarding the possible whereabouts of Eugene Palmer, an FBI Ten Most Wanted Fugitive, who is believed to be armed and dangerous."Palmer is wanted for shooting his daughter-in-law Tammy Palmer three times on Sept. 24, 2012, in the driveway after she sent her two children to school.At the time, Tammy Palmer was estranged from his son, John, whom she had accused of assault.After the murder, Eugene Palmer then drove to his niece's home shortly after and confessed to the crime, left money for his taxes, and then asked for an hour's lead time before she reported the homicide, police said.He is believed to have fled into Harriman State Park where his scent was picked up by bloodhounds near a campsite in the park, police said.Eugene Palmer has been added to the FBI's Most Wanted ListFBISince that time, Palmer has been in the wind, but not forgotten by being added to the FBI's Ten Most Wanted List.After Tuesday's raid, Rose posted on social media that more than 40 gun-wielding agents swarmed her house. She said agents were in trees on her property, as well as her roof, and that she and her children were handcuffed, as agents searched every inch of her property, destroying property in the process.Thoreson said the FBI responds to every lead, call, or tip with all appropriate resources as they continue to seek to locate "this dangerous fugitive, and we take every legal precaution to assure the safety of citizens and law enforcement when responding."Rose said on Facebook that she has bruises and is afraid to open her door. €œThanks for wasting my time, traumatizing my children, and wasting taxpayers’ money.

I literally still feel like I can’t breathe. LEAVE MY FAMILY ALONE," she wrote. Palmer's family claims their father died in Harriman State Park that borders the family's property, but police and the FBI believe that he is still alive and living in another state under an assumed name.On a wanted reward poster, the FBI describes Palmer as being interested in auto racing and as a car enthusiast. He is also an experienced hunter and outdoorsman, they said.

His left thumb is deformed.They are also warning anyone who may know where he is or sees him, that he is considered armed and dangerous.Thoreson added that Palmer is still on the loose, and the FBI asks anyone with information about him to contact the agency at 1-800-CALL-FBI. Click here to sign up for Daily Voice's free daily emails and news alerts.Two fatalities have been confirmed after a crash involving two passenger vehicles and a cement truck in Westchester.It happened around 8:25 a.m. Thursday, Aug. 19 on I-287 eastbound, in the town of Harrison, between Exit 10 (Purchase/Port Chester) and Exit 11 (Port Chester/Rye), state police said.

All eastbound lanes are blocked while accident reconstruction is being conducted. Traffic is being diverted at exit 10 Purchase/Port Chester.The identities of the victim have not yet been released, and more information will be released when it becomes available, state police said.This is a developing story. Check back to Daily Voice for updates. Click here to sign up for Daily Voice's free daily emails and news alerts..

Renova tretinoin cream0.02 pump

Automatically disclosed renova tretinoin cream0.02 pump in applications submitted under the interim order for importing, selling and advertising drugs (proactive release) disclosed on request in applications submitted under the interim order for importing and selling medical devices (released upon request)Information in applications that have been authorized, including those authorized and then revoked, is in scope for public release. This includes. Original application documents documents filed after market authorization is issued (filed at Health Canada’s request or to meet a condition of approval)Information in applications that are refused and were never authorized is out of scope for public release.

This document does not apply to clinical information submitted to support the market authorization of a medical device under renova tretinoin cream0.02 pump the Medical Device Regulations or of a new drug submission under the Food and Drug Regulations (FDR). The exception are new drug submissions for skin care products indications submitted under the FDR. For more information on the public release of this information, see the Public Release of Clinical Information.

Guidance document.Also not applicable under this document is the CBI disclosure authority under renova tretinoin cream0.02 pump section 21.1(3)(c) of the Food and Drugs Act. This section permits the Minister of Health to disclose CBI to certain persons for the purpose of protection or promotion of human health or the safety of the public. For information on this authority, see the guidance document Disclosure of Confidential Business Information under Paragraph 21.1(3)(c) of the Food and Drugs Act.Proactive release of drug application informationWe will proactively publish safety and efficacy information used to support interim order drug applications upon authorization.

This includes clinical information in applications submitted under sections 3, 6 and 14 of the interim order.How to request clinical information in medical device applicationsWe will publish safety and effectiveness information used to support interim order medical device applications when we receive a request from renova tretinoin cream0.02 pump the public and within the limits of our administrative capacity. Requests made for multiple applications will be processed in sequence and subject to prioritization. Further prioritization may be given to products that have a greater impact on the health system, such as.

Products that are used a lot products that have a higher public interestRequests received for information in applications under the interim order will renova tretinoin cream0.02 pump be prioritized over requests for clinical information in non-skin care products19-related drugs submissions and device applications.To request clinical information on medical device applications, use our special portal to submit an electronic request form. Be sure to identify the product name listed on the following sites. Publication process Publication of safety and efficacy information used to support drug interim order applications The publication of information follows the process described in section 4 and Appendix C of the Public Release of Clinical Information guidance document.In accordance with PRCI timelines, we aim to publish a final redacted and anonymized package on our clinical information portal within 120 calendar days from starting the process.

The process renova tretinoin cream0.02 pump starts automatically on the day an authorization is issued.Step 1. Notice to the company and request for proposed CBI redactions and anonymizationFollowing the authorization of a drug under the interim order, Health Canada will give the manufacturer an opportunity to take part in a process initiation meeting. The first 60 days of the 120-day publication process is allocated for the company to review the clinical information.

The company uses the Proposed Redaction Control Sheet (Appendix E, Public Release of Clinical Information (PRCI) guidance document) to propose any redaction of renova tretinoin cream0.02 pump CBI. Proposed CBI redactions should pertain to information that meets the definition of confidential business information. This is defined in Section 2 of the Food and Drugs Act, which mirrors common law in the context of confidential business information that meets each of the following 3 elements of the definition.

That is not publicly available in respect of which the person has taken renova tretinoin cream0.02 pump measures that are reasonable in the circumstances to ensure that it remains not publicly available and that has actual or potential economic value to the person or their competitors because it is not publicly available and its disclosure would result in a material financial loss to the person or a material financial gain to their competitorsFollowing an assessment of the proposals, text within an in-scope document found to meet the above definition will be protected. Similar to Public Release of Clinical Information policies, any information that meets the definition of “clinical information” will not be considered confidential business information. Exceptions to the PRCI regulations described in C.08.009.2(2)(a) and (b) of the Food and Drug Regulations or section 43.12(2)(a) and (b) of the Medical Device Regulations will be considered when applying redactions to confidential business information.

Further information on the application of these exceptions can be found in the renova tretinoin cream0.02 pump Health Canada PRCI guidance document.All personal information should be anonymized in accordance with section 6 of the Public Release of Clinical Information guidance document. The proposal package from the manufacturer should include. The proposed redaction control sheet the draft anonymization report annotated documentsManufacturers submit for Health Canada assessment using either CanadaPost ePost Connect or a suitable secure file transfer site of the manufacturer’s choosing.Step 2.

Health Canada assessment of company representationsWithin 30 days of receiving renova tretinoin cream0.02 pump the proposal package, Health Canada will complete and return our assessment of the proposed CBI redactions and anonymization methodology. Proposed redactions that meet the definition of confidential business information will be protected. We will review the anonymization methodology to ensure all personal information is protected while maximizing the disclosure of useful clinical information.

Step 3 renova tretinoin cream0.02 pump. Revision of proposed CBI redactions and anonymizationIf proposed CBI redactions are rejected or revision is required to the anonymization methodology, in accordance with the Public Release of Clinical Information. Guidance document, the manufacturer will be given 15 days to make the revisions and resubmit.

We will send our final assessment to the manufacturer within 5 days of receiving the revised package renova tretinoin cream0.02 pump. Step 4. Finalization and publicationWithin 5 days of receiving our final assessment, the manufacturer must format and submit the final redacted and anonymization clinical documents within 5 days of receiving our final assessment.

The final documents must comply with the Guidance Document renova tretinoin cream0.02 pump. Preparation of Regulatory Activities using the Electronic Common Technical Document (eCTD) Format. These documents are to be submitted using the Common Electronic Submission Gateway.

We will publish the final redacted documents within 5 days of receiving the final sequence.Publication of safety renova tretinoin cream0.02 pump and effectiveness information used to support medical device interim order applicationsThe publication of information within an interim order application will proceed through the abbreviated process described below. Our goal is to publish a final redacted and anonymized package on our clinical information portal within 120 calendar days from initiation of the process.Step 1. Health Canada screening of requestsAfter we receive a request for information, we will retrieve the interim order application from docubridge (or other location).

Information related to safety and effectiveness will be renova tretinoin cream0.02 pump considered in-scope of publication. Other information will not be released publicly. Only information available at the time the request is made will be considered for disclosure.

Information submitted after the original request for disclosure will renova tretinoin cream0.02 pump be considered for public release upon receipt of a subsequent request.Examples of in scope information include. Clinical testing information validation testing that supports the effectiveness of the product, including testing performed in vitro or in silico summaries or overviews on safety or efficacy pre- or post-market, including literature reviewsExamples of out of scope information include. Manufacturing details not related to safety or efficacy engineering and design details general documents, such as user manuals, package inserts and instructions for use individual patient information, such as patient listings and case report forms, that require extensive anonymization interim clinical study data (see the PRCI guidance)Step 2a.

Health Canada assessment of confidential business information To reduce administrative burden on the manufacturer, we will renova tretinoin cream0.02 pump review in-scope records for confidential business information, as defined in Section 2 of the Food and Drugs Act, which mirrors common law in the context of confidential business information that meets each of the following 3 elements of the definition will be protected. That is not publicly available in respect of which the person has taken measures that are reasonable in the circumstances to ensure that it remains not publicly available and that has actual or potential economic value to the person or their competitors because it is not publicly available and its disclosure would result in a material financial loss to the person or a material financial gain to their competitorsText in an in-scope document found to meet this definition will be redacted using a PDF redaction tool. Similar to Public Release of Clinical Information policies, any information that meets the definition of “clinical information” will not be considered confidential business information.

Exceptions to the PRCI regulations are outlined section 43.12(2)(a) and (b) renova tretinoin cream0.02 pump of the Medical Device Regulations. These exceptions will be considered when applying redactions to confidential business information. Further information on the application of these exceptions can be found in the PRCI guidance document.Step 2b.

Assessing personal informationIn general, in-scope records do not contain a large volume of personal identification renova tretinoin cream0.02 pump information. Any personal information, as defined in the Privacy Act and in accordance with PRCI guidance, information that could help to identify an individual will be protected. For example, this can include the names of authors and investigators as well as subject identification numbers.A large volume of indirectly identifying information is not expected in the medical device records that are in-scope of publication.

Consequently, limited protection of personal information is anticipated.Personal information will be redacted using renova tretinoin cream0.02 pump a PDF redaction tool. Step 3. Notice to the company and request for redaction proposalFollowing the review and redaction of in scope documents, we will send the manufacturer a written notice indicating our intent to publish the identified documents.

A copy renova tretinoin cream0.02 pump of the release package will be sent for the manufacturer’s review. Any further proposed redactions by the manufacturer must be received within 14 calendar days.Manufacturer are asked to use the Proposed Redaction Control Sheet (see Appendix E of the PRCI guidance document) to suggest further redactions.Step 4. Health Canada assessment of company representationsAny further redactions proposed by the manufacturer will be assessed in accordance with the process outlined in step 2, above.

Those that meet the definition of personal renova tretinoin cream0.02 pump or confidential business information will be accepted.Step 5. PublicationIn-scope documents will be published within 120 days following receipt of the request. The redacted information will be uploaded to the Clinical Information Portal, indexed by application number.

Published documents will carry a watermark and be subject to terms of use, as described in the PRCI guidance.Mailing addressInformation Science and Openness DivisionResource renova tretinoin cream0.02 pump Management and Operations DirectorateHealth Products and Food BranchHealth Canada Graham Spry Building 250 Lanark Ave Ottawa ON K1A 0K9 Telephone. 613-960-4687Email. Hc.clinicaldata-donneescliniques.sc@canada.ca Terminology and definitions Anonymization.

Means the renova tretinoin cream0.02 pump process through which personal information is modified by. removing direct identifiers and any related code that would enable linkage with identifying information and ensuring that the remaining indirect identifiers no longer present a serious possibility of re-identifying an individual CBI. Confidential business information, as meant in common law and as defined in Section 2 of the Food and Drugs Act.

in respect of a person to whose business or affairs renova tretinoin cream0.02 pump the information relates, means (subject to the regulations) business information that. Is not publicly available in respect of which the person has taken measures that are reasonable in the circumstances to ensure that it remains not publicly available has actual or potential economic value to the person or their competitors because it is not publicly available and its disclosure would result in a material financial loss to the person or a material financial gain to their competitors Clinical information. Means information in respect of a clinical trial, clinical studies or investigational testing, such as.

clinical overviews, clinical summaries and clinical study reports for drugs summaries and detailed information of all clinical studies and investigational testing that provided evidence of safety and effectiveness for medical devices Clinical study renova tretinoin cream0.02 pump report. Means an "integrated" full report of an individual study of any therapeutic, prophylactic or diagnostic agent (drug or treatment) conducted in patients, in which. the clinical and statistical description, presentations and analyses are integrated into a single report incorporating tables and figures into the main text of the report or at the end of the text appendices contain the protocol, sample case report forms, investigator-related information, information related to the test drugs/investigational products, including active control/comparators, technical statistical documentation, related publications, patient data listings and technical statistical details such as derivations, computations, analyses and computer output FDA.

Food and Drugs renova tretinoin cream0.02 pump Act FDR. Food and Drug Regulations IMDRF ToC. International Medical Device Regulators Forum Table of Contents Medical device.

Has the same meaning as insee the renova tretinoin cream0.02 pump Medical Devices Regulations. For information on the classification of medical devices, please see the guidance documents on the. risk-based classification system for in vitro diagnostic devices (IVDDs) risk-based classification system for non-in vitro diagnostic devices (non-IVDDs) Non-commercial purpose.

Means the renova tretinoin cream0.02 pump information will not be used to support a marketing authorization application anywhere in the world or sold or traded to another person Personal information. Has the same meaning as in Section 3 of the Privacy Act Related linksOn this page About the guidance document This guidance document supports the Interim Order Respecting Drugs, Medical Devices and Foods for a Special Dietary Purpose in Relation to skin care products. The Minister of Health approved the Interim Order on March 30, 2020, to address the unprecedented demand and urgent need for medical devices to treat, diagnose and protect Canadians against skin care products.

The guidance covers sections 15 to 19 renova tretinoin cream0.02 pump of the Interim Order. It remains in effect as long as the Interim Order is in effect. Under the Interim Order, manufacturers and importers must report medical device shortages related to skin care products to Health Canada.

The devices to which the shortages apply are on the List of Medical Devices — Notification of renova tretinoin cream0.02 pump Shortages (specified medical devices). A specified medical device is a device that is either. set out in the list of medical devices or part of a category of medical devices that is set out in that list The guidance is intended to help manufacturers and importers meet their regulatory obligations.

It outlines renova tretinoin cream0.02 pump their responsibilities concerning the mandatory reporting of medical device shortages. About medical device shortages and reporting A medical device shortage occurs when a manufacturer is unable to meet Canadian market demand for the device or for its components, accessories, parts or consumable materials. This does not apply when a substitute device, component, accessory, part or consumable material is available in Canada.

There are 2 types of renova tretinoin cream0.02 pump shortages. actual, when the current supply can’t meet current demand anticipated, when the future supply can’t meet projected demand Manufacturers and importers must. report a medical device shortage provide a shortage status update if there is a change in the shortage information submitted provide additional information related to a shortage when requested by Health Canada report an end of a medical device shortage This guidance document also provides some guidance on how to voluntarily report a medical device shortage that does not fall under the Interim Order.

Everyone has a role renova tretinoin cream0.02 pump to play Manufacturers and importers Manufacturers and importers have a key role to play in preventing and reducing the impact of medical device shortages. They can control the volume of medical devices in the supply chain and can take steps to resolve a medical device shortage when one occurs. They are also in the best position to communicate to customers about the availability of their devices.

When a manufacturer experiences a shortage of a critical medical device it sells, we expect that the manufacturer will take all necessary measures to resolve the shortage as renova tretinoin cream0.02 pump quickly as possible. Provincial/territorial governments and health care authorities Provincial and territorial governments and health care authorities also have an important role to play in preventing and mitigating critical medical device shortages. They can.

conserve and reallocate stock within regions or provinces to where it is most needed and collaborate to share supply identify and secure additional supplies of medical devices from other vendors or another provincial or territorial government identify and secure other compatible substitute medical devices Government of Canada The federal government administers the Food and Drugs Act, Radiation Emitting Devices Act and Medical Devices Regulations.

The process where to get renova includes. procedures when releasing information types of information that fall under the guidelines for CBI and that may be eligible for redaction protection of personal informationScope and application This document applies to information relied upon to issue a market authorization under the. Interim order respecting the importation, sale and advertising of drugs for use in relation to skin care products (September 16, 2020) and interim order respecting the importation and sale of medical devices for use in relation to skin care products(March 18, 2020)The public release of safety and efficacy/effectiveness information reviewed under the 2 interim orders is governed by common law. Information requested where to get renova for release is assessed case by case to determine what is CBI.

Personal information is removed before the safety and efficacy/effectiveness information is released to the public.Following Health Canada’s review of an application, safety and efficacy information will be released as follows. Automatically disclosed in applications submitted under the interim order for importing, selling and advertising drugs (proactive release) disclosed on request in applications submitted under the interim order for importing and selling medical devices (released upon request)Information in applications that have been authorized, including those authorized and then revoked, is in scope for public release. This includes where to get renova. Original application documents documents filed after market authorization is issued (filed at Health Canada’s request or to meet a condition of approval)Information in applications that are refused and were never authorized is out of scope for public release.

This document does not apply to clinical information submitted to support the market authorization of a medical device under the Medical Device Regulations or of a new drug submission under the Food and Drug Regulations (FDR). The exception where to get renova are new drug submissions for skin care products indications submitted under the FDR. For more information on the public release of this information, see the Public Release of Clinical Information. Guidance document.Also not applicable under this document is the CBI disclosure authority under section 21.1(3)(c) of the Food and Drugs Act.

This section permits the Minister of Health to disclose CBI to certain persons for the purpose of protection or promotion of human where to get renova health or the safety of the public. For information on this authority, see the guidance document Disclosure of Confidential Business Information under Paragraph 21.1(3)(c) of the Food and Drugs Act.Proactive release of drug application informationWe will proactively publish safety and efficacy information used to support interim order drug applications upon authorization. This includes clinical information in applications submitted under sections 3, 6 and 14 of the interim order.How to request clinical information in medical device applicationsWe will publish safety and effectiveness information used to support interim order medical device applications when we receive a request from the public and within the limits of our administrative capacity. Requests made where to get renova for multiple applications will be processed in sequence and subject to prioritization.

Further prioritization may be given to products that have a greater impact on the health system, such as. Products that are used a lot products that have a higher public interestRequests received for information in applications under the interim order will be prioritized over requests for clinical information in non-skin care products19-related drugs submissions and device applications.To request clinical information on medical device applications, use our special portal to submit an electronic request form. Be sure to identify the product name listed on the where to get renova following sites. Publication process Publication of safety and efficacy information used to support drug interim order applications The publication of information follows the process described in section 4 and Appendix C of the Public Release of Clinical Information guidance document.In accordance with PRCI timelines, we aim to publish a final redacted and anonymized package on our clinical information portal within 120 calendar days from starting the process.

The process starts automatically on the day an authorization is issued.Step 1. Notice to the company and request for proposed CBI redactions and anonymizationFollowing the authorization of a drug under the interim order, Health Canada will give the manufacturer an opportunity to take part in a process where to get renova initiation meeting. The first 60 days of the 120-day publication process is allocated for the company to review the clinical information. The company uses the Proposed Redaction Control Sheet (Appendix E, Public Release of Clinical Information (PRCI) guidance document) to propose any redaction of CBI.

Proposed CBI redactions should pertain to where to get renova information that meets the definition of confidential business information. This is defined in Section 2 of the Food and Drugs Act, which mirrors common law in the context of confidential business information that meets each of the following 3 elements of the definition. That is not publicly available in respect of which the person has taken measures that are reasonable in the circumstances to ensure that it remains not publicly available and that has actual or potential economic value to the person or their competitors because it is not publicly available and its disclosure would result in a material financial loss to the person or a material financial gain to their competitorsFollowing an assessment of the proposals, text within an in-scope document found to meet the above definition will be protected. Similar to Public Release where to get renova of Clinical Information policies, any information that meets the definition of “clinical information” will not be considered confidential business information.

Exceptions to the PRCI regulations described in C.08.009.2(2)(a) and (b) of the Food and Drug Regulations or section 43.12(2)(a) and (b) of the Medical Device Regulations will be considered when applying redactions to confidential business information. Further information on the application of these exceptions can be found in the Health Canada PRCI guidance document.All personal information should be anonymized in accordance with section 6 of the Public Release of Clinical Information guidance document. The proposal package from the manufacturer should where to get renova include. The proposed redaction control sheet the draft anonymization report annotated documentsManufacturers submit for Health Canada assessment using either CanadaPost ePost Connect or a suitable secure file transfer site of the manufacturer’s choosing.Step 2.

Health Canada assessment of company representationsWithin 30 days of receiving the proposal package, Health Canada will complete and return our assessment of the proposed CBI redactions and anonymization methodology. Proposed redactions that meet the where to get renova definition of confidential business information will be protected. We will review the anonymization methodology to ensure all personal information is protected while maximizing the disclosure of useful clinical information. Step 3.

Revision of proposed CBI redactions and anonymizationIf proposed CBI redactions are rejected or revision is required to the anonymization methodology, in accordance with the Public Release where to get renova of Clinical Information. Guidance document, the manufacturer will be given 15 days to make the revisions and resubmit. We will send our final assessment to the manufacturer within 5 days of receiving the revised package. Step 4 where to get renova.

Finalization and publicationWithin 5 days of receiving our final assessment, the manufacturer must format and submit the final redacted and anonymization clinical documents within 5 days of receiving our final assessment. The final documents must comply with the Guidance Document. Preparation of Regulatory where to get renova Activities using the Electronic Common Technical Document (eCTD) Format. These documents are to be submitted using the Common Electronic Submission Gateway.

We will publish the final redacted documents within 5 days of receiving the final sequence.Publication of safety and effectiveness information used to support medical device interim order applicationsThe publication of information within an interim order application will proceed through the abbreviated process described below. Our goal is to publish a final redacted where to get renova and anonymized package on our clinical information portal within 120 calendar days from initiation of the process.Step 1. Health Canada screening of requestsAfter we receive a request for information, we will retrieve the interim order application from docubridge (or other location). Information related to safety and effectiveness will be considered in-scope of publication.

Other information where to get renova will not be released publicly. Only information available at the time the request is made will be considered for disclosure. Information submitted after the original request for disclosure will be considered for public release upon receipt of a subsequent request.Examples of in scope information include. Clinical testing information validation testing that supports the effectiveness of the product, where to get renova including testing performed in vitro or in silico summaries or overviews on safety or efficacy pre- or post-market, including literature reviewsExamples of out of scope information include.

Manufacturing details not related to safety or efficacy engineering and design details general documents, such as user manuals, package inserts and instructions for use individual patient information, such as patient listings and case report forms, that require extensive anonymization interim clinical study data (see the PRCI guidance)Step 2a. Health Canada assessment of confidential business information To reduce administrative burden on the manufacturer, we will review in-scope records for confidential business information, as defined in Section 2 of the Food and Drugs Act, which mirrors common law in the context of confidential business information that meets each of the following 3 elements of the definition will be protected. That is not publicly available in respect of which the person has taken measures that where to get renova are reasonable in the circumstances to ensure that it remains not publicly available and that has actual or potential economic value to the person or their competitors because it is not publicly available and its disclosure would result in a material financial loss to the person or a material financial gain to their competitorsText in an in-scope document found to meet this definition will be redacted using a PDF redaction tool. Similar to Public Release of Clinical Information policies, any information that meets the definition of “clinical information” will not be considered confidential business information.

Exceptions to the PRCI regulations are outlined section 43.12(2)(a) and (b) of the Medical Device Regulations. These exceptions will be considered when applying redactions to where to get renova confidential business information. Further information on the application of these exceptions can be found in the PRCI guidance document.Step 2b. Assessing personal informationIn general, in-scope records do not contain a large volume of personal identification information.

Any personal information, as defined in the Privacy Act and in accordance where to get renova with PRCI guidance, information that could help to identify an individual will be protected. For example, this can include the names of authors and investigators as well as subject identification numbers.A large volume of indirectly identifying information is not expected in the medical device records that are in-scope of publication. Consequently, limited protection of personal information is anticipated.Personal information will be redacted using a PDF redaction tool. Step 3 where to get renova.

Notice to the company and request for redaction proposalFollowing the review and redaction of in scope documents, we will send the manufacturer a written notice indicating our intent to publish the identified documents. A copy of the release package will be sent for the manufacturer’s review. Any further proposed redactions by the manufacturer must be received within 14 calendar where to get renova days.Manufacturer are asked to use the Proposed Redaction Control Sheet (see Appendix E of the PRCI guidance document) to suggest further redactions.Step 4. Health Canada assessment of company representationsAny further redactions proposed by the manufacturer will be assessed in accordance with the process outlined in step 2, above.

Those that meet the definition of personal or confidential business information will be accepted.Step 5. PublicationIn-scope documents will where to get renova be published within 120 days following receipt of the request. The redacted information will be uploaded to the Clinical Information Portal, indexed by application number. Published documents will carry a watermark and be subject to terms of use, as described in the PRCI guidance.Mailing addressInformation Science and Openness DivisionResource Management and Operations DirectorateHealth Products and Food BranchHealth Canada Graham Spry Building 250 Lanark Ave Ottawa ON K1A 0K9 Telephone.

613-960-4687Email. Hc.clinicaldata-donneescliniques.sc@canada.ca Terminology and definitions Anonymization. Means the process through which personal information is modified by. removing direct identifiers and any related code that would enable linkage with identifying information and ensuring that the remaining indirect identifiers no longer present a serious possibility of re-identifying an individual CBI.

Confidential business information, as meant in common law and as defined in Section 2 of the Food and Drugs Act. in respect of a person to whose business or affairs the information relates, means (subject to the regulations) business information that. Is not publicly available in respect of which the person has taken measures that are reasonable in the circumstances to ensure that it remains not publicly available has actual or potential economic value to the person or their competitors because it is not publicly available and its disclosure would result in a material financial loss to the person or a material financial gain to their competitors Clinical information. Means information in respect of a clinical trial, clinical studies or investigational testing, such as.

clinical overviews, clinical summaries and clinical study reports for drugs summaries and detailed information of all clinical studies and investigational testing that provided evidence of safety and effectiveness for medical devices Clinical study report. Means an "integrated" full report of an individual study of any therapeutic, prophylactic or diagnostic agent (drug or treatment) conducted in patients, in which. the clinical and statistical description, presentations and analyses are integrated into a single report incorporating tables and figures into the main text of the report or at the end of the text appendices contain the protocol, sample case report forms, investigator-related information, information related to the test drugs/investigational products, including active control/comparators, technical statistical documentation, related publications, patient data listings and technical statistical details such as derivations, computations, analyses and computer output FDA. Food and Drugs Act FDR.

Food and Drug Regulations IMDRF ToC. International Medical Device Regulators Forum Table of Contents Medical device. Has the same meaning as insee the Medical Devices Regulations. For information on the classification of medical devices, please see the guidance documents on the.

risk-based classification system for in vitro diagnostic devices (IVDDs) risk-based classification system for non-in vitro diagnostic devices (non-IVDDs) Non-commercial purpose. Means the information will not be used to support a marketing authorization application anywhere in the world or sold or traded to another person Personal information. Has the same meaning as in Section 3 of the Privacy Act Related linksOn this page About the guidance document This guidance document supports the Interim Order Respecting Drugs, Medical Devices and Foods for a Special Dietary Purpose in Relation to skin care products. The Minister of Health approved the Interim Order on March 30, 2020, to address the unprecedented demand and urgent need for medical devices to treat, diagnose and protect Canadians against skin care products.

The guidance covers sections 15 to 19 of the Interim Order. It remains in effect as long as the Interim Order is in effect. Under the Interim Order, manufacturers and importers must report medical device shortages related to skin care products to Health Canada. The devices to which the shortages apply are on the List of Medical Devices — Notification of Shortages (specified medical devices).

A specified medical device is a device that is either. set out in the list of medical devices or part of a category of medical devices that is set out in that list The guidance is intended to help manufacturers and importers meet their regulatory obligations. It outlines their responsibilities concerning the mandatory reporting of medical device shortages. About medical device shortages and reporting A medical device shortage occurs when a manufacturer is unable to meet Canadian market demand for the device or for its components, accessories, parts or consumable materials.

This does not apply when a substitute device, component, accessory, part or consumable material is available in Canada. There are 2 types of shortages. actual, when the current supply can’t meet current demand anticipated, when the future supply can’t meet projected demand Manufacturers and importers must. report a medical device shortage provide a shortage status update if there is a change in the shortage information submitted provide additional information related to a shortage when requested by Health Canada report an end of a medical device shortage This guidance document also provides some guidance on how to voluntarily report a medical device shortage that does not fall under the Interim Order.

Everyone has a role to play Manufacturers and importers Manufacturers and importers have a key role to play in preventing and reducing the impact of medical device shortages. They can control the volume of medical devices in the supply chain and can take steps to resolve a medical device shortage when one occurs.

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Restrictions for religious gatherings and where to get renova gyms will be eased under relaxed skin care products safety rules announced today. From Friday where to get renova 23 October. Religious gatherings/places of worship (excluding weddings and funerals) can have up to 300 people, subject to a skin care products safety plan gyms will only be required to have a skin care products safety marshal if there are more than 20 people in the gym at one time.Treasurer Dominic Perrottet said as the NSW Government eases restrictions the community should continue to be skin care products Safe.“Our aim is to provide as many opportunities as we can for organisations and the community to carry on with their work and lives as much as possible,” Mr Perrottet said.“We want to keep moving forward but for that strategy to be successful we need everyone to follow the skin care products Safety Plans.”Minister for Health Brad Hazzard thanked religious leaders and the community for their ongoing support of the efforts to control skin care products.

€œThe impact of skin care products is being felt right across the community but the further easing of restrictions to allow 300 people at religious gatherings is another cautious step towards a where to get renova ‘skin care products-normal’ life,” Mr Hazzard said.“skin care products is still lurking amongst us so I urge all leaders to continue encouraging everyone at their religious gatherings and places of worship to comply with the health advice to keep themselves and others safe.”Religious gatherings exclude weddings and funerals. However, from 1 December, the number of where to get renova people who can attend weddings will be lifted to 300 people subject to the four square metre rule indoors and two square metre rule outdoors. People attending a religious service will be required to provide their name and contact details when they enter so they can be used for contact tracing.

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I’ve never understood striving for perfection. It’s unattainable. It’s the pinnacle I never want to reach. For if it’s attained, what more is there to achieve?

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Most know that working and working to achieve perfection is a waste of time, but somewhere along the way striving for perfection was drilled into us. It’s at the very core of our existence. When we were young, we worked and worked at achieving something for the accolades we knew would be coming our way. If only we did it right. If only we worked more, we’d hit the mark and hear our praises sung. Our self-worth became dependent on the compliment or two thrown our way. But in doing so, we hung onto the words of others and worked our hands raw, because as children the mark kept moving higher. You could never, ever truly hit the mark. You just kept working and working toward perfection. As an adult I’m telling you, perfection is unattainable. The mark never stops moving.

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Striving for perfection is an addiction. Most perfection addicts falsely believe that achieving perfection indicates excellence. But perfection and excellence are two different things.

The Merriam-Webster Dictionary states perfection as a) freedom from fault or defect, flawlessness, b) the quality or state of being saintly, c) an unsurpassable degree of accuracy or excellence. Excellence on the other hand is a) very good of its kind, b) eminently good, c) first class. Two similar, but totally different degrees in terms.

Who wants to be saintly or flawless anyway? Not I. No siree. I like being a little devilish, a little flawed. Ok, depending on who you ask, quite flawed. Regardless, I don’t demand perfection, but I do demand excellence.

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The driving force of my excellence comes from within. I know I want to be eminently good. First-class. First rate in anything I do. But I could care less what other people demand of or expect from me. I don’t live for them. I live for me. I answer to my own higher conscience, and if it’s good enough for me, then by golly, I’ve hit my mark. If it’s not good enough for them. No worries, they can spend the time to work it and work it to get it perfect. No skin off my nose.

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As a member of Toastmasters International, a public speaking club, in both my leadership and speaking roles, I strive for excellence to the best of my abilities. And therein lies the difference between excellence and perfection. To the best of your ability.

I was terrified when I stood up to give my first speech. Just tell the audience a little bit about myself. If I had strived for perfection that first time up, I never would have gone back to Toastmasters. I would have run out the door with my tail between my legs, or my hand over my mouth, never to look back. In expecting perfection, I never would have become president of the club, nor gone onto win public speaking contests. But because there were goals outlined in the manual, for newbie speakers, I just wanted to hit the mark for those goals. And I did. I had attained excellence for what I was aiming to achieve that night. Looking back now, I’m sure there were countless ums and ahs, long pauses and stuttering in that first speech. But in the end, who cares? I wasn’t laughed off the stage. I hit my mark. I achieved excellence. But not perfection. And that’s ok. If I had walked off that stage as Little Miss Perfect, I would have missed out on so much in learning from others, in pushing my comfort zone, and in becoming a better speaker.

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A fellow Toastmaster gave his third speech this past Tuesday. Was it perfect? Hell no. But was it excellent? You betcha. Even the content of the speech was right on the mark. He said in this day and age, if you ask an audience how many members believe they give 100% at work, guess how many people raise their hands? One hundred percent raise their hands. Know what that means? The average Joe gives 100%. Everybody does. Or so we think. With those odds, in order to be noticed or to move forward, then you better be giving 110%. Do you need to be perfect? Nope. But do you need to demand excellence? Absolutely.

Excellence I can handle. But I don’t ever want to be perfect. No siree, not me. I rather like being Little Miss un-Perfect.