Tuesday, February 21, 2012

Understanding Breast Cancer Responsiveness

Dr. Karen Gelmon (biography and disclosures)

What I did before

When I started treating breast cancer, systemic therapy recommendations were usually based only on the menopausal status of the woman and whether there was cancer in the axillary nodes.? Although estrogen status was being measured the importance of this marker was not appreciated.

What changed my practice

In the last decade there has been an explosion of information about the genetics and molecular makeup of breast cancers with a heightened understanding that breast cancer is not one disease. A landmark publication in 2000 described four types of breast cancer. 1 In a recent as yet unpublished study using newer sequencing technology, researchers at the BC Cancer Agency and collaborators from the UK have suggested 9 distinctive types of the disease. 2 ?The recognition of these subtypes of breast cancer is changing how we approach and treat the disease.

The risk of recurrence is a major concern when an early breast cancer is diagnosed as even with excellent surgery there is a risk of both local and systemic recurrence.? Architectural factors such as the size of the tumour and nodal involvement have classically been used to determine risk. Biological features such as estrogen receptor status, HER2 expression and grade, often measured by Ki67, are now being included in our risk assessment.

The responsiveness of the tumour has also become an important determinant in how we treat the disease.? Responsiveness describes how the tumour will be affected by specific treatments.?? For example, estrogen receptor status determines whether a breast cancer will respond to endocrine therapy; the gene HER2 is associated with response to anti HER2 therapy such as trastuzumab (Herceptin); and high KI67 tumours may be more responsive to chemotherapy than those with a lower grade or KI67.? Thus two similar sized tumours may get different treatment recommendations based on their biology.

What I do now

For patients with low grade estrogen receptor positive tumours I am recommending much less chemotherapy even if there is nodal involvement and/or the woman is premenopausal.? In these tumours, endocrine therapy may be the most effective treatment and chemotherapy may minimally impact survival.? Having said that, some patients still benefit from including chemotherapy in addition to hormone therapy.? For patients with HER2 overexpressing tumours I often recommend chemotherapy and trastuzumab even if the tumour is small with no involved nodes.? Understanding the biology of breast cancers is providing more personalized recommendations and this is translating into better outcomes.

As we further define subtypes, more targeted treatments will be developed but at this time for many cancers we continue to give broad cytotoxic therapy.? As well, new agents are being developed and may be further decrease recurrences. We are also now frequently rebiopsying recurrent cancers to further understand the markers of response and resistance and to tailor treatment. We also need to study the ?host? patient, as the pharmacogenomics of the individual may affect how the drug is metabolized and also may contribute to the effectiveness and the toxicity of the therapy.

How does this affect family physicians?? Treatment recommendations may be more complicated so counseling patients prior to their oncological consultation may be more confusing.? It may be more difficult to know whether chemotherapy will be recommended or not especially if we begin to do more complex assessments of tumours in specialized laboratories. Numerous studies are reported in the lay and academic press and are never substantiated.? Understanding what is of relevance to the care and management of our patients and which data is transient is difficult.? We need to ensure that the government prioritizes an upgrade of our electronic BC Cancer Agency website and electronic record to make it accessible to primary health care providers with the appropriate, evidence based results.

Biological information is often available as soon as the core biopsy diagnoses an invasive cancer.? Early referral to centres with multidisciplinary teams may avoid long delays and confusing information for both the patient and the primary care providers.? Electronic integrated systems may also aid the transfer of information. Frequent updates at family practice meetings and in journals can also provide current treatment and care models to a wider audience.? With this knowledge, family practices can provide a broad idea of the concept of adjuvant therapy for the treatment of early breast cancer and introduce the idea of chemotherapy, hormones and radiation without specifying the details.? Family doctors should be aware of the new patient package, including a patient book that is available through the Alliance for Breast Cancer Information at the BC Cancer Agency. 3 Reassuring patients about the improvements in survival as over 90% of early breast cancer cases in BC now live over 5 years will also help provide helpful information to decrease a woman?s anxiety. 4

References (Note: Article requests require a login ID with CPSBC or UBC)

  1. Perou CM, Sorlie T, Eisen MB, et al.? Molecular portraits of human breast tumours.? Nature 2000; 406 (6797): 747-52 (View article with CPSBC or UBC)
  2. Personal communication with Dr Samuel Aparicio
  3. Alliance for Breast Cancer Information BC, 604 707 5818, and Intelligent Patient Guide ? Olivotto, Gelmon, McCready, 5th edition, 2011 (book)
  4. Coleman MP, Forman D, Bryant H et all.? Cancer survival in Australia, Canada, Denmark, Norway, Sweden and the UK, 1995-2007 (the international cancer benchmarking partnership): an analysis of population ?based cancer registry data.? Lancet 2011; 377(9760): 127-138. (View article with CPSBC or UBC)

UBC CPD Cancer Care Outreach Program on Education (CCOPE)

Over the past 4 months, UBC CPD has been delivering case-based workshops on breast cancer care to various communities in BC, the last workshop is scheduled for Dawson Creek on March 28th.? Workshop contents covers screening guidelines, diagnostic procedures, main treatment options and their potential side effects, and follow-up of breast cancer patients.

Read more about the UBC CPD Cancer Care Outreach Program on Education (CCOPE) .

Read more about CCOPE ? Breast Cancer Community Workshops.

Source: http://thischangedmypractice.com/2012/02/20/breast-cancer-responsiveness/

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Credit unions hope for OK on more business loans - Finance ...

Posted: 4:52 pm Tue, February 21, 2012
By Mark?Anderson
Tags: Al Franken, Jeff Schwalen, Mark Cummins, Michael Ryan, Minnesota Credit Union Network, Small Business Lending Enhancement Act, Tess Rice

Jeff Schwalen, CEO of Hiway Federal Credit Union in St. Paul, recently traveled with other credit union officials to Washington, D.C., to push for a higher cap on business lending. (Staff photo: Bill Klotz)

Franken sponsors legislation to raise lending cap

Minnesota?s credit unions hope to get the OK from Congress this year to lend much more to businesses than current regulations allow. First, they?ll have to overcome a weak lending market and opposition from the banking industry.

Business lending by credit unions is capped now at 12.25 percent of all their assets. The Small Business Lending Enhancement Act, introduced in Congress last March, would raise that cap to 27.5 percent.

Minnesota credit unions are already gaining share in the business market ? their total commercial lending grew 7.3 percent year-over-year to $928 million.

But those volumes were dwarfed by the business lending by banks in the state. Lending by Minnesota-chartered banks ? not including giant lenders like Wells Fargo and U.S. Bank that are chartered elsewhere ? totaled $23.9 billion Sept. 30.

A little more than one-third of credit unions made any business loans during the year, according to the St. Paul-based Minnesota Credit Union Network (MnCUN).

But Minnesota members of Congress told state credit union executives, who visited Capitol Hill earlier this month, that increasing access to capital for small businesses was important, and they supported a role for credit unions.

?We met with senior staff for eight members of the delegation, and they were all positive about supporting the bill as a way to help accomplish that,? said Mark Cummins, MnCUN?s chief executive officer.

U.S. Sen. Al Franken, D-Minn., signed on as a sponsor of the Senate version of the bill. He said in a statement that the credit union expansion will help small businesses ?get the credit they need to grow their companies and create jobs.?

Since credit unions have money to lend, Cummins said, making additional business loans would benefit the borrowers and the lenders.

Credit unions need business loans to replace lower consumer lending levels, he said. Like community banks that lost most of their retail customers to giant regional and money center banks, credit unions lost some of the auto- and home-financing businesses that were staples of the credit union business model.

?We need business lending to provide the third leg of our revenue stool,? supplementing home and consumer loans, said Jeff Schwalen, chief executive at Hiway Federal Credit Union in St. Paul.

Those businesses have slowed during the recession, Cummins said.

Bankers oppose the business loan expansion because they say it would give an advantage to credit unions, which are nonprofits and exempt from corporate income tax, said Tess Rice, general counsel for the Minnesota Bankers Association.

?Banks have plenty of money to lend, but there aren?t creditworthy customers to keep the banks busy now,? she said. ?Saying that it?s necessary for credit unions to be lending to businesses is just incorrect.?

One of the credit union officials who traveled to Washington agrees about the shortage of borrowers.

Jeff Schwalen, CEO of Hiway Federal Credit Union in St. Paul, said his business loan portfolio has declined in each of the last two years. Hiway?s business volume fell from a level just under the 12.25 percent cap at the end of 2009 to 7.25 percent of assets now, or $59.6 million.

?We aren?t seeing much demand locally,? Schwalen said.

Still, there are small business markets that credit unions haven?t tapped yet. Nonprofit groups that work with small businesses such as Minneapolis Consortium of Community Developers and the Small Business Development Center at the University of St. Thomas said credit unions haven?t ventured into their niches.

?A lot of small community banks call me all the time, but we haven?t seen much small business lending with credit unions,? said Michael Ryan, director of the center at St. Thomas.

Cummins said that if the law is passed credit unions that are already active business lenders could make an additional $150 million in new loans.

?It is difficult to predict what Congress will do, but we are hopeful that they will see the benefit of this legislation and pass it this session,? Cummins said.

Source: http://finance-commerce.com/2012/02/credit-unions-hope-for-ok-on-more-business-loans/

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Societal Alienation Inside International locations Based On ...

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Francis Fukuyama, as a famous university student from widely recognized, gave them in-depth in the worsening involved with modern society the united states, a civilised united states. It is usually a number one an associate those countries around the world designed around relatively recent centuries above the oceans through immigration with Europe. All of these nations around the world tend to be in so doing reigned over via the ethos involving individualism, as opposed to the communalism within the more established areas with The japanese not to mention The eu. Individual liberties seem to be proliferating in these lands (which will accordingly become known as a Ultra-West) but throughout those portions of fascination in to the Vatican . . . a strange comparison.

With no extended family aid with these brand new areas, self-sufficiency and personal image actually came out on top. This really is as opposed using the time-tested communitarian worth associated with Japanese groups. These kinds of ideals are actually defined by certain Oriental business leaders as displaying ?Asian values.Woul Nonetheless, migrants within the Mediterranean australia wide memorialize precisely the same morals: people and additionally atomic family members really being backed by your longer familys, esteem for a elders as well as authorised management, including a sense of of a tribe utilizing defensible guidelines, especially when utilized in a new conglomeration about multi-ethnic a persons.

It style involving personal image also has engendered boasts for extra and even more very own liberties. Taken up of a kind, regular admire for others might be declined, if not unnoticed. Situations during uncle particular person legal rights can arise. Australia wide presently, surnames plus tackles stipulating regard to get age, posture, or loving relationship currently have supplied way for you to the particular worldwide using first companies.

Proper rights particular breed the legal ( space ) along with outdoors! The particular growth involved with claimed the legal, improved from those while using the tennis courts to obtain still much more legal (even for outlawed asylum searchers) could be juxtaposed while using the inescapable fact which usually the legal commonly are not prepare through the Constitution, or even Charge of Rights, and also endorsed coverage phrases australia wide. This particular contributes to many societal issues, largely due to a a shortage of relating or maybe counter-balancing personalized duties to your gathered.

Several resulting effects of improved having access to reported particular legal rights will be the struggling generated to make sure you babies because of the impermanence about marriage plus cohabitation, anxiety when unload pavements (all they wanted brutal violence as a result of louts or just a danger so that you can youngsters), the intense misuse in lucrative survival together with free of charge medical-related products, an important denial of non-public task (for example. purchasing capabilities to enable employment and even to re-locate so that you can companies providing a job), and even growing necessitates by way of the well-off to get ?middle style wellbeing.No

Source: http://made4ll.com/societal-alienation-inside-international-locations-based-on-individualism/

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Monday, February 20, 2012

Creighton assistant coach arrested in DUI case (AP)

[unable to retrieve full-text content]AP - An assistant coach of the Creighton University women's basketball team has been arrested on suspicion of drunken driving.

Source: http://us.rd.yahoo.com/dailynews/rss/sports/*http%3A//news.yahoo.com/s/ap/20120220/ap_on_sp_co_ne/bkw_creighton_coach_arrested

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Asia stocks rise as China moves to boost economy (AP)

[unable to retrieve full-text content]

Pedestrians are reflected on an electronic market board in Tokyo, Monday, Feb. 20, 2012. Asian stock markets climbed Monday after China moved to boost bank lending to shore up slowing economic growth. Japan's Nikkei 225 index jumped 1.4 percent to 9,512.28.  (AP Photo/Koji Sasahara)AP - Asian stock markets climbed Monday after China moved to boost its economy by freeing up bank lending and hopes grew that Greece will clinch the aid it needs to avoid bankruptcy.


Source: http://us.rd.yahoo.com/dailynews/rss/stocks/*http%3A//news.yahoo.com/s/ap/20120220/ap_on_bi_ge/world_markets

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Banner Ad Advertising ? Learn To Get More Website Visitors With ...

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02 19th, 2012 |
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Article Source: http://getfliq.com/

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Source: http://www.tz-news.com/2012/02/banner-ad-advertising-learn-to-get-more-website-visitors-with-banner-advertising/

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Sunday, February 19, 2012

Cheap Real Estate Marketing Will Become Increasingly Less Effective

Custom web site design / The SEO Adventure / Real Estate /

Posted by at 7:50 PM on Friday, February 17, 2012

Below I attempt to make an argument that perhaps REALTORs are not allocating enough resources to marketing real estate, and are incurring too much expense in other areas of their lives. Marketing real estate is supposed to be the primary goal if you are a listing agent. If you are a buyer's agent, most likely you are going to have more trouble earning higher commission levels since having a diverse portfolio of listings allows you to capture commission even if someone else sells it. Theoretically, the listing agent will always make more money because of this as long as they have an effective marketing campaign.

I usually see the buyer's agent become a listing agent as they become more successful and perhaps even a broker with agents underneath them in the end. ?It seems like buyer's agents are unable to develop strong marketing campaigns, so they choose to focus on the parts they can do. Perhaps, if I personally build a marketing plan and competing real estate sales team that I will be more effective in demonstrating an effective way to sell real estate. In the process, we can refine our web site systems to more accurately to facilitate the needs of REALTORs through our own experiences selling real estate. The additional income will fund these developments and help create a more diverse range of services.

The concern is that if all my clients refuse to allocate the proper amount of resources, then we will be perceived as a failure to them. ?However, we have all the talent and skills of any world-class design, development and marketing firm. ? I am continuously trying to consider ways to achieve more affordable services, but there are always sacrifices with reducing price. ?In the future, it may no longer be effective to offer certain services unless there is a reasonable chance of success for both sides of the transaction. ? This philosophy of feeling responsible for mutual success should apply to all sales, not just our business.

How many hours of work occur between closings for a REALTOR?

What does the income per hour worked come out to.?? How does this average out with failed contracts and unqualified time wasters eating up your days???What are the pay expectations for a REALTOR and have they become unrealistic??? I don't understand why many REALTORs are unable to afford a reasonable amount for their web site and marketing, yet they dream of selling homes that have $100,000 commission checks. A successful business demands around 80% of its expenses to go towards advertising / promotion efforts even if you need to use your personal time & resources to achieve this. ?Certainly, smaller businesses have trouble doing this, some sacrifices are made, but perhaps a marketing budget that is 5% of your gross income is too small. ?Finding a better balance of perhaps 1/3 or 1/2 income is a more sure way to grow.

If you spent half your money on advertising and shared commission/desk fees and worked 175 hours to make 3% on a $235,000 home, that would be around $7,000 gross income, $3,500 net.? This works out to making $20 per hour and you'd have to sell one a month to make the equivalent of a $45,000 annual salary.?? $45,000 is actually quite a good salary and this is like the equivalent of having a college degree and some seniority in a normal job.? Even at this modest level, it would be possible to invest several thousand per year into additional advertising to grow your business.

If you take home only 2% commission on a 1 million deal, that's $20,000 gross, $10,000 net perhaps in reality.?? If someone had spent an equal amount of time selling this more expensive property (175 hours), that would be $57 per hour,? equivalent of a $120k annual salary assuming another $120k was eaten up in expenses to achieve this.? This is what a full time realtor should be making if they have some actual skill and a small team selling homes between $300,000 and $2 million every month.

Is selling a $235,000 home once every month a realistic amount for 1 full time realtor?

In the worse case, someone makes $40,000 and best case $200,000 annual salary at current 2012 median home prices.?? So lets say a full time realtor expects to make $80,000 a year to have a decent year.? To live a modest life close to work, you might need $25,000 for the whole year.?? If you have a mortgage, maybe double that. ? If you have your own office space, an assistant and a mortgage, you might need all $80,000 to barely cover it. ? So that leaves like $0 to $50,000 per year for buying things, investing, starting a family, etc.?? Investing in the growth of your business seems like it should be a higher priority expense especially if you are already close to maxing out your expenses because you need to be able to get ahead to be able to afford your current expenses.?

If you have almost no time or money to spend on doing the marketing for a job that is essentially a marketing job, something is wrong??Managing yourself to go back and forth between sales efforts and marketing is what I already do so this process of selling homes is nearly identical to my job and I realize it's not easy. Pushing yourself to be a market leader demands you to manage your time better then the competition and not overemphasize one aspect of your business.

Can't afford to spend anything extra right now?

If you simply can't afford to spend any additional time or money, it sounds like steps should be taken to downsize your mandatory recurring expenses and recover your time so you can once again invest in growth.?? I have been doing this for the last year and have managed to decrease my monthly expenses $600 and increase monthly cash flow $600 without raising prices.? This leaves me in a much healthier situation with being able to grow my business without financial pressures.?? If you aren't closing deals, maybe downsizing is better until you grow again.? Don't think you can downsize any further? Here are some ideas:

  • Get a smaller car with better gas efficiency.
  • Move your office back to your home.
  • Move to a different real estate franchise with low or zero fees. Or even start your own.
  • Consolidate your debts and pay them off.
  • Find local markets where you can pay for goods at a lower price instead of the convenience of larger stores.
  • Start cooking your meals again instead of eating out every day.
  • Live with your family or roommates instead of isolating yourself in a huge castle.
  • Motivate your staff to be successful by paying them more for success and either less hourly wages or no wages.
  • Be more modest with gifts & holidays.
  • Try to control your addictive tendencies better by reducing stress and increasing exercise.
  • Make an effort to car pool and share for common needs like shopping and errands.

If you do all of this, suddenly, you'll have another $1000+ per month in free money just like I was able to achieve.?? You'll be back on the healthy track to enjoying life and growing again.

Real Estate Ethics And Administering Some Self Control

When the seller calls to complain that their house is not sold yet and they want to drop you as the listing agent, this is the probably the most stressful situation for a REALTOR. You want to figure out a way to salvage the 3% in additional commission.?? You try to manipulate them into re-listing at the last minute and lose the battle half the time. Perhaps, this is another part of the importance of not overindulging with the commission money. Ultimately, your job is to sell homes and the seller expects you to put your due diligence into marketing their property.

This is not about getting a $10,000 commission for nothing. It's about you effectively selling the home within a reasonable amount of time. Don't make agreements with sellers that you can't honor and be realistic when you fail. Lying to get ahead will eventually come back in the form of increased pressure & anger from the people you have hurt.

Making a profit on every sale might not be a reasonable expectation for you to become a market leader. In fact, most of the largest most successful businesses have intentionally lost money for a period of time to beat their competitors. For example, Netflix was quite affordable until Blockbuster went bankrupt and they have been continuously raising prices ever since. Nearly all cell phones, printers and game consoles have been sold at a loss with the intention of making the profits back in subscriptions, accessories, licensing and software. Gaining market share in a tough economy might be more important that amassing a fortune. You want to build a reputation and network of people that can ensure your future. A more successful marketing campaign can give you the momentum at the right time to have it all come together. Later, ensuring that your marketing campaign is up to date and modern becomes important as well. This means, comparing yourself to competitors, other web sites and to investigate emerging technologies.

You need to enjoy serving people's needs

Over the years, some REALTORs have secretly told me they have a distaste for the actual work of showing homes, talking with buyers and helping people. I would urge REALTORs to reignite an interest in caring about the people they are working with and reduce the negative energy they feel. Providing a service to someone else is an important part of living a good life. It doesn't matter how large or small your act as long as it is with good intention. Don't forget that you're taking a large commission check for relatively unskilled work and if you applied these skills to other industries, you may find your pay to be substantially less and the work even more difficult.

Of course, it's important to make sure buyers aren't lying to you by qualifying them properly. If you have a qualified buyer, you must have the patience and determination to see that they are taken care of regardless of whether you will profit to the level you'd prefer. By treating people with honesty and fairness, you'll earn a reputation for really helping people. Becoming rich at the expense of everyone around you has to be one of the worst choices a person can make. Don't forget to reward the people who influenced your deals appropriately and stay true to your word. Imagine a world where the rule of law did not exist and you had to answer to that person directly - This is a situation where your true integrity would be tested. We all need to treat each other with respect and not hide behind contracts and legal processes.

We Have Amazing Resources For Self Improvement

Steven R. Covey has written one of the most popular and true self-improvement books titled, The 7 Habits of Highly Effective People (1989). I have read this book and I can guarantee that if you live your life according to these principles, you will be happier. I believe sales people are often put in a dangerous position where abuse can easily arise if they start to believe that selfish closing practices are ok. You want to ensure both sides will meet their goals, but this can often only come by first solving the problems that cause you to think you need to be selfish. It can become more important for a salesperson to have strong ethics then people in other types of work because a bad deal can ruin the lives of the buyers.

I Might Be Your Next Business Partner or Competitor

For my web design business, we've previously always let the clients take the risk by paying us in advance for services that may someday let them profit excessively.? This limits my equity and security in the relationship quite a bit since there is no reason for them to pay us after they are successful or even to have a web site in the future.

In 2012, we will be able to have new pricing levels with low cost template offerings and perhaps a shared equity offering that only costs after leads occur.

I'm also considering finding a unseasoned REALTOR to partner with that I would do the online/offline marketing for free, and I'd own the web site / marketing materials 100%.? I'd develop resources for buying/selling presentations, videos, copywriting, link building, web sites, subscriptions to third party services, signs, brochures, everything.? I'd take a cut of the gross commission earned regardless of the lead source in exchange for their efforts and hopefully deliver the best real estate marketing in town.?? The realtor would be responsible for managing the leads, showings and closing processes. This could provide me the ability to build the best real estate web site for our sales efforts above and beyond what we can achieve on web sites for individual clients. ?

My future business partner will want to do it because they will receive world-class marketing services at no cost until the money is earned. ?We could perfect our web site conversion rates and do tests and take risks without having to get permission to do so.? I could flood the market with sites in different niches. ? We could figure out additional problems with our systems that aren't visible now because I'm not yet a realtor.? It could be a good way to grow our services into other areas.

Creativity Has Been Stifled By Limited Budgets

It often feels like my client undervalue technology and online marketing by having more limited budgets with us and a lack of interest in getting involved. Starting a competing real estate business where we invest aggressively into becoming a leading sales team may give us the evidence and system that are needed for other to succeed and our hopefully high sales volume will further justify the value of our marketing services.

The Recruiting Process Begins

If you are a motivated individual who is looking for a semi-permanent business partner to bring you to the next level with your marketing effort in real estate sales, please contact Bruce Kirkpatrick to discuss this further.


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