Saturday, March 26, 2016

Merchants have sought methods to minimize risks since early times.


Merchants have sought methods to minimize risks since early times. Methods for transferring or distributing risk were practiced by Chinese and Babylonian traders as long ago as the 3rd and 2nd millennium BC, respectively. Chinese merchants travelling treacherous river rapids would redistribute their wares across many vessels to limit the loss due to any single vessel's capsizing. The Babylonians developed a system which was recorded in the famous Code of Hammurabi, c. 1750 BC, and practiced by early Mediterranean sailing merchants. If a merchant received a loan to fund his shipment, he would pay the lender an additional sum in exchange for the lender's guarantee to cancel the loan should the shipment be stolen or lost at sea.

Some typical examples of insurance purchased by individuals include house insurance


Some typical examples of insurance purchased by individuals include house insurance (which may protect the insured against loss or damage to the home due to fire or other hazards); car insurance (which protects the driver against damage to her car, other vehicles she may have a collision with, liability for damages suffered by others in a collision, etc.) and life insurance.

This can be a big help to you in choosing a new or gently-used car.


As a money-wise step when car shopping, take the cost of insurance coverage into account. Ask your insurance agent to tell you which cars will get the best rates. This can be a big help to you in choosing a new or gently-used car. If you purchase a car with a high safety rating, insurance will be quite a bit cheaper.

You should comb through your insurance options carefully.


You should comb through your insurance options carefully. Every company is different when it comes to how they determine your premium. Comparing a few different companies before making your final decision can end up saving you quite a bit of money. Try decreasing your mileage each year to boost the savings on your insurance bill. You may find that your insurance company will lower your rate if you lower your annual mileage.

Finding and purchasing the appropriate car insurance can be daunting.



Easy To Understand Auto Insurance Tips

Having car insurance is one of the requirements of being a car owner. Finding and purchasing the appropriate car insurance can be daunting. Your goal should be to obtain an insurance policy that covers all your needs at the lowest cost possible. Before you start shopping around, you must decide exactly what types of coverage you need and in what amounts. Some helpful advice regarding auto insurance can be found in this article.

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Friday, March 18, 2016

LAT Will Not Be Following All of the Cunningham Recommendations

The Licence Appeal Tribunal (LAT) begins accepting applications to resolve auto insurance disputes on April 1, 2016.  LAT has completed a first round of recruitment for adjudicators and case management staff.  Adjudicators are Order-in-Council appointments.  Training of adjudicators and staff is underway.

FSCO will continue to operate beyond April 1, 2016.  If mediation has been completed, but the arbitration process has not begun, a party can apply to LAT and begin the new process.  If the case already has been assigned an arbitration case number by FSCO, the case remains at FSCO.  Existing cases will not be transferred from FSCO to LAT.

Although the new system follows the recommendations put forth by Justice Cunningham in 2016, a number of recommendations have been modified: 

Justice Cunningham recommended that mandatory mediation (along with pre-arbitration hearings) be eliminated and that a settlement meeting be held before arbitration (Recommendations #4 and #13).  LAT has created a case conference prior to arbitration which follows the intent of settlement meetings proposed by Cunningham.

Justice Cunningham recommended that statutory timelines and sanctions regarding settlement meetings, arbitration hearings and the release of arbitration decisions be created (Recommendation #6).  However, no statutory timelines have been created and LAT will manage timeline requirements.  This is essentially the status quo.

Justice Cunningham recommended that the policy of no application fees for claimants at the settlement meeting stage be continued (Recommendation #7).  LAT has introduced a $100 application fee.

Justice Cunningham recommended that settlement meetings be conducted by video conferencing rather than by telephone in cases where it is not feasible for the parties to meet in person (Recommendation #14).  LAT is continuing the current practice and most case conferences will take place over the phone.

Justice Cunningham recommended an adjournment fee be charged to the party requesting an adjournment in the absence of exceptional circumstances (Recommendation #16).  No adjournment fee has been established.

Justice Cunningham recommended that the settlement of future medical and rehabilitation benefits be prohibited until two years after the date of the accident (Recommendation #17).  The SABS have not been amended and settlements will still be permitted one year after the date of the accident.

Justice Cunningham recommended that each insurer establish an internal review process (Recommendations #19, #20 and #21).  A company internal review process has not yet been established.

Justice Cunningham recommended criteria for streaming disputes to paper reviews, expedited in-person hearings and full in-person hearings (Recommendations #25, #26 and #27).  The criteria have not been adopted.  LAT adjudicators will exercise his or her discretion to determine the format of a hearing, which is the status quo.

Below is the full dispute resolution process: 



Thursday, March 17, 2016

Mesothelioma Diagnosis

Mesothelioma Diagnosis
Diagnosis of mesothelioma can be suspected with imaging but is confirmed with biopsy. It must be clinically and histologically differentiated from other pleural and pulmonary malignancies, including reactive pleural disease, primary lung carcinoma, pleural metastases of other cancers, and other primary pleural cancers. Primary pericardial mesothelioma is often diagnosed after it has metastasized to lymph nodes or the lungs.


Imaging

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma.A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytopathology if this fluid is aspirated with a syringe. For pleural fluid, this is done by thoracentesis or tube thoracostomy (chest tube); for ascites, with paracentesis or ascitic drain; and for pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure).[citation needed] However, with primary pericardial mesothelioma, pericardial fluid may not contain malignant cells and a tissue biopsy is more useful in diagnosis.Using conventional cytology diagnosis of malignant mesothelioma is difficult, but immunocytochemistry has greatly enhanced the accuracy of cytology

Biopsy

Generally, a biopsy is needed to confirm a diagnosis of malignant mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. Alternatively, the chest surgeon might directly open the chest (thoracotomy). If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary


Immunochemistry

Immunohistochemical studies play an important role for the pathologist in differentiating malignant mesothelioma from neoplastic mimics, such as breast or lung cancer that has metastasized to the pleura. There are numerous tests and panels available, but no single test is perfect for distinguishing mesothelioma from carcinoma or even benign versus malignant. The positive markers indicate that mesothelioma is present; if other markers are positive it may indicate another type of cancer, such as breast or lung adenocarcinoma. Calretinin is a particularly important marker in distinguishing mesothelioma from metastatic breast or lung cancer.

Subtypes

There are three main histological subtypes of malignant mesothelioma: epithelioid, sarcomatous, and biphasic. Epithelioid and biphasic mesothelioma make up approximately 75-95% of mesotheliomas, and have been well characterized histologically, whereas sarcomatous mesothelioma has not been studied extensively. Most mesotheliomas express high levels of cytokeratin 5 regardless of subtype.

Epithelioid mesothelioma is characterized by high levels of calretinin.

Sarcomatous mesothelioma does not express high levels of calretinin.

Other morphological subtypes have been described:

Desmoplastic
Clear cell
Deciduoid
Adenomatoid
Glandular
Mucohyaline
Cartilaginous and osseous metaplasia
Lymphohistiocytic

Morphological differential diagnosis

Metastatic adenocarcinoma
Pleural sarcoma
Synovial sarcoma
Thymoma
Metastatic clear cell renal cell carcinoma
Metastatic osteosarcoma

Staging

Staging of mesothelioma is based on the recommendation by the International Mesothelioma Interest Group.TNM classification of the primary tumor, lymph node involvement, and distant metastasis is performed. Mesothelioma is staged Ia–IV (one-A to four) based on the TNM status

Prevention

Mesothelioma can be prevented in most cases by preventing exposure to asbestos. The US National Institute for Occupational Safety and Health maintains a recommended exposure limit of 0.1 asbestos fiber per cubic centimeter.

Screening

There is no universally agreed protocol for screening people who have been exposed to asbestos. Screening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for mesothelioma. The level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening.Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells


Pathophysiology

The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibers in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fiber can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibers from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibers may be deposited in the gut after ingestion of sputum contaminated with asbestos fibers.[citation needed]

Pleural contamination with asbestos or other mineral fibers has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers). However, there is now evidence that smaller particles may be more dangerous than the larger fibers. They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System.

Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibers. It has been suggested that in humans, transport of fibers to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localized lesions of accumulated asbestos fibers in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumor.

Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibers remain unclear despite the demonstration of its oncogenic capabilities (see next-but-one paragraph). However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibers has not yet been achieved. In general, asbestos fibers are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.

Analysis of the interactions between asbestos fibers and DNA has shown that phagocytosed fibers are able to make contact with chromosomes, often adhering to the chromatin fibers or becoming entangled within the chromosome. This contact between the asbestos fiber and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.

Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:

Neurofibromatosis type 2 at 22q12
P16INK4A 
P14ARF
Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms:

Inactivation of tumor suppressor genes
Activation of oncogenes
Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region
Activation of DNA repair enzymes, which may be prone to error
Activation of telomerase
Prevention of apoptosis
Several genes are commonly mutated in mesothelioma, and may be prognostic factors. These include epidermal growth factor receptor (EGFR) and C-Met, receptor tyrosine kinasesoverexpressed in many mesotheliomas. Some association has been found with EGFR and epithelioid histology but no clear association has been found between EGFR overexpression and overall survival. Expression of AXL receptor tyrosine kinase is a negative prognostic factor. Expression of PDGFRB is a positive prognostic factor.In general, mesothelioma is characterized by loss of function in tumor suppressor genes, rather than by an overexpression or gain of function in oncogenes.

Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences.

Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres.

 As an environmentally triggered malignancy, mesothelioma tumors have been found to be polyclonal in origin by performing a X-inactivation based assay on epitheloid and biphasic tumors obtained from female patients.These results suggest that an environmental factor, e.g. asbestos exposure, may damage and transform a group of cells in the tissue, therefore result in a population of tumor cells that are, albeit slightly, genetically different

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