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Children from historically marginalized groups or poor backgrounds are less likely to survive neuroblastoma

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Children with high-risk neuroblastoma had worse outcomes if they were from certain racial/ethnic groups or were on public rather than private insurance, despite being treated in clinical trials with standardized protocols, according to a study led by investigators from Dana-Farber/Boston Children’s Cancer and Blood Disorders Center.

The study shows that young patients from historically marginalized populations or from lower-income backgrounds had poorer five-year survival rates even when they were assigned to receive uniform initial treatment after diagnosis with high-risk neuroblastoma.

These findings recapitulate what we have known for decades at the population level-;children from historically marginalized groups are less likely to survive their cancer. They add an essential next layer to our understanding of racial and ethnic disparities in childhood cancer, and that is enrolled on clinical trials is not enough to achieve racial and ethnic equity in survival.”

Puja J. Umaretiya, MD, a clinical fellow in pediatric hematology/oncology at Dana-Farber/Boston Children’s

Umaretiya is presenting the study results at the American Society of Clinical Oncology (ASCO) Annual Meeting, being held June 3-7, 2022, and the study is included in the ASCO press program.

“Clinical trials representing highly standardized care – yet even when receiving care on clinical trials, children with high-risk neuroblastoma do not experience the same outcomes based on their race, ethnicity, and whether they live in poverty,” said Umaretiya, lead author of the study. “This is key, because thus far attention has been paid to getting historically marginalized groups to trials with the assumption that this will reduce survival disparities, but our data suggest that in pediatrics, trial-enrollment is a first step, but clearly not a sufficient one.”

Senior author is Kira Bona, MD, MPH, a pediatric oncologist at Dana-Farber/Boston Children’s with research focused on identifying poverty-associated outcome disparities in childhood cancer and developing interventions to mitigate those disparities.

Bona notes, “That stark racial/ethnic disparities in survival persisting clinical trial participation makes it crystal clear that pediatric oncology trials must incorporate health equity interventions. If a new gene mutation were found to increase risk for trial-enrolled patients, pediatric oncology would not hesitate to begin intervening.

The study looked at outcomes in 696 children enrolled in three Children’s Oncology Group (COG) clinical trials of treatment for high-risk neuroblastoma. Neuroblastoma is a type of cancer that forms in nerve tissue. It frequently begins in one of the adrenal glands but can also originate in the neck, chest, abdomen, or spine. High-risk disease is defined by age, how widely the disease has spread, and biologic characteristics of the cancer cells. The prognosis for long-term survival remains challenging. Treatment is usually an intensive combination of chemotherapy, surgery, stem cell transplantation, radiation, and immunotherapy.

Of the 696 patients in the COG trials, 11% were Hispanic, 16% were Black non-Hispanic, 4% were other non-Hispanic, and 69% were white non-Hispanic. One-third of the children were poverty household-exposed (covered by public insurance); 26% were exposed to neighborhood level poverty (living in a high-poverty ZIP code defined by 20% or more of the population living below the federal poverty line).

The five-year overall survival rate varied by race/ethnicity (47% for Hispanic children; 50% for other non-Hispanic children; 61% for white non-Hispanic children; and 63% for Black non-Hispanic children.) after adjusting For disease-associated factors, Hispanic children were 1.8 times more likely to die and other non-Hispanic patients were 1.5 times more likely to die than white non-Hispanic children.

Patients who had only public insurance (a proxy for household poverty) had a 53% five-year survival rate compared to 63% for others. The survival rate was also lower – 54% — in children living in neighborhood level poverty compared with 62% for others.

“A huge strength of the way that this dataset was created is that we have the ability to look at potential mechanisms that may explain these survival disparities,” said Umaretiya. “For the first time, we will be able to ask whether certain groups experienced delays in therapy or were more likely to stop participating in trials perhaps because of competing family needs secondary to poverty. Most importantly, we will be able to start to look at what happens after relapse – a time when we know treatment becomes less standardized, which may increase the chance that a racial, ethnic, or socioeconomic privilege helps some families access life-extending therapy for their children while others are less able to. relapse will be essential to guiding interventions to improve disparities and we are excited to take this on next.”

Source:

Dana-Farber/Boston Children’s Cancer and Blood Disorders Center

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Allergic Rhinitis Market to Show a Rise During the Forecast

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Allergic Rhinitis Market

Allergic Rhinitis (AR), also known as hay fever, is a type of inflammation in the nose that occurs when the immune system overreacts to allergens in the air. It is usually a long-standing condition that often goes undetected in the primary-care setting. The classic symptoms of the disorder are nasal congestion, nasal itch, rhinorrhea and sneezing.
Some people only get Allergic Rhinitis for a few months at a time because they are sensitive to seasonal allergens, such as tree or grass pollen. Other people get Allergic Rhinitis all year round. Most people with Allergic Rhinitis have mild symptoms that can be easily and effectively treated. But for some people symptoms can be severe and persistent, causing sleep problems and interfering with everyday life.

DelveInsight’s “Allergic Rhinitis Market Insights, Epidemiology, and Market Forecast-2032” report delivers an in-depth understanding of the Allergic Rhinitis, historical and forecasted epidemiology as well as the Allergic Rhinitis market trends in the United States, EU5 (Germany, Spain, Italy, France, and United Kingdom) and Japan.

To know more about Allergic Rhinitis market report, click here: https://www.delveinsight.com/report-store/allergic-rhinitis-market?utm_source=openpr&utm_medium=pressrelease&utm_campaign=apr

Some facts of Allergic Rhinitis Market are:
• As per the Asthma and Allergy Foundation of America: Allergic Rhinitis, often called hay fever. It affects 6.1 million of the children population and 20 million of the adult population in the United States.
• According to the study conducted by Susann Forkel et al. 2020: In Germany, plantain is currently the best choice to screen Allergic Rhinitis patients for weed allergy which identifies 86% of all weed-sensitized individuals. It is being demonstrated that over the last 20 years, there was a significant rise in the total number of weed pollen sensitization as well as increases in polysensitization, predominantly in younger patients.
• Allergic Rhinitisis slightly more common in males in childhood than in females.
• Allergic rhinitis is common, affecting 10 to 30 percent of children and adults in the United States and other industrialized countries.
• According to the study by Bousquet et al, 2020, Allergic Rhinitis is more common in males before puberty, whereas it is more common in females after puberty, these differences are more pronounced in those with asthma and AR concomitantly.

To know more about Allergic Rhinitis market report, click here: https://www.delveinsight.com/report-store/allergic-rhinitis-market?utm_source=openpr&utm_medium=pressrelease&utm_campaign=apr

Scope of the Allergic Rhinitis Market Report
• The report covers the descriptive overview of Allergic Rhinitis, explaining its causes, signs and symptoms, pathophysiology, diagnosis and currently available therapies
• Comprehensive insight has been provided into the Allergic Rhinitis epidemiology and treatment in the 7MM
• Additionally, an all-inclusive account of both the current and emerging therapies for Allergic Rhinitis is provided, along with the assessment of new therapies, which will have an impact on the current treatment landscape
• A detailed review of the Allergic Rhinitis market; historical and forecasted is included in the report, covering drug outreach in the 7MM
• The report provides an edge while developing business strategies, by understanding trends shaping and driving the global Allergic Rhinitis market

To know about the scope of Allergic Rhinitis market report, click here: https://www.delveinsight.com/report-store/allergic-rhinitis-market?utm_source=openpr&utm_medium=pressrelease&utm_campaign=apr

Allergic Rhinitis Companies:
• Novartis Pharmaceuticals
• ALK-Abello
• Torii Pharmaceutical
• Stallergenes Greer
• FAES Farma
• Taiho Pharmaceuticals
• Allergy Therapeutics
• Regeneron Pharmaceuticals
• AOBiome
• Emergo Therapeutics
• Inmonotek
• And Many Others

To know in detail about Allergic Rhinitis pipeline therapies and companies, click here: https://www.delveinsight.com/report-store/allergic-rhinitis-market?utm_source=openpr&utm_medium=pressrelease&utm_campaign=apr

Table of Content:
1. Key Insights
2. Executive Summary of Allergic Rhinitis
3. Competitive Intelligence Analysis for Allergic Rhinitis
4. Allergic Rhinitis: Market Overview at a Glance
5. Allergic Rhinitis: Disease Background and Overview
6. Patient Journey
7. Allergic Rhinitis Epidemiology and Patient Population
8. Treatment Algorithm, Current Treatment, and Medical Practices
9. Allergic Rhinitis Unmet Needs
10. Key Endpoints of Allergic Rhinitis Treatment
11. Allergic Rhinitis Marketed Products
12. Allergic Rhinitis Emerging Therapies
13. Allergic Rhinitis: Seven Major Market Analysis
14. Attribute analysis
15. 7MM: Allergic Rhinitis Market Outlook
16. Access and Reimbursement Overview of Allergic Rhinitis
17. KOL Views
18. Allergic Rhinitis Market Drivers
19. Allergic Rhinitis Market Barriers
20. Appendix
21. DelveInsight Capabilities
22. Disclaimer
23. About DelveInsight

To get detailed TOC of Allergic Rhinitis market, click here: https://www.delveinsight.com/report-store/allergic-rhinitis-market?utm_source=openpr&utm_medium=pressrelease&utm_campaign=apr

About DelveInsight
DelveInsight is a leading Life Science market research and business consulting company recognised for its off-the-shelf syndicated market research reports as well as customized solutions to firms in the healthcare sector.

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DelveInsight is a leading Life Science market research and business consulting company recognised for its off-the-shelf syndicated market research reports as well as customized solutions to firms in the healthcare sector.

This release was published on openPR.

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The Impacts of Severe Asthma on QOL & Productivity

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“Asthma diagnosis and management are based on an unclear combination of subjective, symptom-based measurements (such as daytime and nighttime symptoms and activity impairment) and objective measurements (such as short-acting bronchodilator use and pulmonary function measurements),” explains Weily Soong. MD. “Objective measurements—especially the number of asthma exacerbations and pulmonary function testing—have become the main endpoints in many clinical trials for asthma. However, asthma research has often underappreciated the impact of asthma on quality of life (QOL). In a real-world setting, a patient’s QOL influences their clinician’s treatment decisions. The lives of patients with severe asthma, and their families and loved ones, are substantially affected by their disease. Asthma research mostly focuses on preventing disease exacerbations and life-threatening events, which is critical. However, the day-to-day burden of patients living with severe asthma is also substantial and has not been well-characterized.”

For a paper published in the Journal of Asthma and Allergy, Dr. Soong and colleagues assessed the burden of severe asthma by examining patients enrolled in a large, observational study of patients treated by United States allergists and pulmonologists. Patients completed in-depth surveys regarding the impact of the disease on their QOL (symptoms, activity, and psychosocial aspects) and their work productivity. The researchers summarized these survey results from 1,109 patients enrolled in the first 2 years of the study.

Biologic Treatment Found Effective

“It is clear that severely significant affects patient QOL, work productivity, and overall activity level,” Dr. Song says. “We found that activity impairment appeared to be a major driver of overall QOL. Additionally, we discovered that biologic treatment for severe asthma was associated with improved QOL and work productivity.”

The study team examined the overall correlation between patients’ scores on the QOL survey (overall and across the components of symptoms, activity, and psychosocial impacts) with their overall reported health. These data support the validity of the QOL survey in patients with severe asthma and also underscore the high degree of patient-to-patient variability across these components (Figure),” Dr. Song says.

Patients were also asked for free-text responses to “other activities that your respiratory problems may prevent you from doing,” beyond the items specifically asked about in the QOL survey. A “word cloud” was then created from total responses. “The largest word in the word cloud was ‘going,’ which highlights that patients are prevented from going and doing a multitude of things because of their disease,” Dr. Soong notes, adding that there is a wide-ranging impact of severe asthma on patients’ lives due to the severity and heterogeneity of the disease.

Ask QOL-Focused Questions

“To better understand their patients and the impact of severe asthma on their lives, specialists and their staff should ask patients about activity impairment, work productivity, and psychosocial impacts in addition to asking about symptoms and exacerbations,” Dr. Song notes. “Our results and those of prior research suggest that patients with chronic disease can adapt their expectations regarding QOL over time and, thus, underestimate the full effects of their disease. Our findings further underscore the need to ask about specific patient abilities with regard to physical activity and work productivity, rather than a more general question like, ‘How is your asthma?’

Dr. Soong and colleagues concur that much more research is needed to explore the full effects of severe asthma on patient QOL and work productivity. “Our study did not include children and adolescents with severe asthma, and that group should be studied in the future,” he says. “Also, given the design of our study, there is reason to believe our findings underestimate the true disease burden among patients with severe uncontrolled asthma. As a result, additional studies would be valuable. Furthermore, more research needs to be done on how to measure QOL practically, easily, and consistently in a real-world setting. Finally, we need to explore factors and interventions that can affect patient QOL in the longer-term.”

Tafasitamab/Lenalidomide Shows Efficacy, Tolerability for R/R DLBCL

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During a live virtual event, Brian T. Hill, MD, discussed the results of the L-MIND study of tafasitamab plus lenalidomide for patients with relapsed/refractory diffused B-cell lymphoma.

Targeted OncologyTM: Please describe the study design and patient population of the L-MIND study (NCT02399085) of tafasitamab (Monjuvi) and lenalidomide (Revlimid).

HILL: The L-MIND study was a single-arm, open-label, multicenter, phase 2 study of tafasitamab plus lenalidomide for patients with relapsed/refractory diffused large B-cell lymphoma [DLBCL], having anywhere from 1 to 3 prior lines of therapy. Patients could not be eligible for high-dose chemotherapy and autologous stem cell transplant. Patients with primary refractory DLBCL were excluded, which is something that we should take into account when interpreting the results.

The treatment was tafasitamab which is an intravenously administered monoclonal antibody targeting CD19. It was given at a standard dose on days 1, 8, 15, 22 for 3 [28-day] cycles, meaning weekly for 12 weeks. The cycles overlapped with a full 25 mg dose of lenalidomide on days 1 to 21, with 7 days off on 28-day cycles. For patients who were responding after 3 cycles, the tafasitamab was reduced to every other week starting in cycle 4 and continued up to 12 cycles. For patients who had stable disease or better after 12 cycles, they could continue tafasitamab without lenalidomide until disease progression. The primary end point was an overall response rate [ORR]with secondary end points including progression-free survival [PFS].

There were 81 patients with a median age of 72 years old, with a pretty wide range [from 41 to 86]. International Prognostic Index scores were [evenly divided between 0-2 and 3-5].1 Most of the patients had advanced stage disease and elevated LDH [lactate dehydrogenase]. They had a median of 2 lines of prior therapy. There were some primary refractory patients, [making up] 19%; I believe the study was amended somewhere along the line to exclude those, but about 44% were refractory to the prior line of therapy. Most of these patients have not had a prior stem cell transplant, and cell of origin was skewed towards non-germinal center or indeterminate cell type.

What were the results of this study in terms of efficacy?

The complete authorization [CR] rate was 40%, with 17% partial responses [PR], 16% stable disease, and 26% who had either progressive disease or were not evaluable. The ORR was 57%, and the median duration of response was 44 months.

[In terms of] PFS for all comers, [median PFS was 11.6 months, and] There are patients who had a CR who had very good [long-term] outcomes, and I think it is pretty remarkable that the lenalidomide was only given for 12 months, and beyond that they just were getting infusions with tafasitamab every 2 weeks. There was almost a plateau in the PFS curves going out 3 to 4 years. And so, the media overall survival [OS] after 3 and a half years of follow-up, was [33.5] months.

Looking at the efficacy based on a number of prior lines of therapy, not surprisingly, patients with 1 prior line of therapy tended to do better. The CR rate was almost 50% [in patients with] 1 prior line of therapy, whereas it dropped down to 32% in patients with 2 or more prior lines of therapy. The ORR was 67% for patients with 1 prior line of therapy, whereas it was down to 47% [in those with] 2 or more prior lines of therapy. And similarly, OS was much better in the patients with 1 prior line of therapy.

What was the toxicity profile observed in the L-MIND trial?

I’m sure many physicians are using lenalidomide for their patients with multiple myeloma, or those with myelodysplastic syndrome, so they are familiar with the adverse event [AE] profile of lenalidomide. There was a cumulative rate of neutropenia: 27% had grade 3, and 21% had grade 4. There was a total of 12% who experienced grade 3 or grade 4 febrile neutropenia.

[In terms of] common non-hematologic AEs, they mirror what probably should look familiar for lenalidomide, which is that diarrhea can occur in about a third of patients. You have these other unusual AEs like cough, edema, arthralgias, and back pain. Interestingly, 16% experienced constipation. I’m never sure which way to tell whether patients are going to get diarrhea or are they going to get constipation; it’s hard to predict. There are other AEs like muscle spasms, nausea, abdominal pain, and so forth. They are not much different than the AEs that we see with lenalidomide in general.

The neutropenia is much more common in the 12 months of the combination with lenalidomide, with almost 50% having some neutropenia. Anemia, thrombocytopenia, diarrhea, asthenia are follows. For patients who go a full year, and then get on to the maintenance phase of tafasitamab every other week, AEs were pretty minimal.

The rate of serious AEs was 51%, but the rate of serious AEs suspected to be treatment-related was 19%. So, a lot of the AEs may have been disease-related. [The rate of] discontinuations due to AEs was 12%.

AEs of special interest included AEs like secondary cancers, tumor flare reaction, deep vein thrombosis [DVT], and so forth. What I thought was interesting is that there were, that I can tell, no pulmonary embolism [PE] or DVT deaths, because thrombosis is a known toxicity or risk factor with lenalidomide, and patients did need to have DVT and PE prophylaxis on this study.2

The rate of AEs leading to death was 13%.1 There were 4 deaths out of 30 [in the safety cohort] that were treatment-emergent AEs leading to death. None were considered to be related to study treatment. If there is a death on a clinical trial from some complication, but the investigator deems it not related to the study treatment, then it gets counted as a study-related death, but then the attribution is not always clear. This is a high-risk patient population for AEs.

What did the RE-MIND study (NCT04150328) show about the tafasitamab/lenalidomide combination?

One of the concerns about single-arm trials is, “What are we comparing it with?” [Data from the RE-MIND study] was presented at the 2021 American Society for Clinical Oncology annual meeting.3 It was an attempt to compare the benefit of tafasitamab when combined with lenalidomide, compared with lenalidomide by itself.

This is a retrospective analysis where [the investigators] collected data on several hundred patients with DLBCL who were treated with lenalidomide as a monotherapy; and then, attempted to adjust for all these baseline co-variants with a matched profitability scoring method, and wound up with patients they felt were reasonably matched, and showed that there was a much higher ORR, CR rate, and PR rate with tafasitamab compared to with lenalidomide monotherapy. I’m not sure how much weight to put into these results [since] it wasn’t a randomized trial, but I think it does suggest that the tafasitamab is doing something, it’s not just the lenalidomide that’s doing the heavy lifting here.

References:

1. Duell J, Maddocks KJ, González-Barca E, et al. Long-term outcomes from the phase II L-MIND study of tafasitamab (MOR208) plus lenalidomide in patients with relapsed or refractory diffused large B-cell lymphoma. Haematologica. 2021;106(9):2417-2426. doi:10.3324/haematol.2020.275958

2. Lenalidomide (Revlimid). Prescribing information. Celgene Corporation; 2013. Accessed May 23, 2022. https://bit.ly/3wEwczG

3. Zinzani PL, Rodgers T, Marino D, et al. RE-MIND: Comparing tafasitamab + lenalidomide (L-MIND) with a real-world lenalidomide monotherapy cohort in relapsed or refractory diffused large B-cell lymphoma. Clin Cancer Res. 2021;27(22):6124-6134. doi:10.1158/1078-0432.CCR-21-1471

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Metro Transportation Licensing Commission sets rules for party vehicles

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  • Metro Transportation Licensing Commission sets rules for party vehicles

In a crowded jury assembly room, Mayor John Cooper stood before the Metro Transportation Licensing Commission and spoke strong words.

“It’s time to regulate the party,” he said.

Cooper, along with At-Large Council Member Bob Mendes, appeared before the commission’s monthly meeting Thursday to be put on record about the draft rules for Nashville’s entertainment vehicles.

The Mayor asked for an 11 pm curfew and restrictions during rush hour. He said he saw no reason to have unenclosed vehicles on Nashville’s streets. Those were just two of the issues the commission took up during the nearly six-hour meeting.

Party vehicle regulations:Owners, local groups spar over routes, noise and operating hours

Previously:With the state’s party vehicle bill on Gov. Lee’s desk, Nashville refines local regulations

The commission passed the majority of their draft regulations Thursday but declined to approve a key section defining enclosed and unenclosed entertainment vehicles.

The decision came after heavy discussion about requiring all of the vehicles to be enclosed, banning unenclosed entertainment vehicles entirely.

Industry operators have complained that enclosing the vehicles could lead to dangerous heat in passenger areas as airflow would be limited.

Members of the Commission questioned if tour buses, some of which are open-air, would be required to adhere to the same rules as unenclosed entertainment vehicles. Cooper urged the council to consider a separate classification for tour vehicles.

The commission opted to reserve their approval on the section regarding enclosed and unenclosed vehicles until there is a separate provision for tour buses.

During his remarks, Cooper lambasted unenclosed entertainment vehicles.

“I do not see why this commission should issue any permits for unenclosed vehicles, which pose greater safety risks and disruption,” Cooper said. “And as you determine how many permits to award, I would like to point out that any number greater than zero is already a compromise.”

The rules passed Thursday will not go into effect until the commission reviews the permit applications submitted by the entertainment vehicle companies, Director Billy Fields said. They’ll likely take up those applications at its June meeting.

The commission made several amendments to the remaining rules before adopting them. The changes are as follows:

  • Under insurance requirements: increased the liability insurance requirement for vehicles with less than 16 passengers from $1.5 million to $2 million.
  • Under insurance requirements: increased the uninsured/underinsured motorist insurance coverage for bodily injury, accidents and property damage each to $1 million.
  • Under insurance requirements: increased all insurance requirements for tractors or trucks pulling trailers/wagons to $2 million.
  • Under vehicle operations: added a provision that if there is a crash, MNPD will handle drug screens for the driver when there is suspected activity, otherwise a driver will be required to take a drug test within three hours of an authorized lab opening for business.
  • Under vehicles: removed a rule banning the display of offensive or inappropriate words, phrases, symbols, objects or images.
  • Under sound: removed a rule requiring sound monitoring devices capable of documenting sound level above approved levels.
  • Under: violations rewrote a rule to exclude 21 year olds from the chaperone requirement.

Contact Tennessean reporter Kirsten Fiscus at 615-259-8229 or KFiscus@gannett.com. Follow her on Twitter @KDFiscus.

How Couples Should Decide Whether Counselling Is Worth It, According to Therapists

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Marriage counseling can be difficult, but it is often wise to invest time in your relationship to see if it can be improved. About 44% of couples go to marriage counseling prior to tying the knot. Research also suggests that couples therapy positively impacts 70% of couples receiving treatment. A couples counsellor is unbiased by design, so if you want to work through problems with your significant other, they can provide an outside perspective. It is also a plus that the outside perspective comes from someone who is highly trained in relationship issues. But how do you know when it’s right for you?

Signs you and your partner may need couples counseling

Dr. Gavin Shafron, a New York state-licensed psychologist and couples counsellor at Clarity Therapy NYC, says there are many different reasons a couple could start counseling, one of which is constant conflict. “I often see couples come to therapy when they find themselves in the same repetitive arguments again and again, or when they are concerned about the sustainability or healthiness of their current dynamic.”

Dr. Saliha Bava, a licensed marriage and family therapist and author of The Relational Book for Parenting expanded on this: “I’ve had couples who come in and find they are…getting into conflict and they feel tension, not necessarily fighting, but even still there’s tension in the body. Something feels off and you might say she’s not listening, she’s not getting me.” This distinction is important because, while it might be obvious if there’s a lot of outward fighting, this general tension is often overlooked.

According to Bava, counseling is all about honoring each other’s differences and finding a middle ground. Sometimes a couple may not have “the language or the way to talk with each other because they are too caught up in their differences.”

Communication skills are the cornerstone to healthy relationships. Remember that the decision to enter therapy is entirely your own, but if you are struggling with issues around communication, counseling is a good place to start.

What to do if you’re still unsure

If you or your partner are still unsure if couples counseling is right for you, it’s time to do some reflection. Shafron recommends considering, “What challenges [you or your partner] about the idea of ​​entering counseling?”

He went on, “For some, there may be fear that something will come out in the course of therapy that derails their relationship further, or at worst, ends the relationship, so the lack of readiness can be very existential. For others, there can be shame around their actions or the issues that exist in their relationship. Sometimes, it can be a combination of a number of factors.”

These assumptions can definitely get in the way of pursuing therapy, but remember that a couples counsellor is trained to be neutral. Two helpful questions to ask yourself before starting therapy are whether you feel the challenges in your relationship are already being addressed or if you feel a change needs to happen. Ultimately, the goal of therapy is always building new communication skills and healing wounds together.

Bava also recommends researching as much as possible beforehand. This doesn’t just mean a quick Google search, but actually might mean calling a few therapists to see if they feel right for you. “Most therapists that I know will do a five- to 10-minute call, and you can ask questions and see if it’s a good fit to start out with.” She also recommends trying at least three sessions before you decide for sure it isn’t for you.

When isn’t couples therapy worth it?

Counseling isn’t necessarily for everyone. As Bava explained, “It comes back to what you are looking for in counseling. If you’re seeing it as a quick fix, like a pill, it might not work. It’s a process. You have to be willing to engage in a process.”

Shafron added, “Some come to counseling with the goal of changing traits or characteristics of who their partner is. This isn’t the best use of couples counseling because therapy isn’t about changing the character or personality of another person in order to make a relationship work.” If you aren’t willing to put in the effort and do the (at times) difficult work that comes along with couples counseling, then maybe it’s time to consider other options.

Ultimately, starting couples therapy is a decision that needs to be made by both partners. It is one that requires some reflection, but if you are ready to put in the effort, it can be incredibly healing for your relationship.

Carolyn Hax: Can I stop visiting my children’s grandmother?

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We asked readers to channel their inner Carolyn Hax and answer this question. Some of the best responses are below.

Dear Carolyn: For years, I’ve done all the heavy lifting of maintaining a relationship between my children and their paternal grandmother — even after my divorce five years ago. Recently, my ex did finally try to arrange a visit and she rebuffed him and his new family. Her loss — her new DIL is frankly nicer than me and her kids are polite and adorable.

I normally let her know when I am coming to town and see if she can/wants to get together — my ex and I both live very far away but I regularly travel to see my parents who live a manageable distance away, and my ex does not normally travel that way. I have always done all the driving (two hours each way, a complete tour of the suburbs) — her health genuinely doesn’t permit it now, but even when she COULD drive, she visited us twice in 15 years of marriage and never met my parents. Can I just … not do that anymore? How do I balance “I might regret neglecting a lonely ill person” with “But she makes it so hard and I’m tired and she’s not even my relative”?

Anonymous: You don’t have a responsibility to a former in-law, but you do have a responsibility to your children, so try framing it in that direction: Is their grandmother a positive or negative presence in their lives? Does visiting her enhance their relationship with her? Do they want to spend time with her? Can they do so on their own (are they old enough/responsible enough to make the two-hour drive when you’re visiting your own parents)?

Regarding the potential regret that you might feel, our lives are filled with choices, decisions, things we can do, could have done — because we cannot do all things or be all things. Weigh how great that regret might be against the burden of effort and feelings of resentment. Give yourself permission to value your own time, your own emotions, and see where the balance lands.

Anonymous: You have permission. But you can also compromise here. Consider visiting every other time you come to town or only if your schedule allows. If you are still feeling guilty, consider if there are other, less travel-intensive ways that you can keep grandma connected to grandkids like photo sharing frames and video calls. The best part is, your kids may be even more adept than you at making the technology work, giving you a break from bearing all of the responsibility of staying connected.

Anonymous: Given she is unable to travel, before you end the visits, ask the ex-husband to take on the responsibility of the visits. Explain you made the effort over the years for the benefit of both ex-MIL and children post-divorce, but feel that since enough time and healing has occurred for the children, and his mother is less mobile, it’s time for him to take over coordinating the visits between his mother and the children.

It’s not unreasonable to ask the ex-husband to manage the relationship between his mother and children.

Explain you did not want to abruptly end these visits out of concern for ex-MIL mental well-being. So you are allowing him to step in to make a seamless transition. Then you both should tell his mother he will handle the visits going forward.

Anonymous: I’d advise that it depends on what your children get out of the visits. It’s really about them and their relationship with their grandmother, and not about her or you or your ex. You don’t mention how they feel about these visits at all, which I find strange. If they love her and want a relationship with her to continue, then you should keep making the effort to visit. If the relationship doesn’t benefit them, then I’d say you can stop. But I’d talk to them about it first if you’re not sure. Not to ask them the same way you’ve asked Carolyn, but a much more general conversation about how they feel about their grandmother and visiting her. Don’t put the decision on them, just be clear about what they get from these visits.

Every week, we ask readers to answer a question submitted to Carolyn Hax’s live chat or email. Read the most recent installment here. New questions are typically posted on Fridays, with a Monday deadline for submissions. Responses are anonymous unless you choose to identify yourself and are edited for length and clarity.

Quick-relief Asthma Drugs Market 2022 by Key Players, Regions, Type and Application, Forecast to 2030 – ManufactureLink

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Quick-relief Asthma Drugs Market Research report is a professional and in-depth market report that focuses on primary and secondary drivers, market share, possible sales volume, leading segments and geographical analysis of a industry. It shows that the rise in market value is generally attributed to the rising growth of the application industries and the subsequent rise in demand of applications. This market analysis report gives an examination of various segments that are relied upon to witness the quickest growth amid the approximate forecast frame. The competitive landscape section of the A global business report brings into light a clear insight about the market share analysis of major industry players.

Market segmentation

Quick-relief Asthma Drugs market is split by Type and by Application. For the period 2018-2030, the growth among segments provide accurate calculations and forecasts for revenue by Type and by Application. This analysis can help you expand your business by targeting qualified niche markets.

Market segment by Type, covers

⦿ Tablet

⦿ Spray

Market segment by Application, can be divided into

⦿ Hospital Pharmacy

⦿ Online Pharmacy

⦿ Retail Pharmacy

Market segment by players, this report covers

⦿ Pfizer

⦿ GlaxoSmithKline

⦿ Novartis

⦿ Merck

⦿ Boehringer Ingelheim

⦿ AstraZeneca

⦿ Roche

⦿ Teva Pharmaceutical

⦿ Vectura Group

Market segment by regions, regional analysis covers

⦿ North America (United States, Canada, and Mexico)

⦿ Europe (Germany, France, UK, Russia, Italy, and Rest of Europe)

⦿ Asia-Pacific (China, Japan, South Korea, India, Southeast Asia, Australia, and Rest of Asia-Pacific)

⦿ South America (Brazil, Argentina, Rest of South America)

⦿ Middle East & Africa (Turkey, Saudi Arabia, UAE, Rest of Middle East & Africa)

The content of the study subjects, includes a total of 12 chapters:

Chapter 1, to describe Quick-relief Asthma Drugs product scope, market overview, market opportunities, market driving force and market risks.

Chapter 2, to profile the top players of Quick-relief Asthma Drugs, with revenue, gross margin and global market share of Quick-relief Asthma Drugs from 2019 to 2021.

Chapter 3, the Quick-relief Asthma Drugs competitive situation, revenue and global market share of top players are analyzed emphatically by landscape contrast.

Chapter 4 and 5, to segment the market size by type and application, with revenue and growth rate by type, application, from 2016 to 2026.

Chapter 6, 7, 8, 9, and 10, to break the market size data at the country level, with revenue and market share for key countries in the world, from 2016 to 2021.and Quick-relief Asthma Drugs market forecast, by regions, type and application, with revenue, from 2021 to 2026.

Chapter 11 and 12, to describe Quick-relief Asthma Drugs research findings and conclusion, appendix and data source.

Click The Link To Get A Free Sample Copy Of The Report @ https://crediblemarkets.com/sample-request/quick-relief-asthma-drugs-market-424505?utm_source=Amruta&utm_medium=SatPR

Some Point from Table of Content:

Global Quick-relief Asthma Drugs Market Overview: It includes six chapters, research scope, major manufacturers covered, market segments by type, Quick-relief Asthma Drugs market segments by application, study objectives, and years considered.

Global Quick-relief Asthma Drugs Market Landscape: Here, the competition in the Worldwide Quick-relief Asthma Drugs Market is analysed, by price, revenue, sales, and market share by company, market rate, competitive situations Landscape, and latest trends, merger, expansion, acquisition, and market shares of top companies.

Global Quick-relief Asthma Drugs Market Profiles of Manufacturers: Here, leading players of the global Quick-relief Asthma Drugs market are studied based on sales area, key products, gross margin, revenue, price, and production.

Global Quick-relief Asthma Drugs Market Status and Outlook by Region: In this section, the report discusses about gross margin, sales, revenue, production, market share, CAGR, and market size by region. Here, the global Quick-relief Asthma Drugs Market is deeply analyzed on the basis of regions and countries such as North America, Europe, China, India, Japan, and the MEA.

Global Quick-relief Asthma Drugs Market Application or End User: This section of the research study shows how different end-user/application segments contribute to the global Quick-relief Asthma Drugs Market.

Global Quick-relief Asthma Drugs Market Forecast: Production Side: In this part of the report, the authors have focused on production and production value forecast, key producers forecast, and production and production value forecast by type.

Research Findings and Conclusion: This is one of the last sections of the report where the findings of the analysts and the conclusion of the research study are provided.

Global Quick-relief Asthma Drugs Market: Customization Available

While syndicate research services are among our most sought-after offerings, we like our clients to be aware of the clear fact that the insights in syndicated reports may not be specific enough at times to cater to research demands of a particular organization. Here’s when custom research services step in. Tailor-made research reports support specific research needs of a business, including an extensive survey or an exclusive research methodology. Irrespective of how niche a market is, custom research services that we offer at Credible Markets complement the most critical industry research needs.

We understand that organizations are keen on gaining access to trending market insights, but we also know that a one-size-fits-all approach doesn’t work all the time. Our custom research services help our clients across diverse industry sectors make sound business decisions based on our laser-focused research, targeted at their specific industry and line of business.

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Important Questions Answered

  • What is the growth potential of the Quick-relief Asthma Drugs market?
  • Which company is currently leading the Quick-relief Asthma Drugs market? Will the company continue to lead during the forecast period 2022-2030?
  • What are the top strategies that players are expected to adopt in the coming years?
  • Which regional market is anticipated to secure the highest market share?
  • How will the competitive landscape change in the future?
  • What do players need to do to adapt to future competitive changes?
  • What will be the total production and consumption in the Quick-relief Asthma Drugs Market by 2030?
  • Which are the key upcoming technologies? How will they impact the Quick-relief Asthma Drugs Market?
  • Which product segment is expected to show the highest CAGR?
  • Which application is forecast to gain the biggest market share?

Why Choose Credible Markets?

To help organizations in pharmaceuticals industry, our reports provide in-depth insights on R&D approached of market leaders, drug development and clinical trial capacities, research pipelines, FDA approvals, pricing strategies, raw material sourcing, and demand-supply-distribution networks. Branded and non-branded generics, specialty drugs, and several other sub-sectors are thoroughly analyzed in pharma industry reports.

On another side, medical devices industry stands with a totally different set of challenges and growth opportunities. Delivering valued insights on creation and maintenance of product competency, the medical devices industry market reports allow for better understanding of the medical devices ecosystem and development of competent business models aiming at long-term growth.

About Credible Markets:

Credible Markets is a new-age market research company with a firm grip on the pulse of global markets. Credible Markets has emerged as a dependable source for the market research needs of businesses within a quick time span. We have cooperated with leading publishers of market intelligence and the coverage of our reports reserve spans all the key industry verticals and thousands of micro markets. The massive repository allows our clients to pick from recently published reports from a range of publishers that also provide extensive regional and country-wise analysis. Moreover, pre-booked research reports are among our top offerings.

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Fume all you want, don’t hit erratic drivers in front of you

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No matter how much a driver might fume about the slow driver ahead, the driver behind him is still responsible for maintaining a safe distance to avoid a collision — even if the slow driver tries to block the driver behind him from passing, or stops suddenly in the middle of the street because he might have seen a cat under a parked car.

Insurers typically assign fault to drivers who follow too closely behind others, creating the risk of a fender-bender in case of a sudden stop. And BC’s Civil Resolution Tribunal found the province’s public insurer was not wrong in assigning partial fault to the following driver in Dusdal v. ICBC.

ICBC insured both vehicles involved in a collision on Oct. 8, 2021 in Campbell River, BC

ICBC found Jacob Dusdal and the driver in front of him, identified as “RS,” were equally responsible for the collision. Dusdal disagreed, and went to the CRT for reimbursement of the $1,250 deductible he had to pay to fix his car. Under the province’s Insurance (Vehicle) Actif Dusdal is not responsible for the accident, ICBC must pay for his vehicle repairs, including the deductible.

The court referred to evidence that “the parties were involved in somewhat of a conflict while driving prior to the accident.”

Dusdal testified that RS was driving erratically ahead of him. He said he gave RS a “fairly polite honk” on Lal Road for driving slowly. According to Dusdal’s evidence, he tried to “very slowly” pass RS on the left when RS “suddenly” drove forward to “block” him.

RS says he was driving on South Murphy Street with Dusdal following closely behind him. To allow Dusdal to pass, RS said he turned left onto Lal Road, thinking Dusdal would continue on South Murphy Street. However, Mr. Dusdal also turned left onto Lal Road.

RS described Dusdal’s perception of a “block” maneuver as a realization that, as RS turned right onto Galerno Road (where the collision occurred), Dusdal tried to overtake his vehicle on the left at the same time RS was turning. RS said he realized there was not enough room for the two vehicles to do the left together, so as he completed his turn, Dusdal pulled in back behind him.

As both cars drove straight along Galerno Road, RS noticed a parked car to his right. He thought he saw a cat coming out from under the parked car, so he “applied his brakes firmly but not spiked.” Dusdal hit his vehicle from behind.

ICBC assigned fault to both drivers. And the CRT agreed.

“I find it likely that RS was driving negligently in positioning his vehicle and stopping in the middle of the road,” CRT vice chair Andrea Ritchie wrote in her decision. “Although there is no cat seen in the video footage, I find that does not mean one was not present. I also note from the video footage the stop is not overly sudden. However, given the circumstances, I find RS stopping in the manner he did was in breach of section 144 of the MVA (Motor Vehicle Act).

“But I also find Mr. Dusdal was negligent in the circumstances. I say this because Mr. Dusdal’s own account of RS’s driving behavior leading up to the accident should have led Mr. Dusdal to keep a greater distance between their vehicles. Whether RS ​​saw a cat, other hazard, or stopped for no reason, I find Mr. Dusdal was following too closely behind RS given the events that had already occurred.”

Feature image courtesy of iStock.com/Believe_In_Me

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