title: Spanish Navy

text: The Infantería de Marina is the marine infantry of the Spanish Navy, and the oldest marine corps in existence in the world. It has a strength of 11,500 troops and is divided into base defense forces and landing forces. One of the three base defense battalions is stationed with each of the Navy headquarters. "Groups" (midway between battalions and regiments) are stationed in Madrid and Las Palmas de Gran Canaria. The "Tercio" (fleet — regiment equivalent) is available for immediate embarkation and based out of San Fernando. Its principal weapons include light tanks, armored personnel vehicles, self-propelled artillery, and TOW and Dragon antitank missiles.


title: Spanish Navy

text: As of 2018, there are approximately 138 vessels in service within the Navy, including minor auxiliary vessels. A breakdown includes an amphibious assault ship (also used as an aircraft carrier), amphibious transport docks, frigates, submarines, mine countermeasure vessels, patrol vessels and a number of auxiliary ships. The total displacement of the Spanish Navy is approximately 220,000 tonnes.


title: Spanish Navy

text: The officer ranks of the Spanish Navy are as follows below, (for a comparison with other NATO ranks, see Ranks and Insignia of NATO). Midshipmen are further divided into 1st and 2nd Classes and Officer Cadets 3rd and 4th Classes respectively.


title: Spanish Navy

text: The article Spanish Marine Infantry includes the rank insignia descriptions for this part of the Navy.


title: Spanish Navy

text: The Spanish Navy shares the organization model of its two sister services – the Spanish Army and the Spanish Air and Space Force. Each of them consists of a Headquarters ("Cuartel general"), a Force ("Fuerza", composed of the operational units) and a Force Support ("Apoyo a la fuerza", composed of administration, logistical and training units). For historical traditions the Force of the Spanish Navy is called Fleet ("Flota") and the two terms are used interchangeably. At the head of the Navy is an "Almirante general" (a four-star rank reserved for the Chief of the Spanish Navy and the Chief of the Spanish Armed Forces, when the latter position is held by a naval officer), denominated AJEMA or Admiral Chief of the General Staff of the Navy ("Almirante Jefe de Estado Mayor de la Armada"). Counterintuitive to this official designation he holds authority over all three components of the service and the officer, who actually functions as Chief of Staff is a three-star "Almirante", designated Admiral Deputy Chief of the General Staff of the Navy ("Almirante Segundo Jefe del Estado Mayor de la Armada" or "2º AJEMA")


title: Dope (2015 film)

text: Dope is a 2015 American coming-of-age comedy-drama film written and directed by Rick Famuyiwa and produced by Forest Whitaker and Nina Yang Bongiovi. It stars Shameik Moore, Tony Revolori, Kiersey Clemons, Kimberly Elise, Chanel Iman, Tyga, Blake Anderson, Zoë Kravitz, and ASAP Rocky. The film was also executive produced by Pharrell Williams and co-executive produced by Sean Combs.


title: Dope (2015 film)

text: The film premiered at the 2015 Sundance Film Festival on January 24, 2015 in Park City, Utah and was released in North America on June 19 by Open Road Films. It was re-released on September 4 during the Labor Day holiday weekend. The film received positive reviews and was a moderate commercial success, grossing $18 million over a $7 million budget.


title: Dope (2015 film)

text: Malcolm Adekanbi and his best friends, Jib and Diggy, are high school "geeks" living in "The Bottoms," a high-crime neighborhood in Inglewood, California. They idolize 90's hip hop music and fashion. Malcolm is confident he will be admitted to his dream school, Harvard University, but his school counselor is skeptical and suggests he take an interview with local businessman and Harvard alumnus, Austin Jacoby.


title: Dope (2015 film)

text: While biking home, Malcolm is stopped by Dom, a drug dealer who instructs him to invite a girl named Nakia to his party. Malcolm charms Nakia, who tells him she will only accept if Malcolm goes as well. Jib and Diggy accompany Malcolm to the party, where Dom’s purchase of high-grade, powdered molly is interrupted by an armed gang, and several people are shot. Malcolm escapes as the police arrive, unaware that Dom has hidden the drugs and a gun in his backpack. Nakia drives Malcolm home, and he offers to help her with her GED.


title: Dope (2015 film)

text: The next day, Malcolm discovers the drugs, gun, and an iPhone. An unknown caller reveals that he knows Malcolm's identity and instructs him to turn over the drugs. After school, Malcolm prepares to hand over the drugs when he receives a call from Dom, in custody, who tells Malcolm not to give the drugs to the other caller. He texts Malcolm an address and tells him to ask for AJ.


title: Dope (2015 film)

text: Malcolm, Jib and Diggy flee to the address, chased by the unknown caller, and are greeted by Jaleel and his sister Lily. Since AJ, their father, isn't home, Jaleel invites them inside their mansion and takes Jib and Diggy out for food, while Lily seduces Malcolm, finds the drugs and takes a heavy dose. Intoxicated, Lily passes out while driving Malcolm to his interview before urinating on a bush while bystanders record, and Malcolm drives her car to the meeting himself.


title: Dope (2015 film)

text: Arriving at Jacoby's office, he notices photos of Dom, Lily, and Jaleel and realizes Jacoby is AJ. Malcolm relays Dom's instructions to Jacoby, who denies any knowledge and implies that the contents of the bag are now Malcolm's responsibility. Jacoby reschedules the interview, warning Malcolm that if he has not sold the drugs by then, he will not receive Jacoby’s recommendation to Harvard.


title: Dope (2015 film)

text: Malcolm, Jib and Diggy seek help from hacker Will Sherwood, who sets up an online black-market website to sell the drugs through Bitcoin transactions, which soon goes viral. The three friends enroll in a Google Science Fair project to access the school lab and computer room, where they can sell the drugs to the various buyers. Even though no one suspects them, they almost get caught one day during a routine police search. This episode frightens Jib who wants to leave, but eventually accepts to go on to finish the sales.


title: Dope (2015 film)

text: Malcolm helps Nakia study, and she opens up to him, but he accuses her of being sent by Dom and pushes her away. The next day, Malcolm asks Will to extract cash from the Bitcoins, and arranges a meeting with a money-laundering gangster named Fidel. Malcolm leaves the meeting with a bag of cash, but is assaulted by the school bully, who takes the bag. Desperate, Malcolm pulls out the gun, retrieving the money and earning the bully's respect.


title: Dope (2015 film)

text: Returning to AJ's office, Malcolm tells Jacoby that he has sold the drugs but has left a trail leading to Jacoby – unless Jacoby gets him admitted to Harvard, Malcolm will transfer the Bitcoins to Jacoby's checking account, incriminating Jacoby for the sale and leading to his arrest. Later Malcolm types his college application essay, describing two students – Student A is a music geek who plays in a punk band and gets straight As, while Student B suffers in the hood and makes money in immoral ways. He asks, "Which student do you think I am?"


title: Dope (2015 film)

text: Malcolm gets a modern haircut and waits for Nakia at prom, but she does not show. Later, Nakia meets Malcolm at his home and thanks him for helping her pass her GED, giving him a pass to Six Flags and kissing him on the cheek. He returns to his room to find a letter from Harvard on his bed. He opens it and looks at the audience before smiling.


title: Dope (2015 film)

text: The soundtrack to the film, "Dope (Music from the Motion Picture)", was released by i am OTHER Entertainment and Columbia Records on June 16, 2015.


title: Dope (2015 film)

text: "Dope" debuted in the U.S. Dramatic Competition category at the 2015 Sundance Film Festival, which started on January 22, 2015 in Park City, Utah. At the festival, the film received offers from at least six production companies and film studios before its rights were sold to Open Road Films (who distributed the film domestically) and Sony (who distributed the film internationally) for a reported $7 million plus $20 million for marketing and promotion. It was selected to close the Directors' Fortnight section at the 2015 Cannes Film Festival. It was released in the United States on June 19, 2015. In September 2015, the film competed in the 2015 Deauville American Film Festival where it won the "Prix du Public" (Audience Award).


title: Dope (2015 film)

text: "Dope" grossed $6.1 million in its opening weekend, finishing 5th at the box office behind "Jurassic World" ($106.6 million), "Inside Out" ($90.4 million), "Spy" ($11.2 million) and "San Andreas" ($8.7 million). At the end of its theatrical run, the film grossed just shy of $18 million worldwide.


title: Dope (2015 film)

text: "Dope" received positive reviews from critics. On Rotten Tomatoes, the film holds a rating of 89%, based on 150 reviews, with an average rating of 7.3/10. The website's critical consensus reads, "Featuring a starmaking performance from Shameik Moore and a refreshingly original point of view from writer-director Rick Famuyiwa, "Dope" is smart, insightful entertainment." On Metacritic, the film has a score of 72 out of 100, based on 37 critics, indicating "generally favorable reviews." Audiences polled by CinemaScore gave the film an "A−" grade.


title: Dope (2015 film)

text: "The Guardian" gave the film five stars out of five, describing the entire cast as "revolutionary." IGN awarded it 7 out of 10, saying "Comedy, romance, drama and crime rub shoulders in entertaining coming-of-age flick."


title: Brown

text: Brown is a color. It can be considered a composite color, but it is mainly a darker shade of orange. In the CMYK color model used in printing or painting, brown is usually made by combining the colors orange and black. In the RGB color model used to project colors onto television screens and computer monitors, brown combines red and green.


title: Brown

text: The color brown is seen widely in nature, wood, soil, human hair color, eye color and skin pigmentation. Brown is the color of dark wood or rich soil. According to public opinion surveys in Europe and the United States, brown is the least favorite color of the public; it is often associated with plainness, the rustic, feces, and poverty. More positive associations include baking, warmth, wildlife, and the autumn.


title: Brown

text: The term is from Old English , in origin for any dusky or dark shade of color. The first recorded use of "brown" as a color name in English was in 1000.


title: Brown

text: The Common Germanic adjectives "*brûnoz and *brûnâ" meant both dark colors and a glistening or shining quality, whence "burnish". The current meaning developed in Middle English from the 14th century.


title: Brown

text: Words for the color brown around the world often come from foods or beverages; in the eastern Mediterranean, the word for brown often comes from the color of coffee: in Turkish, the word for brown is ; in Greek, . In Southeast Asia, the color name often comes from chocolate: in Malay; in Filipino. In Japan, the word means the color of tea.


title: Brown

text: Brown has been used in art since prehistoric times. Paintings using umber, a natural clay pigment composed of iron oxide and manganese oxide, have been dated to 40,000 BC. Paintings of brown horses and other animals have been found on the walls of the Lascaux cave dating back about 17,300 years. The female figures in ancient Egyptian tomb paintings have brown skin, painted with umber. Light tan was often used on painted Greek amphorae and vases, either as a background for black figures, or the reverse.


title: Brown

text: The Ancient Greeks and Romans produced a fine reddish-brown ink, of a color called sepia, made from the ink of a variety of cuttlefish. This ink was used by Leonardo da Vinci, Raphael and other artists during the Renaissance, and by artists up until the present time.


title: Brown

text: In Ancient Rome, brown clothing was associated with the lower classes or barbarians. The term for the plebeians, or urban poor, was "pullati", which meant literally "those dressed in brown".


title: Brown

text: In the Middle Ages brown robes were worn by monks of the Franciscan order, as a sign of their humility and poverty. Each social class was expected to wear a color suitable to their station; and grey and brown were the colors of the poor. Russet was a coarse homespun cloth made of wool and dyed with woad and madder to give it a subdued grey or brown shade. By the statute of 1363, poor English people were required to wear russet. The medieval poem "Piers Plowman" describes the virtuous Christian:


title: Brown

text: In the Middle Ages dark brown pigments were rarely used in art; painters and book illuminators artists of that period preferred bright, distinct colors such as red, blue and green, rather than dark colors. The umbers were not widely used in Europe before the end of the fifteenth century; The Renaissance painter and writer Giorgio Vasari (1511–1574) described them as being rather new in his time.


title: Brown

text: Artists began using far greater use of browns when oil painting arrived in the late fifteenth century. During the Renaissance, artists generally used four different browns; raw umber, the dark brown clay mined from the earth around Umbria, in Italy; raw sienna, a reddish-brown earth mined near Siena, in Tuscany; burnt umber, the Umbrian clay heated until it turned a darker shade, and burnt sienna, heated until it turned a dark reddish brown. In Northern Europe, Jan van Eyck featured rich earth browns in his portraits to set off the brighter colors.


title: Brown

text: The 17th and 18th century saw the greatest use of brown. Caravaggio and Rembrandt Van Rijn used browns to create chiaroscuro effects, where the subject appeared out of the darkness. Rembrandt also added umber to the ground layers of his paintings because it promoted faster drying. Rembrandt also began to use new brown pigment, called Cassel earth or Cologne earth. This was a natural earth color composed of over ninety percent organic matter, such as soil and peat. It was used by Rubens and Anthony van Dyck, and later became commonly known as Van Dyck brown.


title: Brown

text: Brown was generally hated by the French impressionists, who preferred bright, pure colors. The exception among French 19th-century artists was Paul Gauguin, who created luminous brown portraits of the people and landscapes of French Polynesia.


title: Brown

text: In the late 20th century, brown became a common symbol in western culture for simple, inexpensive, natural and healthy. Bag lunches were carried in plain brown paper bags; packages were wrapped in plain brown paper. Brown bread and brown sugar were viewed as more natural and healthy than white bread and white sugar.


title: Brown

text: Brown is a dark orange color, made by combining red, yellow and black. It can be thought of as dark orange, but it can also be made in other ways. In the RGB color model, which uses red, green and blue light in various combinations to make all the colors on computer and television screens, it is made by mixing red and green light.


title: Brown

text: In terms of the visible spectrum, "brown" refers to long wavelength hues, yellow, orange, or red, in combination with low luminance or saturation.


title: Brown

text: Since "brown" may cover a wide range of the visible spectrum, composite adjectives are used such as red brown, yellowish brown, dark brown or light brown.


title: Brown

text: As a color of low intensity, brown is a tertiary color: a mix of the three subtractive primary colors is brown if the cyan content is low. Brown exists as a color perception only in the presence of a brighter color contrast. Yellow, orange, red, or rose objects are still perceived as such if the general illumination level is low, despite reflecting the same amount of red or orange light as a brown object would in normal lighting conditions.


title: Brown

text: With few exceptions, all mammals have brown or darkly-pigmented irises. In humans, brown eyes result from a relatively high concentration of melanin in the stroma of the iris, which causes light of both shorter and longer wavelengths to be absorbed and in many parts of the world, it is nearly the only iris color present. Dark pigment of brown eyes is most common in East Asia, Southeast Asia, South Asia, West Asia, Oceania, Africa, Americas, etc. as well as parts of Eastern Europe and Southern Europe. The majority of people in the world overall have dark brown eyes. Light or medium-pigmented brown eyes are common in Europe, Afghanistan, Pakistan and Northern India, as well as some parts of the Middle East. (See eye color).


title: Brown

text: Brown is the second most common color of human hair, after black. It is caused by higher levels of the natural dark pigment eumelanin, and lower levels of the pale pigment pheomelanin. Brown eumelanin is more common among Europeans, while black eumelanin is more often found in the hair on non-Europeans. A small amount of black eumelanin, in the absence of other pigments, results in grey hair. A small amount of brown eumelanin in the absence of other pigments results in blond hair.


title: Brown

text: A majority of people in the world have skin that is a shade of brown, from a very light honey brown or a golden brown, to a copper or bronze color, to a coffee color or a dark chocolate brown. Skin color and race are not the same; many people classified as "white" or "black" actually have skin that is a shade of brown. Brown skin is caused by melanin, a natural pigment which is produced within the skin in cells called melanocytes. Skin pigmentation in humans evolved to primarily regulate the amount of ultraviolet radiation penetrating the skin, controlling its biochemical effects.


title: Brown

text: Natural skin color can darken as a result of tanning due to exposure to sunlight. The leading theory is that skin color adapts to intense sunlight irradiation to provide partial protection against the ultraviolet fraction that produces damage and thus mutations in the DNA of the skin cells. There is a correlation between the geographic distribution of ultraviolet radiation (UVR) and the distribution of indigenous skin pigmentation around the world. Darker-skinned populations are found in the regions with the most ultraviolet, closer to the equator, while lighter skinned populations live closer to the poles, with less UVR, though immigration has changed these patterns.


title: Brown

text: While "white "and" black" are commonly used to describe racial groups, "brown" is rarely used, because it crosses all racial lines.


title: Brown

text: In Brazil, the Portuguese word "pardo", which can mean different shades of brown, is used to refer to multiracial people. The Brazilian Institute of Geography and Statistics (IBGE) asks people to identify themselves as "branco" (white), "pardo" (brown), "negro" (black), or "amarelo" (yellow). In 2008 43.8 percent of the population identified themselves as pardo. (See human skin color).


title: Brown

text: The thin top layer of the Earth's crust on land is largely made up of soil colored different shades of brown. Good soil is composed of about forty-five percent minerals, twenty-five percent water, twenty-five percent air, and five percent organic material, living and dead. Half the color of soil comes from minerals it contains; soils containing iron turn yellowish or reddish as the iron oxidizes. Manganese, nitrogen and sulfur turn brownish or blackish as they decay naturally.


title: Brown

text: Rich and fertile soils tend to be darker in color; the deeper brown color of fertile soil comes from the decomposing of the organic matter. Dead leaves and roots become black or brown as they decay. Poorer soils are usually paler brown in color, and contain less water or organic matter.


title: Brown

text: A large number of mammals and predatory birds have a brown coloration. This sometimes changes seasonally, and sometimes remains the same year-round. This color is likely related to camouflage, since the backdrop of some environments, such as the forest floor, is often brown, and especially in the spring and summertime when animals like the snowshoe hare get brown fur. Most mammals are dichromats and so do not easily distinguish brown fur from green grass.


title: Brown

text: Surveys in Europe and the United States showed that brown was the least popular color among respondents. It was the favorite color of only one percent of respondents and the least favorite color of twenty percent of people.


title: Brown

text: Brown has been a popular color for military uniforms since the late 18th century, largely because of its wide availability and low visibility. When the Continental Army was established in 1775 at the outbreak of the American Revolution, the first Continental Congress declared that the official uniform color would be brown, but this was not popular with many militias, whose officers were already wearing blue. In 1778 the Congress asked George Washington to design a new uniform, and in 1779 Washington made the official color of all uniforms blue and buff.


title: Brown

text: In 1846 the Indian soldiers of the Corps of Guides in British India began to wear a yellowish shade of tan, which became known as khaki from the Urdu word for dust-colored, taken from an earlier Persian word for soil. The color made an excellent natural camouflage, and was adopted by the British Army for their Abyssian Campaign in 1867–1868, and later in the Boer War. It was adopted by the United States Army during the Spanish–American War (1896), and afterwards by the United States Navy and United States Marine Corps.


title: Brown

text: In the 1920s, brown became the uniform color of the Nazi Party in Germany. The Nazi paramilitary organization the "Sturmabteilung" (SA) wore brown uniforms and were known as the brownshirts. The color brown was used to represent the Nazi vote on maps of electoral districts in Germany. If someone voted for the Nazis, they were said to be "voting brown". The national headquarters of the Nazi party, in Munich, was called the "Brown House". The Nazi seizure of power in 1933 was called the "Brown Revolution". At Adolf Hitler's Obersalzberg home, the Berghof, he slept in a "bed which was usually covered by a brown quilt embroidered with a huge swastika.


title: Brown

text: The swastika also appeared on Hitler's brown satin pajamas, embroidered in black against a red background on the pocket. He had a matching brown silk robe." Brown had originally been chosen as a Party color largely for convenience; large numbers of war-surplus brown uniforms from Germany's former colonial forces in Africa were cheaply available in the 1920s. It also suited the working-class and military images that the Party wished to convey.


title: Brown

text: From the 1930s onwards, the Party's brown uniforms were mass-produced by German clothing firms such as Hugo Boss.


title: Brown

text: The color brown is said to represent ruggedness when used in advertising." " is the color of the United Parcel Service (UPS) delivery company with their trademark brown trucks and uniforms; it was earlier the color of Pullman rail cars of the Pullman Company, and was adopted by UPS both because brown is easy to keep clean, and due to favorable associations of luxury that Pullman brown evoked. UPS has filed two trademarks on the color brown to prevent other shipping companies (and possibly other companies in general) from using the color if it creates "market confusion". In its advertising, UPS refers to itself as "Brown" ("What can Brown do for you?").


title: Stephanie Ruhle

text: Stephanie Ruhle Hubbard (born December 24, 1975) is the host of "The 11th Hour" and a Senior Business Analyst for NBC News. Previously, Ruhle was managing editor and news anchor for Bloomberg Television and editor-at-large for Bloomberg News. Ruhle co-hosted the Bloomberg Television show "Bloomberg GO." Ruhle was one of three Bloomberg reporters who broke the story of the London Whale, identifying the trader behind the 2012 JPMorgan Chase trading loss. She became the host of "The 11th Hour" in March 2022.


title: Stephanie Ruhle

text: Her parents are Frank and Louise Ruhle, and she was raised in Park Ridge, New Jersey. She is a graduate of Lehigh University where she earned her bachelor’s degree in international business in 1997. As part of her major, she studied in Guatemala, Italy, and Kenya. Ruhle returned to Lehigh to give the 2017 commencement address.


title: Stephanie Ruhle

text: Prior to joining Bloomberg, Ruhle spent 14 years working in the finance industry. While in college, she spent a summer interning for Merrill Lynch. In 1997, she joined Credit Suisse where she spent six years working in hedge fund sales. During her time at Credit Suisse First Boston, she served as a vice president and became the highest producing credit derivatives salesperson in the United States. In 2003, Ruhle joined Deutsche Bank as a credit salesperson covering hedge funds. She ended her eight-year career there as a managing director in Global Markets Senior Relationship Management. While at Deutsche Bank, Ruhle founded the Global Market Women's Network to help women move into leadership roles at the company.


title: Stephanie Ruhle

text: Ruhle joined Bloomberg Television in October 2011, where she co-hosted a two-hour early morning program called "Inside Track" with co-anchor Erik Schatzker. In 2012, Ruhle and Schatzker joined "Market Makers", a two-hour late morning program. Ruhle then co-hosted "Bloomberg GO" with David Westin before leaving the network. She has profiled figures including former New York City Mayor Michael Bloomberg, Goldman Sachs CEO Lloyd Blankfein, hedge fund managers Stanley Druckenmiller and David Tepper, NBA player Kobe Bryant, Donald Trump, chairman and CEO of JP Morgan Jamie Dimon, Martha Stewart, Sean Parker, former Vice President Al Gore, business magnate Russell Simmons, Masters winner Jordan Spieth, "Miami Heat" star Dwyane Wade, CEO and chair of Macy's Terry Lundgren, and music moguls Sean Combs and Kanye West.


title: Stephanie Ruhle

text: In April 2012, Ruhle, along with Bloomberg reporters Bradley Keoun and Mary Childs, were the first reporters to break the story of the London Whale, the trader behind the 2012 JPMorgan Chase trading loss. Ruhle reported that Bruno Iksil, the London-based trader at JP Morgan, had amassed positions large enough to distort prices in the $10 trillion credit derivative market.


title: Stephanie Ruhle

text: In June 2013, Ruhle wrote a provocative response to Paul Tudor Jones’ comments on women in trading for the "Huffington Post" that elicited responses from both the media and financial industries. In October of that same year, Ruhle sat down with Martha Stewart to discuss social media, blogging, and the creation of the "lifestyle" category.


title: Stephanie Ruhle

text: In 2015, Ruhle produced and hosted "Haiti: Open For Business?" (2015), a documentary that explores Haiti’s emerging market five years after the country was hit by a devastating earthquake. Ruhle also appeared in "Shark Land: A Mission Blue and Fusion Expedition" (2015), which brings attention to the plight of sharks in Cocos Island, a national park off the shore of Costa Rica.


title: Stephanie Ruhle

text: She interviewed in 2015 then-presidential candidate Donald Trump, who faced backlash in the media after noting to Ruhle that "the World Trade Center came down during [former President George W. Bush’s] reign." The previous year, rapper Kanye West strongly criticized photographer Annie Leibovitz during a panel conversation with Ruhle when he revealed that Leibovitz pulled out of taking his official wedding pictures just one day before his wedding to Kim Kardashian. Ruhle’s interview with Martha Stewart in 2013 brought an ongoing feud between Stewart and Gwyneth Paltrow public after Stewart questioned the actress’s place in the "lifestyle business".


title: Stephanie Ruhle

text: Ruhle was a columnist for Shape.com, the website for "Shape" magazine. Ruhle was featured on the cover of "Working Mother" magazine in October 2012, as well as "Fit Pregnancy" on their April/May 2013 issue. She has been profiled by "201 Magazine", Glass Hammer, IWantHerJob, and "Business Insider".


title: Stephanie Ruhle

text: No longer with Bloomberg, Ruhle would become host of an hour of "MSNBC Reports" after having co-hosted, with Ali Velshi, a business program "Velshi & Ruhle", which aired weekdays and Saturday.


title: Stephanie Ruhle

text: Ruhle founded the Corporate Investment Bank (CIB) Women's Network and co-chaired the Women on Wall Street (WOWS) steering committee. Ruhle is also a member of the board of trustees for Girls, Inc. New York and a former member of the iMentor Corporate Advisory Board. She is a member of 100 Women in Hedge Funds, The Women's Bond Club and a member of the corporate council of The White House Project, a not-for-profit organization working to advance women in business, government, and media. She also serves on the board and advises for React To Film, an issue-based documentary film series.


title: Stephanie Ruhle

text: On January 27, 2022, she was named new permanent anchor of "The 11th Hour" after serving as one of several rotating hosts following original anchor Brian Williams's departure from the network in December.


title: MasterChef Canada

text: MasterChef Canada is a Canadian competitive cooking reality show, part of the "MasterChef" franchise, open to amateur home cooks. It premiered on CTV on January 20, 2014, and has aired its seventh season. The show stars three judges: Claudio Aprile, Michael Bonacini and Alvin Leung. The show is produced by Endemol Shine International and Proper Television.


title: MasterChef Canada

text: "MasterChef Canada" airs Tuesday nights on CTV and the Cooking Channel in the United States. The current season airs starting in September of each year in the U.S. It airs also in Sweden, Italy and Spain.


title: MasterChef Canada

text: On August 8, 2018, CTV renewed "MasterChef Canada" for another season, announcing that audition casting for the all new sixth season was greenlit. Filming began in October 2018 and concluded in January 2019. Season 6 premiered on CTV on April 8, 2019, and ended on June 10.


title: MasterChef Canada

text: The series was renewed for a seventh season, which is the franchise's first "Back to Win" season. It aired its premiere on February 14, 2021, and its finale on May 16, 2021. There are currently no plans for an eighth season.


title: MasterChef Canada

text: Amateur chefs compete in a series of challenges to become the best amateur home cook in Canada through challenges issued by judges Claudio Aprile, Michael Bonacini and Alvin Leung. The rest of the format is very similar to the U.S. version starring Gordon Ramsay.


title: MasterChef Canada

text: Each season begins with around 20 applicants invited to the kitchen. To secure a place in the competition, they are tasked with creating their signature audition dish in a certain amount of time. Judging based on the food plating, flavours, technique, and sophistication, the judges will decide whether or not the applicants and their signature dishes are worthy of receiving a coveted white apron (a spot in the competition). In the first three seasons the traditional audition format (like the U.S. version) requires the applicants to earn an affirmative "yes" (thumbs up) from at least two out of the three judges to advance. Since season 4, changes to the audition format have been made. Applicants who fail to produce a passable dish are rejected and sent home. Some other rejected applicants are given a second chance to compete for the white apron.


title: MasterChef Canada

text: After the Restaurant Takeover challenge, the next mystery box challenge is a family-reunion themed episode where the final 5 remaining contestants are visited by their family members. This particular mystery box tasks the contestants with making a stunningly elevated, home-style family-inspired dish while their family members look on from the balcony, followed by the elimination test. In later seasons the family members assisted the contestants.


title: MasterChef Canada

text: In the Top 3 semifinals, the final three remaining semifinalists face the last mystery box/immunity challenge of the season for a shot at immunity. The semifinalist who wins this immunity challenge will automatically advance to the finals and secure a place in the grand finale, safe from elimination, while the remaining two semifinalists go head-to-head and compete against each other in the final replication Pressure Test of the season to earn to last spot in the grand finale. Other times, the semifinalist who wins this first challenge does not automatically advance to the finals/grand finale and must also participate in the last Elimination Test (which they have an advantage over in terms of getting to choose a key ingredient to work with for themselves while giving different key ingredients to the other two semifinalists).


title: MasterChef Canada

text: Once the competition is reduced to the final two remaining competitors left standing, the two or three finalists will compete against each other in a three-hour, three-course dinner cook-off in a ring-like arena while their family members (joined by previously eliminated contestants), spectate and cheer them on. The finalists join the judges in the private dining room for the judging and tasting of their dishes at the end of each course. All three courses of the meal are judged and an overall winner is crowned after the two finalists switch places with the judges and stand on their podium. The winner of each season wins a $100,000 cash prize money, the "MasterChef Canada" trophy, and the title of "MasterChef Canada". Some seasons have also added other prizes. In the first three seasons, the finalists had separate time for each item. Since the Season 4 finale, the finalists must continuously cook non-stop for three whole hours, making sure that each course is ready for serving at the end of each hour and then join the judges in the private dining room once time is up to hear the judges feedback.


title: MasterChef Canada

text: MasterChef U.S. judge Joe Bastianich guest starred in the Season 1 semi-finals (Episode: "Not-Your-Average-Joe") which aired on April 21, 2014. Additionally, MasterChef U.S. judge Graham Elliot guest starred in an episode of Season 2 (Episode: "Good Things in Small Packages").


title: Christina Chang

text: Christina Chang () is an Taiwanese actress, who has appeared in "24", "", and "Nashville". Currently she plays Dr. Audrey Lim, Chief of Surgery, on "The Good Doctor".


title: Christina Chang

text: Chang was born and raised in Taipei, Taiwan, to a Taiwanese Filipino father and a White American mother. She attended Taipei American School and is fluent in Mandarin. At the age of 17, she moved to the United States to study theatre and film at the University of Kansas in her mother's home state of Kansas. Later, she moved to Seattle, Washington where she graduated from the University of Washington. After graduation, she got her first acting role in "Naomi's Road" at the Children's theatre in Seattle. and then appeared in an off-Broadway play by Tina Landau.


title: Christina Chang

text: Chang later moved to New York City and guest starred in various television programs including "Cosby" and "As the World Turns". She earned feature film roles in such films as "28 Days" and "Random Hearts". Chang is best known for her roles on television. She had a regular role on ABC series "Dragnet" (2003–2004), and played recurring roles on "24" as Dr. Sunny Macer, and as State Attorney Rebecca Nevins on "". In 2010, Chang was cast as a regular in ABC's series "No Ordinary Family", but exited after two episodes. She also appeared in "Once and Again", "Boston Legal", "Close to Home", "Brothers & Sisters", "Private Practice", "Suits", "The Mentalist" (s2, eps5) and "Desperate Housewives". In 2013 she was cast in another recurring role, in the second season of the ABC drama series "Nashville", as Megan Vannoy, Charles Esten's character's love interest. In 2014, Chang was cast in the ABC drama pilot "Sea Of Fire", opposite Jennifer Carpenter. She also had a recurring role as Kiki, Vince Korsak’s life coach, then love interest and wife, in "Rizzoli & Isles" in Season 6 & 7. Since 2017, Chang has played Dr. Audrey Lim on "The Good Doctor".


title: Bladder cancer

text: Bladder cancer is any of several types of cancer arising from the tissues of the urinary bladder. Symptoms include blood in the urine, pain with urination, and low back pain. It is caused when epithelial cells that line the bladder become malignant.


title: Bladder cancer

text: Risk factors for bladder cancer include smoking, family history, prior radiation therapy, frequent bladder infections, and exposure to certain chemicals. The most common type is transitional cell carcinoma. Other types include squamous cell carcinoma and adenocarcinoma. Diagnosis is typically by cystoscopy with tissue biopsies. Staging of the cancer is determined by transurethral resection and medical imaging.


title: Bladder cancer

text: Treatment depends on the stage of the cancer. It may include some combination of surgery, radiation therapy, chemotherapy, or immunotherapy. Surgical options may include transurethral resection, partial or complete removal of the bladder, or urinary diversion. The typical five-year survival rates in the United States is 77%, Canada is 75%, and Europe is 68%.


title: Bladder cancer

text: Bladder cancer, as of 2018, affected about 1.6 million people globally with 549,000 new cases and 200,000 deaths. Age of onset is most often between 65 and 84 years of age. Males are more often affected than females. In 2018, the highest rate of bladder cancer occurred in Southern and Western Europe followed by North America with rates of 15, 13, and 12 cases per 100,000 people. The highest rates of bladder cancer deaths were seen in Northern Africa and Western Asia followed by Southern Europe.


title: Bladder cancer

text: Bladder cancer characteristically causes blood in the urine, which may be visible or detectable only by microscope. Blood in the urine is the most common symptom in bladder cancer, and is painless. Visible blood in the urine may be of only short duration, and a urine test may be required to confirm non-visible blood. Between 80 and 90% of people with bladder cancer initially presented with visible blood. Blood in the urine may also be caused by other conditions, such as bladder or ureteric stones, infection, kidney disease, kidney cancers or vascular malformations, though these conditions (except kidney cancers) would typically be painful.


title: Bladder cancer

text: Other possible symptoms include pain during urination, frequent urination, or feeling the need to urinate without being able to do so. These signs and symptoms are not specific to bladder cancer, and may also be caused by non-cancerous conditions, including prostate infections, overactive bladder or cystitis. Some rare forms of bladder cancer like urachal adenocarcinoma produce mucin, which is then excreted in the urine causing it to be thick.


title: Bladder cancer

text: People with advanced disease may have pelvic or bony pain, lower-extremity swelling, or flank pain. Rarely, a palpable mass can be detected on physical examination.


title: Bladder cancer

text: Tobacco smoking is the main known contributor to urinary bladder cancer; in most populations, smoking is associated with over half of bladder cancer cases in men and one-third of cases among women, however these proportions have reduced over recent years since there are fewer smokers in Europe and North America. There is an almost linear relationship between smoking duration (in years), pack years and bladder cancer risk. A risk plateau at smoking about 15 cigarettes a day can be observed (meaning that those who smoke 15 cigarettes a day are approximately at the same risk as those smoking 30 cigarettes a day). Smoking in any form (cigar, pipe, Egyptian waterpipe and smokeless tobacco) increases the risk for bladder cancer. Quitting smoking reduces the risk. Risk of bladder cancer decreases by 30% within 1–4 years and continues to decrease by 60% at 25 years after smoking cessation. However, former smokers will most likely always be at a higher risk of bladder cancer compared to people who have never smoked. Passive smoking also appear to be a risk.


title: Bladder cancer

text: Opium consumption increases the risk of bladder cancer by 3-fold and concurrent use of opium and smoking increases the risk of bladder cancer by 5 times compared to the general population.


title: Bladder cancer

text: Thirty percent of bladder tumors probably result from occupational exposure in the workplace to carcinogens. Occupational or circumstantial exposure to the following substances has been implicated as a cause of bladder cancer; benzidine (dyes manufacturing), 4-aminobiphenyl (rubber industry), 2-naphtylamine (azo dyes manufacturing, foundry fumes, rubber industry, cigarette smoke and cancer research), phenacetin (analgesic), arsenic and chlorinated aliphatic hydrocarbons in drinking water, auramine (dye manufacturing), magenta (dye manufacturing), ortho-toluidine (dye manufacturing), epoxy and polyurethane resin hardening agents (plastics industry), chlornaphazine, coal-tar pitch. Occupations at risk are bus drivers, rubber workers, painters, motor mechanics, leather (including shoe) workers, blacksmiths, machine setters, and mechanics. Hairdressers are thought to be at risk as well because of their frequent exposure to permanent hair dyes.


title: Bladder cancer

text: Infection with "Schistosoma haematobium" (bilharzia or schistosomiasis) may cause bladder cancer, specially of the squamous cell type. Schistosoma eggs induces a chronic inflammatory state in the bladder wall resulting in tissue fibrosis. Higher levels of N-nitroso compounds has been detected in urine samples of people with schistosomiasis. N-Nitroso compounds have been implicated in the pathogenesis of schistosomiasis related bladder cancer. They cause alkylation DNA damage, specially Guanine to Adenine transition mutations in the HRAS and p53 tumor suppressor gene. Mutations of p53 are detected in 73% of the tumors, BCL-2 mutations accounting for 32% and the combination of the two accounting for 13%. Other causes of squamous cell carcinoma of the bladder include chronic catheterizations in people with a spinal cord injury and history of treatment with cyclophosphamide.


title: Bladder cancer

text: The American Institute for Cancer Research have stated that there is strong evidence that drinking water containing arsenic increases the risk of bladder cancer.


title: Bladder cancer

text: Ingestion of aristolochic acid present in many Chinese herbal medications has been shown to cause urothelial carcinoma and kidney failure. Aristolochic acid activates peroxidase in the urothelium and causes transversion mutation in the TP53 tumor suppressor gene.


title: Bladder cancer

text: People who undergo external beam radiotherapy (EBRT) for prostate cancer have a higher risk of developing invasive bladder cancer.


title: Bladder cancer

text: In addition to these major risk factors there are also numerous other modifiable factors that are less strongly (i.e. 10–20% risk increase) associated with bladder cancer, for example, obesity. Although these could be considered as minor effects, risk reduction in the general population could still be achieved by reducing the prevalence of a number of smaller risk factor together.


title: Bladder cancer

text: Mutations in FGFR3, TP53, PIK3CA, KDM6A, ARID1A, KMT2D, HRAS, TERT, KRAS, CREBBP, RB1 and TSC1 genes may be associated with some cases of bladder cancer. Deletions of parts or whole of chromosome 9 is common in bladder cancer. Low grade cancer are known to harbor mutations in RAS pathway and the fibroblast growth factor receptor 3 (FGFR3) gene, both of which play a role in the MAPK/ERK pathway. p53 and RB gene mutations are implicated in high-grade muscle invasive tumors. Eighty nine percent of muscle invasive cancers have mutations in chromatin remodeling and histone modifying genes.


title: Bladder cancer

text: Deletion of both copies of the GSTM1 gene has a modest increase in risk of bladder cancer. GSTM1 gene product glutathione S-transferase M1 (GSTM1) participates in the detoxification process of carcinogens such as polycyclic aromatic hydrocarbons found in cigarette smoke. Similarly, mutations in NAT2 (N-acetyltransferase) is associated with increased risk for bladder cancer. N-acetyltransferase helps in detoxification of carcinogens like aromatic amines (also present in cigarette smoke). Various single-nucleotide polymorphisms in PSCA gene present on chromosome 8 have shown to increase the risk for bladder cancer. PSCA gene promoter region has an androgen response region. Loss of reactivity of this region to androgens is hypothesized as a cause of more number of aggressive tumors in women (unlike in men who have higher amount of androgen).


title: Bladder cancer

text: Muscle invasive bladder cancer are heterogeneous in nature. In general, they can be genetically classified into basal and luminal subtypes. Basal subtype show alterations involving RB and NFE2L2 and luminal type show changes in FGFR3 and KDM6A genes. Basal subtype are subdivided into basal and claudin low-type group and are aggressive and show metastasis at presentation, however they respond to platinum based chemotherapy. Luminal subtype can be subdivided into p53-like and luminal. p53-like tumors of luminal subtype although not as aggressive as basal type, show resistance to chemotherapy


title: Bladder cancer

text: Currently, the best diagnosis of the state of the bladder is by way of cystoscopy, which is a procedure in which a flexible or rigid tube (called a "cystoscope") bearing a camera and various instruments are inserted into the bladder through the urethra. The flexible procedure allows for a visual inspection of the bladder, for minor remedial work to be undertaken and for samples of suspicious lesions to be taken for a biopsy. A rigid cystoscope is used under general anesthesia in the operating room and can support remedial work and biopsies as well as more extensive tumor removal. Unlike papillary lesion, which grow into the bladder cavity and are readily visible, carcinoma in situ lesion are flat and obscure. Detection of carcinoma in situ lesions requires multiple biopsies from different areas of interior bladder wall. Photodynamic detection (blue light cystoscopy) can aid in the detection of carcinoma in situ. In photodynamic detection, a dye is instilled into the bladder with the help of a catheter. Cancer cells take up this dye and are visible under blue light, providing visual clues on areas to be biopsied or resected.


title: Bladder cancer

text: However, visual detection in any form listed above, is not sufficient for establishing pathological classification, cell type or the stage of the present tumor. A so-called cold cup biopsy during an ordinary cystoscopy (rigid or flexible) will not be sufficient for pathological staging either. Hence, a visual detection needs to be followed by transurethral surgery. The procedure is called transurethral resection of bladder tumor (TURBT). Further, a rectal and vaginal bimanual examination should be carried out before and after the TURBT to assess whether there is a palpable mass or if the tumour is fixed ("tethered") to the pelvic wall. The pathological classification and staging information obtained by the TURBT-procedure, is of fundamental importance for making the appropriate choice of ensuing treatment and/or follow-up routines.


title: Bladder cancer

text: If invasive or high grade (includes carcinoma in situ) cancer is detected on TURBT, an MRI and/or CT scan of the abdomen and pelvis or urogram and CT chest should be conducted for disease staging and to look for cancer spread (metastasis). Increase in alkaline phosphatase levels without evidence of liver disease should be evaluated for bone metastasis by a bone scan. Although F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT has been explored as a viable method for staging, there is no consensus to support its role in routine clinical evaluations.


title: Bladder cancer

text: Urine cytology can be obtained in voided urine or at the time of the cystoscopy ("bladder washing"). Cytology is not very sensitive for low-grade or grade 1 tumors (a negative result cannot reliably exclude bladder cancer) but has a high specificity (a positive result reliably detects bladder cancer). There are newer non-invasive urine bound markers available as aids in the diagnosis of bladder cancer, including human complement factor H-related protein, high-molecular-weight carcinoembryonic antigen, and nuclear matrix protein 22 (NMP22). In United States the FDA has approved NMP22, NMP22 BladderChek, and UroVysion tests for detection and surveillance of bladder cancer and ImmunoCyt, BTA-TRAK, and BTA-STAT tests have been approved for surveillance only. BTA-STAT and BladderChek can be performed in the clinic and others are done in the laboratory. Other non-invasive urine based tests include the CertNDx Bladder Cancer Assay, which detects FGFR3 mutation and Urine Bladder Cancer test (UBC), which is a sandwich ELISA for Cytokeratin 8/18 fragment. Likewise, NMP22 is a sandwich ELISA and NMP22 BladderChek is a dipstick immunoassay, both of them detect nuclear mitotic apparatus protein (NuMA) tumor marker (a type of nuclear matrix protein). UroVysion is a fluorescence in situ hybridization which detects aneuploidy in chromosomes 3, 7, 17 and loss of the 9p21 locus. ImmunoCyt is an Immunofluorescence test which detects glycosylated CEA and MUCIN-like antigens (M344, LDQ10, 19A11). BTA-STAT is a dipstick immunoassay for detection of human complement factor H-related protein. BTA-TRAK is a sandwich ELISA which also detects human complement factor H-related protein. Sensitivities across biomarkers ranged from 0.57 to 0.82 and specificities from 0.74 to 0.88. Biomarkers fared better when used in combination with urine cytology than when used alone. However, detection accuracy is poor for low grade cancers and 10% cancers are still missed. Current guidelines do not recommended using urinary biomarkers for detection and surveillance.


title: Bladder cancer

text: Non-papillary carcinoma includes carcinoma in situ (CIS), microinvasive carcinoma and frankly invasive carcinoma. Carcinoma "in situ" (CIS) invariably consists of cytologically high-grade tumour cells.


title: Bladder cancer

text: Transitional cell carcinoma can undergo differentiation (25%) into its variants. When seen under a microscope, papillary transitional cell carcinoma can present in its typical form or as one of its variations (squamous, glandular differentiation or micropapillary variant). Different variations of non-papillary transitional cell carcinoma are listed below.


title: Bladder cancer

text: Bladder cancer is staged (classified by the extent of spread of the cancer) and graded (how abnormal and aggressive the cells appear under the microscope) to determine treatment and predict outcomes. Staging is usually performed with transurethral resection of bladder tumor (TURBT) and radiologic imaging (CT and MRI). Papillary tumors confined to the mucosa or which invade the lamina propria are classified as Ta or T1. Flat lesions that do not invade the basement membrane of the bladder mucosa are termed Tis (in situ). All three categories (Tis, Ta and T1) are grouped together as non-muscle invasive disease for therapeutic purposes and in most cases they are offered cystoscopic resection with TURBT without the need for radical resection of the entire urinary bladder. Tumors in the remaining categories (T2, T3 and T4) are termed muscle-invasive disease and are associated with less favorable prognosis.


title: Bladder cancer

text: The most common sites for bladder cancer metastases are the lymph nodes, bones, lung, liver, and peritoneum. The most common sentinel lymph nodes draining bladder cancer are obturator and internal iliac lymph nodes. The location of lymphatic spread depends on the location of the tumors. Tumors on the superolateral bladder wall spread to external iliac lymph nodes. Tumors on the neck, anterior wall and fundus spread commonly to the internal iliac lymph nodes. From the regional lymph nodes (i.e. obturator, internal and external lymph nodes) the cancer spreads to distant sites like the common iliac lymph nodes and paraaortic lymph nodes. Skipped lymph node lesions are not seen in bladder cancer.


title: Bladder cancer

text: People with non-muscle invasive bladder cancer (NMIBC), are risk-stratified based on clinical and pathological factors so that they are treated appropriately depending on their probability of having progression and/or recurrence. People with non-muscle invasive tumors are categorized into low-risk, intermediate-risk and high-risk or provided with a numerical risk score. Risk-stratification framework is provided by American Urology Association/Society of Urological Oncology (AUA/SUO stratification), European Association of Urology (EAU) guidelines, European Organization for Research and Treatment of Cancer (EORTC) risk tables and Club Urológico Español de Tratamiento Oncológico (CUETO) scoring model.


title: Bladder cancer

text: The EORTC and CUETO model use a cumulative score obtained from individual prognostic factors, which are then converted into risk of progression and recurrence. The six prognostic factors included in the EORTC model are number of tumors, recurrence rate, T-stage, presence of carcinoma-in-situ and grade of the tumor. Scoring for recurrence in the CUETO model incorporates 6 variables; age, gender, grade, tumor status, number of tumors and presence of tis. For progression scoring the previous 6 variables plus T stage is used.


title: Bladder cancer

text: As of 2019, there is limited high level evidence to suggest that eating vegetable and fruits decreases the risk of bladder cancer. Fruit and yellow-orange vegetables, particularly carrots and those containing selenium, citrus fruits and cruciferous vegetables have been identified as having a possibly protective effect.


title: Bladder cancer

text: While it is suggested that the polyphenol compounds in tea may have an inhibitory effect on bladder tumor formation and growth, there is limited evidence to suggesting drinking tea decreases bladder cancer risk. A 2022 review found that a Mediterranean diet has a protective effect on bladder cancer risk. Higher consumption of monounsaturated fat and plant-based oils decrease bladder cancer risk in women. Higher consumption of total dietary fiber and whole grains is associated with a reduced risk of bladder cancer.


title: Bladder cancer

text: As of 2019 there is insufficient evidence to determine if screening for bladder cancer in people without symptoms is effective or not.


title: Bladder cancer

text: Non-muscle invasive bladder cancer (those not entering the muscle layer of the bladder) can be "shaved off" using an electrocautery device attached to a cystoscope, which in that case is called a resectoscope. The procedure is called transurethral resection of bladder tumor (TURBT) and serves primarily for pathological staging. In case of non-muscle invasive bladder cancer the TURBT is in itself the treatment, but in case of muscle invasive cancer, the procedure is insufficient for final treatment. Additionally, blue light cystoscopy with optical-imaging agent Hexaminolevulinate (HAL) is recommended at initial TURBT to increase lesion detection (especially carcinoma in situ) and improve resection quality thereby reducing recurrence. It is important to assess the quality of the resection: if there is evidence of incomplete resection, or if there is no muscle in the specimen (without which muscle invasiveness cannot be determined), then a second TURBT is strongly recommended. Moreover, nearly half of the people with high-grade noninvasive disease have residual tumor after primary TURBT; in such cases a second TURBT is important for avoiding under-staging. At this point classifying people into risk groups is recommended. Treatment and surveillance for different risk groups is indicated in the table below.


title: Bladder cancer

text: Another method for reducing recurrence of tumors is medication after TURBT surgery. The two most common medicines used for this purpose are Bacillus Calmette–Guérin (BCG) and mitomycin. For people who have already had a TURBT procedure, BCG may lead to similar risk of death and may reduce the risk of tumor recurrence. However, this medication may increase the risk of serious unwanted side effects. More research is needed to confirm these results.


title: Bladder cancer

text: A single instillation of chemotherapy into the bladder after primary TURBT has shown benefit in deceasing recurrence by 35% in non-muscle invasive disease. Medications which can used for this purpose are mitomycin C (MMC), epirubicin, pirarubicin and gemcitabine. Instillation of post-operative chemotherapy should be conducted within first few hours after TURBT. As time progress residual tumor cells are known to adhere firmly and are covered by extracellular matrix which decrease the efficacy of the instillation. The most common side effect is chemical cystitis and skin irritation. If there is a suspicion of bladder perforation during TURBT, chemotherapy should not be instilled into the bladder as serious adverse events are known to occur due to drug extravasation. Studies have shown that efficacy of chemotherapy is increased by the use of Device assisted chemotherapy . These technologies use different mechanisms to facilitate the absorption and action of a chemotherapy drug instilled directly into the bladder. Another technology – electromotive drug administration (EMDA) – uses an electric current to enhance drug absorption after surgical removal of the tumor. Another technology, thermotherapy, uses radio-frequency energy to directly heat the bladder wall, which together with chemotherapy (chemohyperthermia) shows a synergistic effect, enhancing each other's capacity to kill tumor cells.


title: Bladder cancer

text: Immunotherapy by Bacillus Calmette–Guérin (BCG) delivery into the bladder is also used to treat and prevent the recurrence of NMIBC. BCG is a vaccine against tuberculosis that is prepared from attenuated (weakened) live bovine tuberculosis bacillus, Mycobacterium bovis, that has lost its virulence in humans. BCG immunotherapy is effective in up to 2/3 of the cases at this stage, and in randomized trials has been shown to be superior to standard chemotherapy. The exact mechanism by which BCG prevents recurrence is unknown. However, it has been shown that the bacteria are taken up by the cancer cells. The infection of these cells in the bladder may trigger a localized immune reaction which clears residual cancer cells.


title: Bladder cancer

text: BCG is delivered as induction and a maintenance course. The induction course consists of 6-week course of intravesical and percutaneous BCG. This is followed by a maintenance course. There is no consensus regarding the maintenance schedule, however the most commonly followed is the Southwestern Oncology Group (SWOG) schedule. The SWOG maintenance schedule consists of intravesical and percutaneous BCG every week for 3 weeks given at 3, 6, 12, 18, 24, 30 and 36 months. Three weekly maintenance regimen with induction has shown complete response rate of 84% compared to 69% in people who received 6-week induction BCG only at 6 months. Many studies have explored alternate treatment schedules and regimes of BCG but has shown no clinical significance. Efficacy of different strains of BCG (Connaught, TICE, Pasteur, Tokio-172) has been shown not to be different however, there is no high-level evidence.


title: Bladder cancer

text: Side effects of BCG therapy include cystitis, prostatitis, epididymo-orchitis, balanitis, ureteral obstruction, bladder contraction, mycobacterial osteomyelitis, reactive arthritis, mycobacterial pneumonia, granulomatous hepatitis, granulomatous nephritis, interstitial nephritis, infectious vasculitis and disseminated infection.


title: Bladder cancer

text: Local infection (i.e. prostatitis, epididymo-orchitis, balanitis) because of BCG should be treated with triple tubercular therapy, with one of the drug being fluoroquinolone for 3 to 6 months. In people with systemic infections, BCG therapy should be stopped and anti-tubercular multidrug treatment for at-least 6 months should be started. Medications that can be used for this treatment are INH, rifampicin, ethambutol, fluoroquinolones, clarithromycin, aminoglycosides, and doxycycline. BCG strains are not sensitive to pyrazinamide therefore, it should not be a part of anti-tubercular treatment.


title: Bladder cancer

text: BCG treatment failure can be classified into 3 groups; BCG relapse, BCG-refractory and BCG-intolerant. In BCG relapse, tumor reoccurs after a disease free period. BCG-refractory tumors are the ones which do not respond to induction and maintenance doses of BCG or which progress during therapy. In BCG-intolerant, tumor reoccurs due to incomplete treatment as the person receiving it is unable to tolerate an induction course of BCG. Around 50% of the people fail BCG treatment and would require further treatment.


title: Bladder cancer

text: People whose tumors recurred after treatment with BCG or who were unresponsive to treatment, are more difficult to treat. In such people a radical cystectomy is recommendation In people who do not show response to BCG therapy and are unfit or unwilling to undergo radical cystectomy, salvage therapies can be considered. Salvage therapy include intravesical chemotherapy with agents such as valrubicin, gemcitabine or docetaxel, chemoradiation or chemohyperthermia.


title: Bladder cancer

text: Untreated, non-muscle invasive tumors may gradually begin to infiltrate the muscular wall of the bladder (muscle invasive bladder cancer). Tumors that infiltrate the bladder wall require more radical surgery, where part (partial cystectomy) or all (radical cystectomy) of the bladder is removed (a cystectomy) and the urinary stream is diverted into an isolated bowel loop (called an ileal conduit or urostomy). In some cases, skilled surgeons can create a substitute bladder (a neobladder) from a segment of intestinal tissue, but this largely depends upon a person's preference, age of the person, renal function, and the site of the disease.


title: Bladder cancer

text: A bilateral pelvic lymphadenectomy should accompany radical cystectomy. At minimum, a standard template of lymphadenectomy should be followed by removing the external and internal iliac and obturator lymph node. When performing a lymphadenectomy, the surgeon can either remove lymph nodes from a smaller (standard) or from larger (extended) area. In comparison with a standard lymph node dissection, having an extended dissection may reduce a person's likelihood of death from any reason, including dying from bladder cancer. The extended procedure may lead to more serious unwanted effects and may or may not influence the likelihood of the cancer recurring over time. The rate of not-so-serious side effects may be similar for both surgeries.


title: Bladder cancer

text: Radical cystectomy has a significant morbidity associated with it. About 50-65% of the people experience complication within 90 days of surgery. Mortality rates was 7% within 90 days of surgery. High volume centers have better outcomes than low volume centers. Some centers are implementing Enhanced Recovery After Surgery (ERAS) society recommendations to decrease morbidity after radical cystectomy. However, due to lack of specific evidence in urologic surgery, ERAS protocol has not been widely incorporated in urologic clinical care.


title: Bladder cancer

text: Even after surgical removal of bladder, 50% of the people with muscle invasive disease (T2-T4) develop metastatic disease within two years due to micrometastasis. In such, neoadjuvant chemotherapy (chemotherapy before main treatment, i.e. surgery) has shown to increase overall survival at 5 years from 45% to 50% with an absolute survival benefit of 5%. Currently the two most used chemotherapy regimens for neoadjuvant chemotherapy are platinum based; methotrexate, vinblastine, doxorubicin, cisplatin (MVAC) and gemcitabine with cisplatin (GC). Other regimens include dose dense MVAC (DDMVC) and cisplatin, methotrexate and vinblastine (CMV).


title: Bladder cancer

text: Although, the optimal regimen has not been established, the preferred regimen for neoadjuvant therapy is MVAC.


title: Bladder cancer

text: Role of adjuvant chemotherapy (chemotherapy after main treatment) is limited to people with high grade tumours (pT3/T4and/or N+) and who have not been treated with neoadjuvant therapy. Adjuvant radiation therapy has not shown any advantage in bladder cancer treatment.


title: Bladder cancer

text: A combination of radiation and chemotherapy (chemoradiation) in conjunction with transurethral (endoscopic) bladder tumor resection can be used as an alternative in certain people. Review of available large data series on this so-called trimodality therapy has indicated similar long-term cancer specific survival rates, with improved overall quality of life as for people undergoing radical cystectomy with urinary reconstruction. However, currently no randomized control trials are available which has compared trimodal therapy with radical cystectomy. People who undergo trimodal therapy are usually highly selected and generally have T2 disease without hydronephrosis and/or carcinoma in-situ. Five year cancer specific survival and overall survival after trimodal therapy is between 50% to 82% and 36% to 74%.


title: Bladder cancer

text: In trimodal therapy, a maximal TURBT is conducted followed by chemoradiation therapy. Radiation sensitizing chemotherapy regimens consisting of cisplatin or 5-flurouracil and mitomycin C are used. Radiation therapy is via external bean radiotherapy (EBRT) with a target curative dose of 64-66 Gy. Surveillance for progression or recurrence should conducted with the aid of CT scans, cystoscopies and urine cytology. Side effects of chemoradiation include nausea, vomiting, loss of appetite, hair loss, mouth sores, diarrhea, constipation, increased risk of infections and bleeding and fatigue.


title: Bladder cancer

text: In people who fail trimodal therapy, radical cystectomy is considered if there is muscle invasive or recurrent tumors. Around 25-30% fail treatment and undergo salvage radical cystectomy. TURBT with intravesical therapy is indicated after treatment failure for non-muscle invasive disease.


title: Bladder cancer

text: In people with solitary tumor without concurrent carcinoma in situ in an area where a clean surgical margins can be achieved, a partial cystectomy with lymphadenectomy can be considered. Management plan including partial cystectomy should be accompanied with neoadjuvant chemotherapy. In people with urachal adenocarcinoma of the bladder, a partial cystectomy with "en-bloc" resection of urachal ligament and umbilicus can be considered.


title: Bladder cancer

text: Cisplatin-containing combination chemotherapy is the standard of care for metastatic bladder care. Fitness for receiving cisplatin based chemotherapy is assessed before treatment. A person is deemed unfit if anyone of the following is true.


title: Bladder cancer

text: People who are deemed fit receive platinum based regimens; methotrexate, vinblastine, doxorubicin, with cisplatin (MVAC) or gemcitabine with cisplatin (GC). Alternative regimens include paclitaxel with gemcitabine and cisplatin (PCG, triple therapy) and cisplatin, methotrexate and vinblastine (CMV). Response rate for cisplatin-based combination ranges from 39 to 65% and complete response is seen in 12-35% of the people. MVAC is better tolerated if it is combined with granulocyte colony-stimulating factor and the regimen is known as dose dense MVAC regimen (DDMVAC). This combination has shown to decease all cause mortality. MVAC regimen is aggressive. Febrile neutropenia (fever due to decrease in white blood cells) occurs in 10 to 14% and death due to toxicity in about 3-4%. Common side effects of MVAC include suppression of bone marrow, fever due to decrease in white blood cells, sepsis, mucositis, and nausea and vomiting. In contrast, the GC regimen has shown lower rates of neutropenic sepsis and grade 3/4 mucositis compared to MVAC. Efforts have been made to increase tolerance of cisplatin-based regimen by replacing it with carboplatin-based chemotherapy. However, cisplatin-based therapy is superior to carboplatin-based chemotherapy in achieving overall and complete response. Nevertheless, nearly half of the people with metastatic disease are "unfit" for cisplatin-based therapy. In such persons a combination of carboplatin and gemcitabine (GemCarbo) can be used as first line chemotherapy. In people who are not eligible for any platinum based chemotherapy and have PD-L1 expression, Atezolizumab and Pembrolizumab can be used.


title: Bladder cancer

text: People with bone metastasis should receive bisphosphonates or denosumab to prevent skeletal related events (e.g. fractures, spinal cord compression, bone pain).


title: Bladder cancer

text: Bladder cancer that is refractory or shows progression after platinum-based chemotherapy can be treated with second-line chemotherapy or immunotherapy.


title: Bladder cancer

text: The most commonly used second-line chemotherapy is single-agent regimes of Taxanes (Paclitaxel, nab-paclitaxel and Docetaxel). Other single-agent regimes include Vinflunine, a third generation vinca alkaloid (approved in Europe), Gemcitabine, Pemetrexed, Oxaliplatin, and Ifosfamide. Side effects of Vinflunine include neutropenia, constipation, fatigue and anemia and has limited its use as a second line agent. Response to second-line chemotherapy occurs in 5%–20% people. Median progression free survival with second-line chemotherapy is 3–4 months.


title: Bladder cancer

text: In people with fibroblast growth factor receptors (FGFR) mutations and fail standard platinum based chemotherapy erdafitinib can be used. Erdafitinib has shown a response rate of 40% in these patients.


title: Bladder cancer

text: Five immunotherapy agents has been approved in the US for use in metastatic bladder cancer. They act by inhibiting programmed cell-death protein 1 (PD-1) or programmed cell-death ligand 1 (PD-L1). Pembrolizumab and nivolumab, and are inhibitors of programmed cell-death ligand 1 (PD-1). Avelumab, atezolizumab and durvalumab are inhibitors of PD-L1.


title: Bladder cancer

text: Pembrolizumab probably improves overall survival a little and may slightly improve quality of life for people with urothelial cancer that has worsened after initial treatment when compared with continued chemotherapy. However, pembrolizumab may have only minimal effects on the rate of death resulting from treatment or the rate at which the cancer advances. Pembrolizumab may cause less serious side effects than chemotherapy.


title: Bladder cancer

text: Contrast enhanced CT is used to monitor lung, liver, and lymph node metastases. A bone scan is used to detect and monitor bone metastasis. Treatment response is measured using the Response evaluation criteria in solid tumors (RECIST) into one of the following groups; response (complete or partial), stable disease and progressive disease.


title: Bladder cancer

text: People with non-muscle invasive tumors have a favorable outcome (5-year survival is 95% vs. 69% of muscle invasive bladder cancer). However, 70% of them will have a recurrence after initial treatment with 30% of them presenting with muscle invasive disease. Recurrence and progression to a higher disease stage have a less favorable outcome.


title: Bladder cancer

text: Survival after radical cystectomy and pelvic lymph node dissection is dependent on the pathological stage. If the disease has not spread to the lymph node and is limited to the bladder (T1 or T2, N0) the 5-year survival is 78%. If it has spread locally around the region of the bladder with no lymph node involved (T3, N0) then the 5-year survival drops to 47%. In disease with lymph node spread (N+, irrespective of T stage) the 5-year survival is 31%. Locally advanced and metastatic disease drastically decreases survival, with a median survival of 3–6 months without chemotherapy. Cisplatin-based chemotherapy has increased the median survival to 15-months. However, the 5-year survival is still 15%.


title: Bladder cancer

text: There are several prognostic factors which determine cancer specific survival after radical cystectomy. Factor with detrimental effect of cancer specific survival are old age, higher tumor grade and pathological stage, lymph node metastasis, presence of lymphovascular invasion and positive soft tissue margin. Lymph node density (positive lymph nodes/total lymph nodes observed in the specimen from surgery) is a predictor of survival in lymph node positive disease. Higher the density lower is the survival.


title: Bladder cancer

text: After radical cystectomy, urinary and sexual function remain inferior to the general population. People who have a neobladder have better emotional function and body image compared with ones with cutaneous diversion (who need to wear a bag to collect urine over their abdomen). Social factors such family, relationships, health and finances contribute significantly for determining good quality of life in people who have been diagnosed with bladder cancer.


title: Bladder cancer

text: A high percentage of people with bladder cancer have anxiety and depression. People who are young, single and have advanced clinical disease have a high risk for getting diagnosed with a psychiatric illness post-treatment. People with psychiatric illness post treatment seem to have worse cancer specific and overall survival.


title: Bladder cancer

text: Globally, in 2017, bladder cancer resulted in 196,000 deaths, a 5.4% (age adjusted) decrease from 2007. In 2018, the age adjusted rates of new cases of bladder cancer was 6 cases per 100,000 people and age adjusted death rate was 2 deaths per 100,000 people. Lebanon and Greece have the highest rate of new cases. In Lebanon, this high risk is attributed to high number of smokers and petrochemical air pollution.


title: Bladder cancer

text: The risk of bladder cancer occurrence is four times higher in men than in women. Smoking can only partially explain this higher rates in men in western hemisphere. One other reason is that the androgen receptor, which is much more active in men than in women, may play a part in the development of the cancer. This hypothesis is also supported by the fact that men undergoing androgen suppression therapy for unrelated reason seem to have a lower risk of developing bladder cancer. In Africa, men are more prone to do field work and are exposed to infection with Schistosoma, this may explain to a certain extent the gap in incidence of squamous cell cancers in areas where bladder cancer is endemic. However, women present with more aggressive disease and have worse outcomes than men. This difference in outcomes is attributed to numerous factors such as, difference in carcinogen exposure, genetics, social and quality of care. One of the common signs of bladder cancer is hematuria and is quite often misdiagnosed as urinary tract infection in women, leading to a delay in diagnosis. Moreover, as mentioned earlier PSCA gene may play a role in aggressive tumors in women.


title: Bladder cancer

text: Bladder cancer is the sixth most common cancer accounting for 3.7% of the new cancer cases. in 2018, 30,700 Canadians were living with bladder cancer, 9160 new cases were diagnosed and 2467 died from it. In 2019, it is estimated that 11,800 new cases will be diagnosed and 2500 will die from it. Among the 11,800 new cases, 9100 will be in men and 2700 in women. Of the 2500 who would die from it, 1800 will be men and 700 will be women.


title: Bladder cancer

text: Bladder cancer is the 14th most common cancer and 16th most common cause of cancer death. In, 2018 it accounted for 82,300 new cases and 38,200 deaths. The number of new cases is comparatively lower compared to its western counterparts. Majority of the people are diagnosed with non-muscle invasive disease (75%) and the rest have muscle invasive disease (25%). Carcinoma in situ was present in only 2.4% of the cases.


title: Bladder cancer

text: In 2015, 131,000 news cases were diagnosed in the European Union with 40,000 deaths. It is the 5th most common cancer and 9th most common cause of cancer deaths.. The 5-year relative survival for bladder cancers diagnosed between 2000 and 2007 is 69%. Geographic variation is seen in survival rates with 5-year survival rates of 75% in Northern to 65% in Eastern Europe.


title: Bladder cancer

text: Bladder cancer is the ninth most common cancer in the UK accounting for 2.7% of all the new cancers cases. In 2018, there was 12,200 new cases and 6100 people died from it.


title: Bladder cancer

text: In the United States in 2019 80,470 cases and 17,670 deaths are expected making it the sixth most common type of cancer in the region. Bladder cancer is the fourth most common type of cancer in men and the 12th most common cancer in women. Around 62,000 men and 19,000 women are diagnosed with bladder cancer in 2019. Between 2012 and 2016 annual rate of new bladder cancer cases decreased by one percent per year.


title: Yakuza Kiwami

text: Yakuza Kiwami is an action-adventure video game developed by Ryu Ga Gotoku Studio and published by Sega. It is a remake of "Yakuza", the first game in the "Yakuza series", originally released on Sony's PlayStation 2. "Yakuza Kiwami" was released on PlayStation 3 and PlayStation 4 in Japan on January 21, 2016, and on PlayStation 4 in Europe and North America on August 29, 2017. It was also ported for Windows worldwide on Steam on February 19, 2019, and was released on Xbox One on April 21, 2020.


title: Yakuza Kiwami

text: Like the original PlayStation 2 game, "Yakuza Kiwami" explores the life of a man named Kazuma Kiryu who is demoted from his clan after taking the blame for his boss's murder. After a decade in prison, Kiryu searches for his old friends who have gone missing. The remake adds extra elements to the story, including Akira Nishikiyama's corruption during Kiryu's imprisonment and constant struggles between Kiryu and his rival Goro Majima. The gameplay was improved to resemble the prequel "Yakuza 0", adding more depth to the fighting system.


title: Yakuza Kiwami

text: Sega had ideas to remake the first "Yakuza" game in 2015 as part of the series' 10th anniversary but were unsure about developing due to their team focused on making "Yakuza 0". Following the success of "Yakuza 0", Sega started working on the remake of the first game and aimed to add new elements to the story while trying to make it more enjoyable than the original game. The game was well received, earning positive sales. Critics praised the simplicity of the gameplay but were divided by the handling of the storyline and pacing. "Yakuza Kiwami" was followed up by "" later in 2016, and another remake based on the second game titled "Yakuza Kiwami 2" was also released in 2018.


title: Yakuza Kiwami

text: Like the original game, "Yakuza Kiwami" is an action-adventure game with role-playing elements set in an open world environment and played from a third-person perspective. The player controls protagonist Kazuma Kiryu as he explores the streets of Kamurocho, a fictional district of Tokyo based on the real-life Kabukichō district. In addition to the main story, players will randomly encounter enemies on the street to battle, as well as meet people that will offer Kiryu side quests which can be completed for rewards.


title: Yakuza Kiwami

text: "Yakuza Kiwami" entirely forgoes the combat system of the original game; its combat is largely similar to the prequel "Yakuza 0". Just like "0", "Kiwami" features four fighting styles that the player can switch between in combat: the balanced Brawler style, the slow and heavy Beast style, the weak but quick Rush style, and Kiryu's traditional Dragon style. Players will earn both money and experience points by defeating enemies or completing side quests. Experience points can be used to acquire upgrades for Kiryu such as new techniques or an extension to his health bar. Money can be spent to purchase equipment or healing items, or to play various minigames and side-activities such as gambling, karaoke, and the card battle game Mesuking. Completing certain objectives will also grant the player special Completion Point currency; this CP can be spent to receive additional bonuses, such as special items or character upgrades.


title: Yakuza Kiwami

text: "Kiwami" introduces a new gameplay system called "Majima Everywhere", which replaces the Mr. Shakedown system previously present in "Yakuza 0", in which rival character Goro Majima will appear frequently to challenge Kiryu to a fight. Majima will appear randomly during exploration, as well as in predetermined challenges based on the player's progress in Majima Everywhere. Majima will also sometimes appear when playing a minigame (like darts or bowling) and will challenge Kiryu. Defeating Majima in different scenarios will increase the player's Majima Everywhere rank and unlock new abilities in Kiryu's Dragon style.


title: Yakuza Kiwami

text: Similar to the plot of the original "Yakuza", the game centers around yakuza lieutenant Kazuma Kiryu, who takes the blame for Sohei Dojima's murder, committed by his sworn brother and best friend Akira Nishikiyama, spending ten years in prison before being granted parole. A free man, Kiryu discovers that Nishikiyama is now a powerful but cold-hearted yakuza boss, his childhood friend Yumi has gone missing, and everyone is searching for ten billion yen that was stolen from his former organization, the Tojo Clan. As war erupts throughout the streets of Kamurocho between many different factions (including government agents and the Triad), Kiryu decides to find Yumi and the missing money, and protect Haruka, a mysterious young girl whom everyone seems to be after. Eventually, a remorseful Nishikiyama sacrifices himself to kill Haruka's father, Kyohei Jingu, who was a corrupt politician bent on destroying the Tojo and his loved ones, while Yumi dies in Kiryu's arms from a gunshot wound. Rather than give into despair and allow himself to be arrested, Kiryu leaves the Tojo and becomes Haruka's adoptive father.


title: Yakuza Kiwami

text: However, the story also introduces two new plot lines focused on Nishikiyama and Goro Majima, a ruthless Tojo captain and Kiryu's rival. In the latter's case, he is reintroduced as a sadomasochistic yakuza who attacks Kiryu for not wanting to fight him. Despite this, Majima is fascinated by Kiryu's stoic strength and considers him to be the perfect opponent. When Kiryu is released from prison, Majima is disappointed by his combat skills going rusty and arranges a series of elaborate and bizarre scenarios to manipulate him into fighting and thus, make him stronger. Despite the fights, Majima collaborates with Kiryu to defeat Dojima Family loyalists and even confesses to him that he does not care about avenging Shimano's death. Once Kiryu regains his combat abilities, Majima challenges him to one final fight, which he ultimately loses. However, Majima finds joy in fighting Kiryu, and promises to keep challenging him for fun.


title: Yakuza Kiwami

text: For Nishikiyama, his story focuses on his descent into madness. The day after Nishikiyama shot Dojima and Kiryu went to prison, the Dojima Family ponders about the culprit, whilst they mock Nishikiyama for his ineptitude. In 1996, the Kazama Family decides to give Nishikiyama his own "family" to control, with the expectation that he would look out for Kiryu now that he had been expelled from the Tojo Clan. However, he proves to be an incompetent leader, with his family captain Matsushige, who was hired because he was the top-earner in the Kazama Family, disrespecting him and commanding more respect among his men. As Yuko, his terminally ill sister, requires a heart transplant, Nishikiyama visits a doctor, who tells him that he needs 30 million yen to pay for it. Nishikiyama tells Matsushige to get the money for him by any means and that he won't question him. Matsushige agrees and decides to rob from stores owned by Osamu Kashiwagi, the Kazama Family captain, so that Nishikiyama could be punished. Kashiwagi violently disciplines Nishikiyama, then forgives him but tells him that Kiryu would be morally better as a leader. Nishikiyama is then fully convinced that the entire Kazama Family hates him after Futoshi Shimano accuses Kazama of deliberately giving Nishikiyama men he cannot control and that Nishikiyama should learn to care for himself instead of Kiryu. Eventually, Nishikiyama learns from Matsushige that the doctor was a fraud who already had the 30 million yen from the beginning. Nishikiyama rushes to confront him, but discovers that he has run away. Yuko dies and Nishikiyama prepares to commit seppuku, but is interrupted by Matsushige. Tired of the disrespect and harassment, Nishikiyama stabs him, and confesses to Dojima's murder, before using the blood to slick back his hair, becoming the changed man Kiryu would encounter during the main story.


title: Yakuza Kiwami

text: Series writer Masayoshi Yokoyama stated that Sega had plans to develop "Kiwami" in 2015 with the company wishing gamers enjoy the first "Yakuza" game on more modern quality. However, they were busy during that time making the game "Yakuza 0". Positive feedback to the prequel led to the making of "Kiwami". The franchise's 10th anniversary and the engine used for "Yakuza 0" also provided help according to Yokoyama. The gameplay was made to be as friendly as possible to newcomers with them being options to save the game's progress whenever they wanted. There were ideas in regards to changing the cast and recordings of the original games, but the staff felt it would not be an appealing remake if there were so many changes.


title: Yakuza Kiwami

text: Rather than make it look like a retro game retaining the elements from the original PlayStation 2 games, the gameplay was made similar to eighth generation titles, most notably "Yakuza 0". Therefore, the team had to face the challenge of understanding the quality of the graphics and audio they could produce with a next generation console in contrast to the original console, which left the team wondering if there were issues with different parts of the game like the way the original "Yakuza" camera worked. The new voice actors include Tomokazu Sugita (who plays Shinji), however, his characterization was left to keep faithful to his bond with Kiryu despite their different ranks. The story was further expanded to increase the length while adding new minigames. The fighting system was borrowed from "Yakuza 0" with a focus on grinding. Similar to that game, "Yakuza Kiwami" has strong depictions of violence, most notably in the Heat Action sequences the player can perform. Yokoyama stated they wanted to make them as intense as possible.


title: Yakuza Kiwami

text: The plot was further explored to focus on the depths of characters who did not have too many appearances in the original game. Due to Goro Majima's popularity, he was made to clash with Kiryu often during sidequests. Majima's characterization was influenced by previous games to keep him motivated with the idea of strength following the events of "Yakuza 0" which further focused on him. "Kiwami" improves the resolution, framerate, textures and loading times compared to the original game, and additional content was added to resolve some of the more confusing plot points, as well as tie the story more closely to the events of the prequel title "Yakuza 0".


title: Yakuza Kiwami

text: A steelbook edition of the game was released as part of the Western launch. A version for Windows was released on February 19, 2019.


title: Yakuza Kiwami

text: The game holds an average of 80 out of 100 in Metacritic indicating "generally favorable reviews". Critics praised the improvements in regards to the fighting system due to the moves Kiryu can perform, with IGN and GameSpot comparing them positively with the one of the previously "Yakuza" released title, "Yakuza 0". Game Informer referred to it as "simple and satisfying", commenting positively on the way Kiryu can easily perform intense fighting techniques. Polygon criticized how Dragon style has to be grinded as the multiple fights against Majima might make the player lose most of their health points. On the other hand, Eurogamer praised the interactions with Majima not only for the grinding but also because of the comic appeal the character brings. While not finding the remake as appealing as other titles, Destructoid found the game overall enjoyable, however, they criticized the boss fights because of their health regenerating during combat as well their style recycled from the fighting system of "Yakuza 0". While overall praising the game, Game Informer criticized the side missions because of their repetitive formula. Nevertheless, the encounters with Majima were praised. GameSpot criticised how going around Kamurocho might feel underwhelming to the players comparing it to other open worlds found in gaming.


title: Yakuza Kiwami

text: In regards to the presentation, the critical response has been mixed. The story was noted by Polygon as being more mature and brutal than in the prequel. Eurogamer praised the additions of the cutscenes involving Nishikiyama due to the new depths Sega brought in the way Kiryu is seen becoming his nemesis. GameSpot also praised the story, calling it "captivating" as generating a contrast between the dark aspects of the main story and the comical aspects of the side missions. Game Informer had mixed thoughts about the way the story was handled because of the "melodramatic" tone and the length of the cutscenes. Destructoid reported that the cutscenes were shorter and more entertaining than the ones from "Yakuza 4", most notably whenever Kiryu interacts with Haruka. Another area praised by Destructoid was the comical spin given to the encounters of Majima. IGN was harsher, believing the game's pacing, storytelling, and length were its weakest points.


title: Yakuza Kiwami

text: For the PC port of the game, "Yakuza Kiwami" retained the same Metacritic score. RPGFan praised the game storyline though it felt somewhat simple and linear. Both RPGFan and PCInvasion described "Kiwami" as an enjoyable starting point for newcomers to the series despite its issues. Vandal felt that the port was well executed and faithful to the original PlayStation 4 game, but lamented that its text was only in English.


title: Yakuza Kiwami

text: The game was nominated for Game, Classic Revival at the National Academy of Video Game Trade Reviewers Awards.


title: Yakuza Kiwami

text: The PlayStation 4 and PlayStation 3 versions were the top two best-selling games in Japan during their release week, selling 103,256 copies for PlayStation 4 and 60,427 for PlayStation 3. Sega's Chief creative officer Toshihiro Nagoshi stated that the western preorders for "Yakuza Kiwami" were generally good for the series. As of June 28, 2018, "Yakuza 0" and "Yakuza Kiwami" were relaunched as PlayStation Hits. The Windows version of "Kiwami" was among the best-selling new releases of the month on Steam.


title: Yakuza Kiwami

text: "Yakuza Kiwami 2", a remake of "Yakuza 2" in the same style as "Yakuza Kiwami", was originally released for PlayStation 4 on December 7, 2017, in Japan, and worldwide on August 28, 2018. The Windows version was released on May 9, 2019, and the Xbox One version was released on July 30, 2020.


title: Demographics of atheism

text: Accurate demographics of atheism are difficult to obtain since conceptions of atheism vary considerably across different cultures and languages, ranging from an active concept to being unimportant or not developed. Also some countries and regions athiesm carries a strong stigma, making it harder to count atheists in these countries. In global studies, the number of people without a religion is usually higher than the number of people without a belief in a deity and the number of people who agree with statements on lacking a belief in a deity is usually higher than the number of people who self-identify as "atheists".


title: Demographics of atheism

text: According to sociologist Phil Zuckerman, broad estimates of those who have an absence of belief in a deity range from 500 to 750 million people worldwide. Other estimates state that there are 200 million to 240 million self-identified atheists worldwide, with China and Russia being major contributors to those figures. According to sociologists Ariela Keysar and Juhem Navarro-Rivera's review of numerous global studies on atheism, there are 450 to 500 million positive atheists and agnostics worldwide (7% of the world's population) with China alone accounting for 200 million of that demographic. Relative to its own populations, Zuckerman ranks the top five countries with the highest possible ranges of atheists and agnostics: Sweden (46-85%), Vietnam (81%), Denmark (43-80%), Norway (31-72%), and Japan (64-65%).


title: Demographics of atheism

text: Of the global atheist and non-religious population, 76% reside in Asia and the Pacific, while the remainder reside in Europe (12%), North America (5%), Latin America and the Caribbean (4%), sub-Saharan Africa (2%) and the Middle East and North Africa (less than 1%).<ref name="Pew Global Unaffiliated 12/2012"></ref> The prevalence of atheism in Africa and South America typically falls below 10%. According to the Pew Research Center's 2012 global study of 230 countries and territories, 16% of the world's population is not affiliated with a religion, while 84% are affiliated. Furthermore, the global study noted that many of the unaffiliated, which include atheists and agnostics, still have various religious beliefs and practices.


title: Demographics of atheism

text: Historical records of atheist philosophy span several millennia. The very first occurrences of atheistic schools are found in Indian thought and have existed from the times of ancient Hinduism. Western atheism has its roots in pre-Socratic Greek philosophy, but did not emerge as a distinct perspective on religious claims until the late Enlightenment.


title: Demographics of atheism

text: Discrepancies exist among sources as to how atheist and religious demographics are changing. Questions to assess non-belief may ask about negation of the prevailing belief, rather than an assertion of positive atheism. Also, self-identification is not congruous to people's lack of beliefs automatically. For instance, merely not having a belief in a god, for whatever reason, does not automatically mean that people self-identify as an "atheist". According to global Win-Gallup International studies, 13% of respondents were "convinced atheists" in 2012, 11% were "convinced atheists" in 2015, and in 2017, 9% were "convinced atheists". However, other earlier global studies have indicated that global atheism may be in decline due to irreligious countries having the lowest birth rates in the world and religious countries having higher birth rates in general.


title: Demographics of atheism

text: The demographics of atheism are difficult to quantify. Words like "God" and "atheism" seldom translate well across cultures or languages, and if they are there, they have variant meanings which make cross-cultural comparisons tenuous. So it can be hard to draw boundaries between atheism, non-religious beliefs, and non-theistic religious and spiritual beliefs. Furthermore, atheists may not report themselves as such, to avoid suffering from social stigma, discrimination, and persecution in some countries.


title: Demographics of atheism

text: Because some governments have strongly promoted atheism and others have strongly condemned it, atheism may be either over-reported or under-reported for different countries. The accuracy of any method of estimation is debatable, as there are opportunities to misreport (intentionally or not) a category of people without an organizational structure. Also, many surveys on religious identification ask people to identify themselves as "agnostics" or "atheists", which is potentially confusing, since these terms are interpreted differently; some identify themselves as agnostic atheists. Additionally, many of these surveys only gauge the number of irreligious people, not the number of actual atheists, or group the two together. For example, research indicates that the fastest growing religious status may be "no religion" in the United States, but this includes all kinds of atheists, agnostics, and theists. According to the CIA World Factbook, non-religious people make up 9.66%, while one fifth of them are atheists.


title: Demographics of atheism

text: Statistics on atheism are often difficult to represent accurately for a variety of reasons. Atheism is a position compatible with other forms of identity including religions. Anthropologist Jack David Eller states that "atheism is quite a common position, even within religion" and that "surprisingly, atheism is not the opposite or lack, let alone the enemy, of religion but is the most common form of religion." Furthermore, he observes that "some atheists call themselves 'spiritual', and as we have shown above, atheism in its broadest sense does not preclude other religious concepts like nature spirits, dead ancestors, and supernatural forces." In many cultures, little conceptual or practical distinction is made between “natural” and “supernatural” phenomena and the very notions of "religious" and "nonreligious" dissolve into unimportance, especially since people have beliefs in other supernatural or spiritual things irrespective of belief in gods. For instance, in the Netherlands some people with lack of beliefs in gods do have a variety of beliefs in other supernatural entities or things.