Item number SCP-1333, Object Class, Enochian, Special Containment Procedures. SCP-1333 is to be contained in the third volume of Gaspar's Revenants, a text which should manage to contain its awesome powers. SCP-1333's energies must be bled off through epic necromantic rituals orchestrated by no fewer than 17 dreadlords. Additional Foundation dreadlords are allowed permitting that additional necromantic angstroms are recorded by the vociferon. Description. SCP-1333 is THE SCREAMING MAN! His power is justifiably feared as a consequence of his very presence ushering in the End Times. Should THE SCREAMING MAN ever actually SCREAM! Then I fear for us all, for his breaths would shatter the very foundations of the universe. Consult a necromancer for further information. Currently, should THE SCREAMING MANS powers ever be harnessed, he could be an unsuppable tool for not super evil, but super good and not evil. Claims that should anyone stare too long into his cavernous nostrils, they will, quote, see into the dark void that lies beyond the soul of man, and, quote, are currently unconfirmed pending testing. Addendum.


So, welcome back. Now, in order to study properties of fluids, we are focusing mainly on two engineering fluids that are air and water, because these are the two fluids that we always deal with in practice in mechanical engineering. For example, we use air compressors, air condenser and similarly, what we have is water for various cooling purposes for various heating purposes in heat exchangers. So, these two fluids are predominantly used in most of the applications in mechanical engineering. So, if I want to study properties of fluids, I would normally like to use such a fluid that is predominantly used in mechanical engineering. And therefore, what we had studied earlier are the air and water properties. So, if I want to go ahead and compare air and water again, just bringing some salient features of these two fluids, let us just see those things. So, if I see air, I can assume it to be a siminal component, though it is a mixture of various gases, which is a plus point. It remains completely in the gaseous form near ambient conditions, because my studies are not going to be at very low temperatures or at very high pressures. I am going to talk about near ambient conditions, wherein we use these fluids mostly. I would like to use such fluids, air and water, which are normally used in atmospheric conditions at around ambient temperatures. And if I compare those properties, that it remains completely in gaseous form near ambient conditions. Similarly, air which is a siminal component, though a mixture, I can still assume to be it an ideal gas for analysis purposes and therefore, I can apply ideal gas law to get various properties of the air at different pressures and temperatures. So, these are the advantages of what we have as air, but then I will be able to study only gaseous air, because at ambient temperature what we have is only gaseous air and therefore, I will not be able to understand the liquid properties of the fluids in liquid form if I use air as a fluid. Because against that, if I see water now, if I were to use water as a fluid, I can observe water in all the three phases at near ambient condition. So, when I say ambient condition, it is around room temperature up to let us say 100 degree centigrade and 0 degree centigrade and for atmospheric pressure, I can see that water exists in all the three forms and I normally use all these three phases for various engineering applications too. So, I can use liquid and gaseous in a predominantly more forms than solid form, but still I can get solid ice, liquid water and gas vapor in the form of steam. All these three phases or the mixture of these phases, all these which constitute water as substance, they exist in near ambient condition. As far as air is considered, I got only gaseous air near ambient condition. The boiling point of air is much below room temperature and therefore, out of these two fluids, two engineering fluids, if I were to study water or air for fluid, I will always prefer water because water exists as a pure substance even if we got two phase mixture of water while air is not and I can study the gaseous as fluids and liquids as fluid also as far as water is considered. So, I am very happy with water if I want to study fluids because I can study gaseous and liquid both. So, water in 0 to 100 degree centigrade easily attainable temperature range, two or three phases mixture of water is a pure substance and therefore, these phases together also constitute as a pure substance. The phase transition from water at one atmosphere are near ambient conditions and are distinctly visible. So, I can study the phase transitions also and each phase of water has significant application in various fields. So, liquid, vapours, solids have got significant applications in various engineering fields also. These are the different advantages of using water as a fluid. So, if I were to study properties of fluid, if I go for water, the fluids which I want to study in the form of gaseous and liquid, water exists in all these forms, water can be studied in gaseous form, water can be studied in liquid form. So, my properties of fluids therefore, can be kept limited to water only. So, here afterwards now therefore, if I want to study properties of fluids, I will study the properties of fluid through water where I can have the gaseous phase, I can have liquid phase also and I can have a combined gaseous plus liquid phase which is also a pure fluid and therefore, I conclude that my study of fluids, properties of fluid can be understood from study the properties of water henceforth. So, my further discussion now will revolve around water vapour, water in gaseous phase, water in liquid phase and water may be gas plus liquid also together. So, various properties of water as far as we know that we got a liquid and we have earlier seen that there is no simple equation of state available for water which is true for liquids, liquid also. The properties of fluids therefore, can be understood and obtained by two methods here and therefore, we can use graphical methodology to get various properties of the for water, we can have a molier chart which gives you some conceptual understanding. We cannot get actual accurate values because it is a graphical method but what normally we refer to get the properties of water is a tabular method where we use steam tables which is basically collection of all the experimental data that they have done and with some property relations they have acquired the data for other points. So, what we have is therefore, steam tables which is what we will refer in the lectures to come, it is essential for calculation because what you get from here are some accurate properties of water at different pressures and temperatures. So, we got steam tables which is what we will refer in future studies. So, summarizing what we have learnt, we have learnt what is a pure fluid, what is the impure fluid, the difference between the two then we concentrate on two basic engineering fluids that we normally use in engineering practice which is air and water and ultimately we concluded that we would like to study water in order to study fluids and we will then go to study the properties of water in the discussions to come.


Hi everybody. My name is Andrea Trotsky and I've been a dental professional since 2005. So that is a while now. I currently have my own practice. I'm a mobile dental hygienist here in Winnipeg, Manitoba where I clean patients' teeth in their own home. It's an amazing service and I love it. I love having my own practice. Something that I see quite often is our parents who are asking me about teething for their babies. I like to see babies, children, as soon as they have one tooth in the mouth. And earlier, if you're concerned about tongue ties or anything like that. And teething is a primary concern. You know, everybody's concerned about teething. What do I do? What if my child spikes a fever? So let me talk about that a little bit. So I'm going to show you guys a little slide that I have here of the children's teeth and when they start to come in to give you an idea. So for babies, their first tooth typically comes in at six months. It could come in at two months. It could come in at seven months. These are just kind of a basic guideline. But if you guys notice over here, it lets you know when that tooth starts to erupt and then when they start to lose that baby tooth and the adult tooth comes in. So six months, they start to get their first tooth usually on the bottom or it could be anywhere until 10 months. This is a wide range, but every baby, every child is different. But this is teething. This is when, even if their tooth isn't popping through the gum line yet, those tooth buds are starting to form. So unfortunately, your baby is going to be uncomfortable there. There's a lot of different signs and symptoms that I'm going to explain for you. And I do have a full document on my website at www.thetoothlady.com. Check it out if you want to see kind of more about signs and symptoms and what to watch out for. Something that you have to remember is it's normal. It's not fine, but it's normal.  Maybe they're crying a bit more and you're concerned. It is completely normal. You will just end up going to emergency waiting several hours for the doctors there to tell you it's normal. Of course, I'm not a doctor. If you are concerned, of course, go to the emergency hospital. But you can also call your doctor as well or even your dentist, but you would basically be bringing them in and they're going to tell you the same thing that I'm telling you is it's normal and they are teething. But let me go over some signs and symptoms for you in a second, but I want to show you that chart once again and kind of explain it a little bit for you. So the first two starts to come in at six months and then notice how on the bottom or I should say on the top, the first tooth on the top comes in at eight to 12 months. So see how this is happening for a while until the 25th to the 33rd month and typically the teeth show up on the bottom first and then the top, but that's not always the case. This is just a general guideline. So a lot of teeth are going to be coming through. As soon as you see that first tooth, it means it's time to start brushing your baby's teeth. Even a toothpaste is completely fine. I have more videos about that, but a toothpaste is fine. Just brush lightly and try to keep plaque and everything off the teeth. But what I want to show you guys and what I want to talk to you guys about, I do have a document here and I'm going to show this on my website as well. Kind of signs and symptoms. So can everybody see this? Okay, I'm just going to move my camera over a little bit. It's kind of hard to see, but I'm just going to pop it up here so I don't forget to mention something. So basically what you should know is your baby's teeth are coming through. It could be just the one, it could be two at a time, it could be five at a time, top or bottom. They are going to be more fussy than usual. It's normal. They are also going to drool a lot. This is one of the main signs and symptoms of teething. But what I do suggest is make sure to clean that away often. You don't want that to sit there and then pull up because then they could start to get a rash where that saliva is pulling up. So do the best you can and clean it away often. If your baby is chewing and gnawing on toys or fingers, it's because they subconsciously are trying to feel better. They want their mouth to feel better that is completely normal. You can get some teething toys that are safe to chew, that are softer. Some you can even put in the freezer to have kind of a cooling effect. I will leave the links for those on my dental Amazon store if you are curious because everybody shops at Amazon. Now their gums around where the teeth are coming in may start to get swollen and this can look very concerning for new parents if you're not used to that. But it's normal. You don't have to rush them to the dentist because if you think about it, what is the dentist going to do? Nothing, right? So you're just putting yourselves and your baby through an unnecessary dental appointment. But having that said, if you're concerned, it can't hurt to call them. And if you're even more concerned, don't be afraid to go to the emergency. But I'm just trying to give you guys things to help you not worry as much. Now their cheeks might get more hot. They might get red. This is another sign of teething. Some babies have this and some babies do not. Unfortunately, they might not be able to sleep very well either. If you notice their sleeping patterns are all over the place, it's because they're teething, they're uncomfortable and they're in pain. So hang in there parents, I promise all of this will be worth it. They might even have a loss of appetite. So if they're not interested in feeding like they normally are, it could be because they're in pain. They're uncomfortable. Something that a lot of parents don't know is they could be pulling at their ears. So you might be thinking, oh, they're starting to explore themselves a little bit. They have found their ears, which is possible. But that's another sign of teething because teeth pain can actually radiate towards their ears. Not nice. Same goes for adults. If you have a toothache, you might also have an earache, unfortunately.  Talk to your doctor about this, but Tylenol, ibuprofen could be given. Tylenol tends to be on the safer side. Make sure to pay attention to how much your baby weighs. Extremely important. If the fever doesn't go down with children's Tylenol, it may be time to call your doctor and or go to the emergency. This is very important, but a fever is very, very normal. So like all of these, you guys, things to keep in mind. I will post this full document on my website at thetoothlady.com. Check it out if you want kind of an itemized list and any teething toys, helpful things that might help. I'm going to put a link to that as well on my Amazon store. Just remember, it's very normal. It typically starts around six months of age. This is where they start to get their first tooth. Even if you don't see it yet, it's developing underneath the gum line. So hang in there. It's not going to be nice for you or your baby, but they will get through it. We all did it. So please hang in there. If you have any questions, let me know and thank you guys so much for watching.


Good day, fellow investors. Ray Dalio recently came out with a new book and when an investor, the biggest hedge fund manager in the world, comes out with a new book, there is always a lot to learn. The purpose of his book is to understand the cause and effect relationships that create that crisis and consequently affect financial markets. So if you're an investor, it is crucial to understand how the economic machine works and that is something that we are going to summarize by discussing his book, at least the first 61 pages of it, which is the summary of the summary of what he has done. His studies enabled him to create the archetypal, the typical model for each important situation, the business cycle, the big debt cycle, deflationary deleveraging and inflationary deleveraging. The main point is to differentiate between what's going on in the long-term in the economy, what are the forces driving the economy, what we do, how we do, how politicians behave, how monetary policyholders behave, etc., etc., and differentiate the long-term picture from the short-term noise that you constantly hear on the news. This long-term is difficult to comprehend and therefore the news always will push the short-term, the short-term, the funny story. However, the long-term is key to comprehend what's going on, how to position yourself, how to position your portfolio, and be at an advantage to all the others that just listen to short-term news. The book contains the following four parts, Delio's template for the archetypal big debt cycle, free iconic case studies, U.S. big depression, great recession, and the Weimar Germany inflation, and then another compendium of 48 K studies, inflationary and deflationary. Delio guarantees that if you take the time to read his 61 pages, and my summary is of course not a summary of his summary, but it's more an introduction to the book, a discussion that might lead you to actually read the book, and that's my goal and I hope Ray Delio doesn't mind. So we'll go through the 60 pages, what I find most important, what I find easy to tell with the goal that you read the book. Tomorrow I'll make another video where I read again the 61 pages and I took out 25 investing tips, so 25 tips that we investors can use that I derived by reading a little bit also through the lines from Delio's book. Then later I'll make also an all-weather portfolio video, what am I doing in relation to what he does, will make, he gives us questions about what is a bubble and how to spot the bubble. So there is a question list, I think I'll make that on Friday, go through the question list to see whether we are in a bubble now or not. So let's start with the book. This is what the book contains and what we'll discuss. What is credit, what is debt, how can it be good or bad, debt crisis, why do we have them, how do we solve debt crisis. The typical long-term big debt cycle, big debt cycle, it's the point of the book. The two kinds of depressions, inflationary and deflationary, the classic deflationary debt cycle, the phases, the role of monetary policy, how to spot bubbles are already mentioned, solving the debt crisis, big risk. The big risk coming from the increase in the wealth gap, the wealth poorly managed crisis, free monetary policy solutions and then the classic inflationary debt cycle, similarly to the long-term but countries don't have currency controls. How it happens, how to get out of it, the risk of it, well and poorly managed inflationary cycles and how it can get to hyperinflation. The key to understand is that all these factors move constantly over time so you really have to apply yourself in depth to understand them, to follow them and to position yourself accordingly in relation to the risk reward, what Ray Dalio is constantly doing. With the typical big debt cycle the key is to understand what is credit and what is debt. Credit is the giving of buying power and that is the promise to pay it back. So whenever you buy something on credit you have created credit and debt. Debt debt can be good or bad. If it is good then it is invested, it produces more, it increases the benefit, economic benefits over the long-term and the benefit, economic benefits are higher than the cost of debt.  If you have too much debt at one point in time debt-debt becomes difficult to manage and then you get into trouble. As we are humans, as we are greedy when things go well, we don't look at the risks, we take more and more debt that at some point debt-debt becomes bad debt because you can't invest it in good things anymore and then we have a crisis and those are normal natural cycles through human history. How those crises are managed that eventually always come depends on whether the policy holders have the ability to control the currency or not. If they have the ability to control the currency it mostly leads to deflationary crisis like we had in the last 10 years but if they can't control the currency because of high foreign debt then it leads to inflationary crisis like Turkey, Argentina or 1920s Weimar Germany. So why do we have debt cycles? Well when you take too much debt you grow faster than what your productivity allows you and then at some point you have the cost of debt hinder your growth which leads you into a recession, deleveraging and then again thanks to new debt the growth reaches again the productivity line.  In this video we'll talk about the long-term debt cycle. Of course it's easier to give credit and the faster economic growth is exciting which makes crisis inevitable. To boot all this into very simple terms you can create a cycle virtually anytime you borrow money. Buying something you can't afford means spending more than you make. So you are not just borrowing from your lender you are borrowing from your future self. Essentially you are creating a time in the future in which you will need to spend less than you make so you can pay it back. The pattern of borrowing spending more than you make and then having to spend less than you make very quickly resembles a cycle. This is true for a national economy as it is for an individual. Borrowing money sets a mechanical predictable series of events into motion. And these cycles of spending are always self-reinforcing. When things are good everything looks like it will continue indefinitely and then confidence is very high you are not afraid to take that mortgage you're not afraid to take that car loan you buy more the economy is doing well unemployment is extremely low new money comes to the market new consumption new demand and that makes everything look perfectly. However at some point there is a tipping point that that is reached and nobody is going to prevent that tipping point to be reached because then you don't win political points and inevitably the cycle turns and then we have the same self-reinforcing cycle that was increased demand increased spending leading everything up turning everything down and putting the economy into crisis. The key is that those economies those crisis can be managed and if done well the next point up is higher than the previous point up and the lower next recession is higher than the previous recession and this you have those ups and downs that are well managed. There are four types of levers that policymakers can pull to bring that and that service levels down relative to the income and cash flow levels that are required to service them austerity so you can spend less that defaults and restructurings so you let someone default someone you finance you bail them out the central bank can print money and transfer money directly. The key is to create a beautiful deleveraging so that everything is in balance that nobody is hurt too much and that there is positivity around the economy for the long term and such small term crisis can easily be managed with lowering interest rates and then you have those small debt cycles but those small debt cycles accumulate and sometimes there is a big debt cycle that can be managed but it has to be done properly. So the typical debt cycle can be managed but up to a point in time because interest rates are lowered when possible to make debt services cost smaller what's extremely important to look is the stability of the interest burden as interest rates go lower the debt goes higher but the interest the debt service cost remain flat and that's why interest rates constantly have been going down for the past 40 something years. A depression happens when those interest rates cannot go lower and then we have boost of the big debt cycle that happened in 2008. Back to the short term cycles those happen on average every five years long-term on average every 75 years you can see here everywhere where the red dips below the black line there has been a recession in the US. The last big one was 1930s and the well-managed 2008-2009. Now when that debt cycle reaches its limit it can lead to two types of crisis one is a deflationary crisis and the other is an inflationary crisis. A deflationary crisis happens when a country lowers interest rates to zero but can't lower them more then of course austerity happens you cannot spend more there is not a lot of credit people don't want to invest the negative cycle is spiraling down and defaults restructurings unemployment rate goes up and the country has to balance itself between taking from those who were greedy in the past let's say and giving monetary stimulating the economy in order not to create hyperinflation but to manage the deflationary effects. If a country has a lot of that in the foreign currency and the negative balance of payments then it can lead to a hyperinflationary crisis because the country starts to print money to cover for the lack of confidence in the domestic currency the lack of demand for the domestic currency and then everything spirals in a much much worse crisis so a deflationary crisis is much easier to manage than an inflationary crisis let's begin with a deflationary depression it's key to understand that all these things happen in phases that take a lot of time let's say 12 years of on average from the early part of the cycle to the boom bust and normalization if we look at the cycle we have the early part that is low things are good the Goldilocks part of the cycle then the bubble starts that starts to rise faster than income and this produces strong accelerating assets returns and growth self-reinforcing income spending increases the prices of assets network increases significantly and asset values rise borrowers capacity to borrow so all of those things rise together and that's not sustainable because that growth rates are increasing faster than the incomes that will be required to service them at some point in time however borrowers feel rich they spend more than they can earn and buy assets at high prices with leverage here is one example of how that happens the start of the bubble the bull market equity prices go up so we have a bubble total debt goes up fast and the debt service also in relation to the GDP goes even faster so bubbles are most likely to occur at the tops in the business cycle the balance of payment cycle and long-term debt cycle as a bubble nears its top the economy is most vulnerable but people are feeling the wealthiest and the most bullish now you might think that policy makers that politicians will intervene to constrain that bubble but that usually doesn't happen the opposite is happening now because when you intervene nobody likes you you don't win any points everybody thinks that this economy how it goes when it is in a bubble period it can go on forever like that until it is the opposite that happens and then we have a crisis and then again monetary policy central banks they focus on inflation and growth they don't focus on the growth of debt and that's radios main goal with this book is to introduce focusing is the hope that central bankers will start focusing on the growth of the debt pile and not just on inflation and growth hoping that they can manage it without focusing on the debt pile they will never ever be able to manage inflation and growth they have to manage the debt pile in order to prevent going thing that things go into a bubble but that's again anti-politician so that is here the debate that delio has against monetary policy makers in the meantime not much tightening until rate later in the bubble and then it's too late and then the downturn is self-reinforcing creating another depression delio even shares his view on how to spot bubbles i'll make a special video about that probably on friday during the news when we incorporate what's going on in the world now and check whether it is in a bubble so tune in on friday for that video now to anticipate the debt crisis ray delio says that we have to really focus also on the debt levels of the individual entities in a system because those get lost in the averages housing bubble in 2008 everybody was focused everything looked well in 2007 but the housing market was too leveraged and that led to the crisis so just one entity into the averages and that's what we have to focus on one country one entity here one entity there and then you get into trouble at some point something happens an external shock defaults some entity in that ecosystem goes bust and that starts a chain starts a self-reinforcing downtrend people start losing their jobs they can't pay their debt defaults increase creditors lenders are not willing to lend any more money that easily the economy contracts and then we have a downward spiler more unemployment so less demand for things and everything that was pushing the economy higher is now pushing the economy lower stock prices start to crash down and the key is to understand that okay then in short-term crisis monetary policies simply lower interest rates which stimulates the economy but when interest rates are already close to zero we come to the end of the long-term debt cycle and this is exactly what happened in this decade and in the 1940s when interest rates can get lower than zero anymore than we are facing depression just an example household debt as a percentage of network increases as network goes down because stocks go down asset prices get go down but that remains fixed just to mention on the big risk that daily is seeing the emerging of populism and the net wealth gap the bottom 90 percent of people are having the same wealth as the top 0.1 percent of people in the us when that happened last time we have a populist era similarly across the globe similarly now we have populists in Italy who had them in Greece and that's a big risk that he sees for the stability of the country to summarize the bubbles the tops the depressions everything can be well managed or poorly managed so i really urge you or to pause this video and to read through this how to manage things and how not to manage things or to simply download the pdf to do that what's extremely important to learn from daily is that there are free monetary policy steps that can help in managing those crises the first one is of course lowering interest rates the second one is printing money quantitative easing and the third one is the one that we haven't seen yet but it's called helicopter money so giving money to those that really need the directly in order to support the economy not true quantitative easing that has been the case where they buy assets lift the prices of assets increase the rich become richer and that in that way hope to support the economy when the banks intervene when there is disruption when there are debt restructuring defaults sometimes at some point things get back to normal austerity and these things getting back to normal can last a long time or a shorter time depending on how the crisis is well managed or badly managed for the normalization part it typically takes roughly five to ten years hence the term the last decade for real economic activity to reach its former peak and it typically takes longer around a decade for stock prices to reach former highs so average 119 months for stock prices to reach former highs 10 years GDP six seven years and change in debt to GDP post stimulation is minus 54 percent between minus 29 and minus 70 going to inflationary depressions and currency crisis the key to understand is that the countries that don't have a reserve currency have low foreign exchange reserves have a large foreign debt have a large and increasing budget and current account deficit have negative real interest rates have a history of high inflation negative total return in the currency those are so easily subjective to an inflationary crisis so here is the well managed inflationary crisis the poorly managed inflationary crisis you can read here how policy makers should go about it and how they shouldn't go about it and then the story is always the same some point at some time the currency gets better and things start to go back to what they were before and the new cycle begins however it's important to say that if it really becomes a hyperinflation then investor returns go to zero then unfortunately if you invest that is something that you don't want to see but that's a risk you have to think about when it comes to inflationary depressions so this is the summary a little bit just to give you an idea of what this is about and the key is now to take what delio has found because he has gathered this knowledge from looking at 48 past crisis because in nature in the economies everything works according to a pattern and the key now is to apply that pattern onto what is going on now what is the risk how does the us economy now fit that pattern that he has created and then we know the risk rewards of investing of our actions how much to be hedged what to do and that's something we are going to discuss in the upcoming videos the next video will be about the 25 tips i gained from delio's book then we'll discuss whether the us is in a crisis on friday and then we'll discuss okay where are we now in the cycle what do we have to expect and how to best position ourselves in line to ray delio's or weather portfolio and this video you can expect it somewhere in the weekend if you're looking at this later you can always check the playlist everything will be there thank you for watching looking forward to your comments and i'll see you tomorrow with 25 investing tips from ray delio's book


So I was literally sitting down because I wanted to do a lyrical breakdown of some of the tracks on Logic's new album and then the James Charles subscriber count feed versus Tati Westbrook subscriber count popped up and I opened it up and I'm like oh my god and I had so many questions that I want to bring up as a topic of conversation. So today we're going to be talking about something called Shot Infrauda. What is up everybody this is Chris from the Rewired Soul where we talk about the problem but focus on the solution and if you're new to my channel what I like to do is take a look at the YouTube community and try to turn this mess into a message because what point is watching things like that subscriber count behind us if we're not trying to learn from them and apply it to our everyday life. So if you're into that kind of stuff make sure you subscribe and ring that notification bell. So yeah like I said this right here popped up on my screen I'm like what is what is this and I clicked on it right obviously I've heard about how many subscribers James Charles is losing how many Tati is gaining she's she just passed seven million right but that's not what was fascinating to me what was fascinating to me is that right here right here in this in this live stream there are over 20 000 people okay that is one third of a football stadium sitting in a live stream right now watching these numbers and I'm like oh my god like I remember when the drama get in happened last year with like Manny MUA and Laura Lee and seeing things like this but there was maybe like hundreds or maybe a couple thousand this has 20 000 people and just when I imagine that many people I just have so many questions some of you who have been long-term like rewired soldiers you know that I I kind of just take a look at at human behavior and our thought processes and I'm just like what's going on so when I saw this I was just like confused and interested and I I started like looking on the internet to try to see like is there something that makes sense so we are going to be talking about Schadenfreude all right and I hope I'm saying that right I actually did like the google like thing a few times to try to see if I can hear it Schadenfreude Schadenfreude but anyways I I it it kind of reminds me of just like people who would go to the viewing of somebody like getting the electric chair right like this this kind of feeling of justice being served now what is Schadenfreude Schadenfreude just the the loose definition of it is getting getting pleasure out of somebody else's pain right and I was trying to look for something a little bit more fitting for this situation because there are some people who just get natural pleasure out of seeing other people's pain but this is a different case because it's when like like karmic justice is being served and we're going to talk more about karmic justice in a second so it's a little bit different with the James Charles and Tati Westbrook situation and yeah I ended up stumbling across this psychology today article that kind of breaks down why why we get pleasure from this all right so this article from psychology today I'll link it down in the description below but here's an excerpt from it the brain will choose pleasure over fear every time have you ever put someone down at work or at home just as it is beneficial to include someone in the group make them a member and access their resources it is also rewarding to exclude someone from the group deny them access to resources and thereby save more for yourself at that other person's expense we are conditioned to avoid what we fear and seek what gives us pleasure if alienating someone is pleasurable perhaps it is also addictive on some level we know that to put someone down to lie or to cheat is not a good thing to do yet in little ways we may do it with some frequency a research team out of the University of Brazil I think I said that right in Switzerland gave study subjects extra dopamine the chemical of pleasure that all drugs and alcohol force the brain to release people who got more dopamine were more likely to cheat if they knew they were not going to get caught or suffer any consequences so yeah what what that's saying is is shot in Florida can be somewhat addictive too pleasure comes from the dope dopamine right I'm a recovering drug addict and alcoholic you get addicted to that right and I'm wondering I'm wondering if like people are like like getting off on this like watching this like every tick of James subscriber going down people like yeah yeah right like this this live stream not only does it have 20,000 people watching it but there's like super chats in there and I'm like why why like no hate to whoever's hosting this live stream like make your money baby girl but it's just interesting to me the human behavior behind this so when it comes to cancel culture in general I feel that we have this this this thirst for like comic justice right where something happens or we find out somebody did something wrong we want something bad to happen to them we want that person to get what we feel like they deserve but one of the things that just comes up in my mind is in this day and age with social media and all of the public shaming and cancel culture and everything like that like it's I feel I this is my opinion I feel like we've kind of gone two extremes right like don't get me wrong James Charles did some awful things not cool things but I don't know it just feels like there's not a spectrum what else is very interesting about this whole situation is not only seeing James Charles numbers go down but Tati Westbrook her numbers going up so it almost feels like in these situations you know we're looking for a hero like the one who who leaked this information the one who exposed the other person I remember last year during the drama get-in situation um and more things have changed since then because Gabriel Zamora he exposed Manny MUA and people had a similar sub feed count going same thing with James Charles and you saw Laura Lee and Manny going down Gabriel Zamora and and Jeffrey Starr going up right so one thing that's interesting to me is how I think as part of our tribal instincts is that people are always looking to pick sides right like this is something that like goes back to like when I was younger not too young but in my early 20s but like when twilight was around right like team team vampire guy or team wolf guy I forgot what their names were Edward and wolf guy right or or oh oh how about this going back to friends right when that whole thing like they were on a break you know what I mean there was like team Ross and team Rachel and I feel like people try to align themselves when these things happen and why else why else like when you look on Twitter and there's so much talk and chatter going around this and whenever these situations happen with anybody you see people picking sides and I feel like I feel like people when like part of their just like evolutionary psychology it's like they're they're vocalizing on social media like on Twitter like here's whose side I'm on right I'm on this side I'm on this side look at me I'm part of the tribe I'm not part of that tribe I am part of this tribe accept me right and I would love to hear from all of you like if you're somebody watching this live stream tell me down in the comments like I'm trying to understand I'm trying to figure this out like dang there's there could be some great psychological studies on this thing like why are you watching this right why do you why why are you so fascinated by this why are you intrigued by this why are you getting pleasure out of this why have you vocalized um whose side you're on if you're somebody who switched from James Charles to Tati like that's really interesting like why were you not subscribed to Tati Westbrook before why are you now right if because it almost feels like subscribing to a channel in this day and age it's not even about you like that creator or you like their content sometimes it just it's a sign of who you support right and nobody can really see who you support like it's not like when you walk around on the streets people see who you're subscribed to so nobody else knows who you're subscribed to unless you tell them so why is that like why were these people not subscribed to Tati Westbrook before but they are now because I'm sure I'm sure if you were subscribed to James Charles you you knew who Tati Westbrook was so I don't know and this this place this platform for me I get to kind of like toss around ideas I'm actually starting a podcast this coming week as well and it's just like where I just want to throw out ideas and have conversations like I like working through these things in my head and have an audience where I can converse with you and just try to understand this because life is this crazy complex thing us humans we act so strangely it seems to defy logic and there's just so many questions out there so I would love to hear what you guys's thoughts are on this subject down in the comments below all right but anyways that's all I got for this video if you liked this video please give it a thumbs up if you're new make sure you subscribe and ring that notification bell because I make a ton of videos and a huge huge thank you to everybody supporting the channel over on Patreon you are all amazing and if you would like to get your name in the credits get access to our monthly Q&A and some other perks and benefits and help support what I'm doing here click or tap right there all right thanks again so so much for watching I'll see you next time


Good afternoon, everyone, and thank you for joining our webinar today. Welcome to my office. This is my office at the Breast Center at Bayshore Medical Center. I'm so excited to be with you today. As Kaylin said, I'm Dr. Harriet Borowski, and I'm honored to serve as medical director of Breast Imaging both at Bayshore Medical Center and at Riverview Medical Center. This is my dream job, and I am so pleased to work with my really talented colleagues, including Dr. D'Angelo, who I'm sure many of you know, and Dr. Sokolovskaya. Of course, it's October, and it's Breast Cancer Awareness Month, and I am certain it doesn't need to be October for all of us, everyone who's on this webinar. I know Breast Cancer has touched our lives in one way or another because it is so common. I'm so pleased to be discussing with you what has been my professional passion for the past two decades, and that's early detection and diagnosis of breast cancer. During today's talk, I'm going to share with you what I have learned about breast cancer and what I think are the most important things that you need to know about breast cancer that could possibly save your life or that of your friend or family member. So we're going to talk about why we screen for breast cancer, who should be screened, when and how often, what imaging modalities are best, and where to be screened for breast cancer. We all know breast cancer knows no racial, ethnic, socioeconomic, or political divides. It is the most frequently diagnosed cancer in women with about 2 million cases, new cases per year worldwide. Nearly 290,000 cases in the United States per year. Think about that number. It's a big number, and what about those of us that are so blessed to live in the state of New Jersey? Nearly 8,500 new cases per year, and it is just an all too common and significant cause of deaths with nearly 40,000 per year in the United States and about 1200 per year in our state of New Jersey. And these are the most recent statistics from the American Cancer Society showing estimated cancers. And I have to say for the past number of years, breast cancer has surpassed prostate cancer, but in 2022, prostate cancer is the most common malignancy, and breast cancer is right behind it. However, in the United States, breast cancer, new cases, and these are new diagnosis of cancer, is more frequent than prostate cancer, generally speaking.  And you may or may not know that the state of New Jersey is a hot spot. It is in the top 10 states of hot spots for breast cancer. As you can see on the East Coast, there is New Jersey, Delaware, Connecticut, New Hampshire, North Carolina, and then mid states. And it is a hot spot. No one knows why these states and Hawaii is also a hot spot for breast cancer incidents for reasons that we don't know. What about counties?  Mommeth County is up there, but for whatever reason, Hunterton County has the highest incidence in the state of New Jersey. And after I'm finished talking, if anyone has any ideas about why this might be, certainly share it. I'm relatively new to the state of New Jersey. So let us know. Here's the good news about breast cancer. Out of all of the cancers we can get, it is highly curable, especially when it's found early. As you can see from this graph, when breast cancer is localized to the breast, as it is in 62 percent of cases, and this exactly corresponds to about the number of women in the United States that gets screened. It's about 62 to 65 percent. So we all need to increase that number, and we all can by getting the word out. That's why I'm here with you today. When breast cancer is localized to the breast, look at the five-year survival rate. It's 99 percent. When it's regional, and that means involving lymph nodes on that side, as it is in 30 percent of the cases, the five-year survival rate goes down, but it's 86 percent. And when it is diagnosed at a stage when it is metastatic, that means spread to other parts of the body beyond the axillary or underarm lymph nodes, as it is in six percent of cases, the five-year survival rate is much lower. It's 27 percent, and that's why I'm here today to tell you about the importance of screening. So if you look at the incidence of breast cancer, and this is in the United States, divided into racial and ethnic people, you can see that white women in the United States have the highest incidence of breast cancer. Black women are second, and then you can see American Indian, Alaska Native, Asian, Pacific Islands, or in Hispanic are all going down the line.  And here you can see a difference. Black women in the United States have the highest death rates from breast cancer, and we're going to talk about that as I share some other statistics with you. So that's in the United States. What about in the state of New Jersey? You can see it's very similar. White women have the highest incidence, followed by Black women, been followed by Hispanic women, and then Asian and Pacific Islanders. And again, look at the death rates. You can see that Black women in the state of New Jersey have higher death rates from breast cancer. One of the reasons, as I just showed you, stage is so important. Stage at which breast cancer is diagnosed has a very direct impact on prognosis and survival. And if you look at Black women compared to white women, you can see, and the stages are the less deep shades of pink. Black women are diagnosed at higher stages when there are regional lymph nodes involved, 31% compared to 24 and 27, 29, and 31% among Hispanic women. And then greater percentage of women diagnosed with distant metastatic disease. So we're seeing more advanced stage breast cancers generally in Black women compared to other racial and ethnic groups. And then what about the types of breast cancer? Because there are many different types, including those that are more aggressive. And again, if you look at Black women compared to other racial and ethnic groups, you can see that they tend to be diagnosed with breast cancers that we consider to be more aggressive. Those are breast cancers that express something called the HER2 oncogene, and those are breast cancers that are triple negative. So that all contributes to the difference in death rates. When we talk about breast cancer, we tend to talk about breast cancer as if it is one disease. And actually it's very many different diseases presenting at different stages. And so you really can't compare one woman's experience to another's because there are so many different types and subtypes, whether breast cancer starts in our ducts, which lead toward the nipple or lobules where milk is produced when we're breastfeeding, whether breast cancer is invasive, as it is most of the time 75% of cases versus in situ just in the ducts, which is stage zero, which it is about 25% of the time. How aggressive the cells look under the microscope generally there's three grades, grade one least aggressive, grade three most aggressive, and then the specific genetic traits of the tumor itself, not the person, accounts for different types of breast cancers, whether the tumor expresses an estrogen or progesterone receptor and whether or not it expresses the HER2 oncogene, and all of these things inform individualized, personalized, and targeted treatments. So why do we screen for breast cancer?  So screening is an opportunity to halt the natural progression of the disease. And it's an opportunity, of course, to save lives. That's why we screen. We're screening to test a population of healthy women in order to find unsuspected breast cancer in smaller sizes and earlier stages than would otherwise be found, for example, if you have a lung. Who should be screened for breast cancer?  I don't know why my doctor sent me for a mammogram. There is no family history of breast cancer. Well, I'll share with you about 75 to 80% of all women diagnosed with breast cancer have no family history. The two main risk factors are having breasts, being a woman, and getting older. And that's something that all of us are experiencing together. And you can see by this graph, as we age, particularly at the time of about 35 and on, the number of breast cancers increases up until about the age of 75. So all of us, just by being women, have a lifetime risk of getting breast cancer of about 14%. And that's one in seven women. But some women are what we call at elevated or high risk for breast cancer. Those are women who themselves have had a personal history of breast cancer. You can see they're at three to four times higher risk of getting another breast cancer. Those women that have a relative with breast cancer, especially a first degree relative, especially if there's more than one first degree relative, and if there is a male relative with breast cancer. And I want to share with everyone because it is sort of a myth or a misperception that only the mother side of the family is important for breast cancer risk. That is not true. Your father side of the family and the DNA you get from your father is equally important from the DNA you get from your mother in terms of breast cancer risk and almost everything. Dense breast tissue, that's the type or the composition of tissue under the skin. It's different in all of us. Memograms are sort of like a thumbprint. I know some women just from their mammogram. Having more fibrous dense breast tissue for reasons that we do not know is an independent and significant risk factor for breast cancer. Those of us that have more fibrous tissue and I'm one of them are at higher risk than our girlfriends who have fattier tissue and it's significant. If you have a prior biopsy showing atypical ductal hyperplasia or any atypia or lobular neoplasia, you're at higher risk for getting breast cancer. Some women had Hodgkin's disease. It's a certain type of lymphoma and they had chest radiation back in very many years ago. Children were radiated who had enlarged thymus tissue and that creates a markedly elevated risk for breast cancer down the road. When you get older and of course if you've inherited certain genetic mutations, the most well known are the BRCA1 and BRCA2 mutations, though there are others, you're at significantly higher risk for getting breast cancer. Then there are associations that I sort of think of in terms of our hormonal milieu. It is felt that perhaps the proliferative changes that we go through just in our normal cycles may predispose breast cancer due to DNA mutations and cellular proliferation. If you started having your period early and you have menopause late, you've had more ovulatory cycles and therefore perhaps an opportunity for a breast cancer to develop from a DNA mutation. Also, if you've had no children, we know when we have children we don't have her period for nine months and if we breastfeed that also creates a lag for a halt to our periods during that time. If you're on hormonal therapy, estrogen and progesterone after menopause, it doesn't necessarily cause breast cancer, but it may promote breast cancer or certainly create a hormonal environment where breast cancers are able to grow and divide and do their thing. Postmenopausal obesity is a risk factor for breast cancer and alcohol consumption as well. Thinking about prevention, I wish I could tell you we knew what causes breast cancer and we could prevent it, but there are certain decisions we can make in healthy lifestyles that can certainly perhaps decrease our risk, exercise, healthy diets, and decreasing our alcohol consumption for sure. There are computer models available to us and hopefully one that will be available in our computer system epic, our electronic health record that can actually quantify a risk. If we put in all of our ages, our reproductive history, our family history, our breast density, we can sort of get a lifetime risk for breast cancer and that can help inform personalized screening recommendations. I'll also share with you the American College of Radiology recommends that all women should have a breast cancer risk assessment by the time they are at the age of 30. Why? We want to identify those high-risk women that may need to have genetic counseling and testing and therefore start their screening at the age of 25 to 30 and some women, particularly who have first-degree relatives that had breast cancer at young ages may need to actually start screening by the age of 30. So talk to your primary care physician and gynecologist about a risk assessment. So despite all the new technologies and everything we've heard about breast cancer, the single most important screening test, the one that's tried and true and is the primary imaging modality and proven to reduce deaths from breast cancer remain a mammogram. But in this day and age, not just any mammogram, but all women should be having what's called a 3D mammogram or digital breast tumor synthesis, I think in the year 2022 and almost 2023. This is the current standard of care. Mammograms are relatively inexpensive, quick to perform, they are safe and well tolerated. The radiation dose is extremely low. It's similar to a radiation dose we might experience from a flight from here to Chicago. Mammograms are readily accessible to large populations of women. We start doing mammograms early in the morning at our centers at seven o'clock and at Riverview go into the early evenings. And we do mammograms on Saturdays.  Mammograms are accurate. And as I said, they're the only screening tests that have been proven to reduce deaths from breast cancer. At Bayshore, we have what I consider to be the next generation of 3D mammograms. Bayshore has the most advanced 3D mammography unit. It has a more comfortable curved paddle. We all know what it's like to be under that compression. It is quite uncomfortable for some women more than others, but it's brief. So this curved compression paddle, and you can see it right here, just makes it a little bit less uncomfortable. Most importantly, from my perspective, being the breast imager or breast radiologist, the images are the highest resolution that are currently available. The proof of benefit from mammograms are not one, not two, not three, but seven randomized control trials. This is considered the gold standard for proof of benefit showed that women invited to be screened compared to women not invited to be screened. And these were trials that were done in the 1960s, 70s, and 80s, showed that there was a reduction in breast cancer deaths. And the women who were invited to be screened by 25 to 52%, and that's felt to be an underestimate. And we know that since we have developed screening programs in the 1990s, death rates from breast cancer have decreased by 40%. And certainly early detection has led to an enormous paradigm shift in how we treat breast cancer. Because most cancers are early stage lymph node negative small tumors, which have de-escalated the type of surgery, type of radiation therapy, and many women no longer need to have chemotherapy. Of course, not every screening test is perfect. And I do want to share with you, having a negative mammogram does not mean you don't have breast cancer. It means breast cancer was not detected. And mammograms alone may not detect a breast cancer in about 6 to 10% of the time. It's higher in women who really have fibrous dense breast tissue. Mammograms may miss 20 to 30% of breast cancers in women who have dense breast tissue. And that's 50% of us. And those cancers that are not detected tend to be more aggressive, which is why seeing your doctor and having a breast exam and never ignoring a lump is really important. What are the current screening guidelines? It's a little bit complicated and confusing because our governing bodies, the different medical groups, and societies have different screening recommendations. They all agree on one thing. Annual screening mammograms save the most lives. It is just that what has been factored in in the screening recommendations include the anxiety by being recalled. Most of the time when we recall women for extra images, everything turns out to be okay. And even when we do biopsies, about 80% of the time the results are benign. If you factor in that stress and anxiety by what are called false positives, then if you screen less frequently, you'll decrease that stress, that anxiety that is due to false positives. And that is why different organizations have different screening guidelines. We feel we can help women with that stress and anxiety by giving them the results, doing biopsies quickly, minimally invasive biopsies. And so the American College of Radiology, the National Comprehensive Cancer Network, Society of Breast Imaging, American College of Gynecologists, and the American Society of Breast Surgeons recommend annual mammograms 40 and above. And when should you stop having mammograms? Well, mammograms are for healthy, vibrant women who have a life expectancy of at least 10 years. I'm certain that's everyone who's on the webinar today. If you have a first degree relative who had breast cancer, premenopausal, you want to start screening 10 years earlier than the age at which they were diagnosed. And certain high-risk women and those women with dense breast tissue should consider having what we call supplemental breast imaging, which could be a mammogram and an ultrasound or a mammogram and an ultrasound and an MRI in six months. That is why when you receive your mammogram results, you are notified if you have dense breast tissue that is a New Jersey state law that informs women that you have dense breast tissue. Therefore, you're at elevated risk. And there's a greater chance that mammograms might not show everything. And that's why we do additional imaging. So if you're curious about what it looks like to have dense breast tissue, here are the four categories from fatty tissue. This is the type of tissue under the skin that creates a dark, very see-through pattern. We're going to step up to those women who have average density breast tissue under the skin. There is some white areas, but again, it's mostly dark tissue, which is the fatty tissue to category C, which is heterogeneously dense. You can start to see there is more whiter tissue in the mammogram. And then our fourth category by RADS D, which are women who have extremely dense breast tissue. So just to give you a sense of the heterogeneity of how a mammogram looks and what the type of tissue can look like. So what do we use for supplemental imaging? Well, one imaging modality that I'm sure many of us have had, not just for our breasts, perhaps when we were pregnant or abdomens is ultrasound. That uses sound waves. It's easy to perform. It's very well tolerated. It's safe. It provides cross-sectional imaging, and it's not impeded by our breast density. We can see well through most women who have dense breasts. And the indications for having a screening breast ultrasound is for women who are at average risk and have dense breast tissue or intermediate and high risk as well. And this is just an example of a 57-year-old patient of mine with a family history of breast cancer. Because I've taught you well, you can see that this is a woman who has heterogeneously dense breast tissue. There's a lot of whiteness in the pattern. And ultrasound detected this very small irregularity in the tissue.  What about MRI? MRIs of the breast are done with contrast. Many of you have heard of MRIs of the brain, the joints, the spine. We do MRIs of the breast. We have a special table. You lay down on the table. There is an IV started in your arm, because what we're looking for is areas in the breast that have an increased blood flow and leaky vessels. So what MRI gives us that we don't get with a mammogram and ultrasound is this functional information about what areas in the breast have abnormal blood flow, because we know that the most impressive type of tumors, the very first thing they need to do is bring in a blood supply. And they have abnormal increased vessels. And so MRI gives us this unique very high-resolution soft tissue detail information that we don't get from a mammogram and ultrasound. Who should get annual MRIs for screening purposes? Well, there are specific guidelines. This is specifically for high-risk women who have a lifetime risk based on a model of greater than or equal to 20 percent. These are often women who have dense breast tissue and at least one first-degree relative. Those women who have known genetic mutations that predispose them for breast cancer, the most well-known are the BRCA1 and BRCA2, not just them, but their untested first-degree relatives. Other known mutations that are associated with breast cancer, those women should have MRIs in addition to their mammograms once a year. If there is a history of chest radiation, mostly for young women who had Hodgkin's disease between the ages of 10 and 30, they should have MRIs once a year. And if you have a personal history of breast cancer and you have dense breast tissue or you were diagnosed at or before the age of 50, we recommend MRIs once a year. And here's an example of an MRI in a patient of mine who had a known BRCA2 mutation. She had a normal mammogram.  They are easy to see.  There is a new technology that we are going to be implementing soon, which is called contrast-enhanced mammography. So I just shared with you that contrast that we give through the vein can give us functional information about blood flow and leaky vessels. What if we combine the high resolution images of the 3D mammogram with contrast? Well, this technology is FDA approved. It is being utilized at many breast centers across the country and in Europe. We are hoping to implement this soon. And that combines the mammogram with contrast. And I'll show you what that looks like. It's a subtraction image. We give contrast while a woman is sitting in the mammography room and she gets a mammogram after contrast at a low energy and then high energy. And the subtraction of the two shows us anything in the breast, which is enhancing. And this is what the contrast-enhanced mammogram looks like. And it's sort of a way to get that functional information. And yet, as you know, not having MRI. MRIs are very expensive. They can be uncomfortable. They're about a 35 to 40 minute exam you're laying on the table. And so this is sort of an alternative for certain women to get that information that contrast can give us. So a lot of information I've given you. Where you have your mammogram could be the most important thing I say today matters. Just like, you know, where you put your trust in care is so, so important. And lots of orthopedic surgeons, fixed bones, do joints, do everything. But if you need a knee replacement, you probably want to go to an orthopedic surgeon who specialized in knees. Well, it's the same thing about your mammogram. You want to have your mammogram at an ACR accredited breast imaging center of excellence. Why? Those are centers that are officially accredited. They're not just saying they're good. They have been inspected and they're accredited in the areas of mammography, breast biopsy, tumble synthesis guided biopsies, ultrasounds and MRIs. And that means that they go through an inspection process. A physicist has to sign off on all of these modalities. They have to have the most experienced technologists and physicians. And that's just for your own personal safety. You want to go to their forest center that has dedicated physicians and technologists. That's all they do. And so they have a very high level of expertise and experience in breast imaging. You want to go to a place where you have access to multi modality screening that I just shared with you. Minimally invasive breast biopsies and also where if you are diagnosed with breast cancer, we've got a multi disciplinary team of highly experienced breast surgeons, breast oncologists, radiation oncologists, genetic counselors. So you have access to all of this with most importantly continuity of care and in the hands of very compassionate people. Our team of physicians include myself, Dr. DeAngelo and Dr. Sokolovskaya. And with that, I think I'll end my talk today and find out if you have any questions, concerns, anything you want to ask me while we have this time together. Thank you. Thank you, Dr. Barofsky. Very informative. Somebody had asked and I know that you kind of covered it or you did cover it, but they may have missed. Does Hackensack have these mammograms services? Absolutely. Hackensack has all of the services, Bayshore Medical Center, Riverview Medical Center, where I am the medical director, has all of the services that I described to you today, including minimally invasive breast biopsies that we do under ultrasound guidance, 3D guidance and MRI guidance and most of the centers at Hackensack Meridian Health do. I'm not familiar probably with all of them, but most of them certainly the larger centers. Another question here is, are mammograms safe for breastfeeding person? I'm 35 and I have never checked my breasts. I don't have breast cancer in my family history. I also don't have any symptoms, but should I wait until the end of breastfeeding? If you're 35 and you're breastfeeding and there is no family history, I would wait to have your baseline mammogram until after you've completed breastfeeding, but your question is such an important one. Women who are of screening age, who are breastfeeding, can certainly have a mammogram. As you know, when you're breastfeeding, the breasts are very enlarged. They are often engorged, but in high-risk women, we still continues. It is safe to have a mammogram when you're breastfeeding. It is still better than no mammogram when we usually combine a mammogram with an ultrasound. If you are breastfeeding and you are of screening age or you're high-risk, we still do mammograms in women who are breastfeeding. If you're 35 and you have no family history and you're breastfeeding, you can put it off until you have completed your breastfeeding and guideline for starting screening is the age of 40. Any other questions or is there anything I didn't touch upon? Another question came in, what are calcifications in a breast? Calcifications in the breasts are very, very common. I also should tell you that we do mammograms, of course, to screen for breast cancer, but guess what? We find all sorts of things, most of which are not cancer. One of the most common things we find and we call you back for extra views and we do biopsies of are calcifications. Here's our dilemma. Our breasts are very proliferative throughout our lives. There are so many changes that go on normally and calcifications in our depths are most often in normal finding. I see calcifications on mammograms more often than I don't. Here's the dilemma. Breast cancers and even pre-cancerous changes tend to form calcifications. That is why mammograms are so good at early detection. I would say about 80% of breast cancers form calcifications. If you have a mammogram and we find calcifications that are grouped or hanging out together or have increased in number, we always do magnification views to see them better. If we have any concern about them, the only way to know for sure is to take a biopsy. Having calcifications in your breast does not mean you have breast cancer. They're very common. I have them on mine and most women on this webinar also have calcifications, but they can be a reason that you need extra views and perhaps need a biopsy. They can sometimes be indicative of pre-cancerous changes and cancerous changes in the breast. Another question we have, does having larger breasts make it more difficult to detect cancer? Having larger breasts and a complex mammogram pattern and dense breast tissue does because it can mask breast cancers hiding in there. It's not necessarily the size. It's really the complexity of the pattern, but the larger size may make it difficult for ultrasound alone to really penetrate through all of that dense breast tissue. Mammograms will be inclusive of the breast tissue, but sometimes not of everything, just so you know. Most of the organs in our body are encapsulated and have a top, bottom, side to side. You can tell where the organ stops and ends just so you know breast tissue is not like that. Breast tissue can sometimes extend to the sternum, the bone in the center of our breast. Breast tissue can extend up into our armpit, down into what's called the inframammary fold, and mammograms alone may not detect or include, I should say, all of the breast tissue, particularly women who have larger breasts or have breast tissue under their arms. That's why you want to go to a really good center with wonderful technologies to make sure all that tissue is included, but larger women who have larger and dense breast tissue, it may be harder to detect breast cancer with mammograms alone. Another question is, are there any discounts or for uninsured women paying out of pocket for a mammogram? So we do have a program, the foundation has a program for uninsured women to come and have mammograms. So please call, I'm glad our phone numbers are here, call Bayshore, call Riverview Medical Center if you don't have insurance, and you need to have a mammogram. The foundation has funds for that, and I believe it's called the pink fund, Kailin, or does anyone on the line have any other information, but give us a call because we can support you, both of our foundations at Bayshore and Riverview have funds to support, not just the screening mammogram, but anything else that might be needed. Thank you for that. And actually, excuse me, for the anonymous question, if you'd like to send another anonymous message with your email address, I can send that over to you for additional information. And that leads me to share one other important bit of information to share everyone together today. And that is, in the state of New Jersey, you don't need to have a doctor's prescription to have a mammogram because mammograms are screening tests that can be lifesaving. We don't want to have any obstacles or create disparities in care. We all know some people maybe don't have insurance or, for that reason, don't have a regular doctor or sometimes you call your doctor for an appointment and you can get in in six months. Well, you're already two years behind on your mammogram because of COVID or for whatever reason, you can have a mammogram without a doctor's prescription. So we don't want to have any obstacles for you calling in and scheduling that appointment. Great point. I was actually going to bring that up as well, Dr. Barofsky.  So as Dr. Barofsky mentioned, feel free to reach out and we'll definitely get you scheduled for your screening mammogram. There's another question here. Is it possible that dense breasts last year will not be the case for this year's mammogram or should ultrasounds be the standard procedure? So glad you asked that question. That reminds me to share with everyone that how dense or fibrous the tissue is or really the breast composition for that matter, believe it or not, is a genetic trait that we inherit either from our mother or father side of the family. Generally speaking, particularly the breast tissue that is the densest since it is a genetic trait, it's pretty constant throughout a woman's life. If your breast density changes from one year to the next, there may be a couple reasons that that can happen. Number one, weight gain. When women gain weight, it generally is under the skin in the subcutaneous tissues. Guess what? Our breasts are skin appendages. They're highly specialized skin appendages. So when we gain weight, fat is deposited under the skin and in the breast. And actually it can make the breast look less dense. And conversely, when we lose weight, there can be an increase in breast density. After we go through menopause, because there are hormonal influences for breast density, there can be what we call fatty involuntial changes where some fatty tissue creeps in. And so you can be heterogeneously dense one year. And then over the course of the years, you can change your density to average. So that can be a reason that the breast density has changed. And also, and I'll be honest with you, the breast density is somewhat subjective. There are four categories of breast density, fatty, average, heterogeneously dense and extremely dense. And I can tell you as someone who reads mammograms every day of her professional career, there's everything in between. So because it's subjective, one doctor might decide your density is average and to another doctor that that looks heterogeneously dense. So that can be a reason that there's a different density in your mammogram report. And that's probably because you're in between the two. Another question. If you don't need a prescription, why has Riverview told me I can't schedule my mammogram without one? So that shouldn't be happening anymore. It was traditionally that way. And we have evolved a process so that we can do screening mammograms without a doctor's prescription safely. The most important thing, if there isn't a doctor's order, we have to assure and take it upon ourselves that appropriate follow up is given. So we need to make sure that women who came in without a doctor gets her results. And we have to make sure if the mammogram is abnormal, we have a way to inform her and make sure she schedules an appointment to come back in. And so we send out certified letters. But it is relatively new that we are accepting women for screening mammograms without a prescription. It's been about a year. So if you get that information that you can't have a mammogram without a prescription or you get sent out the door because you've left your prescription at home, certainly let everyone know that you've been told otherwise. Or give us a call. Ask to speak to Dr. Borowski.


Hello, this is Griffin Bass with gomustangesports.com. I'm with field hockey head coach Morgan Bitting after their four to three win over Virginia Wesleyan coach. I came right down to the wire there, but the girls held it on. It's three in a row and you're three and one on the season. How's it feel to get the win? It was an ugly win, but we found a way to come together today and get a much needed team win. Really proud of Emma Gladstein in her individual performance today. She was awesome out there. And it's funny because it's everything that we focused on in practice with her and in individual sessions the past couple of days. And it was nice to see her put all of that out on the field today. That was my next question about Gladstein. You've been with her since your time at Delaware. Is that four goals today? Is that something you expected coming into today or any game this season? We really hope that we don't have to rely on individuals for a four goal effort. And even last game, Riley Leekway had both of our goals against McDaniel on corners. And I think our focus going into tomorrow, which we're really excited that we have the opportunity to bounce back tomorrow and play our style of hockey and that we can play team hockey, we can share the ball. But Emma did have an incredible individual performance today and we needed her to score those goals. And she did and they were brilliant goals. And it was a close game. What kind of things can you take away from a close game like that as you continue this non-conference portion of the schedule? Yeah, I think just learning from each game and each quarter and each moment and opportunity and we weren't proud of our performance today. We really weren't. It wasn't Stevenson field hockey. We just didn't do the things that we preach every single day in practice. And all the credit to Virginia Wesleyan, like they stepped on this field today, they had an attitude, they played with that attitude and we didn't. So I hope we bring it tomorrow to Cedar Crest. Thanks coach, good luck tomorrow night.


Each of SCP-536's dials alters the value of one of the fundamental physical constants within the chamber. The dials control, respectively, the speed of light, C, the gravitational constant, G, Planck's constant, H, the fundamental charge, E. Except for the viewing window, SCP-536 is totally opaque to the electromagnetic radiation and subatomic particles. No abnormal physical behavior has yet been observed outside the chamber during testing.


Korat Cat vs British Shorthair Cat. What are the differences between these two cat breeds? Move over, rabbit's foot. The Korat is a living good luck charm in his home country of Thailand, where he is also known as the seesawat cat. The silver blue cats with emerald green eyes are said to date to the 14th century based on their depiction in ancient literature. They were popular gifts, always presented in pairs, and had special meaning when given to brides because of their association with prosperity and fertility. The name Korat comes from the region in northeast Thailand where the cats are thought to have originated. It's unclear when Korat's first came to the west. A cat that resembled a Korat was exhibited at a show in England in 1896, but whether it was truly a Korat, pronounced Korat, or simply a self-blue Siamese, meaning solid colored, is not known. You may not realize it, but you probably grew up with the British Shorthair. He's the clever feline of puss in boots and the grinning Cheshire cat of Alice in Wonderland. The British Shorthair is native to England. With the rise of cat shows during the Victorian era, cat fanciers began to breed the cats to a particular standard and keep pedigrees for them. At the earliest cat shows, British Shorthairs were the only pedigreed cats exhibited. All others were simply described by coat type or color. Two world wars devastated the breed, and few British Shorthairs remained after World War II. With the help of other breeds, the Shorthairs, as they are called in Britain were revitalized. The American Cat Association recognized the British Shorthair in 1967, but the Cat Fanciers Association did not accept it until 1980. Now, all cat associations recognize the breed. With his silver-tipped blue coat and huge green eyes, as sparkling as the dew drops on a lotus leaf the Korat is one of Thailand's most beautiful exports. He is noted as well for his heart-shaped head, large ears, and alert expression. A Korat's eyes are blue at birth. As he matures, the eyes turn to amber, the pupil surrounded by a fringe of the green. By the time the cat is 2-4 years old, the eyes have become the brilliant green for which the breed is known.  Unlike some breeds, the coat has its silver-blue color from the time kittens are born, although kittens may have what are known as ghost-tabby markings. These should disappear with maturity. The Korat's nose leather, lips, and paw pads range from dark blue to lavender.  His body is compact but powerful with a broad chest, strong legs with rounded paws, and a thick tail with a rounded tip. The coat comes in just about any color or pattern you could wish for, including lilac, chocolate, black, white, pointed, tabby, and many more. The best known color is blue, gray, and the cats are sometimes referred to as British blues. The short hair does not reach full physical maturity until he is 3-5 years old. Hello. This video is sponsored by Beemix Pets. Are you looking for high-quality cat collars at an affordable cost? Check out BeemixPets.com. Use coupon code KittenLife, to get 20% off. The smart and opinionated Korat is possessive of his people. He likes to stay close by and won't desert them for visitors. He gives his heart to one or two people whose company he prefers, or with whom he spends the most time, but he's certainly willing to accept affection from others as well. Be aware of this propensity before you get a Korat, just in case having a cat follow you around all the time would drive you crazy. A Korat is not a loner. He does best with companionship, whether that is someone who works at home or another animal. There's a reason, it seems, that traditionally they were always given in pairs. A Korat who is frequently left alone or ignored may develop behavior problems such as aggression or separation anxiety. That's not to say that adult Korats can't switch their affections. Cats placed in new homes quickly adapt and bond closely with their new family.  It's easy to teach household rules to the Korat if you reward him with petting, a happy good cat or a treat. Limit corrections to a loud no. Or hand clap. If you have multiple cats, be sure you have plenty of toys to go around. The Korat did not learn to share in the kitty garden, and he can be stubborn about giving up toys or other objects that he views as his. Although he can be bold with definite likes and dislikes, the Korat is generally a quiet cat who likes a quiet environment. Although he's not known for being talkative, he is capable of making many different sounds, from a chirp to a scream, when he wants to get his point across. Choose the Korat if you enjoy having a lap cat. He will be pleased to fulfill this desire anytime you like. The British Shorthair is mellow and easygoing, making him an excellent family companion. He enjoys affection, but he's not Amy, me, me type of cat. Expect him to follow you around the house during the day, settling nearby wherever you stop. Full of British reserve, the Shorthair has a quiet voice and is an undemanding companion. He doesn't require a lap, although he loves to sit next to you.  This is a cat with a moderate activity level. He's energetic during kittenhood but usually starts to settle down by the time he is a year old.  When they run through the house, they can sound like a herd of elephants. British Shorthairs are rarely destructive, their manners are those of a proper governess, not a soccer hooligan. They welcome guests confidently. The Karat Shorth single coat requires little grooming. Comb it weekly to remove any dead hairs. A bath is rarely necessary. The British Shorthair's short, smooth coat is simple to groom with weekly brushing or combing to remove dead hairs. A bath is rarely necessary. Brush the teeth to prevent periodontal disease. Daily dental hygiene is best, but weekly brushing is better than nothing. Trim the nails every couple of weeks. Wipe the corners of the eyes with a soft, damp cloth to remove any discharge. Use a separate area of the cloth for each eye so you don't run the risk of spreading any infection. Check the ears weekly. If they look dirty, wipe them out with a cotton ball or soft, damp cloth moistened with a 50 to 50 mixture of cider vinegar and warm water. Avoid using cotton swabs, which can damage the interior of the ear. Keep the litter box spotlessly clean. Cats are very particular about bathroom hygiene. It's a good idea to keep a Karat and British Shorthair as an indoor only cat to protect them from diseases spread by other cats, attacks by dogs or coyotes, and the other dangers that face cats who go outdoors, such as being hit by a car. Cats who go outdoors also run the risk of being stolen by someone who would like to have such a beautiful cat without paying for it. Karats will appreciate the attention of a child who treats them respectfully, and they enjoy playing and learning tricks. With proper supervision, they can be a good companion for children. Like many cats that originated in Southeast Asia, Karats tend to prefer other Karats. They can get along with other cats, and with dogs, but they expect to have pride of place. This may or may not go over well with other animals. The Karat likes to have company, however, and if he spends a lot of time with another cat or dog, they will likely become close friends. This mild-mannered cat is well suited to life with families with children and cat-friendly dogs. He loves the attention he receives from children who treat him politely and with respect, and is forgiving of clumsy toddlers. Supervise young children and show them how to pet the cat nicely. Instead of holding or carrying the cat, have them sit on the floor and pet him. Other cats will not disturb his equilibrium. For best results, always introduce any pets, even other cats, slowly and in a controlled setting. If you enjoyed this video, kindly press the like button. Also don't forget to subscribe with notifications on, so that you don't miss out on videos like this. Thank you for watching.


The study found that the treatment success rate for drug-resistant tuberculosis, DRTB, in the Republic of Tajikistan has improved over the past few years. In 2014, the success rate was 46.3%, but it rose to 56% in 2017. Additionally, the percentage of patients who failed or separated from treatment dropped from 58% in 2015 to 37% in 2017. However, the percentage of patients who continued treatment also fell from 2.1% in 2015 to 1.4% in 2017. Despite these improvements, there is still room for improvement, as the overall success rate remains below 60%. This article was authored by PU Makhmadova, RU Makhmadova, K.A. Zakharova, and others.