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Did you know that congenital cytomegalovirus (cCMV) is the most common congenital viral infection in newborns and a leading cause of non-genetic hearing loss? Despite its prevalence, awareness and screening for cCMV remain inconsistent across healthcare systems. In this episode, we dive into the critical importance of cCMV screening, early diagnosis, and intervention. Join our expert guests Dr. Ingrid Camelo and Dr. John Noel as they discuss: The impact of cCMV on neonatal and long-term health outcomes Best practices for screening and diagnostic methods The role of early intervention, including antiviral therapy How advocacy efforts are shaping the future of universal screening policies Tune in to stay informed on how pediatricians and healthcare providers can play a vital role in improving outcomes for infants affected by cCMV. Special thanks to Dr. James Grubbs for peer reviewing this episode. CME Credit (requires free sign up): Link Coming Soon! References:  American Academy of Pediatrics. A targeted approach for congenital cytomegalovirus. Available at: https://publications.aap.org/pediatrics/article/139/2/e20162128/60211/A-Targeted-Approach-for-Congenital-Cytomegalovirus. Accessed August 13, 2024. Chiopris G, Veronese P, Cusenza F, Procaccianti M, Perrone S, Daccò V, Colombo C, Esposito S. Congenital cytomegalovirus infection: update on diagnosis and treatment. Microorganisms. 2020 Oct 1;8(10):1516. doi: 10.3390/microorganisms8101516. PMID: 33019752; PMCID: PMC7599523. Gantt S. Newborn cytomegalovirus screening: is this the new standard? Curr Opin Otolaryngol Head Neck Surg. 2023 Dec 1;31(6):382-387. doi: 10.1097/MOO.0000000000000925. Epub 2023 Oct 11. PMID: 37820202. Minnesota Department of Health. Minnesota implements universal newborn screening for cytomegalovirus. Available at: https://www.health.state.mn.us/news/pressrel/2023/ccmv020823.html. Accessed August 13, 2024. National CMV Foundation. Advocacy: universal newborn CMV screening. Available at: https://www.nationalcmv.org/about-us/advocacy#:~:text=Minnesota%20was%20the%20first%20state%20to%20enact%20universal%20newborn%20CMV%20screening. Accessed August 13, 2024. New York State Department of Health. Newborn screening for cytomegalovirus. Available at: https://www.health.ny.gov/press/releases/2023/2023-09-29_newborn_screening.htm#:~:text=ALBANY%2C%20N.Y.,all%20babies%20for%20the%20virus. Accessed August 13, 2024. UpToDate. Congenital cytomegalovirus (CMV) infection: clinical features and diagnosis. Available at: https://www.uptodate.com/contents/congenital-cytomegalovirus-ccmv-infection-clinical-features-and-diagnosis?search=cmv%20screening&source=search_result&selectedTitle=1%7E28&usage_type=default&display_rank=1#H92269684. Accessed August 13, 2024. UpToDate. Congenital cytomegalovirus (CMV) infection: management and outcome. Available at: https://www.uptodate.com/contents/congenital-cytomegalovirus-ccmv-infection-management-and-outcome?search=congenital%20cmv&source=search_result&selectedTitle=2%7E66&usage_type=default&display_rank=2. Accessed August 13, 2024. UpToDate. Ganciclovir and valganciclovir: an overview. Available at: https://www.uptodate.com/contents/ganciclovir-and-valganciclovir-an-overview?search=ganciclovir&source=search_result&selectedTitle=2%7E80&usage_type=default&display_rank=1#H6. Accessed August 13, 2024. University of Texas Medical Branch. Neonatology manual: infectious diseases. Available at: https://www.utmb.edu/pedi_ed/NeonatologyManual/InfectiousDiseases/InfectiousDiseases3.html#:~:text=may%20be%20required.-,Cytomegalovirus,Clinical%20findings. Accessed August 13, 2024. National Center for Biotechnology Information. Cytomegalovirus (CMV) infection. Available at: https://www.ncbi.nlm.nih.gov/books/NBK541003/. Accessed August 13, 2024.                                                                                                             

Joining us for this episode of Feedstuffs in Focus is Dr. David Baumert, Senior Technical Services Veterinarian at Zoetis Pork, to discuss the reasons why producers sometimes choose not to treat pigs — usually heavier weight finishers — in need of swine respiratory disease (SRD) therapy and the implications of non-use from a performance, labor and economic standpoint. This episode of Feedstuffs in Focus has been brought to you by Zoetis Pork.IMPORTANT SAFETY INFORMATION: People with known hypersensitivity to penicillin or cephalosporins should avoid exposure to EXCENEL RTU EZ. Do not use in swine found to be hypersensitive. Withdraw 6 days prior to slaughter when injection site volumes are greater than 5 mL up to 15 mL per injection site and 4 days prior to slaughter when injection site volumes are less than or equal to 5 mL per injection site. See full Prescribing Information at Excenelpork.com/PI.ReferencesPantoja L, Kuhn M, Farrand E, et al. Impact of a Husbandry Education Program on nursery pig mortality, productivity, and treatment cost. Journal of Swine Health and Production [serial online]. 2013;21 (4):188-194. Available from: CAB Abstracts, Ipswich, MA. Accessed May 1, 2018. Pineiro C, Morales J, Doncecchi P, et al. Individual Pig Care program improves productive performance and animal health in nursery-growing pigs. Journal of Swine Health and Production [serial online]. 2014;22 (6):296-299. Available from: CAB Abstracts, Ipswich, MA. Accessed August 1, 2018.Bowersock, T. L., Meeuwse, D. M., Kausche, F. M., Lucas, M. J., Bryson, W. L. and Dame, K.J. Efficacy of ceftiofur crystalline free acid and ceftiofur hydrochloride administered intramuscularly in swine inoculated with Actinobacillus pleuropneumoniae. Pharmacia Animal Health. 2001. Data on file, Study Document No. ZRD-PSC-004402, Zoetis Inc.All trademarks are the property of Zoetis Services LLC or a related company or a licensor unless otherwise noted. © 2024 Zoetis Services LLC. All rights reserved. EXC-00084

This episode is a mini episode about a famous artist who had to fight from having everything taken away from her. You might have even seen the movie about her life. SOURCES Flynn, William. “Where Did He Get Those Eyes.” The San Francisco Examiner (San Francisco, California), October 14, 1970. www.newspapers.com. Kobayashi, Ken. “Jury Awards $4 Million In Art Trial.” The Honolulu Advertiser (Honolulu, Hawaii), June 4, 1986. www.newspapers.com. Margaret Keane - paintings, Movie & Big Eyes. Accessed August 27, 2024. https://www.biography.com/artist/margaret-keane. “Margaret Keane.” Wikipedia, August 25, 2024. https://en.wikipedia.org/wiki/Margaret_Keane. “Margaret Keane: Big Eyes Artist, Whose Husband Claimed Credit, Dies at 94.” BBC News, June 29, 2022. https://www.bbc.com/news/entertainment-arts-61980385. “Relative of Discredited ‘big Eyes' Artist Makes a Keane Defense.” Los Angeles Times, January 2, 2015. https://www.latimes.com/entertainment/arts/la-et-cm-keane-nephew-20150102-story.html. Ronck, Ronn. “Margaret Keane Issues New Challenge for Paint-Out.” Honolulu Star-Advertiser (Honolulu, Hawaii), July 1, 1984. www.newspapers.com. SOUND SOURCES Al Jolson. “I'll Say She Does.” www.pixabay.com/music. Lucille Hegamin and The Dixie Daisies. “Cold Winter Blues.” www.pixabay.com/music. Sophie Tucker. “Reuben Rag.” www.pixabay.com/music.

On March 12, 1912, the Girl Scouts of America had their very first meeting ever. Since then, millions of girls have participated in the organization. What else was making news on that exact same day in history? Find out with three fun additional history stories. SOURCES “10 Things You Probably Didn't Know about Girl Scouts.” GSCCC Blog, July 11, 2019. https://girlscoutsccc.com/2019/07/18/10-things-you-probably-didnt-know-about-girl-scouts/. “About Early Girl Scouting.” Juliette Gordon Low Birthplace. Accessed August 21, 2024. https://www.juliettegordonlowbirthplace.org/en/explore/history/about-early-girl scouting.html#:~:text=Whenever%20there%20was%20a%20question,the%20United%20States%20in%201913. “Advertisement: Olympic and Titanic (Page 21).” Chicago Tribune (Chicago, Illinois), March 12, 1912. www.newspapers.com. “Bring Boy Back to Reformatory.” Star-Gazette (Elmira, New York), March 14, 1912. www.newspapers.com. “The Cardiff Giant Fools The Nation, 145 Years Ago.” History.com. Accessed August 22, 2024. https://www.history.com/news/the-cardiff-giant-fools-the-nation-145-years-ago. “Cardiff Giant.” Wikipedia, August 19, 2024. https://en.wikipedia.org/wiki/Cardiff_Giant. www.newspapers.com. “Circuit Court.” Dubbo Dispatch (Dubbo, New South Wales, Australia), April 16, 1912. www.newspapers.com. “The Cumnock Poisoning Case: Some Additional Evidence.” The Leader (Orange, New South Wales, Australia), March 12, 1912. www.newspapers.com. “Cumnock Sensation: Death of Mrs. Johnson.” The Molong Express (Molong, New South Wales, Australia), March 16, 1912. www.newspapers.com. “Death of Mrs. Johnson.” The Molong Argus (Molong, New South Wales, Australia), October 13, 1911. www.newspapers.com. “First Own Sound Company of Girl Guides.” Owen Sound Sun (Owen Sound, Ontario, Canada), March 12, 1912. www.newspapers.com. “Juliette Gordon Low: Girl Scouts.” Girl Scouts of the USA. Accessed August 21, 2024. https://www.girlscouts.org/en/discover/about-us/history/juliette-gordon-low.html. “Sell CardiffcGiant Pay Storage Claim.” Star-Gazette (Elmira, New York), October 31,c1912. www.newspapers.com. “Sues for ‘Board' of Cardiff Giant.” Star-Gazette (Elmira, New York), March 14, 1912. www.newspapers.com. “‘Cardiff Giant' Again.” St. Joseph News-Press (St. Joseph, Missouri), March 12, 1912. www.newspapers.com. “'Twas Good Story But Wasn't True.” Star-Gazette (Elmira, New York), March 18, 1912. www.newspapers.com. SOUND SOURCES Al Jolson. “I'll Say She Does.” www.pixabay.com/music. Lucille Hegamin and The Dixie Daisies. “Cold Winter Blues.” www.pixabay.com/music. Sophie Tucker. “Reuben Rag.” www.pixabay.com/music.

On January 11, 1964, the Surgeon General of the United States issued an official statement that immediately made top headlines in the United States and around the world. It was the first time someone officially said that smoking could cause cancer. What else was sharing headlines with such a controversial topic that day? You'll find out with three great additional history stories. SOURCES “Advertisement: Singer Sewing Center (Pg 7).” The Bismarck Tribune (Bismarck, North Dakota), January 11, 1964. www.newspapers.com.  “Arsenic Probe Continues; 8 Survivors Improved.” The Evening Sun (Baltimore, Maryland), November 26, 1956. www.newspapers.com.  Associated Press. “Food Poisoning Fatal to 2 Tots.” The Cumberland News (Cumberland, Maryland), November 16, 1956. www.newspapers.com.  Associated Press. “Life Term For Killing Cop.” The Daily Times (Davenport, Iowa), January 11, 1964. www.newspapers.com. Baldwin, Nick. “Grinnell Officer Slain.” The Des Moines Tribune (Des Moines, Iowa), November 13, 1963. www.newspapers.com.  Barewald, Robert, and Walter Shotwell. “Boys' Past: Delinquency, Thefts, Trouble in School.” The DesMoines Register (Des Moines, Iowa), 1958. www.newspapers.com.  Brannon, William T. “The Case of the Mass Poisoner.” Eureka Humboldt Standard (Eureka, California), January 11, 1964. www.newspapers.com.  “Cause Giving For Illness Of Father.” The Morning Herald (Hagerstown, Maryland), November 20, 1956. www.newspapers.com.  “Cop Kills Student in Basement Duel with Knife & Gun.” Daily News (New York City, New York), January 11, 1964. www.newspapers.com.  “Current Cigarette Smoking among Adults in the United States.” Centers for Disease Control and Prevention, May 4, 2023. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm.  “Current Trends Smoking and Health: A National Status Report.” Centers for Disease Control and Prevention. Accessed August 13, 2024. https://www.cdc.gov/mmwr/preview/mmwrhtml/00000823.htm#:~:text=Only%2030%25%20of%20all%20persons,report%20in%201964%20(2). “Gary Lee Wessling (1940-1973) .” Find a Grave. Accessed August 19, 2024. https://www.findagrave.com/memorial/250100737/gary-lee-wessling.   “Girls Checked in Poison Case.” The Evening Sun (Baltimore, Maryland), December 4, 1956. “Health Men Visit Home.” The Morning Herald (Hagerstown, Maryland), November 21, 1956. www.newspapers.com.  Lamberto, Nick. “Hunt Killers' Dope Source.” The Des Moines Register (Des Moines, Iowa), February 27, 1958. www.newspapers.com.  Mills, George. “Gunman Parole a ‘Mistake.'” The Des Moines Register (Des Moines, Iowa), November 14, 1963. www.newspapers.com. “Nine Kidwell Children Have Pneumonia.” The Morning Herald (Hagerstown, Maryland), November 15, 1956. www.newspapers.com.  “The Panama Riots of 1964: The Beginning of the End for the Canal.” Association for Diplomatic Studies and Training. Accessed August 13, 2024. https://adst.org/2016/07/panama-riots-1964-beginning-end-canal/. “Surgeon General's 1964 Report: Making Smoking History.” Harvard Health, January 10, 2014. https://www.health.harvard.edu/blog/surgeon-generals-1964-report-making-smoking-history-201401106970#:~:text=On%20a%20Saturday%20morning%2050,should%20do%20something%20about%20it. United Press International. “Mystery Illness Fells Father, Two Children.” The Weirton Daily Times (Weirton, West Virginia), November 23, 1956. www.newspapers.com. United Press International. “Wessling Gets 30 Year Term; Craig Guilty.” The Courier (Waterloo, Iowa), June 5, 1958. www.newspapers.com. United Press International. “‘Cigaret [Sic] Smoking Causes Cancer' [and Other Front Page Headlines].” El Paso Herald-Post, January 11, 1964. www.newspapers.com.  SOUND SOURCES Al Jolson. “I'll Say She Does.” www.pixabay.com/music. Lucille Hegamin and The Dixie Daisies. “Cold Winter Blues.” www.pixabay.com/music. Sophie Tucker. “Reuben Rag.” www.pixabay.com/music.

Being queen is never easy, and no one knew that better than Queen Min. At only eight years old, she was left without a father, but funnily enough, her lack of ambitious male relatives made her the perfect candidate for queen to the irresponsible and impressionable King of Korea. Min bided her time under the thumb of her overbearing father-in-law until she was able to outsmart him and take over the court. Over her twenty-year reign, she managed to modernize Korea in everything from the military to education, all while dealing with the encroaching Japanese empire. Join me to learn about her story on today's episode. This podcast is sponsored by Common Era Jewelry. Use code: AYDEN for 15% off your entire purchase. Bibliography Administration, Cultural Heritage. “Birth Home of Empress Myeongseong - Heritage Search.” Cultural Heritage Administration. Accessed August 28, 2024. https://english.cha.go.kr/chaen/search/selectGeneralSearchDetail.do?mn=EN_02_02&sCcebKdcd=21&ccebAsno=00460000&sCcebCtcd=31&pageIndex=388®ion=&canAsset=&ccebPcd1=&searchWrd=&startNum=&endNum=&stCcebAsdt=&enCcebAsdt=&canceled=&ccebKdcd=&ccebCtcd=. Contributors to Wikimedia projects. “Empress Myeongseong.” Wikipedia, August 26, 2024. https://en.wikipedia.org/wiki/Empress_Myeongseong#Photographs_and_illustrations. ———. “Gojong of Korea.” Wikipedia, August 27, 2024. https://en.wikipedia.org/wiki/Gojong_of_Korea. ———. “History of Women in Korea.” Wikipedia, June 23, 2024. https://en.wikipedia.org/wiki/History_of_women_in_Korea. ———. “Internal Princess Consort Hanchang.” Wikipedia, March 25, 2024. https://en.wikipedia.org/wiki/Internal_Princess_Consort_Hanchang. ———. “Min Chi-Rok.” Wikipedia, June 4, 2024. https://en.wikipedia.org/wiki/Min_Chi-rok. ———. “Shamanism.” Wikipedia, August 25, 2024. https://en.wikipedia.org/wiki/Shamanism#Ecological_aspect. ———. “Sunjong of Korea.” Wikipedia, July 12, 2024. https://en.wikipedia.org/wiki/Sunjong_of_Korea. New World Encyclopedia. “Empress Myeongseong.” Accessed August 28, 2024. https://www.newworldencyclopedia.org/entry/Empress_Myeongseong. “FamilySearch.Org.” Accessed August 28, 2024. https://www.familysearch.org/en/surname?surname=min. MadMonarchist. “Consort Profile: Empress Myeongseong of Korea.” Accessed August 28, 2024. https://madmonarchist.blogspot.com/2011/10/consort-profile-empress-myeongseong-of.html. Szczepanski, Kallie. “Biography of Queen Min, Korean Empress.” ThoughtCo, July 23, 2012. https://www.thoughtco.com/queen-min-of-joseon-korea-195721. Team, Gale Review. “The Murder of Empress Myeongseong of Korea.” The Gale Review, August 16, 2022. https://review.gale.com/2022/08/16/the-murder-of-empress-myeongseong-of-korea/. “The Legacy of Joseon Korea (1392-1897).” Accessed August 28, 2024. https://www.roots.gov.sg/stories-landing/stories/the-legacy-of-joseon-korea/story.

When eighteen-year-old recent high school graduate Tiffany Valiante was struck and killed by a train in July 2015, the news came as a shock to friends and family, who couldn't fathom why the teenager had been out walking the tracks that night. Their shock and confusion quickly turned to outrage and disbelief when, less than twenty-four hours later, Tiffany's death was ruled a suicide by the New Jersey Transit Police, who were tasked with investigating the incident. As far as everyone knew, Tiffany was a happy, outgoing girl with a bright future and a sports scholarship to Mercy College in the fall—they couldn't think of a single reason why she would have wanted to end her life. Despite the official conclusions about her death, the Valiante family have never believed Tiffany intentionally stepped in front of the train that night, and in the months and years that have passed since her death, many other people have come to a similar conclusion. In fact, they're confident the evidence and numerous unanswered questions suggest Tiffany had not gone into the woods voluntarily and that her death is at best suspicious, and at worst a murder. Thank you to the incredible Dave White of Bring Me The Axe Podcast for research and writing support! ReferencesConklin, Eric. 2023. "Family of Tiffany Valiante marks 8 years since teen's death with 2nd docuseries in the works." Press of Atlantic City, July 24.Daily Beast. 2022. "Was high school grad being chased before grisly train death?" Daily Beast, July 16.D'Amato Law. 2017. "“It's just not the Tiffany I knew,” said Allison Walker, head women's volleyball coach at Stockton University who coached Valiante in the East Coast Crush Volleyball Club, a junior travel volleyball team. “The time of night really didn't sit right with me." D'Amato Law. July 17. Accessed August 20, 2024. https://damatolawfirm.com/in-the-news/who-killed-tiffany-valiante-questions-persist-as-family-marks-the-third-anniversary-of-her-mysterious-death/.—. 2022. Mishandling Key Evidence In 2015 Tiffany Valiante Suspicious Death Case Impeded Independent Forensic DNA Analysis, Reports Renowned Lab. March 29. Accessed August 20, 2024. https://damatolawfirm.com/in-the-news/mishandling-key-evidence-in-2015-tiffany-valiante-suspicious-death-case/.DeAngelis, Martin. 2016. "Death of teen not suicide, suit says." Press of Atlantic City, July 20: 3.DiFilippo, Dana, and Joe Hernandez. 2017. Family of N.J. teen killed by train disputes suicide ruling, sues to prove kidnap-murder plot. July 19. Accessed August 19, 2024. https://whyy.org/articles/family-of-nj-teen-killed-by-train-disputes-suicide-ruling-sues-to-prove-kidnap-murder-plot/.Houseman, H. Louise. 2017. Investigative report submitted by H. Louise Hoiusman, Senior Medical Investigator. Investigative Report, Egg Harbor, NJ: D'Amato Law.Huba, Nicholas. 2015. "Suicides shock, sadden teens." Press of Atlantic City, July 19: 1.Jason, Dr. Donald. 2018. Re: Death of Tiffany Valiante. Forensic evaluation, Egg Harbor, NJ: D'Amato Law.Low, Claire. 2018. "A walk thgrough hell." Press of Atlantic City, December 16: 1.Morgan, Kate. 2022. Tiffany Valiante's last night. November. Accessed August 15, 2024. https://sjmagazine.net/featured/tiffany-valiantes-last-night.Stephen F. Valiante and Diane F. Valiante v. Does et al. 2017. ATL-L-1411-17 (Superior Court of New Jersey, Law Division, July 18).Sterling, Stephen, and S.P. Sullivan. 2017. Death and dysfunction: HGow N.J. fails the dead, betrays the living and is a national disgrace. December 14. Accessed August 19, 2024. https://death.nj.com/.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

1014. This week, we debunk misconceptions about gendered language, tracing the etymology of words like "cockamamie" and "gynecology." We also look at the flexibility of English grammar, examining how common words like "that" and "up" can function as different parts of speech in various contexts.The "gendered words" segment was written by Samantha Enslen, who runs Dragonfly Editorial. You can find her at dragonflyeditorial.com.The "grammar leaks" segment was written by Edwin Battistella, who taught linguistics and writing at Southern Oregon University in Ashland, where he served as a dean and as interim provost. His books include Bad Language: Are Some Words Better than Others?, Sorry About That: The Language of Public Apology, and Dangerous Crooked Scoundrels: Insulting the President, from Washington to Trump. It originally appeared on the OUP blog and is included here with permission.

Mary Todd Lincoln does not have the best reputation amongst first ladies. She was remembered in her time as a mentally unstable overspender who had questionable ties to the Confederacy. However, in this episode, I want pepole to learn about the bright and independent young woman who tried to make the best of every situation she was in and suffered more tragedy than anyone could understand. Join me on this episode as we talk about the sad but extraordinary life of Mary Todd Lincoln. This podcast is sponsored by Common Era Jewelry. Use code: AYDEN for 15% off your entire order. Boomer, Lee. “Life Story: Mary Todd Lincoln (1818-1882).” Women & the American Story, November 11, 2020. https://wams.nyhistory.org/a-nation-divided/civil-war/mary-todd-lincoln/. Caroli, Betty Boyd. “Mary Todd Lincoln.” Encyclopedia Britannica, July 20, 1998. https://www.britannica.com/biography/Mary-Todd-Lincoln. Contributors to Wikimedia projects. “Abraham Lincoln.” Wikipedia, August 8, 2024. https://en.wikipedia.org/wiki/Abraham_Lincoln#Assassination. ———. “Mary Todd Lincoln.” Wikipedia, July 26, 2024. https://en.wikipedia.org/wiki/Mary_Todd_Lincoln. ———. “Robert Smith Todd.” Wikipedia, June 26, 2024. https://en.wikipedia.org/wiki/Robert_Smith_Todd#Personal_life. Family, Death, Facts | HISTORY Mary Todd Lincoln: “Mary Todd Lincoln: Family, Death, Facts.” HISTORY, December 16, 2009. https://www.history.com/topics/first-ladies/mary-todd-lincoln. The White House. “Mary Todd Lincoln,” January 12, 2021. https://www.whitehouse.gov/about-the-white-house/first-families/mary-todd-lincoln/. Mary Todd Lincoln House. “Mary Todd Lincoln — Mary Todd Lincoln House.” Accessed August 9, 2024. https://www.mtlhouse.org/biography. “Mary Todd Lincoln Timeline and Highlights.” Accessed August 9, 2024. https://www.abrahamlincolnonline.org/lincoln/education/marytimeline.htm. Turner, Justin G. and Turner, Linda Levitt (1987) Mary Todd Lincoln: Her Life and Letters, Fromm International Pub. Corp. Emerson, Jason (2006). "The Madness of Mary Lincoln". American Heritage Magazine. Catherine Clinton, Mrs. Lincoln: A Life (New York: Harper Perennial, 2010)

Episode 176: Self-sampling for HPV screeningFuture Dr. Markarian explains the importance of HPV screening for the prevention of cervical cancer. Dr. Arreaza adds some insight about cervical cancer.Written by Chantal Markarian, MSIV, American University of the Caribbean. Editing and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Insights into Cervical Cancer.Chantal: Cervical cancer stands as the most prevalent form of cancer in women globally costing the lives of approximately 350,000 women annually. About 4,000 women die of cervical cancer a year in the US. Cervical cancer is initially asymptomatic, allowing it to advance to a more severe stage if not detected early. The positive news is that cervical cancer is highly preventable through screening for precancerous lesions or the presence of HPV —the primary culprit behind most cases.The role of HPV: Human Papilloma Virus, according to the World Health Organization, caused an estimated 620,000 cancer cases in women and 70,000 cancer cases in men.Cervical cancer is more prevalent in certain regions. In regions with established screening initiatives, the incidence rate and mortality rate of cancer are lower than in resource-limited areas. This highlights that resource-constrained countries continue to bear a burden of this disease. In nations like the United States, access to the HPV vaccine along with routine screenings, like Pap smears and HPV tests has significantly decreased the prevalence of cervical cancer.Screening recommendations from the US Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS).The U.S Preventive Services Task Force advises that women aged 21 to 29 undergo a Pap test every three years while those aged 30 to 65 should opt for co-testing (Pap and HPV tests) every five years. These examinations are usually conducted in outpatient facilities, where a medical professional collects a sample of cervical cells that are later examined under a microscope.A normal result states that the sample was adequate for evaluation, in other words, that endocervical/transformation zone components are present, and that the patient is “Negative for intraepithelial lesion or malignancy.” ACS recommends cervical cancer screening begin at age 25 for women and people with a cervix. Those aged 25 to 65 should have a primary HPV test every 5 years. (A primary HPV test means the HPV test is done without cytology; follow-up screening can be done with a Papanicolaou (Pap) test if needed.) If primary HPV testing is not available, screening may be done with either a co-test every 5 years, which combines an HPV test with a Papanicolaou (Pap) test, or a Pap test alone every 3 years. How is Cervical Cancer Classified?Two systems categorize lesions: the Cervical Intraepithelial Neoplasia (CIN) scale and the Bethesda system.The CIN scale categorizes lesions based on the degree of involvement of the cervical lining ranging from mild (CIN I) to moderate (CIN II) to severe dysplasia (CIN III).The Bethesda system emphasizes cytological findings organizing results into categories such as atypical squamous cells, low-grade lesions (LSIL), and high-grade lesions (HSIL).ASCUS (Atypical Squamous Cells of Undetermined Significance) is the most common abnormality seen in pap smears. It may or may not indicate a problem, you have to make a decision based on the patient. Cervical cancer is largely linked to high-risk HPV (hrHPV), mostly HPV 16 and 18, and scientists are investigating tests that identify hrHPV DNA or RNA. These tests may provide a more accurate evaluation of cancer risk compared to traditional cytology. Examples include DNA amplification tests like Cobas test and the Xpert HPV test.Obstacles to Screening.Despite the efficacy of cervical cancer screening, many women face many obstacles to testing. In regions with limited resources, fear, embarrassment, lack of awareness, and restricted healthcare access pose challenges to screening.In Nigeria, a study revealed that women often avoid Pap smears due to a lack of awareness. Similarly, healthcare providers in Ecuador highlighted issues like the absence of screening programs and inadequate health promotion efforts. Women in Peru face obstacles such as long waiting times preferences for female healthcare providers and limited access to health facilities. In 2022, 31% of minority women in the US did not undergo Pap smears in the past three years; many of these women were uninsured, unemployed, or low-income. These challenges contribute to higher rates of cervical cancer among women who do not follow recommended screening guidelines.We must mention the cultural obstacle as well. Some cultures do not allow any kind of pelvic exams before marriage. They put a major emphasis on being a “virgin,” and placing a speculum in the vagina may be considered culturally unacceptable. In those cases, the doctor has to use their best persuasion skills to accomplish the goals of care. For example, they may suggest having the mother in the room during the pap smear, using the smallest speculum possible, or other techniques.Self-sampling.In 2020, the World Health Organization (WHO) introduced a global initiative to combat cervical cancer worldwide. The initiative aims to:Vaccinate 90% of girls by age 15.Screen 70% of women by age 35.Treat 90% of women with lesions and invasive cancer by 2030.To achieve these goals, self-sampling for HPV testing has been introduced as a viable option for cervical cancer screening. Self-sampling for HPV testing is seen as an alternative for cervical cancer screening that addresses barriers associated with traditional methods. This approach enables women to take samples themselves using swabs or brushes removing the necessity for a pelvic examination. The option to mail in samples and receive results within two weeks enhances the convenience, privacy, and accessibility of the process giving individuals control over their health.While self-sampling for hrHPV detection is not currently standard practice in the United States, it has been successfully implemented in countries across Europe, Africa, and South America. Pilot studies are ongoing in nations like Canada and New Zealand to assess its effectiveness offering promise for its impact.In May 2024, the Food and Drug Administration (FDA) approved primary HPV self-collection for cervical cancer screening in a health-care setting. That means, the patient still has to go to a clinic to self-collect her sample. How Effective is HPV Self-Sampling?Research supports the accuracy of HPV self-sampling. A study conducted by Polman et al., which involved a randomized controlled trial, demonstrated that HPV tests on self-collected samples were just as precise as those done on samples collected by clinicians in detecting high-grade lesions (CIN II and CIN III). Similarly, a meta-analysis conducted by Arbyn et al. showed no difference in sensitivity or specificity between self-sampled and clinician-sampled tests for detecting CIN grade II or higher.These results indicate that self-sampling could be an adequate screening method for cervical cancer. This reassurance may motivate women to partake in screenings knowing they have a convenient and effective option. Ok, let's say a patient has collected her sample or the sample was collected by a clinician, what is next?Management of Cervical Cancer Screening Results.The process of managing cervical cancer screening results involves evaluating a patient's immediate and five-year risk of developing cervical abnormalities (CIN 3+) following guidelines from the American Society for Colposcopy and Cervical Pathology (ASCCP).The ASCCP app is the best investment you can make in primary care. It is only $9.99, but it can save you a lot of time in clinic. Estimating risk is a process that considers factors such as current HPV test results, past screening outcomes, the patients' age, and whether they've had a hysterectomy or not. When Risk is Elevated, Prompt Action.If a patient's immediate risk of developing CIN 3 exceeds 4%, expedited treatment is typically recommended. This treatment may entail one of several procedures aimed at removing abnormal cervical tissue.Loop Electrosurgical Excision Procedure (LEEP): A common method that removes tissue using an electric wire loop. Cold Knife Conization: In this procedure, a scalpel removes a cone-shaped section of the cervix.Laser Cone Biopsy: This technique involves removing a cone-shaped section of tissue using a laser.Alternatively, healthcare providers may opt for treatment methods such, as cryotherapy, thermos-ablation, and laser ablation to eliminate abnormal tissue.And those procedures are typically out of the scope of family medicine, but many family doctors may perform them with the proper training and experience.When the risk is deemed low, Surveillance.Patients with a risk of CIN 3 below 4% are typically advised to undergo surveillance with HPV testing every 1-5 years. If HPV testing is not available cytology alone (Pap test) is considered acceptable.Special considerations for women.For women under 25, a cautious approach is taken. If a low-grade lesion (LSIL) is identified through cytology, it is recommended to repeat the test annually for two years. If two consecutive tests show normal results the patient can resume screening intervals based on age. However, if a high-grade lesion (HSIL) is detected, a colposcopy and biopsy are recommended. It should be noted that expedited treatment is generally not advised for this age group since many high-grade lesions may resolve spontaneously.For women over 25, the presence of low-grade lesions or persistent high-risk HPV often leads to recommendations for colposcopy and cervical biopsy.When a cervical biopsy shows adenocarcinoma in situ it is suggested to perform an excisional procedure to rule out invasive cancer. The next steps depend on the margins of the excised tissue; If the margins show positive results (indicating abnormal tissue remains) further excision is necessary to ensure clear margins. This may be followed by a hysterectomy due to the risk of residual disease. For individuals who have been treated for high-grade lesions there is still a risk of developing cervical cancer. Therefore, long-term surveillance is essential. Women over 25 should undergo HPV testing six months after treatment, then annually until three consecutive negative tests are obtained. Subsequently testing every three years is advised for 25 years. As for women under 25, cervical cytology should be done six months post-treatment. Then at six-month intervals until three consecutive negative results are achieved. Once they reach 25 years old, they should switch to HPV testing.As summary, HPV is the most common cause of cervical cancer, and screening must be implemented no matter what your zip code is because adequate screening can lead to a lower mortality. Remember that self-collection is an alternative for your patients, and it is FDA-approved if it is done in a healthcare setting. The ASCCP guidelines are very useful but difficult to memorize, so you can invest in the ASCCP phone app to provide accurate care for your patients. Thanks!References: 1. World Health Organization. HPV and Cervical Cancer Fact Sheet. 2024. Available online: https://www.who.int/en/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer (accessed on 10 August 2024).2. Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191-e203.3. Serrano B, Ibáñez R, Robles C, Peremiquel-Trillas P, de Sanjosé S, Bruni L. Worldwide use of HPV self-sampling for cervical cancer screening. Preventive Medicine. 2022;154:106900.4. Gupta S, Palmer C, Bik EM, et al. Self-sampling for human papillomavirus testing: increased cervical cancer screening participation and incorporation in international screening programs. Front Public Health. 2018;6:345033.5. Ubah C, Nwaneri AC, Anarado AN, Iheanacho PN, Odikpo LC. Perceived barriers to cervical cancer screening uptake among women of an urban community in South-eastern Nigeria. Asian Pac J Cancer Prev. 2022;23(6):1959-1965.6. Vega Crespo, B., Neira, V.A., Ortíz Segarra, J. et al.Barriers and facilitators to cervical cancer screening among under-screened women in Cuenca, Ecuador: the perspectives of women and health professionals. BMC Public Health 22, 2144 (2022). https://doi.org/10.1186/s12889-022-14601-y7.Olaza-Maguiña AF, De la Cruz-Ramirez YM. Barriers to the non-acceptance of cervical cancer screenings (Pap smear test) in women of childbearing age in a rural area of Peru. Ecancermedicalscience. 2019;13:901.8. Sharma M, Batra K, Johansen C, Raich S. Explaining correlates of cervical cancer screening among minority women in the United States. Pharmacy. 2022 Feb 15;10(1):30.9. Polman NJ, Ebisch RMF, Heideman DAM, et al. Performance of human papillomavirus testing on self-collected versus clinician-collected samples for the detection of cervical intraepithelial neoplasia of grade 2 or worse: a randomised, paired screen-positive, non-inferiority trial. The Lancet Oncology. 2019;20(2):229-238.10. Costa S, Verberckmoes B, Castle PE, Arbyn M. Offering HPV self-sampling kits: an updated meta-analysis of the effectiveness of strategies to increase participation in cervical cancer screening. British Journal of Cancer. 2023 Mar 23;128(5):805-13.11. Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2020;24(2):102-131.12. Straughn, Jr, J Michael, and Catheryn Yashar. “Management of Early-Stage Cervical Cancer.” Www.uptodate.com, 2 Aug. 2024, https://www.uptodate.com/contents/management-of-early-stage-cervical-cancer. Accessed 13 Aug. 2024.13. AMBOSS GmbH.Cervical cancer screening. https://amboss.com/. Accessed August 18, 2024.14. Royalty-free music used for this episode: Lofi-Chilly by Gushito, downloaded on Nov 06, 2023, from https://www.videvo.net

Citations: Francesco Nepitello on Twitter: @FNepitelloThe One Ring by Free League Publishing: https://freeleaguepublishing.com/games/the-one-ring/  (Accessed August 27, 2024)War of the Ring strategy game by Ares Games: https://www.aresgames.eu/games/war-of-the-ring-line (Accessed August 27, 2024)

In a special co-branded episode between Oncology On the Go and the American Society for Transplantation and Cellular Therapy (ASTCT)'s program ASTCT Talks, Rahul Banerjee, MD, FACP, and Noopur Raje, MD, discussed the risk of secondary malignancies in patients with multiple myeloma who receive CAR T-cell therapy. Banerjee is an assistant professor in the Clinical Research Division of Fred Hutchinson Cancer Center and an assistant professor in the Division of Hematology and Oncology at the University of Washington. Raje is the director of the Center for Multiple Myeloma at Massachusetts General Hospital Cancer Center and a professor of medicine at Harvard Medical School. Banerjee and Raje spoke in the context of prior advisories from the FDA on the potential development of secondary T-cell malignancies in patients who receive CAR T-cell therapy for hematologic cancers. Specifically, the agency required a boxed warning for secondary T-cell malignancy risks for BCMA- or CD19-targeting therapies in April 2024.1 The conversation also touched upon reports of secondary malignancies in cases and trials such as CARTITUDE-1 (NCT04181827), in which second primary cancers were highlighted in 9 patients who received treatment with ciltacabtagene autoleucel (Carvykti).2 Considering these reports and warnings, Banerjee and Raje emphasized shared treatment decision-making with patients after assessing the risks and benefits of CAR T-cell therapy compared with other agents like bispecific antibodies. They also reviewed optimal strategies for monitoring and referring patients based on the incidence of certain toxicities. “[Treatment with] CAR T cells requires planning, and we need to have good control of the disease. We need to have 4 to 6 weeks of a lead time to get these effective treatments to our patients, so early referral is a good idea,” Raje said. “[For example], if you see chronic diarrhea in someone that is way out of the window of what you would expect, referring back to the CAR T-cell center is important so that we don't miss some of these toxicities.” References FDA requires boxed warning for T cell malignancies following treatment with BCMA-directed or CD19-directed autologous chimeric antigen receptor (CAR) T cell immunotherapies. News release. FDA. April 18, 2024. Accessed August 22, 2024. https://tinyurl.com/5n8pm5ca San-Miguel J, Dhakal B, Yong K, et al. Cilta-cel or standard care in lenalidomide-refractory multiple myeloma. N Engl J Med. 2023;389(4):335-347. doi:10.1056/NEJMoa2303379

In a special co-branded episode between Oncology On the Go and the American Society for Transplantation and Cellular Therapy (ASTCT)'s program ASTCT Talks, Rahul Banerjee, MD, FACP, and Noopur Raje, MD, discussed the risk of secondary malignancies in patients with multiple myeloma who receive CAR T-cell therapy. Banerjee is an assistant professor in the Clinical Research Division of Fred Hutchinson Cancer Center and an assistant professor in the Division of Hematology and Oncology at the University of Washington. Raje is the director of the Center for Multiple Myeloma at Massachusetts General Hospital Cancer Center and a professor of medicine at Harvard Medical School. Banerjee and Raje spoke in the context of prior advisories from the FDA on the potential development of secondary T-cell malignancies in patients who receive CAR T-cell therapy for hematologic cancers. Specifically, the agency required a boxed warning for secondary T-cell malignancy risks for BCMA- or CD19-targeting therapies in April 2024.1 The conversation also touched upon reports of secondary malignancies in cases and trials such as CARTITUDE-1 (NCT04181827), in which second primary cancers were highlighted in 9 patients who received treatment with ciltacabtagene autoleucel (Carvykti).2  Considering these reports and warnings, Banerjee and Raje emphasized shared treatment decision-making with patients after assessing the risks and benefits of CAR T-cell therapy compared with other agents like bispecific antibodies. They also reviewed optimal strategies for monitoring and referring patients based on the incidence of certain toxicities. “[Treatment with] CAR T cells requires planning, and we need to have good control of the disease. We need to have 4 to 6 weeks of a lead time to get these effective treatments to our patients, so early referral is a good idea,” Raje said. “[For example], if you see chronic diarrhea in someone that is way out of the window of what you would expect, referring back to the CAR T-cell center is important so that we don't miss some of these toxicities.”  References 1. FDA requires boxed warning for T cell malignancies following treatment with BCMA-directed or CD19-directed autologous chimeric antigen receptor (CAR) T cell immunotherapies. News release. FDA. April 18, 2024. Accessed August 22, 2024. https://tinyurl.com/5n8pm5ca  2. San-Miguel J, Dhakal B, Yong K, et al. CIlta-cel or standard care in lenalidomide-refractory multiple myeloma. N Engl J Med. 2023;389(4):335-347. doi:10.1056/NEJMoa2303379 

Eric and Glenn are back from a little summer break, prepping for the 2024 IAI Conference in Reno. They do a final “Where in the Whorld?” game. Then they jump into a recent paper on “Inconclusive” decisions (Swofford, et al. (2024) “Inconclusive Decisions and Error Rates in Forensic Science”, Forensic Science International: Synergy (vol 8; 100472)) authored by several members of NIST. The paper proposes a method for computing and communicating error rates when “inconclusive” decisions are made. The paper also focuses on making clear distinctions between “method performance” versus “method conformance”. The guys discuss their views on the method and the implications the paper may have for fingerprint examiners and their agencies. Swofford, H. , Lund, S. , Iyer, H. , Butler, J. , Soons, J. , Thompson, R. , Desiderio, V. , Jones, J. and Ramotowski, R. (2024), Inconclusive Decisions and Error Rates in Forensic Science, Forensic Science International: Synergy, [online], https://doi.org/10.1016/j.fsisyn.2024.100472, https://tsapps.nist.gov/publication/get_pdf.cfm?pub_id=957335 (Accessed August 31, 2024) Link to open source paper here: https://doi.org/10.1016/j.fsisyn.2024.100472

We're back with our sixth Leave The Light On episode where we recap the cases we covered in the previous month, discuss crime headlines from the month, and give you a sneak peek at what is coming up in the next month.   References:  Kaitlyn Huamani and Andrew Dalton, “What to know about the 5 people charged in Matthew Perry's death”, AP News, Aug 15, 2024, https://apnews.com/article/matthew-perry-arrests-doctor-assistant-3a9230ff6658e6b478751c8c1ec3e430, accessed Aug 29, 2024.  Josh Campbell and Cheri Mossburg, “Autopsy shows Matthew Perry died of ‘acute effects of ketamine'”, CNN, Dec 16, 2023, https://www.cnn.com/2023/12/15/entertainment/matthew-perry-autopsy-report/index.html, accessed Aug 29, 2024.  John O'sullivan, “Walmart's emergency codes explained: From 'Code red' to 'Code brown', know what they signify”, MSN.com, July 3, 2024, https://www.msn.com/en-us/news/technology/walmarts-emergency-codes-explained-from-code-red-to-code-brown-know-what-they-signify/ar-BB1plYI8, accessed Aug 29, 2024.  Anne D'Innocenzio and Alexandra Olson, “Walmart wrestles with how to respond to active shooters”, AP News, Aug 6, 2019, https://apnews.com/general-news-43ee7a174b0641e49a92f71f8e76c7de, accessed Aug 29, 2024.   Christopher Kokoski, “How To Write a Manifesto: 15 Easy Steps (With Examples)”, Writing Beginner, https://www.writingbeginner.com/how-to-write-a-manifesto/#:~:text=A%20manifesto%20is%20a%20declaration%20of%20an%20idea%2C,like%20a%20book%20or%20the%20Declaration%20of%20Independence., accessed Aug 30, 2024.  Jeff Somers, “THE MOST FRIGHTENING CRIMES THAT HAPPENED ON THANKSGIVING”, Grunge.com, Feb 7, 2022, https://www.grunge.com/261400/the-most-frightening-crimes-that-happened-on-thanksgiving/, accessed Aug 30, 2024.     Julia Reinstein, “Thomas Lane, former cop convicted in George Floyd's death, released from prison”, ABC News, August 20th 2024, https://abcnews.go.com/US/thomas-lane-former-cop-convicted-george-floyds-death/story?id=112982850 , accessed Aug 30, 2024    Lisa Kadane, “Canada's mysterious lake monster” BBC, March 10 2020, https://www.bbc.com/travel/article/20200309-ogopogo-the-monster-lurking-in-okanagan-lake , accessed Aug 30, 2024    Anna Kaufman, “Where did not wearing white after Labor DAy come from? FAshion's famed rule, explained” USA Today, August 12 2022, https://www.usatoday.com/story/life/2022/08/12/white-after-labor-day-explained/10269739002/ , Accessed August 30, 2024  

In a conversation with CancerNetwork®, Brian A. Van Tine, MD, PhD, spoke about the FDA accelerated approval of afamitresgene autoleucel (afami-cel; Tecelra) for patients with metastatic or unresectable synovial sarcoma expressing MAGE-A4. He discussed the data from the phase 2 SPEARHEAD-1 trial (NCT04044768) supporting the agent's use in this patient population and highlighted how this approval might pave the way for other potential developments in the sarcoma landscape. Van Tine, a professor of medicine and pediatrics and a medical oncologist at Siteman Cancer Center of Washington University in St. Louis, detailed results from SPEARHEAD-1 leading to the FDA's approval of afami-cel. Based on these findings and the agent's potential availability as a one-time intravenous fusion, afami-cel may offer improvements in quality of life to patients with synovial sarcoma compared with standard treatment options such as chemotherapy. Topline data from cohort 1 of the SPEARHEAD-1 trial showed that treatment with afami-cel produced an objective response rate of 43% among 44 evaluable patients, which included a complete response rate of 4.5%. Additionally, the median duration of response was 6 months (95% CI, 4.6-not reached). Of patients with a response, durable responses lasting for 12 months or longer occurred in 39%.  In terms of other potential benefits following the accelerated approval of afami-cel, Van Tine said that the T-cell therapy may increase treatment access to specific subsets of patients. For those who are unable to relocate and live near certain treatment centers during their therapy, afami-cel may offer a more readily accessible alternative that can allow patients to undergo treatment at home. Van Tine also described how this accelerated approval may “open the gateway” for other advancements related to the use of afami-cel and similar agents in solid tumors.  “We're all working hard to get these therapies open at our institutions,” Van Tine said regarding the next steps for increasing access to afami-cel following the accelerated approval. “Knowing who [has] HLA-A*02–positive [disease], knowing who has synovial sarcoma, and being ready to trigger the screening for MAGE-A4 is in every patient's best interest. If you're one of the patients who have synovial sarcoma, you need to know your status [to determine] how we're going to integrate this into your care plan.” Reference Adaptimmune receives U.S. FDA accelerated approval of TECELRA® (afamitresgene autoleucel), the first approved engineered cell therapy for a solid tumor. News release. Adaptimmune Therapeutics. August 2, 2024. Accessed August 14, 2024. https://tinyurl.com/mw6k4hjh

Episode Notes Books: Crowley, Aleister. The Book of the Law. Weiser Books, 1976. https://www.amazon.com/Book-Law-Aleister-Crowley/dp/0877283346 Crowley, Aleister. The Confessions of Aleister Crowley: An Autohagiography. Arkana, 1989. https://www.amazon.com/Confessions-Aleister-Crowley-Autohagiography-Arkana/dp/0140191897 Crowley, Aleister. Magick in Theory and Practice. Dover Publications, 1976. https://www.amazon.com/Magick-Theory-Practice-Aleister-Crowley/dp/0486232952 Crowley, Aleister. The Book of Thoth: A Short Essay on the Tarot of the Egyptians. Weiser Books, 2019. https://www.amazon.com/Book-Thoth-Essay-Tarot-Egyptians/dp/0877282684 Sutin, Lawrence. Do What Thou Wilt: A Life of Aleister Crowley. St. Martin's Griffin, 2000. https://www.amazon.com/Do-What-Thou-Wilt-Aleister/dp/0312288972 Kaczynski, Richard. Perdurabo: The Life of Aleister Crowley. North Atlantic Books, 2010. https://www.amazon.com/Perdurabo-Life-Aleister-Crowley/dp/1556438990 King, Francis. The Magical World of Aleister Crowley. Weiser Books, 2004. https://www.amazon.com/Magical-World-Aleister-Crowley/dp/1578633292 Symonds, John. The Great Beast: The Life and Magick of Aleister Crowley. Macmillan, 1952. https://www.amazon.com/Great-Beast-Life-Magick-Crowley/dp/0595479532 Booth, Martin. A Magick Life: A Biography of Aleister Crowley. Coronet, 2001. https://www.amazon.com/Magick-Life-Biography-Aleister-Crowley/dp/0340728375 Churton, Tobias. Aleister Crowley in America: Art, Espionage, and Sex Magick in the New World. Inner Traditions, 2017. https://www.amazon.com/Aleister-Crowley-America-Espionage-Magick/dp/1620556526 Articles: McDonald, R. (2021). "Aleister Crowley: The Wickedest Man in the World." History Extra. https://www.historyextra.com/period/modern/aleister-crowley-the-wickedest-man-in-the-world/ Espinosa, M. (2019). "Aleister Crowley's Influence on Modern Magic." Smithsonian Magazine. https://www.smithsonianmag.com/history/aleister-crowleys-influence-on-modern-magic-180971848/ Churton, T. (2016). "Aleister Crowley, the Occult, and Rock & Roll." VICE. https://www.vice.com/en/article/9k5edz/aleister-crowley-the-occult-and-rock-roll Bogdan, H. (2012). "The Influence of Aleister Crowley on Kenneth Anger." Cinema Journal. https://muse.jhu.edu/article/472788 Pasi, M. (2009). "Aleister Crowley and the Temptation of Politics." Nova Religio: The Journal of Alternative and Emergent Religions. https://online.ucpress.edu/nr/article-abstract/12/3/4/70854/Aleister-Crowley-and-the-Temptation-of-Politics?redirectedFrom=fulltext Levy, M. (2004). "Aleister Crowley in the Desert: The Last Ritual of the Great Beast." Esoterica. https://www.esoteric.msu.edu/VolumeIV/Crowley.htm Websites: "The Aleister Crowley Foundation". Accessed August 20, 2024. http://www.aleistercrowleyfoundation.org/ "The Hermetic Order of the Golden Dawn - Aleister Crowley". Accessed August 20, 2024. Episode "Thelema: Aleister Crowley's Religious Philosophy". Accessed August 20, 2024. https://www.thelema.org/ "Ordo Templi Orientis (O.T.O.)". Accessed August 20, 2024. http://www.oto.org/ "Aleister Crowley: The Great Beast 666". Accessed August 20, 2024. https://www.aleister-crowley-666.com/ "The Boleskine House Foundation: Aleister Crowley's Legacy". Accessed August 20, 2024. https://www.boleskinehouse.org/ "Sacred Texts: Aleister Crowley". Accessed August 20, 2024. https://www.sacred-texts.com/oto/crowley.htm "Aleister Crowley on Thelemapedia". Accessed August 20, 2024. http://www.thelemapedia.org/index.php/Aleister_Crowley Find out more at https://three-minute-modernist.pinecast.co

As I was reading stuff online I came across an article from Roman Catholic apologist Dave Armstrong against William Lane Craig's defense of monothelitism.Armstrong blames Craig's error on Sola Scriptura and rejecting the "infallibility" of the Roman Catholic church.While I agree that Craig is wrong about monothelitism, I also believe Armstrong is wrong about why.This episode addresses both the error of monothelitism and the error of Roman Catholic epistemology. I believe Craig's philosophy is the problem. I also believe history disproves Armstrong's "infallible church" idea and that Scripture is the authority for determining who Jesus is.Sources Cited:William Lane Craig, "#75 Monotheletism," Reasonable Faith, September 22, 2008.Dave Armstrong, "William Lane Craig's Christological Errors (Monothelitism +)," Patheos, Updated April 5, 2018.Dave Armstrong, "Sola Scriptura Can't Definitively Refute Christological Heresy," Patheos, Updated June 14, 2020.William Lane Craig, "Does Christ Have Two Wills or One?" drcraigvideos, July 15, 2022, educational video, 0:07 to 0:56."Third Council of Constantinople (A.D. 680-681)," New Advent, Accessed August 18, 2024."Discourse I" in "Four Discourses Against the Arians (Athanasius)," New Advent, Accessed August 18, 2024."Gregory of Nazianzus - Critique of Apollinarius and Apollinarianism," Early Church Texts, Accessed August 18, 2024.Scriptures Referenced:Isaiah 53:11Galatians 3:132 Corinthians 5:211 Peter 3:18Acts 2:22,30-31Hebrews 1:2-3; 2:16-18; 4:14-15; 5:7-9James 1:13-14*** Castle Rock Women's Health is a pro-life and pro-women health care ministry. They need your help to serve the community. Please consider a monthly or one-time donation. ***We value your feedback!Have questions for Truthspresso? Contact us!

As I was reading stuff online I came across an article from Roman Catholic apologist Dave Armstrong against William Lane Craig's defense of monothelitism.Armstrong blames Craig's error on Sola Scriptura and rejecting the "infallibility" of the Roman Catholic church.While I agree that Craig is wrong about monothelitism, I also believe Armstrong is wrong about why.This episode addresses both the error of monothelitism and the error of Roman Catholic epistemology. I believe Craig's philosophy is the problem. I also believe history disproves Armstrong's "infallible church" idea and that Scripture is the authority for determining who Jesus is.Sources Cited:William Lane Craig, "#75 Monotheletism," Reasonable Faith, September 22, 2008.Dave Armstrong, "William Lane Craig's Christological Errors (Monothelitism +)," Patheos, Updated April 5, 2018.Dave Armstrong, "Sola Scriptura Can't Definitively Refute Christological Heresy," Patheos, Updated June 14, 2020.William Lane Craig, "Does Christ Have Two Wills or One?" drcraigvideos, July 15, 2022, educational video, 0:07 to 0:56."Third Council of Constantinople (A.D. 680-681)," New Advent, Accessed August 18, 2024."Discourse I" in "Four Discourses Against the Arians (Athanasius)," New Advent, Accessed August 18, 2024."Gregory of Nazianzus - Critique of Apollinarius and Apollinarianism," Early Church Texts, Accessed August 18, 2024.Scriptures Referenced:Isaiah 53:11Galatians 3:132 Corinthians 5:211 Peter 3:18Acts 2:22,30-31Hebrews 1:2-3; 2:16-18; 4:14-15; 5:7-9James 1:13-14See AlsoIs Jesus Like My Favorite Superhero? (Playlist feed)*** Castle Rock Women's Health is a pro-life and pro-women health care ministry. They need your help to serve the community. Please consider a monthly or one-time donation. ***We value your feedback!Have questions for Truthspresso? Contact us!

CancerNetwork® spoke with Ritu Salani, MD, about the expanded FDA approval of dostarlimab-gxly (Jemperli) in combination with carboplatin/paclitaxel for patients with primary advanced or recurrent endometrial cancer.1  Salani, a board-certified gynecologic oncologist and director of Gynecologic Oncology at the University of California, Los Angeles Health, discussed the clinical benefit the dostarlimab combination showed for patients with endometrial cancer, particularly those with mismatch repair-deficient (dMMR) tumors, in the phase 3 RUBY trial (NCT03981796). Data leading to the approval showed a statically significant progression-free survival (PFS) and overall survival (OS) benefit in patients with dMMR or microsatellite-instability high (MSI-H) endometrial cancer, as well as for those across the overall population. Noting the significant impact dostarlimab had on survival benefit without significant added toxicity, which investigators reported as early as March 2023, Salani said it was “wonderful” to have a relatively short turnaround time in making the combination therapy available for patients with primary advanced or recurrent endometrial cancer. Beyond the particular benefit among patients with dMMR tumors, she expressed the need to improve outcomes for patients with mismatch repair-proficient (pMMR) or microsatellite stable (MSS) tumors, who did not experience as much of a pronounced benefit from treatment with dostarlimab. Salani also addressed the role of immunotherapy in subsequent lines of treatment following frontline therapy. Being thoughtful about sequencing agents in this setting may be an optimal strategy to give patients the greatest survivability and quality of life. She also considered alternative treatment strategies for certain patients, such as those with pMMR tumors.  “The thing that is interesting is the study highlighted patients who had residual disease or measurable disease present when they were getting this therapy, and that seems to be where the most significant impact [is],” Salani said. “Seeing more data on the right selection of patients will be really important. There are other avenues of treatment for these patient populations, particularly the pMMR population, where you might see some other therapies that may have an equally profound impact as immunotherapy. Maybe that will lend itself to leading immunotherapy for second-line treatment, if needed.” Reference FDA expands endometrial cancer indication for dostarlimab-gxly with chemotherapy. News release. FDA. August 1, 2024. Accessed August 15, 2024. https://tinyurl.com/mtr6tpyp

This week on Parallax, Dr Ankur Kalra welcomes Dr Marc Gerdisch to discuss a groundbreaking study on reducing opioid use after cardiac surgery. Dr Marc Gerdisch is the Chief of Cardiovascular and Thoracic Surgery and Co-Director of the Heart Valve Center and Atrial Fibrillation Program at Franciscan St. Francis Health. He is a senior partner at Cardiac Surgery Associates and a Clinical Assistant Professor of Thoracic and Cardiovascular Surgery at Loyola University Medical Center in Chicago. Dr Gerdisch shares insights into his research on rigid sternal fixation and enhanced recovery protocols, which have shown promising results in postoperative pain management and patient recovery. In this episode, Dr Kalra and Dr Gerdisch discuss the specifics of the study, including the four-cohort design and the steps taken to expedite opioid-free recovery. Dr Gerdisch also shares valuable advice on overcoming physician inertia and building a strong case for implementing such a programme, including cost-benefit analysis considerations. What motivated the study? How can a holistic approach to cardiac surgery recovery be implemented? What advice does Dr Gerdisch have for our listeners? Sources: Gerdisch MW, et al. Ann Thorax Surg 2024. Rigid Sternal Fixation and Enhanced Recovery for Opioid-Free Analgesia After Cardiac Surgery. DOI: 10.1016/j.athoracsur.2024.06.032 CE Cox. TCTMD 2024. Holistic Approach to Cardiac Surgery Can Sharply Cut Opioid Use. Available at: https://www.tctmd.com/news/holistic-approach-cardiac-surgery-can-sharply-cut-opioid-use. Accessed August 12, 2024.

Episode 164: More Than Just A HeadacheDr. Song presents a case of a subacute headache that required an extensive workup and multiple visits to the hospital and clinic to get a diagnosis. Dr. Arreaza added comments about common causes of subacute headaches.    Written by Zheng (David) Song, MD. Editing and comments by Hector Arreaza, MD.  You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Introduction to the episode: We are happy to announce the class of 2027 of the Rio Bravo / Clinica Sierra Vista Family Medicine Residency Program. Our new group will be (in alphabetical order): Ahamed El Azzih Mohamad, Basiru Omisore, Kenechukwu Nweke, Mariano Rubio, Nariman Almnini, Patrick De Luna, Sheila Toro, and Syed Hasan. We welcome all of you. We hope you can enjoy 3 enriching and fulfilling years. During this episode, you will hear a conversation between Dr. Arreaza and Dr. Song. Some elements of the case have been modified or omitted to protect the patient's confidentiality. 1. Introduction to the case: Headache. A 40-year-old male with no significant PMH presents to the ED in a local hospital due to over a month history of headaches. Per the patient, headaches usually start from the bilateral temporal side as a tingling sensation, and it goes to the frontal part of the head and then moves up to the top of the head. 8 out of 10 severities were the worst. Pt reports sometimes hypersensitivity to outdoor sunlight but not indoor light. OTC ibuprofen was helpful for the headache, but the headache always came back after a few hours. The patient states that if he gets up too quickly, he feels slightly dizzy sometimes, but it is only for a short period of time. There was only one episode of double vision lasting a few seconds about 2 weeks ago but otherwise, the patient denies any other neurological symptom. He does not know the cause of the headache and denies any similar history of headaches in the past. The patient denies any vomiting, chest pain, shortness of breath, cough, abdominal pain, or joint pain. The patient further denies any recent traveling or sick contact. He does not take any chronic medication. The patient denies any previous surgical history. He does not smoke, drink, or use illicit drugs. What are your differential diagnoses at this moment? Primary care: Tension headache, migraines, chronic sinusitis, and more.2. Continuation of the case: Fever and immigrant.Upon further inquiries, the patient endorses frequent “low-grade fever” but he did not check his temperature. He denies any significant fatigue, night sweats, or weight loss. He migrated from Bolivia to the U.S. 12 years ago and has been working as a farm worker in California for the past 10 years. He is married. His wife and daughter are at home in Bolivia. He is currently living with friends. He is not sexually active at this moment and denies having any sexual partners. Differential diagnoses at this moment?  Tension headache, migraine, infections, autoimmune disease, neurocysticercosis. 3. Continuation of the case: Antibiotics and eosinophilia. As we kept asking for more information, the patient remembered he visited a clinic about four months ago for a dry cough and was told he had bronchitis and was given antibiotics and the cough got better after that. He went to another local hospital ED one month after that because the cough came back, now with occasional phlegm and at that time he also noticed two “bumps” on his face but nothing significant. After a CXR at the ED, the patient was diagnosed with community-acquired pneumonia and sent home with cough medication and another course of antibiotics. His cough improved after the second round of antibiotics. We later found on the medical record that the CXR showed “mild coarse perihilar interstitial infiltrates of unknown acuity”. His blood works at the ED showed WBC 15.2, with lymphocyte 21.2%, monocyte 10.1%, neutrophil 61.7%, eosinophil 5.9% (normally 1-4%), normal kidney, liver functions, and electrolytes, and prescribed with benzonatate 100mg TID and doxycycline 100mg bid for 10 days. He went to the same ED one month before he saw us for headache and fever (we reviewed his EMR, and temp was 99.8F at the ED). After normal CBC, CMP and chest x-ray. The patient was diagnosed with a viral illness and discharged home with ibuprofen 400mg q8h.Due to the ongoing symptoms of headache and fever, the patient went back to the same clinic he went to four months ago for a dry cough and requested a complete physical and blood work. The patient was told he had a viral condition and was sent home with oseltamivir (Tamiflu®) for five days. However, the provider did order some blood work for him. Differential diagnoses at this moment?  Patients with subacute meningitis typically have an unrelenting headache, stiff neck, low-grade fever, and lethargy for days to several weeks before they present for evaluation. Cranial nerve abnormalities and night sweats may be present. Common causative organisms include M. tuberculosis, C. neoformans, H. capsulatum, C. immitis, and T. pallidum. At his physical exam visit, the patient actually asked the provider specifically to check him for coccidiomycosis because of his job as a farm worker and he heard from his friends that the infection rate is pretty high in the Central Valley of California. His serum cocci serology panel showed positive IGG and IGM with CF titer of 1:128. His HIV, syphilis, HCV, HBV are all negative. The patient was told by that clinic to come to ED due to his history of headache, fever, and very high serum coccidiomycosis titer.  The senior and resident intern were on the night shift that night and we were contacted by the ED provider at around 9:30 pm for this patient. When reviewing his ED record, his vitals were totally normal at the ED, the preliminary ED non-contrast head CT showed no acute intracranial abnormality. A lumbar puncture was performed by the ED provider, which showed WBCs (505 - 71%N, 20%L, 7%M), RBC (1), glucose (19), and protein (200). CSF: High Leukocytes, low glucose, and high protein.On the physical exam, the patient was pleasant and cooperative, he was A&O x 4, he had a normal examination except for two brown healing small nodules on his forehead and left cheek and slight neck stiffness. At that point, we knew the patient most likely had fungal meningitis by cocci except for the predominant WBC in his CSF fluid was neutrophil not the more typical picture of lymphocyte dominant. And because of his very benign presentation and subacute history, we were not 100% sure if we had a strong reason to admit this patient. We thought this patient could be managed as an outpatient with oral fluconazole and referred to infectious disease and neurology. 4. Continuation of case: Admission to the hospital.Looking back, one thing that was overlooked while checking this patient in the ED was the LP opening pressure. Later, the open pressure was reported as 340mm H2O (very high). The good thing was, after speaking to the ED attending and our attending, the patient was admitted to the hospital and started on oral fluconazole.  Three hours after the admission, a rapid response was called on him. While the floor nurses were doing their check-in physical examination, the patient had a 5-minute episode of seizure-like activity which included bilateral tonic arm/hand movements, eye deviation to the left, LOC unresponsive to sternal rub, and the patient desaturated to 77%. He eventually regained consciousness after the seizure and pulse oximetry increased to 100% on room air. The patient was started on Keppra and seen by a neurologist the following day. His 12-hour EEG was normal, but his head MRI showed “diffuse thickening and nodularity of the basal meninges are seen demonstrating enhancement, suggesting chronic meningitis, possibly related to cocci. Other etiologies including sarcoidosis and TB meningitis and/or infiltration by metastatic process/lymphoma are not excluded. The ventricles are slightly prominent in size”. MRI of the cervical, thoracic, and lumbar spines also showed extensive diffuse leptomeningeal thickening, extensive meningitis, and nodular dural thickening. Also, his chest x-ray showed “some heterogeneity and remodeling of the distal half of the left clavicle. Metabolic bone disease, infectious etiology and/old trauma considered”. This could also be due to disseminated cocci infection. The infectious disease doctor saw this patient and recommended continuing with fluconazole, serial LPs until opening pressure is less than 250 mmH2O and neurosurgery consultation for possible VP shunt placement. The neurologist recommended the patient continue with Keppra indefinitely in the context of structural brain damage secondary to cocci meningitis.Take home points: Suspect cocci meningitis in patients with subacute headache associated with respiratory symptoms, new skin lesions, photophobia, neck stiffness, nausea, vomiting, eosinophilia, erythema nodosum (painful nodules on the anterior aspect of legs). Other symptoms to look for include arthralgias, particularly of the ankles, knees, and wrists.____________________Brief summary of coccidiomycosis. Etiology Coccidioidomycosis, commonly known as Valley fever, is caused by dimorphic soil-dwelling fungi of the genus Coccidioides (C. immitis and C. posadasii). They are indistinguishable in clinical presentation and routine laboratory test results.1, 2, 3, 5Epidemiology In the United States, endemic areas include the southern portion of the San Joaquin Valley of California and the south-central region of Arizona. However, infection may be acquired in other areas of the southwestern United States, including the southern coastal counties in California, southern Nevada, southwestern Utah, southern New Mexico, and western Texas (including the Rio Grande Valley). There are also cases in eastern Washington state and in northeastern Utah. Outside the United States, coccidioidomycosis is endemic to northern Mexico as well as to localized regions of Central and South America.1, 2Overall, the incidence within the United States increased substantially over the 1998-2019, most of that increase occurred in south-central Arizona and in the southern San Joaquin Valley of California. From 1998 to2019, reported cases in California increased from 719 to 9004.1, 6The risk of infection is increased by direct exposure to soil harboring Coccidioides. Past outbreaks have occurred in military trainees, archaeologists, construction or agricultural workers, people exposed to earthquakes or dust storms. However, in endemic areas, many cases of Coccidioides infection occur without obvious soil or dust exposure and are not associated with outbreaks. Change in population, climate change, urbanization and construction activities, and increased awareness and reporting, are possible contributing factors.1, 2, 5 Pathology In the soil, Coccidioides organisms exist as filamentous molds. Small structures called arthroconidia from the hyphae may become airborne for extended periods. Arthroconidia are usually 3-5 μm—small enough to evade bronchial tree mucosal mechanical defenses and reach deep into the lungs.1, 3Once inhaled by a susceptible host into the lung, the arthroconidia develop into spherules (theparasitic existence in a host), which are unique to Coccidioides. Endospores from ruptured spherules can themselves develop into spherules, thus propagating infection locally.1, 3, 5Although rare cases of solid organ donor-derived or fomite transmitted infections have been reported, coccidioidomycosis does not occur in person-to-person or zoonotic contagion, and transplacental infection in humans has never been documented.2, 5Cellular immunity plays a crucial role in the host's control of coccidioidomycosis. Among individuals with decreased cellular immunity, Coccidioides may spread locally or hematogenously after an initial symptomatic or asymptomatic pulmonary infection to extrathoracic organs.1, 3, 7Clinical manifestationThe majority of infected individuals (about 60%) are completely asymptomatic. Symptomatic persons (40% of cases) have symptoms that are related principally to pulmonary infection, including cough, dyspnea, and pleuritic chest pain. Some patients may also experience fever, headache (common finding in early-stage infection and does not represent meningitis), fatigue, night sweats, rash, myalgia.1, 2, 3, 5In most patients, primary pulmonary coccidioidomycosis usually resolves in weeks without sequelae and lifelong immunity to reinfection. However, some patients may develop chronic pulmonary complications, such as nodules or pulmonary cavities, or chronic fibrocavitary pneumonia. Some individuals with intense environmental exposure or profoundly suppressed cellular immunity (e.g., in patients with AIDS) may develop a primary pneumonia with diffuse reticulonodular pulmonary process in association with dyspnea and fever.1, 3, 5Fewer than 1% of infected individuals develop extrathoracic disseminated coccidioidal infection. Common sites for dissemination include joints and bones, skin and soft tissues, and meninges. One site or multiple anatomic foci may be affected. 1, 2, 3, 7It is estimated that coccidioidal meningitis, the most lethal complication of coccidioidomycosis, affects only 0.1% of all exposed individuals. Patients with coccidioidal meningitis usually present with a persistent headache (rather than a self-limited headache in some patients with primary pulmonary infection), with nausea and vomiting, and sometimes vision change. Some may also develop altered mental status and confusion. Meningismus such as nuchal rigidity, if present, is not severe.Hydrocephalus and cerebral infarction may develop in some cases. Papilledema is more commonly observed in pediatric patients.1, 3, 4, 5, 7When meningitis develops, most patients may not have any respiratory symptoms nor radiographic manifestation of pulmonary infection. However, a large number of these individuals also present with other extrathoracic lesions.7DiagnosisAlthough early diagnosis carries obvious benefits for patients and the health care systems as a whole (e.g., decreases patient anxiety, reduces the cost of expensive and invasive tests, removes the temptation for empirical antibacterial or antiviral treatments, and allows for early detection of complications), considerable diagnostic delays up to several weeks to months are common in both endemic areas and non-endemic areas.3, 7 Most symptomatic persons with coccidioidal infection present with primarily pulmonary symptoms and are often misdiagnosed as community-acquired bacterial pneumonia and treated with antibiotics. In endemic areas like south-central Arizona, previous studies found up to 29% of community-acquired pneumonia is caused by coccidioidomycosis. Healthcare providers thus should maintain a high clinical suspicion for coccidioidomycosis when evaluating persons with pneumonia who live in or have traveled to endemic areas recently. Elevated peripheral-blood eosinophilia of over 5%, hilar or mediastinal adenopathy on chest radiography, marked fatigue, and failure to improve with antibiotic therapy should prompt suspicion and testing for infection with coccidioidomycosis in endemic areas.1, 3, 5Serological testing plays an important role in establishing a diagnosis of coccidioidomycosis. Enzyme immunoassay (EIA) to detect IgM and IgG antibodies is highly sensitive and therefore commonly used as the screening tool. Immunodiffusion is more specific but less sensitive than enzyme immunoassay. It is used to confirm the diagnosis of positive EIA test results. Complement fixing (CF) test, which indirectly detects the presence of coccidioidal antibodies by testing the consumption of serum complement, are expressed as titers. Serial measurements of titers are of not only diagnostic but also prognostic value.1, 2, 3, 5Other methods, including culture, microscopic, or polymerase chain reaction (PCR) exam on tissue or respiratory specimens, are limited by their availability, sample obtaining and handling, or lack of sufficient evaluation.1, 2, 3, 5Cerebrospinal fluid (CSF) examination in coccidioidal meningitis usually demonstrates lymphocyte dominated elevation of leukocytes, although polymorphonuclear leukocyte dominance can also be seen in the early stage of the infection. Profound hypoglycorrhachia and elevated protein levels in CSF examination are also very common in coccidioidal meningitis.1, 7Although isolating Coccidioides from CSF or other CNS specimens are diagnostic for coccidioidal meningitis, in practice, diagnoses are often made based on the combination of clinical presentation, CSF examination that suggesting fungal infection, and positive Coccidioides antibodies found in CSF.7Imaging, especially enhanced magnetic resonance imaging (MRI), can help in diagnosing coccidioidal meningitis. Basilar leptomeningeal enhancement is a more common finding even though hydrocephalus, cerebral infarction, and vertebral artery aneurysm can also be seen.7TreatmentMost patients with focal primary pulmonary coccidioidomycosis do not require antifungal therapy. According to 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline, antifungal therapy should be considered in patients with concurrent immunosuppression that adversely affect cellular immunity (e.g., organ transplant patients, AIDS in HIV-infected patients, and patients receiving anti–tumor necrosis factor therapy) and those with significantly debilitating illness, extensive pulmonary involvement, with concurrent diabetes, pregnant women, or who are otherwise frail because of age or comorbidities. Some experts would also include African or Filipino ancestry as indications for treatment. Conversely, humoral immunity comprise splenectomy, hypocomplementemia, or neutrophil dysfunction syndromes are not major risk factors for this disease.1, 2, 3, 4, 5Triazole antifungals (fluconazole or itraconazole) are currently considered as the first-line medications used to treat most cases of coccidioidomycosis. Amphotericin B is reserved for only the most severe cases of dissemination and patients with coccidioidal meningitis in whom triazole antifungal therapy has failed. It is also the choice of therapy for coccidioidomycosis in pregnant women during the first trimester because of the possible teratogenic effect of high-dose triazole therapy during this period of time.1, 3, 4, 5Treating coccidioidal meningitis (CM) poses a special challenge because untreated meningitis is nearly always fatal. Lifelong therapy is recommended for CM because the majority 80% patients with CM experience relapse when therapy is stopped despite initial response to antifungal treatment. Shunting of CSF is required in cases of meningitis complicated by hydrocephalus.1, 3, 4, 5, 7Prevention Avoidance of direct contact with contaminated soil in endemic areas (e.g., respirator use by construction workers) may reduce disease risk, although clear evidence of its benefit is lacking.1, 5Some special population groups may benefit from prophylactic use of antifungals, such as those about to undergo allogeneic solid-organ transplantation or patients with a history of active coccidioidomycosis or a positive coccidioidal serology in whom therapy with tumor necrosis factor α antagonists is being initiated. The administration of prophylactic antifungals is not recommended for HIV-1-infected patients even if they live in an endemic region.1, 5Conclusion: Now we conclude episode number 164, “More than just a headache.” Dr. Song explained that a headache with an indolent course, accompanied by subacute respiratory symptoms, nausea, vomiting, photophobia, neck stiffness, and skin lesions can be secondary to Valley Fever. The Central Valley of California, as well as other areas with dry climate, are endemic and we need to keep this disease in our differential diagnosis.This week we thank Hector Arreaza and Zheng (David) Song. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Roos KL, Tyler KL. Acute Meningitis. McGraw Hill Medical. Published 2023. Accessed August 18, 2023. https://accessmedicine.mhmedical.com/content.aspx?bookid=2129§ionid=192020493Information for Healthcare Professionals. Published 2023. Accessed August 18, 2023. https://www.cdc.gov/fungal/diseases/coccidioidomycosis/health-professionals.html#printValley Fever (Coccidioidomycosis) a Training Manual for Primary Care Professionals. Accessed August 18, 2023. https://vfce.arizona.edu/sites/default/files/valleyfever_training_manual_2019_mar_final-references_different_colors.pdfAmpel NM. Coccidioidomycosis. Idsociety.org. Published July 27, 2016. Accessed August 18, 2023. https://www.idsociety.org/practice-guideline/coccidioidomycosis/Herrick KR, Trondle ME, Febles TT. Coccidioidomycosis (Valley Fever) in Primary Care. American Family Physician. 2020;101(4):221-228. Accessed August 18, 2023. https://www.aafp.org/pubs/afp/issues/2020/0215/p221.htmlValley Fever Statistics. Published 2023. Accessed August 18, 2023. https://www.cdc.gov/fungal/diseases/coccidioidomycosis/statistics.htmlUpToDate. Uptodate.com. Published 2023. Accessed August 18, 2023. https://www.uptodate.com/contents/coccidioidal-meningitis?search=7%20Coccidioidal%20meningitis&source=search_result&selectedTitle=1~10&usage_type=default&display_rank=1Royalty-free music used for this episode: Tropicality by Gushito, downloaded on July 20, 2023, from  https://www.videvo.net/

In this Complex Care Journal Club podcast episode, Dr. Ulfat Shaikh discusses the development of an implementation toolkit to prevent medication errors in the home and community using quality improvement methodology. She describes the process of translating recommendations from a policy statement into practice, opportunities for collaboration with the Council on Quality Improvement and Patient Safety, and next steps from this work. SPEAKER Ulfat Shaikh, MD, MPH, MS Professor of Pediatrics and Medical Director for Healthcare Quality University of California Davis Health HOST Kristina Malik, MD Assistant Professor of Pediatrics, University of Colorado School of Medicine Medical Director, KidStreet Pediatrician, Special Care Clinic, Children's Hospital Colorado DATES Initial publication: March 11, 2024. JOURNAL CLUB ARTICLE Shaikh U, Kim JM, Yin SH. Implementing Strategies to Prevent Home Medication Administration Errors in Children With Medical Complexity. Clin Pediatr (Phila). 2023 Aug 29:99228231196750. doi: 10.1177/00099228231196750. Epub ahead of print. PMID: 37644803. OTHER ARTICLES REFERENCED Agency for Healthcare Research and Quality. Health Literacy Universal Precautions Toolkit, 3rd Edition. Use the Teach-Back Method: Tool 5. Content last reviewed February 2024. https://www.ahrq.gov/health-literacy/improve/precautions/tool5.html‌ ‌‌American Academy of Pediatrics Council on Quality Improvement and Patient Safety. Preventing home medication administration errors implementation resources. Published November/December 2021. Accessed August 16, 2023. bit.ly/44kK68W.‌ ‌ ‌Yin HS, Neuspiel DR, Paul IM, Franklin W, Tieder JS, Adirim T, Alvarez F, Brown JM, Bundy DG, Ferguson LE, Gleeson SP, Leu M, Mueller BU, Connor Phillips S, Quinonez RA, Rea C, Rinke ML, Shaikh U, Shiffman RN, Vickers Saarel E, Spencer Cockerham SP, Mack Walsh K, Jones B, Adler AC, Foster JH, Green TP, Houck CS, Laughon MM, Neville K, Reigart JR, Shenoi R, Sullivan JE, Van Den Anker JN, Verhoef PA. Preventing Home Medication Administration Errors. Pediatrics. 2021 Dec 1;148(6):e2021054666. doi: 10.1542/peds.2021-054666. PMID: 34851406. TRANSCRIPT https://op-docebo-images.s3.amazonaws.com/Transcripts/Preventing+Pediatric+Medication+Errors+at+Home_Shaikh_030824.pdf Clinicians across healthcare professions, advocates, researchers, and patients/families are all encouraged to engage and provide feedback! You can recommend an article for discussion using this form: https://forms.gle/Bdxb86Sw5qq1uFhW6 Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user.For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Shaikh U, Malik K. Preventing Pediatric Medication Errors at Home: Putting a Policy Statement into Practice. 3/2024. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/preventing-pediatric-medication-errors-at-home-putting-a-policy-statement-into-practice

In the early morning hours of June 4, 1904, New York City police were called to Lower Manhattan for what they were told was the death of Frank “Ceasar” Young from a self-inflicted gunshot wound to his chest. When they arrived at the scene, they found Young's body in the back of a Hansom cab, slumped over into the lap of a young actress named Nan Patterson, with whom he'd been having an affair. Nan claimed Young had shot himself when she refused to accompany him back to England, where he was headed to meet his wife that morning, but the police believed otherwise, and Nan was arrested and charged with Young's murder.What followed was not one, but three sensational murder trials that commanded the attention of New Yorkers across all five boroughs, and all of them had an opinion about Nan Patterson and her relationship with Caesar Young.Thank you to the fantastical David White, of Bring me the Axe podcast, for research assistance :)ReferencesAllen, Oliver. 2017. When today's Tribeca was the site of a most sensational murder. November 15. Accessed August 30, 2023. www.tribecatrib.com/content/when-todays-tribeca-was-site-most-sensational-murder.New York Times . 1904. "Nan Patterson hears the case against her." The New York Times, November 22: 6.New York Times. 1904. "Bookmaker is shot in cab with actress." New York Times, June 5: 1.—. 1904. "Actress recommitted at Jerome's insistance." The New York Times, June 7: 2.—. 1904. "Aged witness speaks for Nan Patterson." The New York Times, November 2: 16.—. 1904. "Allows Nan Patterson bail." The New York Times, September 2: 14.—. 1905. "Choose married men for Patterson case." The New York Times, April 19: 20.—. 1904. "Coroner says Nan Patterson is guilty." The New York Times, June 9: 2.—. 1905. "Disagreement in Patterson case." The New York Times, May 4: 1.—. 1905. "Indictment against Morgan Smiths quashed." The New York Times, May 6: 16.—. 1905. "Misdirected sympathy." The New York Times, January 2: 6.—. 1904. "Nan Patterson case results in mistrial." The New York Times, December 24: 14.—. 1905. "Nan Patterson Free." The New York Times, May 13: 3.—. 1905. "Nan Patterson free; Jerome blames press." The New York Times, May 13: 3.—. 1904. "Nan Patterson swears Young shot himself." The New York Times, December 20: 1.—. 1904. "Nan Patterson will not answer questions." The New York Times, June 10: 3.—. 1904. "Nan Patterson's trial to begin again Monday." The New York Times, November 29: 4.—. 1904. "New Patterson trial soon." The New York Times, December 25: 11.—. 1904. "Patterson counsel witness at trial." The New York Times, December 10: 16.—. 1904. "Rand highly praised for closing address." The New York Times, December 22: 6.—. 1904. "Rand springs surprise in Nan Patterson case." The New York Times, December 14: 16.—. 1904. "The Nan Patterson case, letter to the editor." The New York Times, December 30: 8.—. 1904. "Witness corroborates Hazelton's version." The New York Times, November 3: 16.—. 1904. "Witness ill, may halt Nan Patterson trial." The New York Times, November 19: 5.—. 1904. "Young, witness says, hit Nan Patterson." The New York Times, November 24: 4.New York Tmes. 1904. "Skeleton in court in Young case." The New York Times, November 23: 5.San Francisco Call. 1904. "'Caesar' Young, the Californian slain while riding in cab with actress." The San Francisco Call, June 5: 21.San Francisco Chronicle . 1904. "Young's death still puzzling." San Francisco Chronicle, June 6: 1.San Francisco Chronicle. 1904. "Young's death still puzzling." San Francisco Chronicle , June 6: 1.Segrave, Kerry. 2020. Death in a Hansom Cab; The 1904 Persecution of Nan Patterson. Cheltinham, UK: History Press.The Washington Times. 1904. "Nan Patterson's mother very ill." The Washington Times, June 6: 1.Woolcott, Alexander. 1930. "The mystery of the Hansom cab." The New Yorker, May 3: 36-44.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Shop Morbid coffee at www.deadsledcoffee.com and the Morbid Zodiac Mug Collection at www.wonderyshop.comIn the fall of 1961, Betty and Barney Hill took a trip to Niagara Falls. On the drive back from Canada to their home in Portsmouth, NH, the Hills claimed their trip was interrupted when, after stopping to investigate a strange flying object hovering above the car, the couple was abducted by what Barney later described as “beings [that] were somehow not human.”Thank you to the wondrous Dave White for Research Assistance!References:Friedman, Stanton, and Kathleen Marden. 2007. Captured! The Betty and Barney Hill UFO Experience. Red Wheel : Newburyport, MA.Palmer, Barry. 1965. "Portsmouth couple wes 600 persons here." Nashua Telegraph, December 1: 3.Public Broadcasting Sysetm. 1997. Nova: Kidnapped by UFOs? Boston, MA, April 1.Robinson, J. Dennis. 1999. "The Grounding of Betty Hill." The Portsmouth Herald, February 5.—. 2008. The UFO romance of Betty and Barney Hill. Accessed August 17, 2023. http://www.seacoastnh.com/the-ufo-romance-of-betty-and-barney-hill/?showall=1.The Portsmouth Herald. 1969. "Barney Hill dies in city at age 46." The Portsmouth Herald, February 26: 3.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Many of you know my deep love for my birthday twin Queen Claude of France but have you heard of Claude's little sister Renee? Renee had a turbulent life from almost the second she was born from the death of her parents to her disinheritance at a young age. Renee also lived at the height of the religious wars in France and was a princess caught between worlds and it almost cost her everything. Join me to learn about her fascinating life on today's episode. Bibliography Barlow, Jill. “Renée de France: A Woman of the Reformation.” The Village Church. Accessed August 12, 2023. https://www.thevillagechurch.net/resources/articles/renee-de-france-a-woman-of-the-reformation. Contributors to Wikimedia projects. “Anne of Brittany.” Wikipedia, August 10, 2023. https://en.wikipedia.org/wiki/Anne_of_Brittany. ———. “Ercole II d'Este, Duke of Ferrara.” Wikipedia, May 1, 2023. https://en.wikipedia.org/wiki/Ercole_II_d%27Este,_Duke_of_Ferrara. ———. “Louis XII.” Wikipedia, August 6, 2023. https://en.wikipedia.org/wiki/Louis_XII. ———. “Michelle de Saubonne.” Wikipedia, July 3, 2023. https://en.wikipedia.org/wiki/Michelle_de_Saubonne. ———. “Renée of France.” Wikipedia, July 13, 2023. https://en.wikipedia.org/wiki/Ren%C3%A9e_of_France. Editor. “Renée of France: Kept by God's Grace.” Leben, December 19, 2016. https://leben.us/renee-france-kept-gods-grace/. Jansen, Sharon L. “Renée of France, Duchess of Ferrara.” Accessed August 12, 2023. https://www.monstrousregimentofwomen.com/2015/10/renee-of-france-duchess-of-ferrara.html. Kelly, Amy Eloise. “Renée of France - The Protestant Duchess of Ferrara.” History of Royal Women, October 24, 2017. https://www.historyofroyalwomen.com/renee-of-france/renee-france-protestant-duchess-ferrara/. kyra. “Renée of France – Kyra Cornelius Kramer.” Accessed August 12, 2023. https://www.kyrackramer.com/2017/10/24/rene-of-france/. Longueville, Olivia. “Renée of France: A Valois Princess, a Protestant Duchess of Ferrara.” Olivia Longueville, October 26, 2020. https://olivialongueville.com/2020/10/26/renee-of-france-a-valois-princess-a-protestant-duchess-of-ferrara/. The Freelance History Writer. “Princess Renée de France: Staunch Huguenot ~ A Guest Post by Keira Morgan,” March 10, 2021. https://thefreelancehistorywriter.com/2021/03/10/princess-renee-de-france-staunch-huguenot-a-guest-post-by-keira-morgan/. Musée protestant. “Renée de France (1510-1575).” Accessed August 12, 2023. https://museeprotestant.org/en/notice/renee-de-france-1510-1575-2/. The Horoscope. “October 25 Zodiac - Full Horoscope Personality.” www.thehoroscope.co. Accessed August 12, 2023. https://www.thehoroscope.co/zodiac-signs/october-25-zodiac-scorpio.html.

In the summer of 1974, paranormal investigators and UCLA students Barry Taff and Kerry Gaynor were approached in a bookstore by a woman who'd overheard their conversation about the supernatural and said she had a friend who needed help from someone with their expertise. The friend in question was Doris Bither, a middle-aged single mother of four who claimed she and her family were under attack from unseen entities in their Culver City, California home. According to Doris, the attacks began several months earlier and included, among other things, objects moving on their own, the presence of inexplicable foul odors in the house, unusual noises with no point of origin, and most distressingly, multiple physical and sexual assaults that were increasing in frequency and intensity. Thank you to the lovely David White for research assistance :)ReferencesBiddle, Kenny. 2021. "A Closer Look at the Entity Photographs." Skeptical Inquirer 45 (6).O'Keeffe, Ciaran, James Houran, Damian Houran, Neil Dagnall, Kenneth Drinkwater, Lorraine Sheridan, and Brian Laythe. 2019. "The Dr. John Hall story: a case study in putative “Haunted People Syndrome"." Mental Health, Religion & Culture 22 (9): 910-929.Ortega, Xavier. 2011. The Real Entity Case, Part II. August 6. Accessed August 23, 2023. https://www.ghosttheory.com/2011/08/06/the-real-entity-case.Radford, Benjamin. 2021. "The ‘True' Story behind The Entity: Untangling Hollywood Horror." Skeptical Inquirer 45 (6). https://skepticalinquirer.org/2021/10/the-true-story-behind-the-entity-untangling-hollywood-horror/.2005. The Entity Files. Directed by Perry Martin. Produced by Anchor Bay Entertainment. Performed by Barry Taff.—. 2011. The Real Entity Case. August. Accessed August 24, 2023. http://barrytaff.net/2011/08/the-real-entity-case-2/.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In the depths of American history there are few examples of mass hysteria that loom larger than the Salem witch trials of 1692. As horrific as it was, it was far from the only example of witch-hunting in Massachusetts' history. In fact, ten years before hysteria over black magic gripped the village of Salem, similar accusations of witchcraft were aimed at Mary Webster of Hadley, a small village in Western Massachusetts. Thank you to the incredible Dave White for Research assistance.ReferencesClancy, Hal. 1977. "In good old days, wicthes would hang for a May snow." The Boston Globe, May 14: 1.Judd, Sylvester. 1905. History of Hadley. Springfield, MA: H.R. Hunting.Manning, Alice. 1976. "Witches in the Connecticut Valley: a historical perspective." Daily Hampshire Gazette, December 15: 35.Marshall, Bridget. 2003. "Mary (Reeve) Webster, the "Witch" of Hadley." University of Massachusetts Lowell. Accessed August 28, 2023. https://faculty.uml.edu//bmarshall/Mary%20Webster.htm.Mather, Cotton. 1967. Magnalia Christi Americana. New York, NY: Russell and Russell.Perera, Lisa. 1992. "Before Salem, Valley had witch trials of its own." Daily Hampshire Gazette, May 16: 22.Smith, Anna. 2019. The Witch of Hadley: Mary Webster, the Weird, and the Wired. October 15. Accessed August 28, 2023. https://www.massreview.org/node/7575.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode, we briefly review RSV (respiratory syncytial virus) infections and focus on new data supporting the use of two different RSV vaccines (Abrysvo and Arvexy) in preventing RSV infections in older adults and in pregnant women. Key Concepts RSV is a contagious respiratory virus that is usually mild and self-limiting in most patients but can cause severe disease especially in young children or older adults with certain risk factors. The FDA recently approved two vaccines for RSV (Abrysvo from Pfizer and Arexvy from GSK). The initial FDA approval was for adults 60 years of age and older; however, the FDA recently granted an additional indication for Abrysvo for pregnant women (to prevent the infant from severe RSV infection once born). When studied in older adults, both vaccines did meet efficacy criteria but the incidence of RSV infection was relatively low and thus the number needed to treat (NNT) is high. Both studies were done at times with lower RSV prevalence - the NNT would likely be more favorable during RSV outbreaks. Unlike Abrysvo, Arvexy (GSK) contains an adjuvant to improve the immune response. Although direct comparisons of efficacy and safety are not appropriate, Arvexy does appear to elicit more systemic adverse effects such as fever, myalgias, headache, and fatigue. References Respiratory Syncytial Virus Infection (RSV). Centers for Disease Control and Prevention. https://www.cdc.gov/rsv/index.html Abrysvo (respiratory syncytial virus vaccine). US Food & Drug Administration. https://www.fda.gov/vaccines-blood-biologics/abrysvo Arexvy (respiratory syncytial virus vaccine, adjuvanted). US Food & Drug Administration. https://www.fda.gov/vaccines-blood-biologics/arexvy Use of Respiratory Syncytial Virus Vaccines in Older Adults: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023. Morbidity and Mortality Weekly Report (MMWR). July 21, 2023 / 72(29);793-801. https://www.cdc.gov/mmwr/volumes/72/wr/mm7229a4.htm CDC. ACIP Recommendations. Last reviewed August 4, 2023. www.cdc.gov/vaccines/acip/recommendations.html. Accessed August 23, 2023. RENOIR - Walsh EE, Pérez Marc G, Zareba AM, et al. Efficacy and Safety of a Bivalent RSV Prefusion F Vaccine in Older Adults. N Engl J Med. 2023;388(16):1465-1477. doi:10.1056/NEJMoa2213836 AReSVi-006 - Papi A, Ison MG, Langley JM, et al. Respiratory Syncytial Virus Prefusion F Protein Vaccine in Older Adults. N Engl J Med. 2023;388(7):595-608. doi:10.1056/NEJMoa2209604 MATISSE - Kampmann B, Madhi SA, Munjal I, et al. Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants. N Engl J Med. 2023;388(16):1451-1464. doi:10.1056/NEJMoa2216480 RSV-NET Interactive Dashboard. Centers for Disease Control and Prevention. https://www.cdc.gov/rsv/research/rsv-net/dashboard.html ACIP Meeting Information - Meeting Materials. https://www.cdc.gov/vaccines/acip/meetings/index.html

Many people are familiar with the stories that come out of the Hundred Years War, like the heroism of Joan of Arc or the battle of Agincourt, but few know the story of the queen of four kingdoms who helped France win the war. Yolande was born the daughter of the king of Aragon and, over her life, was the unofficial queen of four nations. As a teen, she was strategically married off to the Duke of Anjou, but despite being Spanish, she became a full-blown Francophile and was key to the continued survival of the French monarchy. Join me today to learn her story. Bibliography BookBrowse. “Yolande of Aragon: Background Information When Reading Joan of Arc.” BookBrowse.com. Accessed August 6, 2023. https://www.bookbrowse.com/mag/btb/index.cfm/book_number/3238/joan-of-arc. Contributors to Wikimedia projects. “Joanna of Aragon, Countess of Foix.” Wikipedia, June 14, 2023. https://en.wikipedia.org/wiki/Joanna_of_Aragon,_Countess_of_Foix. ———. “John I of Aragon.” Wikipedia, June 28, 2023. https://en.wikipedia.org/wiki/John_I_of_Aragon. ———. “Louis II of Anjou.” Wikipedia, April 30, 2023. https://en.wikipedia.org/wiki/Louis_II_of_Anjou. ———. “Violant of Bar.” Wikipedia, July 14, 2023. https://en.wikipedia.org/wiki/Violant_of_Bar. ———. “Yolande of Aragon.” Wikipedia, July 25, 2023. https://en.wikipedia.org/wiki/Yolande_of_Aragon. Dan Moorhouse - The Hundred Years War. “Yolande of Aragon - The Hundred Years War.” The Hundred Years War - 1337-1453, February 13, 2022. https://thehundredyearswar.co.uk/yolande-of-aragon/. ellena. “August 11th Zodiac Sign — Leo Traits, Careers, Mantras & More.” Popular Vedic Science, December 7, 2022. https://popularvedicscience.com/astrology/august-11-zodiac-sign/. Jansen, Sharon L. “Yolande of Aragon, the Queen of Four Kingdoms.” Accessed August 6, 2023. https://www.monstrousregimentofwomen.com/2019/08/yolande-of-aragon-queen-of-four-kingdoms.html. Longueville, Olivia. “Yolande of Aragon: Her Mother, Violant de Bar, as a Role Model.” Olivia Longueville, August 13, 2021. https://olivialongueville.com/2021/08/13/yolande-of-aragon-her-mother-as-a-role-model/. TV Tropes. “Yolande Of Aragon / Useful Notes.” Accessed August 6, 2023. https://tvtropes.org/pmwiki/pmwiki.php/UsefulNotes/YolandeOfAragon. Encyclopedia.com. “Yolande of Aragon (1379–1442).” Accessed August 6, 2023. https://www.encyclopedia.com/women/encyclopedias-almanacs-transcripts-and-maps/yolande-aragon-1379-1442.

Sure, children are the future, but why shouldn't they have a hand in the present? Today's episode of Zero Hour introduces us to two HIV advocates—one an HBCU professional and the other a person born with HIV—who are centering education for youth and adolescents in their missions to end the epidemic. Our guests are: Leslie Hall, director of the Historically Black Colleges and Universities Program at the Human Rights Campaign. He shares his intersectional experiences as a Black queer man and discusses the significance of bringing HIV prevention and education to HBCUs. Ashley Rose Murphy, a National Youth Ambassador for the Canadian Foundation for AIDS Research and a global HIV speaker and rights advocate. She shares her triumphant story of outliving a six-month life expectancy after being born with AIDS and channeling her experiences into a life of activism. This podcast was created and fully funded by Gilead Sciences, Inc. GILEAD, the GILEAD logo, and the & design are trademarks of Gilead Sciences, Inc. © 2023 Gilead Sciences, Inc. All rights reserved. IHQ-UNB-4353 Date of Preparation August 2023. References: United Negro College Fund. The HBCU Effect®. Accessed August 3, 2023. Available at: https://uncf.org/pages/the-hbcu-effect

On the morning of December 31, 1946, nineteen-year-old Pearl Lusk boarded a crowded subway train in Brooklyn. A few days earlier, she'd met a man named Allen in a bar who offered her a very strange, yet simple job: she was to follow a young woman named Olga and take a photo to determine whether she was wearing any stolen jewelry. That morning, as Pearl and Olga exited the crowded subway train, Pearl raised the camera in Olga's direction and pulled the wire to take a photo, but what happened next would put into motion a series of events that rivals fiction.Thank you to the wonderful Dave White for Research assistance!ReferencesAdams, Toni. 1947. "Troopers hunt and kill Alphonse Rocco." Kingston Daily Freeman, January 7: 1.Brooklyn Daily Eagle. 1947. "Camera-gun suspect flees in stolen car." Brooklyn Daily Eagle, January 6: 2.Buffalo Evening News. 1947. "'Camera' shooting victim asks N.Y. City to pay her $200,000." Buffalo Evening News, February 14: 1.—. 1953. "Court frees city of liability for not averting shooting." Buffalo Evening News, April 22: 25.—. 1947. "Police press quest for spouse of camera-gun victim." Buffalo Evening News, January 2: 9.—. 1946. "Times Square Station is scene of shooting." Buffalo Evening News, December 31: 10.International News Service. 1947. "Estranged wife and family glad Ruocco is dead." Buffalo Evening News, Janaury 7: 1.Kingston Daily Freeman. 1947. "Victim of camera shooting guarded." Kingston Daily Freeman, January 2: 18.McKelway, St. Clair. 1953. The Perils of Pearl and Olga. August 8. Accessed August 10, 2023. https://www.newyorker.com/magazine/1953/08/08/the-perils-of-pearl-and-olga.New York Times. 1947. "Camera-gun victim files for $200,000." New York Times, February 15: 17.—. 1947. "'Camera-gun' victim loses a leg." New York Times, Janaury 3: 1.—. 1947. "Girl, dupe in plot, shoots woman with 'camera' gun." New York Times, January 1: 1.—. 1947. "Lusk girl freed; will leave city." New York Times, Janaury 11: 20.—. 1947. "Rocco killed by the police in Catskills." New York Times, January 7: 1.Smith, Delos. 1947. "Gullible girl hoaxed into plot on life of estranged wife." Daily Boston Globe, January 1: 13.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

On this week's episode, we welcome Shannon Murphy to the show, our first ever guest! Shannon is a minimalist-minded professional declutterer and organizer from the UK, and founder of Simpl Living Co. We talk about the correlation between our physical space at home and our mental well-being, her own manifesting journey, and how to start living a more minimalist, sustainable and ultimately FREE life so we can effectively pursue our wildest dreams.Visit Shannon's Instagram here!Visit Simpl Living Co's website here!RESOURCES:Environmental Audit Committee (2019) Fixing fashion: clothing consumption and sustainability, UK Parliament. Available at: https://publications.parliament.uk/pa/cm201719/cmselect/cmenvaud/1952/full-report.html (Accessed: August 2023).McMains, S., Kastner, S. (2011) Interactions of top-down and bottom-up mechanisms in human visual cortex, The Journal of Neuroscience. DOI: 10.1523/JNEUROSCI.3766-10.2011.Raines, A., Boffa, J., Allan, N., Short, N., Schmidt, N. (2014) Hoarding and eating pathology: the mediating role of emotion regulation, Comprehensive Psychiatry. DOI: 10.1016/j.comppsych.2014.11.005Saxbe, D.E., Repetti, R. (2009) No Place Like Home: Home Tours Correlate With Daily Patterns of Mood and Cortisol, Personality and Social Psychology Bulletin. DOI: https://doi.org/10.1177/0146167209352864.WRAP Org. (2016) Extending clothing life protocol, WRAP Org. Available at: https://wrap.org.uk/resources/guide/extending-clothing-life-protocol (Accessed: August 2023).Follow the show's Instagram here! Follow Inma's Instagram here! Check out the show's website here!

In the spring of 2009, Edwin Gonzalez and his girlfriend, Lillian Otero, fled their house in Gardner, MA, less than one year after moving into what they believed was their dream home. Later, once they were safely away from the old Victorian, Gonzalez and Otero would explain to friends and family that they had been driven out by angry ghosts who had done everything—including possessing Lillian—in order to torment them, leaving them no other options than to abandon the house that had once held such promise. Although they didn't know it when they moved in, Gonzalez and Otero's home, the S.K. Pierce Mansion, had long been considered by locals to be haunted. Indeed, in its more than one-hundred-year history, the Victorian home had seen more than its fair share of tragedies, including several deaths in the house as recent as the 1960s, as well as countless other unsavory myths and legends.Thank you to Dave White for research assistance. ReferencesCity of Gardner. n.d. History. Accessed August 1, 2023. https://www.gardner-ma.gov/316/History.Discovery Channel. 2013. "Haunted Victorian." A Haunting. New York, NY: Discovery Channel, October 19.Farragher, Thomas. 2022. "Want to be a ghost host? Come to Gardner." Boston Globe, August 20: B1.Fiorentino, Alyssa. 2021. How the S.K. Pierce Mansion became one of the most haunted homes in Massachusetts. October 27. Accessed July 31, 2023. https://www.housebeautiful.com/lifestyle/a38046654/sk-pierce-haunted-victorian-mansion/.Fitchburg Sentinel. 1963. "Gardner man, 47, dies in room fire." Fitchburg Sentinel, April 9: 11.—. 1891. "Notes." Fitchburg Sentinel, December 8: 2.Gelinas, Brian. 2012. "Group of ghost hunting enthusiasts converge on Gardner mansion." Athol News, October 6: 1.Gershon, Livia. 2006. Ghost hunters. July 28. Accessed August 1, 2023. https://www.thegardnernews.com/story/news/2006/07/28/ghost-hunters/11341583007/.Ilinitch, Shawn. 2003. Psychic profiler detects spirits in South Gardner home. October 31. Accessed August 1, 2023. https://www.thegardnernews.com/story/news/2003/11/01/psychic-profiler-detects-spirits-in/11284159007/.Landry, Stephen. 2021. "Debunking rumors about the S.K. Pierce Mansion." Gardner News, September 22.—. 2020. "New book details history of S.K. Pierce Mansion." Gardner News, September 25.Pelletiere, Nicole. 2016. Homeowner to turn 'haunted' mansion into scary attraction. September 2. Accessed August 1, 2023. https://abcnews.go.com/Lifestyle/homeowner-turn-haunted-mansion-scary-attraction/story?id=41769810.SK Haunted Victorian Mansion. 2023. The Mansion. Accessed August 2, 2023. https://www.skhauntedvictorianmansion.com/index.html.Stanway, Eric. 2013. The Victorian. September: Independent.—. 2013. "Gardner mansion shelters ghostly past." Worcester Telegram and Gazette, July 10.Zillow. 2023. 4 West Broadway, Gardner, MA. Accessed August 1, 2023. https://www.zillow.com/homedetails/4-West-Broadway-Gardner-MA-01440/57587523_zpid/See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Meet sisters Caroline Martin, Virginia Wardlaw and Mary Snead. They left a long trail of devastation and death of family members from Kentucky to Tennessee and Virginia on to New Jersey where they were implicated in the mysterious death of a young family member.  Want more Southern Mysteries?  Hear the Southern Mysteries show archive of 60+ episodes along with Patron exclusive podcast, Audacious: Tales of American Crime and more when you become a patron of the show. You can immediately access exclusive content now at patreon.com/southernmysteries Connect Website: southernmysteries.com Facebook: Southern Mysteries Podcast Twitter: @southernpod_ Instagram: @shannonballard_ Email: southernmysteriespodcast@gmail.com  Episode Sources “Soule Sisters Series”, Daily News Journal, Sunday, October 2009. Accessed March 2, 2028. https://rutherfordtnhistory.org/rutherford-county-hosted-three-wicked-witches/ “Three Sisters in Black: The Bizarre True Case of the Bathtub Tragedy” by Norman Zierold. Accessed March 1, 2018. https://books.google.com/books?id=wqdLDwAAQBAJ&printsec=frontcover#v=onepage&q&f=false “Ghosts of past still frighten New River Valley”, Collegiate Times, October 31, 2006. Accessed March 10, 2018.  https://www.collegiatetimes.com/lifestyle/ghosts-of-past-still-frighten-new-river-valley/article_0b71ec43-ff02-5af4-a83e-8016c081891a.html “Sister Act: The Bizarre Drowning of Ocey Snead”, The Lineup, July 19, 2018. Accessed August 1, 2023. https://the-line-up.com/the-bizarre-drowning-of-ocey-snead Episode Music Theme Song “Dark & Troubled” by Pantherburn. Special thanks to Phillip St Ours for permission for use. Colorless Aura by Kevin MacLeod. Licensed under Creative Commons.

Today, I'll be talking about happiness. What is happiness? How do we achieve long-lasting happiness? Are there different types of happiness? And what are hedonia and eudaimonia? We answer all these questions, and discuss 3 strategies to be happier, or to find a more profound sense of happiness and joy that has nothing to do with immediate, short-term pleasures, and that finds its source in the wellness of the self. I'll talk about how psychological well-being is related to physical well-being, health & fitness, and how these contribute to happiness, purpose and fulfillment, all of them coming from within.RESOURCES:Henderson, L.W., Knight, T., Richardson, B. (2013) “An exploration of the well-being benefits of hedonic and eudaimonic behaviour”, The Journal of Positive Psychology, 8:4, 322-336, DOI: 10.1080/17439760.2013.803596Sanfeliciano, A. (2018) “Eudaimonía y hedonismo: dos formas de experimentar la felicidad”, La Mente es Maravillosa. Available at: https://lamenteesmaravillosa.com/eudaimonia-y-hedonismo-dos-formas-de-experimentar-la-felicidad/ (Accessed: August 2023).Schaffner, A.K. (2016) “How to Escape the Hedonic Treadmill and Be Happier”, PositivePsychology. Available at: https://positivepsychology.com/hedonic-treadmill/ (Accessed: August 2023).Vinney, C. (2020) “What's the Difference Between Eudaimonic and Hedonic Happiness?”, ThoughtCo. Available at: https://www.thoughtco.com/eudaimonic-and-hedonic-happiness-4783750 (Accessed: August 2023).Follow the show's Instagram here! Follow Inma's Instagram here! Check out the show's website here!

Leaving home is never easy—especially when discrimination, xenophobia, and cultural barriers await you in your new destination. In this episode, Zero Hour™ speaks with two leaders who are working to not only ease the transition for migrants and displaced people, but to also connect them with vital HIV services and resources. Our guests are: Denis Onyango, a grassroots activist who organizes HIV testing, prevention, and peer support services through his role as Programs Director for the Africa Advocacy Foundation. He reflects on how losing his brother and three sisters to AIDS spurred his focus on HIV activism, as well as the harsh realization that the care they went without was widely available in other parts of the world. Isjed Hussain, founder of the Prisma Group Foundation, which supports bicultural and Muslim LGBTQ people in the Netherlands. They explain how Prisma helps refugees to navigate the asylum process and how they assist refugees living with HIV. This podcast was created and fully funded by Gilead Sciences, Inc. GILEAD, the GILEAD logo, and the & design are trademarks of Gilead Sciences, Inc. © 2023 Gilead Sciences, Inc. All rights reserved. US-UNBC-1760 Date of Preparation August 2023. Correction: Guest states that a study took place with 3000 participants in 10 countries. In actuality, the study took place in 9 countries with 2009 participants. References: Alvarez-Del Arco D. et al, AIDS, 2017; 31(14):1979-1988. Accessed August 23, 2023 European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2021 – 2020 data. Stockholm: ECDC; 2021. Accessed July  15, 2023. Available at: https://www.ecdc.europa.eu/en/publications-data/hiv-aids-surveillance-europe-2021-2020-data European Centre for Disease Prevention and Control. HIV and migrants. Monitoring implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia: 2018 progress report. Stockholm: ECDC; 2019. Accessed July 15, 2023. Available at: https://www.ecdc.europa.eu/en/publications/hiv-migrants-monitoring-implementation-dublin-declaration-2018-progress-report Frescura L, Godfrey-Faussett P, Feizzadeh A A, El-Sadr W, Syarif O, Ghys PD; on behalf of the 2025 testing treatment target Working Group. Achieving the 95 95 95 targets for all: A pathway to ending AIDS. PLoS One. 2022 Aug 4;17(8):e0272405. doi:10.1371/journal.pone.0272405. Gbadamosi SO, Trepka MJ, Dawit R, Jebai R, Sheehan DM. A Systematic Review and Meta-analysis to Estimate the Time from HIV Infection to Diagnosis for People with HIV. AIDS Rev. 2022 Mar 1;24(1):32-40. doi: 10.24875/AIDSRev.21000007. PMID: 34077404; PMCID: PMC8636511. Accessed August, 23 2023 US Department of Health and Human Services. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. March 2023. Accessed July 15, 2023. Available at: https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf

In the summer of 1980, nineteen-year-old Nancy Santomero, and two friends, twenty-six-year-old Vicki Durian and nineteen-year-old Liz Johndrow, left Durian's parents' home in Iowa to hitchhike to West Virginia to attend a gathering of the Rainbow Family. Five days later, Santomero and Durian's bodies were discovered in the woods in West Virginia, shot to death just hours before being found, and Johndrow was nowhere to be seen.More than a decade after their bodies were discovered, police in West Virginia had identified several suspects and eventually charged thirty-four-year-old farmer Jacob Beard, who was convicted in 1993 and sentenced to life in prison. Upon appeal, however, it was revealed that the investigation into Beard was rife with dubious circumstantial evidence, police misconduct, and perjury, which led to a new trial and Beard was exonerated. Thank you to the lovely Dave White for research assistanceReferences: Associated Press. 1992. "W. Va drops Rainbow charges." Roanoke Ties and World-News, July 21: 6.—. 1992. "Arrests in women's deaths 'witch hunt' attorney says." The Daily Progress , April 25: 7.—. 2000. "Jury finds man innocent in Rainbow murder trial." The Roanoke Times, June 1: 21.Behrens, David. 2000. "Too many years without answers." Newsday, February 16: B6.Daily Press. 1980. "2 murdered women in 'Rainbow Family'." Daily Press, June 27: 44.Danville Reigister and Bee. 1993. "Jury deliberating in slayings case." Danville Register and Bee, June 4: 10.Darling, Lynn. 1980. The Rainbow People. July 7. Accessed August 7, 2023. https://www.washingtonpost.com/archive/lifestyle/1980/07/07/the-rainbow-people/80aadbf3-ef61-4d43-9d62-766d4d01fc56/.Horn, Dan. 1997. "Franklin's boasting may unlock convict." The Cincinnati Post, April 18.Lovegrove, Richard. 1980. "Rainbow camp still going up despite slaying of women." The Roanoke Times, June 28: 1.—. 1980. "Two women slain near 'Rainbow' camp remain unidentified." The Roanoke Times, July 10: B-8.Possley, Maurice. 2012. Jacob Beard. July 30. Accessed August 8, 2023. https://www.law.umich.edu/special/exoneration/Pages/casedetail.aspx?caseid=3963.State of West Virginia v. Jacob W. Beard. 1998. 24644 (Supreme Court of Appeals of West Virginia, July 15).State of West Virginia v. Jacob W. Beard. 1995. 22504 (Supreme Court of Appeals of West Virginia, January).The Gazette. 1983. "2 West Virginia men charged in death of Wellman woman." The Gazette, April 8: 14.—. 1992. "4 charged in Wellman woman's 1980 slaying." The Gazette, April 17: 10.United Press International. 1980. "Young woman who skipped tragic hitchhiking trip found." The Daily Progress, July 17: 7.Wallace, Terry. 1992. "Seething hostility led to killing of hitchhikers." The Daily Progress, April 20: 1.West Virginia Public Broadcasting. 2020. Two Women Murdered Traveling to Rainbow Gathering. June 25. Accessed August 8, 2023. https://wvpublic.org/june-25-1980-two-women-murdered-traveling-to-rainbow-gathering/.https://kmbllaw.com/dont-just-ask-to-suppress-the-involuntary-statement-and-the-evidence-thats-fruit-of-the-poisonous-tree-ask-for-a-full-kastigar-hearing/#:~:text=In%20other%20words%2C%20the%20Kastigar,compelled%20after%20an%20immunity%20order.https://www.upcounsel.com/legal-def-habeas-corpus#:~:text=The%20writ%20of%20habeas%20corpus%20serves%20as%20an%20important%20check,290%2D91%20(1969).See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Today, I tell you about the incredible health benefits (mental health AND physical health) of having a grateful outlook, how gratitude can change the way you perceive your whole life, how it makes you happier and how it can help you in your manifesting journey. I give you different strategies and tools so that you can start adding a sprinkle of gratitude on your everyday life, in order to hard-wire your brain to find more things that make you feel grateful. Nothing in your external life needs to change for that, it all comes from your subconscious mind, and the way you train it.RESOURCES mentioned:Conley, M. (2011) “Thankfulness Linked to Positive Changes in Brain and Body,” ABC News. Available at: https://abcnews.go.com/Health/science-thankfulness/story?id=15008148 (Accessed August 2023).Korb, A. (2012) “The Grateful Brain: The Neuroscience of Giving Thanks,” Psychology Today. Available at: https://www.psychologytoday.com/us/blog/prefrontal-nudity/201211/the-grateful-brain (Accessed: August 2023).Nafousi, R. (2022) Manifest: 7 Steps To Living Your Best Life. Penguin Random House UK.Nafousi, R. (2023) Manifest: Dive Deeper. Penguin Random House UK.Shetty, J. (2020) Think Like A Monk. Thorsons.Follow the show's Instagram here! Follow Inma's Instagram here! Check out the show's website here!

Otto Wood was a self–proclaimed one armed-bandit from North Carolina. He made a name for himself as a bootlegger who loved stealing from the rich. Being sent to jail only heightened his fame. He escaped prison so many times he was nicknamed the Hillbilly Houdini.   Want more Southern Mysteries?  Hear the Southern Mysteries show archive of 60+ episodes along with Patron exclusive podcast, Audacious: Tales of American Crime and more when you become a patron of the show. You can immediately access exclusive content now at patreon.com/southernmysteries   Connect Website: southernmysteries.com Facebook: Southern Mysteries Podcast Twitter: @southernpod_ Instagram: @shannonballard_ Email: southernmysteriespodcast@gmail.com    Episode Sources ‘They started popping bullets': Eyewitness recalls the day Otto Wood died. Salisbury Post. January 2015. Accessed August 1, 2023. https://www.salisburypost.com/2015/07/30/they-started-popping-bullets-eyewitness-recalls-the-day-otto-wood-died/   Wood, Otto.  Life history of Otto Wood: inmate, State Prison. Raleigh, N.C.: 1926.    Otto Wood: North Carolina's One Man Crime Wave. Old Hat Records. Accessed August 3, 2023. http://www.oldhatrecords.com/ResearchOttoWood.html   The not too well-known desperado. Accessed August 3, 2023. http://kronsell.net/woodenglish.htm    McKenzie, T. (2021). Otto Wood, the Bandit: The Freighthopping Thief, Bootlegger, and Convicted Murderer behind the Appalachian Ballads. University of North Carolina Press. http://www.jstor.org/stable/10.5149/9781469665672_mckenzie   Episode Music The Colonel by Zachariah Hickman. Licensed under Creative Commons; Otto Wood: The Bandit by The Carolina Buddies, Columbia Phonograph Recordings, 1931. Theme Song “Dark & Troubled” by Pantherburn. Special thanks to Phillip St Ours for permission for use.

Welcome to this special episode of the NeurologyLive® Mind Moments® podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. For major FDA decisions in the field of neurology, we release short special episodes to offer a snapshot of the news, including the main takeaways for the clinical community, as well as highlights of the efficacy and safety profile of the agent in question. In this episode, we're covering the recent expanded indication of valbenazine (Ingrezza; Neurocrine Biosciences) to include the treatment of chorea associated with Huntington disease (HD). Erin Furr-Stimming, MD, FAAN, FANA, a professor of neurology at McGovern Medical School of UTHealth Houston, and principal investigator of the phase 3 KINECT-HD studies, valbenazine's supportive studies, offered her immediate reaction to the news. In addition, she spoke about the efficacy observed in these trials, the advantages valbenazine has as a VMAT2 inhibitor, and the remaining unmet needs in the management of HD.   For more of NeurologyLive®'s coverage of valbenazine's expanded indication, head here: FDA Approves Neurocrine Biosciences' Valbenazine for Huntington Disease Chorea Episode Breakdown: 0:30 – Valbenazine approved for Huntington disease chorea 1:35 – Erin Furr-Stimming, MD, FAAN, FANA, on immediate reaction 2:15 – Treatment toolbox for HD chorea  3:05 – Furr-Stimming on mechanistic advantages of valbenazine 5:10 – Phase 3 efficacy data of valbenazine 5:55 – Furr-Stimming on greatest clinical takeaways from trials 6:55 – Current state of Huntington management 8:00 – Furr-Stimming on current unmet needs for patients, including research on disease-modifying therapies Thanks for listening to the NeurologyLive® Mind Moments® podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com. REFERENCES 1. Neurocrine Biosciences Announces FDA Approval of INGREZZA® (valbenazine) Capsules for the Treatment of Chorea Associated With Huntington's Disease. News Release. Neurocrine Biosciences. Published August 18, 2023. Accessed August 21, 2023.

Click to listen to episode (4:20).Sections below are the following:Transcript of AudioAudio Notes and AcknowledgmentsImagesExtra InformationSourcesRelated Water Radio EpisodesFor Virginia Teachers (Relevant SOLs, etc.)Unless otherwise noted, all Web addresses mentioned were functional as of 8-18-23. TRANSCRIPT OF AUDIO From the Cumberland Gap to the Atlantic Ocean, this is Virginia Water Radio for the weeks of August 21 and August 28, 2023. MUSIC – ~15 sec – instrumental. That's part of “The Foggy Dew,” an Irish song performed here by Timothy Seaman of Williamsburg, Virginia, with Ann Robinson on Celtic Harp.  In the song's traditional lyrics, fog and dew set the scene for the Easter Uprising in 1916, during the Irish Revolution for independence from Great Britain.  This Water Radio episode's focus isn't on those important historical events, but rather on a number related to fog and dew, and to whether the weather on a summer day feels comfortable or close.  That number is the dew point temperature, or simply the dew point. The National Weather Service gives the following descriptions of “general comfort levels” at various dew points:“less than or equal to 55 degrees Fahrenheit: dry and comfortable;“between 55 and 65: becoming ‘sticky' with muggy evenings;“[at 65 or more]: ...becoming oppressive.” Note, however, that perceived comfort levels at different dew points depend on the climate conditons to which a person is acclimated. Let's explore some of the science of the dew point. Any parcel of air can hold a given amount of water vapor, depending on the air parcel's temperature; air with higher temperature can hold more water vapor.  The term relative humidity refers to how much water vapor an air parcel actually holds, compared to its potential maximum.  The dew point, then, is the temperature at which an air parcel reaches a relative humidity of 100 percent.  Cooling air below its dew point results in water vapor condensing into fog, dew, or some other kind of precipitation; if temperatures are below freezing, the dew point is then considered the frost point. Now, here's the key concept for how humid the air feels: a higher dew point indicates that an air parcel is holding more moisture at any given temperature or relative humidity.  With more moisture in the air, the human body has more trouble evaporating sweat, the process that removes heat and cools the body.  With sweat not evaporating as readily, it feels hotter and more humid; the term “heat index” refers to how hot people feel in combinations of temperature and humidity. Humidity, sweat and evaporation, comfort or mugginess: there's a lot to learn from the daily dew point. Thanks to Timothy Seaman for permission to use this episode's music, and we close with about 35 more seconds of “The Foggy Dew.” MUSIC – ~34 sec – instrumental. SHIP'S BELL Virginia Water Radio is produced by the Virginia Water Resources Research Center, part of Virginia Tech's College of Natural Resources and Environment.  For more Virginia water sounds, music, or information, visit us online at virginiawaterradio.org, or call the Water Center at (540) 231-5624.  Thanks to Stewart Scales for his banjo version of “Cripple Creek” to open and close this episode.  In Blacksburg, I'm Alan Raflo, thanking you for listening, and wishing you health, wisdom, and good water. AUDIO NOTES AND ACKNOWLEDGEMENTS “The Foggy Dew,” a 2023 single release, is copyright by Timothy Seaman, used with permission.  It features Ann Robinson on Celtic Harp.  More information about Timothy Seaman is available online at https://timothyseaman.com/en/.  “The Foggy Dew” is a traditional Irish song, whose lyrics talk about the 1916 Easter Uprising, part of the Irish Revolution and War of Independence (1919-1921) against Great Britain.  The song describes scenes of battle on Easter morning taking place amidst “the foggy dew.”  Information about the song is available online at https://www.o-em.org/index.php/fieldwork/62-the-foggy-dew-processes-of-change-in-an-irish-rebel-song. Virginia Water Radio thanks David Carroll, of the Virginia Tech Department of Geography, and Kevin McGuire and Stephen Schoenholtz, of the Virginia Water Resources Research Center and Virginia Tech Department of Forest Resources and Conservation, for their help with this episode. Click here if you'd like to hear the full version (1 min./11 sec.) of the “Cripple Creek” arrangement/performance by Stewart Scales that opens and closes this episode.  More information about Mr. Scales and the group New Standard, with which Mr. Scales plays, is available online at http://newstandardbluegrass.com. IMAGES The following two photos of dew and were taken by Virginia Water Radio in Blacksburg, Va., on August 12, 2023, around 8 a.m. EDT, when the dew point and the actual temperature were the same. EXTRA INFORMATION ABOUT DEW POINT AND HEAT INDEX The following information is quoted from the National Weather Service, accessed at the Web sites noted on August 21, 2023. Dew Point Information From “Dew Point vs. Humidity,” online at https://www.weather.gov/arx/why_dewpoint_vs_humidity. “The dew point is the temperature the air needs to be cooled to (at constant pressure) in order to achieve a relative humidity (RH) of 100%.  At this point the air cannot hold more water in the gas form.  If the air were to be cooled even more, water vapor would have to come out of the atmosphere in the liquid form, usually as fog or precipitation. “The higher the dew point rises, the greater the amount of moisture in the air.  This directly affects how ‘comfortable' it will feel outside.  Many times, relative humidity can be misleading.  For example, a temperature of 30 and a dew point of 30 will give you a relative humidity of 100%, but a temperature of 80 and a dew point of 60 produces a relative humidity of 50%.  It would feel much more ‘humid' on the 80 degree day with 50% relative humidity than on the 30 degree day with a 100% relative humidity.  This is because of the higher dew point. “So if you want a real judge of just how ‘dry' or ‘humid' it will feel outside, look at the dew point instead of the [relative humidity].  The higher the dew point, the muggier it will feel.” “General comfort levels using dew point that can be expected during the summer months:*less than or equal to 55: dry and comfortable;*between 55 and 65: becoming ‘sticky' with muggy evenings;*greater than or equal to 65: lots of moisture in the air, becoming oppressive.” Heat Index Information From “What is the heat index?” online at https://www.weather.gov/ama/heatindex. “

When it comes to HIV, women are forced to contend with more than just stigma and barriers to care. Factors like gender inequality, intimate partner violence, and bodily autonomy make everything from prevention and treatment to status disclosure more difficult and more dangerous. In this episode, we're exploring common obstacles women encounter in the fight against HIV, as well as the global efforts to improve women's visibility and protection. Our guests are: Dr. Rageshri Dhairyawan, a sexual health and HIV doctor currently serving as Consultant in Sexual Health and HIV Medicine at Barts Health NHS Trust in London. Roukhaya Hassambay, program coordinator at Ikambere, an organization that offers holistic supports to women living in precarious situations and with chronic illness. This podcast was created and fully funded by Gilead Sciences, Inc. GILEAD, the GILEAD logo, and the & design are trademarks of Gilead Sciences, Inc. © 2023 Gilead Sciences, Inc. All rights reserved. IHQ-UNB-4319 Date of Preparation August 2023. References: Borumandnia N, Khadembashi N, Tabatabaei M, Majd HA. The prevalence rate of sexual violence worldwide: a trend analysis. BMC Public Health. 2020;20:1835. doi:10.1186/s12889-020-09926-5 UNAIDS. Fact sheet 2023. Global HIV statistics. Accessed August 7, 2023. Available at: https://www.unaids.org/en/resources/fact-sheet GLAAD. Glossary of Terms: Transgender. Accessed August 7, 2023. Available at: https://glaad.org/reference/trans-terms/ World Bank. Girls' education. Updated February 2023. Accessed August 7, 2023. Available at: https://www.worldbank.org/en/topic/girlseducation Cabecinha M et al. Current PrEP provision does not align with women's preferences: early results from a cross-sectional survey investigating PrEP awareness, interest, and preferences among women in England. British HIV Association conference, Gateshead, April 2023. Abstract P028. Available at: https://www.bhiva.org/file/645cfa43aca4f/P028.pdf Desgrées-du-Loû A, Pannetier J, Ravalihasy A, et al. Sub-Saharan African migrants living with HIV acquired after migration, France, ANRS PARCOURS study, 2012 to 2013. Euro Surveill. 2015;20(46):1-8. doi: 10.2807/1560-7917.ES.2015.20.46.30065 Dhairyawan R, Tariq S, Scourse R, Coyne KM. Intimate partner violence in women living with HIV attending an inner city clinic in the UK: prevalence and associated factors. HIV Med. 2013 May;14(5):303-10. doi: 10.1111/hiv.12009 Smith K, Coleman K, Eder S, Hall P. Homicides, Firearm Offences and Intimate Violence 2009/10. Supplementary Volume 2 to Crime in England and Wales 2009/10. 2011 Home Office Statistical Bulletin. Accessed August 7, 2023. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/116512/hosb0111.pdf Sullivan TP. The intersection of intimate partner violence and HIV: detection, disclosure, discussion, and implications for treatment adherence. Top Antivir Med. 2019 May;27(2):84-87. US Department of Health and Human Services. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. March 2023. Accessed August 7, 2023. Available at: https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf. American Association for the Advancement of Science. People living with HIV at substantially higher risk of depression and suicide, especially in first 2 years after diagnosis. Press Release. European Congress of Clinical Microbiology & Infectious Diseases (ECCMID); Copenhagen, Denmark, 15-18 April, 2023. Accessed August 7, 2023. Available at: https://www.eurekalert.org/news-releases/984677

On how freshness emerges from stagnant waters.Samuel Taylor Coleridge (1802). Dejection: An Ode, https://tinyurl.com/56xrjd7t (poetryfoundation.org). Accessed August 2023.Aleister Crowley (2004). The Book of Thoth. York Beach, ME: Weiser.Sigmund Freud (1905). Fragment of an Analysis of a Case of Hysteria. In: The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 7, London: Hogarth.Carl Gustav Jung (1956) Symbols of Transformation. In: The Collected Works of C. G. Jung, Vol. 5, Princeton, NJ: Princeton University.Support the podcast and access additional content at: https://patreon.com/oeith. Buy me a coffee at https://ko-fi.com/oeith or https://www.buymeacoffee.com/dbarfordG. Or you could send me a lovely book from https://www.amazon.co.uk/hz/wishlist/ls/1IQ3BVWY3L5L5?ref_=wl_share. Hosted on Acast. See acast.com/privacy for more information.

Violence toward healthcare workers in healthcare settings has increased over the past decade. As with most other aspects of healthcare, COVID-19 exacerbated these trends. Chris Barfield, an RN and patient safety analyst consultant at ECRI, joins the podcast to discuss ECRI's latest report on healthcare workplace violence and how institutions can apply Total Systems Safety to curb the rise of such violence. References 1. Not Part of the Job: Addressing Workplace Violence in Healthcare. 2. Schub T, Karakashian A. Workplace violence: assault by patients. 3. Workplace violence. The American Nurses' Association. October 26, 2017. Accessed August 3, 2023. https://www.nursingworld.org/practice-policy/advocacy/state/workplace-violence2/.

https://youtu.be/9h0iidPzMXE Everyone's heard of the infamous "Tragedy of the Commons," but the real tragedy is that Elinor Ostrom's work refuting it isn't similarly popular. -Links for the Curious- “Aristotle, Politics, Book 2.” n.d. Accessed August 8, 2023. https://www.perseus.tufts.edu/hopper/text?doc=Perseus:abo:tlg,0086,035:2. Big Think, dir. 2012. *Ending The Tragedy of The Commons | Elinor Ostrom | Big Think*. https://www.youtube.com/watch?v=Qr5Q3VvpI7w. Carson, Kevin. n.d. “Governance, Agency and Autonomy: Anarchist Themes in the Work of Elinor Ostrom.” “Commons and Contradictions: The Political Ecology of Elinor Ostrom - Undisciplined Environments.” 2017. September 20, 2017. https://undisciplinedenvironments.org/2017/09/20/commons-and-contradictions-the-political-ecology-of-elinor-ostrom/. Dietz, Thomas, Elinor Ostrom, and Paul C Stern. 2003. “The Struggle to Govern the Commons” 302. “‘Elinor Ostrom's Rules for Radicals: Cooperative Alternatives Beyond Markets and States' by Derek Wall Reviewed by John Barry.” n.d. Accessed August 4, 2023. https://marxandphilosophy.org.uk/reviews/16044_elinor-ostroms-rules-for-radicals-cooperative-alternatives-beyond-markets-and-states-by-derek-wall-reviewed-by-john-barry/. Frischmann, Brett M., Alain Marciano, and Giovanni Battista Ramello. 2019. “Retrospectives: Tragedy of the Commons after 50 Years.” *Journal of Economic Perspectives* 33 (4): 211–28. https://doi.org/10.1257/jep.33.4.211. Hardin, Garrett. 1968. “The Tragedy of the Commons: The Population Problem Has No Technical Solution; It Requires a Fundamental Extension in Morality.” *Science* 162 (3859): 1243–48. https://doi.org/10.1126/science.162.3859.1243. Laerhoven, Frank van, and Elinor Ostrom. n.d. “Traditions and Trends in the Study of the Commons.” Ostrom, Elinor. 2012. “Green from the Grassroots | by Elinor Ostrom.” Project Syndicate. June 12, 2012. https://www.project-syndicate.org/commentary/green-from-the-grassroots-2012-06. ———. 2015. *Governing the Commons: The Evolution of Institutions for Collective Action*. 1st ed. Cambridge University Press. https://doi.org/10.1017/CBO9781316423936. Ostrom, Elinor, Joanna Burger, Christopher B. Field, Richard B. Norgaard, and David Policansky. 1999. “Revisiting the Commons: Local Lessons, Global Challenges.” *Science, New Series* 284 (5412): 278–82. Sustainable Development and the Tragedy of Commons - https://www.youtube.com/watch?v=ByXM47Ri1Kc. Elinor Ostrom on Resilient Social-Ecological Systems - https://www.youtube.com/watch?v=LqC7xG8fxHw. Velicu, Irina, and Gustavo García-López. 2018. “Thinking the Commons through Ostrom and Butler: Boundedness and Vulnerability.” *Theory, Culture & Society* 35 (6): 55–73. https://doi.org/10.1177/0263276418757315. Icons for Principles of the Commons from The Noun Project: https://thenounproject.com/icon/puzzle-5278809/ https://thenounproject.com/icon/monitoring-2906106/ https://thenounproject.com/icon/russian-nesting-dolls-2671768/ https://thenounproject.com/icon/pillory-4509440/ https://thenounproject.com/icon/boundary-3856835/ https://thenounproject.com/icon/arbitration-1142571/ https://thenounproject.com/icon/revise-1085288/ https://thenounproject.com/icon/raised-fist-4914991/ Trap music from Freesound: https://freesound.org/people/Inespy/sounds/514311/

If you like our podcast and would like to subscribe and leave us a 5-star review, we would be extremely grateful!   “The hope and faith in the medical system. Hope in my relationship with him. Knowing that I'm not going through this alone.” -Vanessa Naum   We're excited to welcome back Physician Marriage Coaches, Dr. George (Dr. Jeep) and Vanessa Naum.    In this episode, Vanessa discusses her experience dealing with Fibromyalgia and how being married to a physician has impacted her journey living with a chronic illness. Dr. Jeep and Vanessa give advice on how to best help a partner or loved one dealing with a chronic illness and the importance of understanding and compassion.  You don't want to miss this inspiring episode!   According to a report by the Centers for Disease Control and Prevention (CDC) published in 2018, approximately 60% of adults in the United States have at least one chronic condition, such as heart disease, diabetes, or cancer.    Furthermore, a survey conducted by the National Alliance for Caregiving and AARP Public Policy Institute found that about one in three adults in the United States, or 34.2 million people, have provided unpaid care to an adult aged 50 or older in the past 12 months. Of these caregivers, 60% reported providing care for someone with a chronic illness.   It's worth noting that these statistics are from studies conducted before the COVID-19 pandemic, which may have had an impact on the prevalence of chronic illnesses and caregiving in the United States.   According to a study published in The Journal of the American Medical Association (JAMA) in 2020, 16.5% of physicians in the United States reported having a chronic illness and 14.2% reported providing care for an adult family member with a chronic illness.    The study also found that female physicians were more likely than male physicians to have a chronic illness or care for someone with a chronic illness. Additionally, physicians who reported having a chronic illness were more likely to work part-time or reduce their clinical workload than those without a chronic illness.    It's worth noting that the characteristics and experiences of physicians with chronic illnesses may vary based on the type of illness, severity of symptoms, and other factors. _   We hope you check out these two previous episodes with Dr. Jeep and Vanessa Naum:   145: Why Physician Marriages Have Challenges with Dr. Jeep and Vanessa Naum   186: Becoming a Doctor, the Struggle Is Real with Dr. Jeep & Vanessa Naum   Episode mentioned in the podcast on chronic pain: 180: The Paradigm Shift To Cure Chronic Pain for You and Your Patients with Dr. Howard Schubiner   The Naum's Gift To You: Go to their website at www.BestFriendsAgain.com and scroll down to receive a FREE copy of the chapter: Love Letter Method with Your Spouse, from Dr. Jeep's book, “What's Forever For? A Physician's Guide for Everlasting Love and Success in Marriage.”   The Naums encourage their new connections to do a relationship needs assessment. It's a good health and wellness check for your relationship. Their clients have found it extremely helpful! https://bestfriendsagain.wufoo.com/forms/relationship-needs-assessment/   Dr. Jeep and Vanessa Naum's social media: https://www.instagram.com/bestfriendsagain/ https://www.linkedin.com/in/drgeorgenaum-do-physician-author-marriage-relationship-intimacy-coach/ https://www.linkedin.com/company/best-friends-again/ https://www.linkedin.com/in/vanessanaum-physicianwellness-sex-marriagecoachingforphysicians-healthcare-coach/ _ The past few weeks have been busy at DocWorking! We have been working behind the scenes to add a 24/7 CONFIDENTIAL COUNSELING CARE LINE to our new low cost DocWorking THRIVE Essential package, as well as even more CME credits for our THRIVE small group coaching and courses. Let your CME budget help you prioritize your own wellness so you can get on with living your best life on your own terms, as defined by you, with DocWorking THRIVE. You can take the first step today by taking the DocWorking 2-Minute Balance to Burnout Quiz! Where are you on the Balance to Burnout Continuum? Take the quiz and find out today! DocWorking empowers physicians and entire healthcare teams to get on the path to achieving their dreams, both in and outside of work, with programs designed to help you maximize life with minimal time. We are now enrolling for several new low cost DocWorking THRIVE Well-Being pilot programs, for your care team members including nurses, techs, medical assistants and others, as well as special programs for recruitment and retention of your new physician and other clinician hires. CONTACT US TO LEARN MORE If you like our podcast and would like to subscribe and leave us a 5-star review, we would be extremely grateful! We're everywhere you like to get your podcasts! Apple iTunes, Spotify, iHeartRadio, Google, Pandora, Stitcher, PlayerFM, ListenNotes, Amazon, YouTube, and Podbean. You can also find us on Instagram, Facebook, and LinkedIn. Some links in our blogs and show notes are affiliate links, and purchases made via those links may result in payments to DocWorking. These help toward our production costs. Thank you for supporting DocWorking: The Whole Physician Podcast!   References: Regarding the prevalence of chronic illness and caregiving in the U.S. population: - Centers for Disease Control and Prevention (2018). "Chronic Diseases in America." Accessed August 31, 2021, at https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm. - National Alliance for Caregiving and AARP Public Policy Institute (2015). "Caregiving in the U.S. 2015." Accessed August 31, 2021, at https://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-executive-summary-revised.pdf.   Regarding the prevalence of chronic illness and caregiving among physicians: - Shanafelt, T.D., Hasan, O., Dyrbye, L.N., et al. (2020). "Intended and Unintended Consequences of the COVID-19 Pandemic on Physician Well-being." JAMA, 324(20), 2005-2007. Accessed August 31, 2021, at https://jamanetwork.com/journals/jama/fullarticle/2771765.

On this week's episode of Fast Facts - Perio Edition, we are going to shrink down and magic school bus into a furcation. For all my millennials out there, we all learned science with Ms. Frizzle, and today we're going to learn about the science of furcations by shrinking down and really exploring what we know about furcations.  Quotes:  “Yes, we do know that our maxillary and mandibular molars will present with furcations in the maxillary.” “Fun Fact the maxillary first premolar, 61% of the time, will also be bi-furcated.” Resources: DentistRX: https://www.dentistrx.com  More Fast Facts: https://www.ataleoftwohygienists.com/fast-facts/  Katrina Sanders Website: https://www.katrinasanders.com  Katrina Sanders Instagram: https://www.instagram.com/thedentalwinegenist/    Nield-Gehrig J. Advanced instrumentation techniques for root surfacedebridement.Journal of Practical Hygiene. 2004;13(3):19-22.http://www.perio.org/resources-products/pdf/management.pdf. Accessed August 25,2009.Scheid, RC.Woelfel's Dental Anatomy Its Relevance to Dentistry. 7th ed.Philadelphia, PA: Lippincott Williams & Wilkins, 2007:205.

Hearing Loss is a very important topic and as of the 16th of August 2022, the FDA released its final rule affecting the industry as a whole and how you will be able to buy your hearing aids. But is it a good thing? My guests, two PhD Audiologist and President of the Hearing Industries Association.KATE CARR Kate Carr, Ph.D., joined the Hearing Industries Association (HIA) as President in May 2018. She brings extensive expertise in non-profit management, government, cause marketing and advocacy to HIA and has devoted her career to organizations that change outcomes in health care and improve the lives of children and families. THOMAS POWERS Thomas Powers, Ph.D., is the Managing Member of Powers Consulting, LLC, providing management consulting to the hearing health industry. Dr. Powers is an audiologist and industry consultant and serves as a strategic advisor for the Hearing Industries Association. Dr. Powers will discuss the medical implications and comorbidities associated with hearing loss. This new FDA rule means for hearing health and what listeners need to know about hearing loss and treatment. HIA supports greater access to hearing aids and suggests that before making a purchase, having a hearing test by a professional is a smart move. Earlier this summer, HIA, in partnership with multiple industry leaders, professional and consumer organizations, announced the Hear Well campaign (hearing.org), which aims to educate the public about the importance of hearing health and the value of seeing a hearing professional.  What we know: Around 1 in 3 people between the ages of 65 and 74 have hearing loss, and nearly half of those older than 75 have difficulty hearing.[ii] Mild hearing loss doubles dementia risk, moderate hearing loss triples the risk, and people with a severe hearing impairment are 5x more likely to develop dementia.[iii] In a survey of over 3,000 individuals with hearing difficulty, 38% of respondents with hearing difficulty reported having a hearing aid. 8 in 10 people who chose to treat their hearing loss report life-changing results and 91 percent of hearing aid owners say they are satisfied with their hearing professional.[iv] One-third of the total cost of hearing aids accounts for the manufacturing of the technology and the style of device chosen (basic, standard, advanced, or premium) while the remaining cost consists of services provided by the hearing professional and the cost of maintaining a business. Over-the-counter (OTC) hearing aids will be sold to adults with perceived mild-to-moderate hearing loss without the service of the hearing professional which impacts the overall price of the device(s) and allows consumers to find treatment at a wider range of price points. Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: National Health Interview Survey, 2012 (PDF). National Center for Health Statistics. Vital Health Stat 10(260). 2014 [ii] Age-Related Hearing Loss (Presbycusis) — Causes and Treatment. (2022). Retrieved from https://www.nidcd.nih.gov/health/age-related-hearing-loss#:~:text=Approximately%20one%20in%20three%20people,%2C%20doorbells%2C%20and%20smoke%20alarms [iii] “The Hidden Risks of Hearing Loss.” Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/healthy_aging/healthy_body/the-hidden-risks-of-hearing-loss Accessed August 16, 2018 [iv] Powers TA, Carr K. MarkeTrak 2022: Navigating the changing landscape of hearing healthcare. Hearing Review. 2022;29(5):12-17. For more information please visit: hearing.org

In this episode, we will discuss the rationale behind the FDA approval of two new pneumococcal conjugate vaccines (PCV20 and PCV15), the characteristics of these vaccines, their place in therapy as recommended by the ACIP, and subsequent CDC immunization schedule changes. Key Concepts Pneumococcal disease is mainly caused by various serotypes of Streptococcus pneumoniae and presentation can vary from mild forms (sinusitis, otitis media) to more severe (pneumonia, bacteremia, or meningitis). Previously we used PCV13 and PPSV23 vaccines for adults ages 18 years and older for prevention of pneumococcal disease, but the recommendations were rather complicated based on age, underlying condition/immune status, and vaccination status.  Two new conjugate-type pneumococcal vaccines, PCV20 (Prevnar 20) and PCV15 (Vaxneuvance) are now approved by the FDA and were recently added to the CDC's adult immunization schedules. These updated recommendations are more simplified where adults with high-risk conditions and those ages 65 years and older should receive either 1 dose of PCV20 vaccine or 1 dose of PCV15 and then 1 dose of PPSV23 a year later to complete their pneumococcal vaccine series.   PCV15 is now FDA approved for children and updated recommendations for children have been voted upon by the Advisory Committee on Immunization Practices (ACIP) and will be final once it is made official policy by the CDC. References and Resources Kobayashi M, Farrar JL, Gierke R, Britton A, Childs L, Leidner AJ, et al. Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR. 2022;71(4);109–117. https://www.cdc.gov/mmwr/volumes/71/wr/mm7104a1.htm?s_cid=mm7104a1_w Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. 14th ed. Hall E., Wodi A.P., Hamborsky J., et al., eds. Washington DC: Public Health Foundation; 2021. Goldblatt D, O'Brien KL. Pneumococcal Infections. In: Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson J. eds. Harrison's Principles of Internal Medicine 21e. McGraw Hill; 2022. Accessed August 04, 2022. Wagner AL, Boulton ML. Pneumococcal Infections. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022. Accessed August 04, 2022. CDC's PneumoRecs VaxAdvisor mobile app: https://www.cdc.gov/vaccines/vpd/pneumo/hcp/pneumoapp.html CDC's Pneumococcal vaccine timing for adults: https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf